Brian Lehrer: It's the Brian Lehrer Show on WNYC. Good morning again, everyone. Joining me now to discuss the mental health toll on yet another winter in a pandemic or from another winter, yet another winter in a pandemic and about the path forward as individuals and for improving our mental healthcare system is Ashwin Vasan MD PhD, epidemiologist, and professor at Columbia and CEO of Fountain House, a New York based community Mental Health Focused Organization. Dr. Vasan, thanks for coming on. Unfortunate that it's needed, but welcome back to WNYC.

Vasan: It's great to be here, Brian. It truly unfortunate that we're here again, but it's good to be with you.

Brian Lehrer: Listeners we'll open up the phones for you right away to share how you are feeling going into the third year of the pandemic and with this omicron surge and how you're dealing with it. 212-433-WNYC, 212-433-9692 or tweet a question for Dr. Vasan @BrianLehrer.

Dr. Vasan, throughout the pandemic of course, we've talked on this show as people have all over the place about burnout, how do you think that term has changed for people now with omicron and entering year three?

Dr. Ashwin Vasan: It's a good question. Burnout in some ways has become the new normal, this constant feeling of when will this end and it can over time accumulate into a sense of general malaise and hopelessness. I think that that's where us mustering once again the collective response to stand up to this pandemic, knowing that, this time around, we have a lot of tools in our arsenal.

I'd hope that as Dr. Vama talked about and as many on your show talked about before, we're not in the same place that we were. I hope that that offers up a little bit of perspective, but I do think burnout has become in some ways the new normal and it's across sectors, across society, across income and demographic groups.

I think we're seeing rates of depression, anxiety and no one's measuring malaise, but certainly in my life and all of our lives, we're experiencing those around us with those kinds of feelings. We have to really work hard to push through this pandemic to ensure that even if we feel like burnout is the new normal, that that's not a permanent state of affairs and that we see a light at the end of the tunnel.

Brian Lehrer: Is there a difference clinically between burnout and depression, and if so, how can people tell if they've crossed that threshold?

Dr. Ashwin Vasan: Well, I think, most importantly is, are your symptoms, are your feelings, are your moods affecting your function? Is it interfering with your ability to go to work, go to school, maintain healthy relationships, take care of yourself, get enough rest, Is it interfering with your sleeping, or your eating patterns?

I think when we start to see it veer into those areas is when we ascribe to it more of a clinical diagnosis, but the daily grind and fatigue and malaise that many of us are feeling, maybe we're all feeling to some degree or another, I think that it's qualitatively different. Certainly, and especially if you walked into this pandemic with any underlying risks for developing depression, or if you came in with preexisting mental illness, you're certainly at a higher risk of having clinical symptoms during this really challenging time of isolation.

Brian Lehrer: Should we mention the opioid epidemic in this context, two of the really shocking stats that I saw in the last few days. One was that on COVID deaths themselves. One out of 100 Americans over 65 has died with COVID since the beginning of the pandemic. That's not one out of 100 who got the disease, that's one out of 100 people over the age of 65 and the entire population have succumbed to COVID.

The other stat for younger people was that fentanyl is now the leading cause of death among adults under 45. That passes usual younger adult leading causes of deaths like accidents and suicide. Do you see that as pandemic, mental health related?

Dr. Ashwin Vasan: Yes. In medical terms we call that acute chronic, which means we had prior to COVID 20 years of arising mental health epidemic. We've talked about it on this show before, measured for example by things like deaths of despair, deaths from alcoholism, deaths from suicide and violence and deaths from drug overdose. Those have been rising for the last 20 years consistently, and they really spiked in the last seven to eight years with the rise of the opioid epidemic.

Certainly we're seeing a spike, particularly in urban centers around the country of opioid deaths during the pandemic, because I think people are feeling isolated. People are feeling depressed. If you came in with preexisting risks, people are turning to substance use, and let's not forget that really dramatic economic social and health strain that people are under due to the pandemic. People's livelihoods are under threat. People's housing is under threat.

This really accumulates over time, and people are turning to substances. On top of that, the pernicious effect of fentanyl infecting our illicit drug supply. That becomes a really dangerous combination, which is why I'm incredibly encouraged by efforts to launch things like safe injection facilities. Those are life saving interventions. Those are life saving interventions that I hope can do some part, go some way to stemming the tide of these preventable deaths.

