RURAL MENTAL HEALTH CONNECTIONS WEBINAR Transcript–April 13, 2022

Rural Mental Health Connections Webinar Transcript – April 13, 2022

Panelists:

• Jeff Ditzenberger, a Wisconsin farmer, sharing his story of attempting suicide and founding of TUGS, a mental health nonprofit to address the stigma surrounding mental health challenges and suicide

• Mark A. Frye, MD – A Consultant in the Department of Psychiatry & Psychology at the Mayo Clinic, speaking about the empowerment of sharing lived experience with mental illness and addiction and the value of mental health support groups

• Pravesh Sharma, MD – Assistant Professor of Psychiatry & Psychology at Mayo Clinic Health System, sharing an innovative approach to providing patients with telemental health services in rural communities

• Michael Pollock – CEO of Depression & Bipolar Support Alliance (DBSA), providing an overview of the organization’s services including a national mental health support group network and the addition of rural-focused support groups

• Jeff Winton – Rural Minds Founder and Chairman, and New York dairy farmer, providing an introduction to Rural Minds and website access to suicide crisis and mental health services

• The webinar was moderated by Julie Lux, Rural Minds Vice President of Communications.

Please note that this webinar discusses aspects of mental health, including suicide, that certain individuals may find disturbing or triggering. If you or someone you know is experiencing a mental health crisis or suicidal thoughts, please reach out immediately to the Suicide Prevention Lifeline at 800-273-8255, or text HOME to the Crisis Text Line at 741741. These services are free and confidential.

[00:00:00] Julie Lux: Hello and welcome. My name is Julie Lux, and I am the vice president of communications at Rural Minds. And it is my pleasure to welcome you to the first Rural Mental Health Connections webinar. Tonight's presentation will focus on the power of sharing lived experiences and confronting mental health challenges. In addition to personal stories about overcoming mental illness and attempted suicide, this event will feature medical validation of the benefits of peer support for mental health and access to relevant information and services.

[00:05:53] This is the first of four webinars that are planned for this year. And we greatly appreciate everyone who is joining us for this first inaugural webinar. The one thing that we wanted to talk about, just very briefly, at the beginning is that we honor and respect the confidentiality of our audience this evening.

[00:06:15] And we wanted to point out just a couple of things as we begin, first, attendees. So those of you who are watching the webinar will only be able to see the webinar presenters. No one watching the webinar will be able to see the names or the images of any of the other people that are watching the webinars.

[00:06:35] So people in our audience. We do, however, encourage you to use either the chat function or the Q&A function at the bottoms of your screen to ask questions. We will have time for all of the presenters this evening to answer your questions. Those will be kept completely anonymous. The only people who will see those questions will be the presenters and myself. So, we hope that you will please that ask questions and join in with us, but your own identities will be perfectly anonymous. So, to begin things tonight, it is my pleasure to introduce Jeff Winton. Jeff is the founder and the CEO of Rural Minds, and it is a nonprofit organization with the mission to serve as the informed voice of mental health in rural America, and to provide mental health information and resources. So, with that, please join me in welcoming Jeff Winton.

[00:07:55] Jeff Winton: Thank you very much, Julie. Good evening to all of you who are joining. And I should say good morning and good afternoon as well, because I know we have some international attendees from what I've gathered from social media, which is wonderful.

First, I'd like to thank the Rural Minds team who have really rallied around this and made this something very special. And I hope you will agree with that at the end of this evening. It might not seem like an hour-long program with a handful of people talking. It's a big endeavor, but those of you who have done webinars, and many of us have the last two years during COVID, know full well that it can be quite a time-consuming proposition, but it was a labor of love on the part of many people.

[00:08:30] And I'd like to just acknowledge them at the beginning of our evening. First of all, I'd like to thank Chuck Strand, who is our executive director with whom nothing else would have happened. Not only on this, but many other things with Rural Minds. Also, Julie Lux, of course, our head of communications, Adriel McMahan and Carol Ann Underwood, who are our social media experts. They have done a terrific job promoting this.

