Dr. Helen Egger, Co-founder and Chief Medical and Scientific Officer, Little Otter Kristina Saffran, Co-founder and CEO, Equip Zoe Tait, Vice President, National Student Advisory Committee, Active Minds Solome Tibebu, Founder and CEO, Behavioral Health Tech Moderator: Alexa Mikhail, Fortune
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TechTranscript
00:00Thank you all so much for joining us.
00:03So to jump right in, this year the annual World Happiness Report outlined how the United
00:08States has fallen out of the top 20 happiest countries for the first time in the list's
00:13history, largely due to young people feeling worse about their lives.
00:17So while we are all dealing with a broader mental health crisis, I wanted to ask each
00:20of you to briefly first describe and pinpoint some of the defining contributors driving
00:25the rates of young people's mental health today.
00:28And Helen, I'm just going to start with you and go down the line.
00:30Great.
00:31Thank you.
00:32Well, the first thing is we had a child mental health crisis before our current situation,
00:37COVID, and the current stresses have made it worse.
00:40But for the last 30 years, we've known that 20% of kids have an impairing mental health
00:46disorder and fewer than 50% get care.
00:49That was the number when I did my postdoc, was 50%.
00:54The number is 50% now.
00:56And so I think lack of access to high quality mental health care and the stigma has really
01:03contributed to this crisis.
01:05Thank you.
01:06Christina?
01:07Yeah, I work in eating disorders, and we often say that with eating disorders, genetics load
01:12the gun, environment pulls the trigger.
01:14We always had an environment, unfortunately, that idealized thinness, but in today's social
01:21media age, that environment has just become increasingly toxic.
01:26We have young people spending an average of seven hours a day on social media, looking
01:33at doctored images of their peers, comparing themselves constantly to those peers.
01:41I mean, can you imagine puberty?
01:44Going through puberty while posting selfies of yourself on social media for folks to comment
01:49on while looking at images of your peers, hundreds and hundreds of images each day,
01:55thinking she's prettier than me, thinner than me, cooler than me, et cetera.
02:01So I think certainly we've always had genetic underpinnings, but the environment has hypercharged
02:06these issues.
02:07Zoe, what about you?
02:09As you said, we are in a world where we are receiving an information overload.
02:15At earlier and earlier ages nowadays, as both a student and someone working in the research
02:19field to really understand some of the treatment methods that can be used to combat this, I
02:23definitely see how constantly being able to compare against your peers, see this information,
02:29see what's happening in this place, what's happening in this place, what do we need to
02:32worry about in order to improve society in high school, in college, that's increasingly
02:38making people aware of what's going on in the world, but also raising their anxiety
02:43and other diagnoses at an increasingly alarming rate.
02:48And I think that not having necessary access to support, clinicians, service, as well as
02:55stigma, which has only kind of increased over the past few years, has really impacted some
03:01of these rates.
03:02Solomay, anything to add on that?
03:03I mean, so many great points.
03:05I would just add a false sense of community.
03:08I mean, yes, we've got so many apps and social media tools that are supposed to spur community,
03:15but really it's just isolating young people to their rooms, and that is, I think back
03:21to when I was a teen, it was AOL Instant Messenger, and I could see girls online, oh, I bet they're
03:29talking to each other, but now the way that social media has advanced and evolved, there
03:34are so many ways that you can spin up ideas and insecurities, and so, yeah, lack of real
03:42community is a huge factor.
03:44Definitely.
03:45Zoe, you are deeply entrenched in mental health advocacy as a student, and you have this on-the-ground
03:51lens, right?
03:52So, I want to ask you, you know, what kinds of interventions and potential solutions are
03:56we not talking enough about that you can share with all of us?
03:59Yeah, that's a great question.
04:01I think there's two different aspects I really want to touch on.
04:05You brought up a great point about the sense of community.
04:07We're living in a world where digital interventions and the digital world generally is becoming
04:12more prominent in all of our lives.
04:14You wake up, you look at your phone, you go to sleep, you look at your phone, you're kind
04:18of in this process where you're really seeing these pages, and because of that, you're not
04:22necessarily as connected, we are not necessarily as connected on a human level to each other
04:28as much as we could be, and I think it's really, really important to remember that.
04:33People go to college, and they want to be able to socialize and learn new things, join
04:37new groups, and that's definitely still happening, but some things might now get in the way of
04:43that.
04:44People are nervous because maybe they have to post about an event after, and it adds
04:47to the pressure of actually going out and seeking connection.