Brian Lehrer: Before we get to some calls, yesterday I saw that the US Department of Health and Human Services announced funding for a new three digit mental health crisis help line. We have 911 for other emergencies. There's going to be one of those three digit help lines, mental health specific. According to NPR, the new number will replace the 10 digit suicide prevention hotline and will come not until July of next year. Do you think that's important and what happens when people call these hotlines? Are they helpful?

Dr. Ashwin Vasan: They're certainly helpful. The National Suicide Prevention Hotline, things in New York like NYC Well, those are helpful resources when people are in need. Whether or not they're in a mental health crisis when they need someone to talk to, when they need to reach out, it is crucial that we've got those sorts of outlets for people.

Look, we have a fairly broken mental health system across this country. Mental health crisis response is no different. We've seen some encouraging signs that we can do things a different way by really treating mental health crisis which are health conditions, with the health response and the evidence from programs like Kahoots and programs in Denver. There's pilots all across the country that are showing that we can do this safely, keeping the community safe, keeping the person safe, keeping responders safe, and consistently to get people the help they need.

On top of that, the 988 legislation which is truly the first meaningful National Mental Health Legislation that has come down the pike in quite some time. What we see is an opportunity. What people in the mental health space see is an opportunity to bring some shape, some definition, some standardization, some coordination to what is currently a deeply decentralized, organized and fragmented and fairly inconsistent mental health system.

Crisis response services are no different, very, very heterogeneous across the country. What we need to see is much more consistency evidence-based and standards across this program.

Brian Lehrer: If you're just joining us, my guest is Dr. Ashwin, Vasan a mental health specialist who founded, or his CEO of Fountain House a New York based community, Mental Health Focused Organization, as well as a professor of medicine and epidemiology at Columbia. He's an MD and a PhD and an epidemiologist. We're going to take a call now from Dee in the Bronx. Dee, you're on WNYC with Dr. Vasan.

Dee: Hi, good morning. How are you? In terms of me as an individual, I am extremely tired. My biggest concern is for my two children. There is almost an invisible issue that's occurring with the isolation of kids as they're going through quarantine. Yes, the schools are remaining open but the schools are not sending anything home with these kids to be educated. The kids are starting to feel isolated, as well as ignored in everything that's going on, and also scared of COVID. What do we do to help them to help get through this?

Dr. Ashwin Vasan: Thank you for the question, Dee. I'm a parent of three school-aged kids myself so this really hits home. My kids have really suffered during this pandemic, as so many kids have from isolation and from the social and emotional effects of this incredibly strange time that we're all living in. I think you said part of the answer is exactly right. We need schools to be open. We need in-person learning to continue and that has to be a priority. It has to continue to be a priority.

It seems to have been a priority in a lot of places. That needs to continue to be priority because we know what happens when we pull kids out of school, put them in front of screens, and take them out of the environments for social and emotional development that they so crucially need. I think you're raising a separate issue as well, which is, what are we doing to really support our kids during this time? Even when they're doing in-person learning, what are we sending them home with?

I think that's a very good question. What are our curriculums around social and emotional development? How are we talking about COVID and social isolation to our kids? How are we talking about their coping mechanisms? How are we talking about the effect of social media as a coping mechanism on these kids? We have to catalyze a public conversation around mental health for all of us, but especially for our children, which is why I was very encouraged to see the Surgeon General raise this up as a public health crisis.

I think he said it best in the Surgeon General's report, it would be a shame if we allowed one public health crisis to be replaced by another. I think that that's exactly right. We have a lot of work to do to support our kids with the teaching and education and conversation that you're describing. Thank you, for the question.

Brian Lehrer: The US Surgeon General for people who don't know issued a rare advisory on what he described as an emerging mental health crisis for children in the United States. Thank you for addressing that. Kate, in Brooklyn, you're on WNYC. Hi, Kate.

Kate: Hi, how are you? I am calling about I just got COVID. I'm on my third day right now and starting to feel a little bit better.

Dr. Ashwin Vasan: I am sorry to hear that, Kate. I hope you're feeling better.

Kate: Thank you. I'm vaccinated. I was about to go get my booster yesterday but now obviously I have to wait. My question pertains to those of us who work in the entertainment industry, service industry, which a lot of us also have had to double down on jobs like that, in our mental health and where resources can come for us. It feels like right now at this point we're not getting paid. If you have to take off of work, you have to just stay home.

I went back after getting work finally, back in September. I had a tour with my project. Now, I'm back to no work and just picking up jobs when I can. I think that I probably contracted the virus from my job, which is at a bar. I'm just wondering, like where resources are going to be for us? There's a lot of people that most of my friends are they're destitute right now. Their bank accounts are completely drawn.