[00:08:59] Also Joan Todd, Gayle Mahoney and Karen McDermott. So that's the Rural Minds team. I'll be talking a little more about Rural Minds later in the call. We're a new organization that was just launched in October, but we're very excited about this evening. This is our first webinar, as Julie said. We had a stretch goal for this evening, and I won't tell you what that is, but I've got to say as of this morning, we had exceeded our stretch goal.

[00:09:27] So I am very encouraged by the receptivity of the panel you'll meet this evening and the topics we will be covering. And last, but certainly not least, I'd like to thank our distinguished panel of experts. Many of whom are leaders in this field, and we're very grateful and honored that they would make time to help us address this very important topic. So thank you to all of the panelists.

[00:09:55] In particular, it's my pleasure to introduce another Jeff and another farmer. So, this is going to get to be a little confusing because my name is Jeff and I am a dairy farmer. Our next speaker is Jeff Ditzenberger, who is a Wisconsin farmer, who will tell you about his own personal journey and the great work that he's doing in Wisconsin and across the country, in addressing this topic in small towns and rural areas, he's a founder of T.U.G.S.

[00:10:32] And again, I'm sure Jeff will give you some background as to what T.U.G.S stands for and how the name came about being. But Jeff, I know you're traveling. I believe you're doing this from a hotel room someplace, so we especially appreciate your participation and your active involvement in support in Rural Minds. You've been a terrific partner and we appreciate you very much. So, with that, please meet Jeff Ditzenberger.

[00:10:59] Jeff Ditzenberger: Thank you for that wonderful introduction, Jeff. And you guys can call me Ditz. Everybody else has been calling me Ditz since I was like six years old. I rarely answered a Jeff to be quite honest.

[00:11:08] So but again, it's a pleasure to be here. My name is Jeff Ditzenberger, not only am I a farmer in Wisconsin, I'm also a big iron auctions district manager which is a position that I've just taken recently. I'm traveling. I'm in Iowa tonight and glad that we have these new technological ways to make this work.

[00:11:32] So really quick about my background, you know, I always tell everybody I'm 25 and I've been farming for three years, but truth is I grew up in a small dairy farm down in South Wayne, Wisconsin of about 400 people. Back in the late eighties, we sure didn't talk about mental health then very much.

[00:11:53] If we did, you were kind of shunned by people. One of the things that I noticed as a young lad, is that we couldn't talk about our emotions or growing up as young men, we would hear, you know, “Boys don't cry,” or “Quit crying,” or “I'll give you something to cry about.”

[00:12:15] And I always wondered why that was. I graduated high school and went into the service in the United States Navy. When you're 17 and a half years old, I'll tell you, when you raise your right hand and swear to defend your country against all enemies, foreign and domestic, you sure don't think about actually being in a war.

[00:12:36] And shortly after I got in the Gulf War broke out. After that happened, there's some things that no person should have to see. Now, I wasn't boots on the ground like a lot of military people were, but one of the things that I did see is the SCUD missiles getting shot out of the sky.

[00:13:01] And we came back to the United States and people weren't as warm and welcoming as one would think. Not nearly as bad as it was for Vietnam War vets, but it was still something that kind of concerned me that we couldn't talk about things that happened over there. I started noticing this pattern at 19, 20 years old, you know, I'm like, “Oh, we still can't talk about our emotions. We can’t still talk about our problems.” And so, I got out of the Navy. I was married at the time. I made the mistake when we were moving that I opened up her diary. And for those of you that don't know what a diary is, that's where this older generation used to keep all of our secrets and our notes.

[00:13:44] And apparently, they call it Facebook now. But one of the things that I found out in there is that she had started cheating on me shortly after we had gotten married while I was over in the Gulf. I started asking other friends of mine. I'm like, “Dude, I just want to have a conversation. Like I'm not feeling good today. I'm not, I feel depressed.” And it was the constant, “Suck it up buttercup,” or “Oh, dig a little deeper,” or “Man up,” and starting to figure it out that nobody wants to listen to me. I kind of just starting to get the feeling of being a complainer and a whiner. Maybe the world would be better off without me.

[00:14:22] So, I planned my mom's birthday party, a surprise birthday party for her. And that night, I decided it was going to be the night that I was going to take my own life. And one of the misconceptions out there that I think people don't realize is that when it comes to suicide, people don't make a rash decision on that.