04:51Additionally, we do have these digital tools at our fingertips, which gives us an incredible
04:56belt to be able to propel some of these interventions to the next level, and I think it's really
05:01important to remember that and understand how can we safely deploy some of these innovations
05:06in digital technology, in artificial intelligence, and to our communities so that the people
05:10working with this technology can actually use it to better their mental health.
05:14Yeah, you bring up a really interesting point, and Helen, I kind of want to turn to you.
05:19You mentioned in the green room that there's a lot of bad mental health care out there,
05:22so I am going to call on that, but as Zoe pointed out, when social media has also contributed
05:28to the rise in a lot of mental health problems, potentially, how are you seeing digital innovation
05:33as a solution, as Zoe said?
05:35Yeah, so those are two questions.
05:36I'm going to start with the fact that the majority of mental health care is not very
05:42good, and so if you're just looking at the standard we have now, it's not good enough,
05:47and if you look at other branches of medicine in terms of accountability, in terms of clinical
05:53pathways and outcomes, we have not held ourselves accountable as a field and haven't demanded
06:01that we teach people that that's what they deserve.
06:06Impairing mental health disorders are medical disorders, and so that's where I think getting
06:09to the question of the growth in social media, that is true, but I think it's also in some
06:16ways almost trivializes some of the fact that there are impairing mental health disorders
06:23that we can diagnose and we treat, and my area is early childhood mental health.
06:29The rate of impairing mental health disorders in children two to six is the same as at older
06:34ages.
06:35It's a different pattern.
06:36Fifty percent of adult mental health disorders start before the age of 14, and the second
06:42leading cause of death for children 10 to 14 is suicide, so I think it's very important
06:48that this conversation, particularly at a health conference, is focusing on, again,
06:54a lot of the zeitgeist, anxiety, et cetera, but also that we invest in high-quality mental
07:02health care that's measurable and evidence-based and doesn't start with teenagers but actually
07:10starts in the early childhood period and goes across development.
07:16Yeah, and thinking about how we can define what that quality of mental health care looks
07:20like, Solomay, I'm going to bring you into the conversation.
07:22I mean, since launching the Behavioral Health Tech Summit and community, what have you learned
07:27about that definition that Helen brought up?
07:29What is quality mental health care?
07:31What's working?
07:32Oh, my goodness.
07:33I could not agree more.
07:34There are just thousands and thousands of digital mental health apps on the market today,
07:38which is very confusing for a lot of consumers and providers, but I have been optimistic
07:45to see, as much as it's a buzzword, a measurement-based care, there is now higher levels of expectations
07:52that virtual providers, digital health companies are being held to a higher standard to embrace
07:58those practices, and just as Dr. Egger, Christina, other companies are doing a great job of that,
08:04and so my hope is that there'll be more transparency, more outcomes, period, so that plans, providers
08:13can better assess who are the companies that are actually treating folks in an effective
08:19way, so I have optimism, I'll say.
08:23Definitely.
08:24Christina, I wanted to turn to you.
08:26Eating disorders are the second deadliest mental illness, and the incidence of eating
08:29disorders in youth has dramatically increased in the last few decades.
08:34They also disproportionately affect youth, which you've been outspoken about.
08:38Just to highlight a couple of really important statistics, black teenagers are 50% more
08:43likely than white teenagers to exhibit behaviors of bulimia, and less likely to be screened
08:47and therefore treated, and a respondent in your EQUIP's recent survey found LGBTQ plus
08:53individuals were 2.5 times more likely to experience an eating disorder than their heterosexual
08:59peers, so really important information, and I want to ask you, what are some of the barriers
09:04we're seeing standing in the way of equitable care, and how do we overcome them?
09:09Thank you for those fantastic statistics that just show how ineffective our outreach
09:17and interventions in eating disorders have really been.
09:21I think it's really important to highlight that there are large inequities in all of
09:26mental health care.
09:27For eating disorders, 80% of folks don't get any treatment.
09:32Only about 1% have access to treatment that works, and going back to Dr. Eggers' point,
09:36it is so critical.
09:39Access to care that doesn't work can not only be ineffective, it can actually be really
09:44harmful to folks.
09:45I have peers who've spent years and years cycling in and out of facility-based care
09:50before they've ever heard about evidence-based treatment.
09:54We know that early intervention is especially critical to get people good quality outcomes.
10:00I'll share a story personally.
10:03We think there's a huge stereotype that still persists, that eating disorders only affect
10:08one type of person.