I'll take my question off air. I just wanted to put that out there that people are suffering out there in a lot of ways that I don't think it's being talked about, and especially within the entertainment and the service industry. Thank you.

Brian Lehrer: Kate, thank you very much. Dr. Vasan, the way she put it, I think it's so important because it doesn't compartmentalize things, and to just this is mental health. This is economic. This is COVID prevention. When she talks about people in the service industries, people in the arts, the things that are both more at risk and more likely to be shut down, and the economic impact maybe at the economic level, we're going to need another round of relief bills with omicron.

The Congress will have to discuss and the President maybe we'll hear something about that from Biden when he addresses the nation about omicron at two o'clock this afternoon. The mental health becomes obviously wrapped up with all those multiple stresses that people are feeling at the same time.

Dr. Ashwin Vasan: Kate, again, I hope you're feeling better. I'm sorry that happened to you. Brian, you're exactly right. She's encapsulated a lived experience of what this is like at the intersection of mental health, health, healthcare, economic security, job security. That is the embodiment of why do we need to advance an agenda that says mental health is health, mental health is public health and it has to be thought of as both an upstream set of issues we can prevent with better policies and strategies to support people through this pandemic and beyond but also a downstream consequence of not doing that.

We shouldn't be surprised when we've got a mental health crisis on our hands and we're not addressing those upstream drivers. When we're not ensuring that people know whether they can stay in their homes, we should not be surprised that there is a mental health crisis when we're not sure that we can guarantee people's jobs and their economic security, especially for casual workers. I know there are a lot of part-time workers and casual workers, and temp workers in the entertainment industry.

When we don't protect the economic security of those folks, we shouldn't be surprised that we have a mental health crisis on our hands. She's raising another point, which is where to get help when you need it. 100 and I think it's more now but last I checked, it's about a third of Americans live in what's called the mental health professional shortage area. That's a US government health and human services statistic that suggests that those folks one out of three Americans, when they need mental health care, they can't access it, either through lack of providers and geography, a lot of people in rural areas, for instance, face this challenge, or these economic and non-economic barriers to accessing care that Kate's describing.

We have laws on the books, for instance, like our mental health parity laws that suggest that insurers should be fully reimbursing and covering and including behavioral health, mental health, and addiction services under their plans and yet enforcement and compliance with our parity laws is quite poor across the nation, and again, quite heterogeneous, really different depending on what state you're in and what plan you're on.

We have to have federal leadership here to step in and say, "No, this is a priority. We want standardization. We want Kate and everyone and all of her colleagues to be able to get access to basic mental health care when they need it without having to hunt and peck and save and scrounge just to go talk to someone when you're in a time of need." That can't stand. That isn't smart public health. It isn't smart pandemic response, and it's not smart social policy. I thank you for the question, Kate. I think you embodied a lot of what we're facing now.

Brian Lehrer: Before you go in about five minutes, I'm going to ask you to arm people with the best contacts that you know of that are general enough that a lot of people could use them to find mental health resources if they don't know where to turn right now. We're going to take a phone call from Stacey in Nutley who I think did turn to one last night and maybe with mixed results.

Stacy, you're on WNYC with Dr. Ashwin Vasan from Fountain House. Thank you so much for calling in.

Stacy: Thank you for taking my call. I did actually call into a crisis hotline. It was actually on Saturday night. It wasn't really for suicide. It was really more just for depression. I just felt I needed to reach out and speak to someone. I called the Crisis Text Line. I texted at 12:31 AM actually and I did not get a human response until 7:29 in the morning. I stayed up till two o'clock and then I gave up and I shut my phone off. I turned it on and off a few times through the night. I kept getting messages saying, "We're going to connect you," and nothing until the morning.

I just wanted to throw that out there that as much as I did reach out I couldn't find a resource and I was very saddened by that. I know that these numbers are put out there, "We're here for you," but in my time of need, thank God it wasn't a tremendous need, it was just more I needed to talk but what if it wasn't that I just needed to talk? What if I really was at my wit's end and I reached out and nobody was there for me?

I just wanted to share my story about that. How disappointing it was and that the system does seem to be flawed. Even though I know it's incredibly well-meaning but the bottom line is they were not there when I needed them.

Brian Lehrer: Dr. Vasan, talk to Stacy.