[00:14:42] I actually planned for my suicide for over six weeks. I wrote a note. I wrote that note over that almost that entire time I went and saw people, friends of mine and kind of make peace with them. And I gave away some of my toy collection, my tractor toy tractor collection, and some of my guns.

[00:15:03] And I told everybody, when they were like, “Oh, what's this for my guy? Just, “I'm not going to need them.” And they're like, “Well, that's just seems weird, but thanks.” Then they would say, “See you later Ditz.” And I'm like, “Yeah, probably not.” And nobody picked up on it. So, the night that I tried to die by suicide, I actually took a note on paper, put it in my pocket and then walked into an old, abandoned house and decided that's how I was going to end my life, was by setting this house on fire.

[00:15:31] Now, for those of you in the audience, you're like, “Well, that's really dumb because nobody's going to be able to read your note if you're in a fire.” I wasn't thinking about that at the time. All I was thinking about was that the pain that I had been enduring wasn't going to be there anymore.

[00:15:46] And a lot of people will say to me, “Why didn't you do your suicide quicker? Like, why didn't you have something less painful?” And I think as men, you know, we've been told to man up, you know, make it as painful as possible, which statistically is something that I have that I have noticed that men dying in more painful ways than what women and children do.

[00:16:07] And for whatever reason, all of a sudden, I was like, “What am I doing here? Why in the heck am I inside this burning house?” I called 911. I was on the fire department at the time. I went to the scene with the fire department and the next morning Sheriff's Department called me and asked me if I would come in and talk to them because they thought I had some information on the house fire.

[00:16:31] And of course I wanted to help out and the next thing I know I'm being told that I could either go to jail or I could go to the mental institution. Now, mental institutions, you know, Hollywood portrays them as bad places. And people, you know, are acting all crazy and weird and stuff like that.

[00:16:50] And, you know, I didn't really think that I wanted to go to jail that bad. And here's the first opportunity that I had that I could actually go someplace where I was hoping that I could finally get some help for everything that was going on in my head. Best decision I ever made. You know, I went to the mental institution and for the first time in my life, I felt like I wasn't judged. Went to jail, got charged with felony arson, lost a lot of rights, lost a lot of money, lost a lot of respect. And then in 2014, I wrote a blog for Wisconsin Farm Bureau Federation. And they wanted me to do something on

farming. So, I wrote about farming, men, and mental health and how we still couldn't talk about it. They weren't going to publish it. And finally, they did decide to publish it.

[00:17:39] It went viral and I was asked shortly afterwards to speak at Madison, Dane County's Guys Night Out. When I got there, they talked about my military career, and I didn't really know what I was going to talk about that night. I ripped up my speech on the way up there and a buddy of mine, who was with me says, “Wasn't that your speech?”

[00:18:00] And I'm like, “Yeah, but it just doesn't seem to be working.” I get to Guys Night Out, and we started talking about my Navy career. And it dawned on me, the ship that I was on in the Navy is the second largest displacement ship next to an aircraft carrier. So, whenever we would come into port, or we would go down locks and dams, or narrow waterways, or on the unfortunate chance that we might be dead in the water, like something went wrong that we couldn't get back, we would call for a tugboat. And you can't see the tugboat, but you can hear its little “toot toot.” You might see a little smoke going over. And it was really cool when we were in the ship itself waiting to get into port, we would go completely quiet. So quiet. Like we used to joke downstairs that down in the engineering room that we could hear the fish eating the barnacles off of the whole of the ship and you'd feel this little bump.

[00:18:54] And then you could feel yourself move. And there was a sense of calm that would come over you. And as we keep moving, you'd feel another little bump and then this magical voice would come across the loudspeaker. And it would say to us, I'm going to paraphrase: safe at home.

[00:19:09] And I thought to myself, “Why couldn't life be like that? Like, what if you were a big, tough, strong, exterior ship and you're having a bad day and you were in a storm, what if you could call a tugboat?” So, I told my buddy, my best friend Scott, on the way home, I want to start a nonprofit.