10:10I happen to look fairly much like the stereotype of what you think an eating disorder sufferer
10:16would look like.
10:18The reality is these affect folks equally across race, class, ethnicity.
10:2340% of those who struggle identify as boys and men.
10:26The majority of people with eating disorders are not underweight.
10:30But me, who fits the stereotype as a 13-year-old who had a history of anorexia, small-bodied
10:38person, went into my pediatrician having lost eight pounds, history of anorexia, and the
10:43pediatrician doesn't say anything.
10:46So if I'm being missed for an eating disorder, everyone is being missed.
10:50We know that even for folks who fit the stereotype, it takes three years to get an accurate diagnosis.
10:57If you're black, if you're a man, if you're in a larger body, which we know those folks
11:02are affected equally with eating disorders, you might go a decade plus or never get a
11:08diagnosis contributing to this being the second highest mortality rate.
11:12Yeah.
11:13Thank you for sharing that story.
11:14And I mean, when you talk about kind of these barriers, how do you get out of bad mental
11:19health care if so many people are getting sucked into it?
11:22I think this is where payers and providers and the health care system really have a responsibility
11:28to step up.
11:30I talk a lot about how mental health parity, we need to be talking about parity 2.0 and
11:36bringing in the quality factor.
11:39And I think for a very long time, Dr. Egger and I are really fortunate to be partnered
11:44with really, really fantastic payers who I think say to us, we want this.
11:49You are raising the bar in terms of showing us the measurement-based outcomes that we
11:54should expect to see in these populations.
11:57We want to direct families to care that actually works, and steerage has been a really dirty
12:04word amongst payers.
12:07That's ridiculous.
12:08That is exactly what they should be.
12:10When a family comes in in crisis with the only tools that they have to wade through
12:15glossy marketing advertisements, they rely on their payers and providers to help them
12:22separate what is actually true quality mental health care from what is just what looks good
12:27on a marketing brochure.
12:28Thank you.
12:29Definitely.
12:30And I just am speaking as I was in academic medicine for 30 years before founding Little
12:36Otter and doing it full time.
12:38We have excellent evidence base in mental health.
12:42We don't have all the answers, but we know how to diagnose mental health disorders in
12:46children starting as early as, you know, in early childhood.
12:51And we have a number of effective evidence-based treatments, but they don't take two sessions.
12:57There's no quick bot that is going to really be an evidence-based intervention for a child
13:05with an eating disorder, an anxiety disorder, with depression.
13:08And I think that, you know, I am really hoping that people would, we should have the same
13:14standard that if you came in with chest pain to your doctor, or you have cancer, people
13:20with mental health disorders, whether they're children or adults, deserve the same standard
13:26of care that's up to par with the science.
13:29And that's what I think all of our work is really focusing on, lifting that bar.
13:35Definitely.
13:36And standardizing across the board.
13:38I want to turn to the audience.
13:40Are there any questions that we have at this moment?
13:43Anything that I'm missing?
13:46Okay.
13:47Yes.
13:48We have one over here.
13:49Hi.
13:50Great panel.
13:51I'm not a parent yet, but have a bunch of nieces and nephews in the middle school and
13:58high school area, so I kind of see it.
14:01I think it's easy for us to point to the screens in social media and tech companies as the
14:06boogeyman.
14:07Trust me, I'm no fan of social media, what it's doing to the children.
14:10But a comment on, or a question, the community loss aspect, I don't want to point fingers
14:18at generalized parents, but where do the parents fit in on all of this, in your guys' opinion?
14:23And then if we are actually identifying that this is everybody's issue and not just the
14:29kids and the phone, what should we do from a policy standpoint at the government level
14:34as well?
14:36Because I think we've identified a pretty big accelerator of it.
14:40Yeah.
14:41Thank you.
14:42Well, I'd love to address that.
14:43I mean, I think that's a critical ... I personally think there's a contribution, but I think
14:47it's also an en vogue boogeyman.
14:50This is the cause of all of our problems.
14:53What we do at Little Otter is we take what we call a whole family approach, so we assess
14:57children and parents and we provide mental health care for children and for parents and
15:03couples work and family therapy in an integrated approach.
15:07And so I think the point that you're making broadly is you never can be treating a child
15:13as an isolated individual.
15:14A child lives in a family, the relationships, and if parents are themselves having mental
15:20health problems, that has a huge impact on the child.
15:24And I think the other thing as an early childhood person, it's the parents' use of phones that
15:31concerns me much more than children.