Dr. Ashwin Vasan: Stacy, I'm so sorry. Thank you for being brave enough to share the story. I'm so sorry you didn't get the help you wanted or needed at the time. I want to just applaud you for reaching out and even taking that step, asking for help. Reaching out for help is such a big, big decision you made and it's a life-saving decision. Maybe not in your specific case at the moment but millions of Americans need to take that step and reach out and demand the kind of thing you're demanding right now. Which is better access to care and better crisis response, better access to someone to talk to.

Right now what you're describing is the fact that we're leaving it to individual programs to cobble together different approaches in the absence of real meaningful national-federal leadership on this issue. We need a national well-funded crisis line that is standard, whether you're in New York or California, or wherever you are, that you know you can turn to and talk to someone within a reasonable amount of time and get the help you need. 988-

[crosstalk]

Brian Lehrer: Stacy, can I?

[crosstalk]

Dr. Ashwin Vasan: Oh, sorry, Brian.

Brian Lehrer: 988 is coming not until July, right?

Dr. Ashwin Vasan: Correct. It's not coming until July and it leaves a lot to be desired in terms of its funding, how is it going to be supported, but the fact that it is a federal program and has federal mandates and standards behind it really means that we need to push for really expanded funding to make this work because what you're describing, Stacy, is a patchwork. A hit and miss. This is people's lives-

[crosstalk].

Brian Lehrer: Let me jump in because I know we're going to run out of time in the segment in about two minutes and I want Stacy to have one more say. Stacy, say whatever you want. I was also curious when they did get back to you the next morning if you found it helpful and if they said anything about being overwhelmed themselves. Maybe there was such a supply and demand mismatch considering what's going on right now. That at some other time they might have been there at 12:31 AM but then they couldn't get back to you until 7:29 because of omicron.

Stacy: Yes. I believe that they said that they had a higher volume of calls. They thanked me for reaching out to them and they said it took courage, again, this was all via text, but it was so ironic that when I reached out and when I was depressed that this was the response I got. It made me just feel more depressed. Again, not suicidal, but I just felt like, "What is the world coming to that you can't even call a crisis text line on a Saturday night in bed when you're so sad and you can't even find a human being to reach out to."

I actually thought this needs to change. We need to find a better way even though these people are amazing. I'm sure that they want to help me. They couldn't because they didn't have the resources. I actually thought to myself maybe I should volunteer because look at what I went through. Maybe I thought I can call them and maybe I can be there for somebody because nobody was there for me.

Brian Lehrer: Stacy, it's so great that you called. I think just hearing your voice and hearing what you have to say is probably helpful to a lot of listeners right now so thank you.

Stacy: Thank you.

Brian Lehrer: Please call us again. Dr. Vasan, I know you got to go in a minute so pick up on what Stacy was just talking about. Do they take volunteers who may not be officially credentialed mental health professionals who can in some way be helpful to people and where can people reach out if they need to talk to someone but don't have private health insurance that covers mental health services or anything else?

Dr. Ashwin Vasan: Stacy, thank you so much. Your call is so powerful, your story is so powerful, and you are embodying the cry that the American people are making to our leaders, which is, "Step up for us." For too long mental health has been thought of as an individual problem that you got to deal with individually. Sorry, you're going through that. That's just a part of the story.

There is a collective response here that can only be solved through better policy, better public policy, better investment and it's going to take leaders stepping up and saying, "Mental health is a public health issue, mental health is a public policy issue and we're going to deal with it at the highest levels of government everywhere."

Only then are we going to see the kinds of crisis lines and immediate support services, long-term access to care, really a meaningful community mental health system that's never really been built since the 1960s when we started to close down our mental health asylums. It's only then with that level of federal leadership and leadership across the board that we're going to see Stacy's experience change because, otherwise, it's left to a crapshoot. You're going to have interactions that are not so good and interactions that are better, and that it can't be left up to chance.

There are resources out there for listeners and for all of us. Here in New York City, we have NYC Well. It is an important resource for people to get connected to the help they need here in the city. None of these resources are perfect. I just want to be clear about that but the fact that they exist is really essential and I do think we should use them. It's also a demand-driven business. When we use it and demand better from it that's when things change.

There's also the National Suicide Prevention Hotline 1-800-273-8255. That is a national program that's been around for years and does have a network of local crisis centers that provide free and confidential support to people in emotional distress or in a suicidal crisis. The resources are not enough and this is why we need leaders to step up to fundamentally reshape mental health in our country.

Brian Lehrer: Dr. Ashwin Vasan, CEO of Fountain House, and Professor of Medicine and Epidemiology at Columbia. Thank you so much.

Dr. Ashwin Vasan: Thank you, Brian.

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