[00:19:28] And he's like, “You already farm. Do you need another one?” And I was like, “No, dude, like I want a nonprofit that helps people. And doesn't have a lot of government red tape.” I didn't realize how hard nonprofits are to start. That was another lie apparently. But anyways that night I laid awake, and I came up with T.U.G.S. Talking. Understanding. And at that time we started with growth and support because even big ships need little ships sometimes. And we went through the process to become a 501-C3 starting in 2015. And I actually didn't get my full non-profit status until November of 2019 or 2020. It was a bit of a process, but we ran under another 501-C3 at the time.

[00:20:12] And one of the biggest things about my group T.U.G.S: Talking to Understand and Growing and Supporting is to get people to talk. To link people up with people that they can have conversations with that are candid, non-judgmental, no garbage conversations. Like Scott, my best friend, is one of my T.U.G.S. I called him one day and I said, “Dude, I can't stand my lunch. I'm having a bad day.” And he's like, what's wrong with your launch? And I'm like, it's leftovers. And he's like, “Okay, what's wrong with it?” I said, “It's leftovers.” He goes, “Well, who packed your lunch?” I go, “Well, my wife did.” He goes, “Well, then pack your own lunch if you don't like it.” But the day that the guy that I farm with got diagnosed with brain cancer, and I didn't know if he was going to live, Scott was the same guy who on the other end of the line. Sat and listened for 48 minutes while I sobbed trying to get the words out. And what a T.U.G does is they're there for you. They toot their little horn, and they blow their little smoke, and they bump up against you. And they wrap that mooring line around you and they push you safely to home. They get you out of those rough waters. And the thing that has frustrated me, especially with 2020, when we looked at all the cases of mental health that increased during a pandemic, that is nothing like the pandemic of mental health that we've seen come about, was people not having that ability to talk to people.

[00:21:36] We talked about COVID like we talk about having cereal for breakfast. But we still can't talk about mental health and that's one of the things that my organization wants to do. That's one of the things that I personally want to do. I want it to be so that we can have a conversation about mental health, about PTSD, bipolarism, schizophrenia, all the diagnosis that are possibly out there. Like we talk about COVID, the common cold, the flu, and a bunch of other things that we talk about out there that are extremely contagious. Yet mental health is not contagious and yet we still don't talk about.

Julie Lux: Jeff, or I guess I should say Ditz. I hate to stop you because this has absolutely been fascinating information and I'd love to encourage everyone who's watching to follow Ditz on Facebook. He has a Facebook page, and this is just the tip of the iceberg of the many things that this gentleman is doing to help support mental health. And I'm so excited because I now know what T.U.G.S stands for. So that's awesome. But while we have you, we have a couple of questions that we'd like to like to pose to you while we have you here. The first one they're asking: I've heard people say something like, “I don't want to complain about my problems. Everybody's got problems and talking about them isn't going to change anything.” How do you respond to someone when they say that to you?

Jeff Ditzenberger: We talk about successes all the time and we revel in those. I think its the same thing with problems. I don't call them problems, Julie, I call them opportunities. Let’s have those candid conversations. I think the thing is, is that when we do have those conversations about, you know, when people feel like they're complaining about the bad things in their life, people aren't as apt to listen to those, as much as they are to listen to the successes, or the good things that are happening.

[00:23:36] So let's change that mindset. Let's say, “No, Julie let's have a 25-minute conversation about what's bothering you.” At the end of that 25-minute conversation, let's not tell them, “Oh, somebody got it worse than you do. Suck it up, buttercup.” Let’s validate their feelings. Let's tell them that it's okay to not be okay.

[00:23:52] Let's tell them that what they're feeling is all right. We don't want it to be forever, but it's okay for them to have that at the moment. And we will be there to create space with them, to let them lean in, and walk that journey with them and be that tugboat.

Julie Lux: sometimes it's just having that other person validate, “It's okay to have that feeling,” because so many times, like you said, you're told don't have that feeling, but you have it.

[00:24:19] So I think that's wonderful advice and great what your organization is doing. The next question people like to know is: You personally have come so far from an attempted suicide years ago, to founding T.U.G.S., you're speaking here with us today. To what do you credit your ability to overcome your mental health challenges and continue to persevere?