15:33If you go to a park nowadays and see people with young children playing on the playground
15:39and the parents are looking at their phones and not interacting with their child and not
15:43interacting with their baby, that is really impacting the architecture of that baby's
15:50brain because it's through social relationships and social interactions that we set the foundation
15:58for healthy emotional and behavioral health across the lifespan.
16:03I just want to add to the comment that families are absolutely critical.
16:07For so long, mental health is so far behind physical health in so many areas, but one
16:10of the biggest ones that's been so detrimental is performing these parent dectabases, really
16:16removing the families, and actually blaming the families.
16:19It is one of the few areas where we still blame families.
16:23And we know-
16:24Mothers particularly.
16:25Absolutely.
16:26Decades of evidence shows us that not only are families not to blame, they are our best
16:32asset in getting kids to a healthy place in recovery.
16:37We talk often for eating disorders, but it really does apply to many serious mental illnesses,
16:43that these are brain disorders.
16:45They require you to fight your brain many times per day.
16:48It's not only ineffective, but actually kind of mean to treat that as an individual illness.
16:54You need to bring in the people who love the child most.
16:58Some people will say, in the case of eating disorders, well, if the family has issues
17:02with diet, culture, and stuff with food and body, we absolutely need to exclude them.
17:09Absolutely not.
17:10All the more reason to include them, because at the end of the day, that child is going
17:14back to live in that family system, and so how do you set up that family system for full
17:20health and full recovery?
17:21Salome, I wanted to turn to you to comment on that, but also, we're talking a lot about
17:26the importance of community and connection in terms of solutions.
17:29We're in a global loneliness epidemic, so when you're thinking about tech innovation,
17:35how are you balancing that with the importance for community and connection?
17:39Yeah, I'd love to comment on the policy piece as well.
17:43For me, thinking about a scale of innovation, on one end of the spectrum, it's totally Jetson,
17:49AI, all the novel, cutting-edge stuff, and on the other end, it's just putting one-on-one
17:54therapy online, not really doing anything to scale our dire shortage of workforce.
18:02I'm most excited about this middle ground where the provider is still in the driver's
18:07seat, but it's the technology that is expanding their reach to that many more patients, and
18:13I use the term provider loosely.
18:15That could be a peer or a coach, and so those are the kinds of solutions that I am very
18:20excited about to help, especially reach young people on tech where they're comfortable receiving
18:27care, but also people heal in relationships, as Dr. Agar mentioned, and having that provider
18:33connection, and that, in partnership with the Commonwealth Fund and Meadows Mental Health
18:39Policy Institute, my organization, Behavioral Health Tech, we took these, which we called
18:45workforce extenders, and we came up with some recommendations for the administration
18:51to be able to have some near-term strategies to disseminate youth digital mental health
18:57tools more broadly in the Medicaid market, and one of the first steps that we offered
19:02was just even defining what agency is responsible for what so that innovators can know how to
19:11navigate the government to be able to partner and disseminate these tools, so a lot of opportunities
19:18still there.
19:19Yeah, and we could talk about this forever, and I have so many more questions, but I did
19:24want to just ask one more quick question for each of you.
19:26It can feel really daunting to be on the front lines of mental health care, so first of all,
19:31thank you, and I would love to ask in a word to a sentence, however you want to take it,
19:37what do you see as the next frontier of mental health care?
19:39Zoe, I'll start with you, and I'll go back to Solomay and then back around.
19:43I think that this last conversation geared towards psychoeducation and just involving
19:48the entire community into understanding what mental health care is and what the options
19:52are is critical, and I think integrating this into society, into the information overload
19:58that we are already receiving is the perfect opportunity to do so.
20:02Solomay.
20:03Mine is partnerships.
20:04We've got amazing solutions, but now it's time to work together.
20:08A lot of payers already have solutions in their portfolio, so how are the new innovators
20:13going to come and coexist and integrate with them?
20:16Perfect.
20:17Digital mental health interventions not only have the ability to expand access to evidence-based
20:22care that works, but actually to take the evidence-based care that we know and make
20:27it better through measurement-informed care and learning on more diverse populations.
20:32Yeah, and I would say accountability, and accountability from ourselves in the mental
20:39health field, but also from payers and the psychoeducation and empowerment of parents
20:46and children to be able to demand the care they deserve.
20:49Yeah, it's a great way to end.
20:51Thank you all so much.
20:52Thank you.
20:53Really appreciate it.
20:54Thank you.