[00:24:46] Jeff Ditzenberger: Part of it is I got tired of burying friends for a permanent solution to a temporary problem. And when I finally found a person that would listen to me and validated my stuff, I'm like, “Why can't we all do that?” I've kind of embraced my mental health diagnosis. I kind of jokingly will say to people, “I'm definitely crazy. I just had momentary lapses of sanity.” I think about it now with my grandbaby, my kids, my significant other, the girls that I’ve coached for softball, and the people that have reached out to me, who I know whose lives have changed and who have reached out to me in that moment of despair and not making that ultimate, final choice. That’s what keeps me going.

[00:25:39] I thought I had it pretty bad and I do know there's people that have it a lot worse than me, and it doesn't make my things any worse or any better, but I just want to see people live. I want to see people enjoy the things that I've enjoyed over the 51 years, even times that I went through that I struggled. They say not to look in the rear-view mirror, but sometimes you have to and remind yourself that you came from a very, very dark place. And I just want to be the light for other people.

[00:26:08] Julie Lux: Well, Jeff Ditzenberger, thank you so much for being with us tonight. Once again, remind everyone to find out more about T.U.G.S and what's going on with this great organization, follow them on Facebook.

[00:26:23] Thank you so much again Ditz, for your time this evening. We are going to move on to our next our next special guest right now. And this is Dr. Mark Fry. Dr. Fry is a consultant at the Department of Psychiatry and Psychology at Mayo Clinic. And he joined Mayo in 2006 and holds the academic rank of Professor of Psychiatry, Mayo Clinic, College of Medicine and Science, and served as an esteemed Chair of the Department of Psychiatry and Psychology for more than a decade. Dr. Fry will be speaking about the empowerment of sharing, lived experiences with mental illness and addiction and the value of a mental health support groups. Dr. Fry, welcome.

[00:27:12] Dr. Mark Frye: Julie, thank you, Julie and Jeff, really a pleasure to join this great group. I wish you incredible success with Rural Minds and this first webinar. I know you know, I'm speaking to the converted.

[00:27:27] We really need you in this resource and very pleased that it's off and running. And I suspect one galvanizing force, I'm sure, has been the pandemic that we all are living in. I can tell you that as a psychiatrist, the pandemic has increased rates of depression, addiction and suffering substantially. The one glimmer, if I was to find something in the context of this pandemic, it has forced our country, our mental health service delivery systems, clinics, and universities to really build tele-psychiatry, tele-health, digital outreach in ways that it would have taken a decade had we not had the pandemic. So, I'm very pleased this type of delivery is available. It's not going away and will be instrumental in providing support and sharing stories. Rural Minds and this group will lead the way, I'm sure. I wanted to tell you a little bit about my job and how I have come to really appreciate the critical importance of sharing stories, lived experiences, much like what we've just heard from Jeff Ditzenberger and the incredibly inspiring work of T.U.G.S.

[00:28:56] I am a psychiatrist that has a particular interest in mood disorders, depression and bipolar disorder. It's been an honor to serve people who are struggling with mood disorders. And I can tell you over the 25 years of my practice, we are getting to a point now where there's greater awareness, more comfort, and more ability to really reach out and get that peer support that is very, very important. I don't want to minimize my role. I know it's important to get the right diagnosis and to guide treatment, but I know my role is limited in some ways. People who are struggling with depression and bipolar disorder can, at times, get support from family or friends, sometimes more neutral parties might prove to be as helpful, if not more so. And that's where, in my opinion, the concept of peer support, sharing lived experiences, supporting each other really is invaluable. And I've been involved with the Depression Bipolar Support Alliance for a good number of years. And you'll hear more about the importance of this concept with some of the virtual mental health peer support that's being developed.

[00:30:14] I can tell you from my practice at Mayo, I have found peer support to be incredible in a couple of different ways. It has a powerful message. When a person struggling with depression can comfort, share the burden, give good advice of doctors, resource centers, therapists, support groups, that experience, and that bi-directional exchange helps both parties.

[00:30:43] It's incredible to see that happen with a young person and an old person, with people that were of the same age, from different walks of life. It doesn't matter the composition. Sharing the burden, sharing that life experience can be really, really powerful. And as a psychiatrist, I would tell you that it's a critically important part of the overall treatment plan.

[00:31:08] Yes, I can contribute to the overall recovery process. But these types of support groups are invaluable and I would say are necessary. Now, having been born and raised in Minnesota, I can tell you, there are a lot of small towns and rural areas that have not had that access, and that reach that they need to.

[00:31:33] And this is where I get so encouraged, and really excited and enthusiastic about the potential of groups like what we are doing this evening. I wanted to introduce my Mayo colleague who is really a young, energetic clinician, thinking about the most meaningful ways to develop digital, inclusive healthcare. That obviously would include people, young and old, who are struggling with depression and/or addiction. But I wanted you to hear some of the really innovative ideas that my colleague, Pravesh Sharma, has been developing in our Mayo Midwest Department based in Eau Claire. We were lucky enough to recruit Pravesh several years ago. Dr. Sharma is trained in adult psychiatry and child psychiatry, and really spans a great level of interest and expertise in diagnosis and treatment. But what I think I've been really impressed by, and I know he will help lead Mayo efforts, is how do we really think about the best digital resource and outreach for diverse communities, rural communities, really recognizing this technology can be very therapeutic. Thanks for joining us, Pravesh.

[00:33:02] Dr Pravesh Sharma: Thank you Dr. Fry for the introductions and giving my talk a head start here. I'd like to also think Rural Minds, and especially Jeff, calling us for this inaugural webinars and lot of great speakers ahead. And thank you, Jeff for sharing your story. It was really empowering. I agree with Dr. Fry when we hear from these lived experiences, it's a bi-directional flow of information. We tend to learn from these stories as well. I would like to start ahead and talk about the work that we've been doing in past couple of years in understanding where do we stand in regard to digital healthcare. Just echoing what Dr. Fry mentioned that if only, a minutely positive thing that in such a loss, it's hard to find such things. Just a little thing, if we can find was the acceleration of digital healthcare in America. A lot of healthcare systems had to adapt the way they provide healthcare in the U.S. and across the world.

[00:34:20] And digital healthcare was one of those things. We already know that in rural communities, the provider shortage was already there. So sometimes the question arises, that if we talk about digital healthcare, would it be an answer to physician shortage? We’ll see. So this is me, I'm an assistant professor of Psychiatry and Psychology in Mayo Clinic.

[00:34:46] My area of research is about digital health equity. How to involve various people in the rural area, from diverse background to kind of cash upon this digital revelation that is going on in our country. Digital health equity seems like a complicated word, but if you move it around a little bit, then this is how it reads: equal health digitally, which means you provide equal health to people via digital means. And during the pandemic, what happened, the rural area already lacked digital healthcare. Once these digital equity measures will look at closely, we found that it actually made

disparities worse. And I'll talk to you in the next slide about it. So, this is one of the papers that we recently published. We talked about how digital means is actually a social determinant of health, a rather complicated word, which means that how, where you live, work and play affects your ability to seek any care.

[00:36:08] That's your social determinant of health. So basically, where you live your area, zip code, how far is a mental health organization, or any instance of a health institution is from your locality, your local laws, neighborhood, social community, all this tells you about how close you are to any healthcare system.

[00:36:36] So we call it social determinant of health. Now, over the COVID period, people who did not have internet connections, smart devices, who had poor digital literacy, which means they had cell phones, they had computers, but they don't know how to work these. So, that is called digital literacy. So, people who lack digital literacy, people who have low or no broadband internet connection, people who did not have smartphone devices, they lack further in healthcare.

[00:37:12] We think that digital health care should be included in social determinant of health, because if you don't have it, then it means you're not able to get healthcare. And that's true actually, in the case of the pandemic. Numbers matter. There's a rule of one fifth, one fifth of the U.S. population lives in rural areas. And about one fifth of those people already have a mental illness. So, you see the burden of mental illness is largely there in rural populations. Mental health treatment disparity. The reason for that is limited access to specialty healthcare. There are limited number of psychiatrists, and forget about child psychiatrists, there’s not even primary care physicians sometimes in rural areas. So, specialty healthcare is lacking. Geographical location is also a determining factor, which means that if a rural area is way far inside and it's hard to go to a special healthcare. I know sometimes I see patients about 150 miles deep in Wisconsin because there's no mental health, child psychiatry for about 150 miles from Mayo Clinic Health System. Lack of coordination. Stigma is a big deal and Jeff talked about this in detail. Limited mental health literacy, people in rural areas tend to normalize mental illness. And again, Jeff taught beautifully in during, during his presentation in it. So, let's talk about a case that we saw a few days ago. Actually, a few months ago. The name is Mr X. He was a young male diagnosed with bipolar disorder. Diagnosed by a primary care physician (PCP) and PCP was reluctant to treat the patient with bipolar depression. There were no nearby psychiatrists. He had to travel 150 miles, but he was reluctant to do that because he would miss his daily wage. He was worried about stigma, if his employer knew about it, not sure if his insurance was going to cover the mental health needs, this led to his stress induced drinking.

[00:39:26] He was smoking a lot, gained about 20 pounds in three months during the pandemic because of uncontrolled symptoms of bipolar depression that affected his relationship with his peers, his girlfriend. He started getting more depressive episodes since decelerations. So this is a very

common situation that we see as psychiatrists, especially when we work in rural areas where people are not able to get healthcare that they need and their symptoms tends to deteriorate.

[00:39:58] So what's the solution? The solution for Mr. X was to get telemedicine. And he actually did. And the reason why he was able to get it, is because of the federal law during the pandemic. Mental health needs and other needs were labeled under emergency provisions. And that's why he was able to get telemedicine covered by his insurance. So, that was a glimmer of hope for Mr. X. Now, what could be other potential solutions? There are actually three treatment arms that could happen with Mr. X, either he could get a one-time consult with us and continue to collaborate with his primary care physician or have one-time contact with us and infrequently collaborate with PCP, or he continues via telemedicine to us. So basically, all these potential solutions will depend upon a lot of other things that I talked about previously, which are his insurance, is he going to come back and see us?

[00:41:14] What we suggest in lot of cases, when a person is living far away from our healthcare system is that we do a one-time consult, and the patient is actually seen by the primary care physician. What are the barriers for telemedicine services? One barrier is of course high-speed internet services, which a lot of telemedicine services require, access to smartphones, and digital literacy.

[00:41:43] If you have smartphones or internet, but you don't know how to use those smart devices, then smart devices and internet has no meaning. Your reimbursement once this public health emergency is gone, what would happen to the reimbursement via insurance companies?

[00:42:04] So these are the factors that are going to play a big role once this public health emergency is gone and if we want to look in the future. So, if you remember this left side of social determinant of health curve, right side is the potential solutions that we propose in our paper. We talked about how it is important to screen each and every individual about their digital competency.

[00:42:36] And currently in the Mayo Clinic, our colleagues are working on a screening instrument, that every time when you come to see any healthcare provider in Mayo clinic, you will be screened for your digital competency. This way, we will be able to know if you are coming from an area of low broadband connection. Do you have a no access to a smartphone, or if you have access to a smartphone, or you have broadband connection, is it the digital literacy that is lacking? And based on that, we potentially will be able to provide solutions to to the particular problem. So, this is where we are currently working on in the Mayo Clinic. And this project will probably evolve in the next year or so. We are really hopeful that once we identify these problems, we will be able to target the specific areas of these problems.

[00:43:40] This is a busy slide. Just wanted to show you that this is the way that we developed our screening tool. We really believe in stakeholder involvement. So, we involve community participants.

We involved patients. We did an extensive literature review of all the studies that have been done in the past.

[00:44:00] We involved the patients in developing that screening tool. We are currently in a stage of refinement and understanding how valid that instrument is. And once we understand that, then we will be able to disseminate, and we'll be able to use that screening tool to identify the problem areas and provide potential solutions.

[00:44:22] Julie Lux: Thank you, Dr. Sharma. I wish we had more time. I think every one of our speakers could probably take up a whole a whole session. We have a few questions. I'm just going to give you and Dr. Fry one quick question so that we can get onto Michael Pollock, so he can talk to us about DBSA. One thing that you talked about in your example was a gentleman, who was able to do telemedicine and also talk with his PCP, but what about those people who are unwilling or unable to get help? Can a family member or a friend provide a sympathetic ear even if they're untrained in mental health? Can well-intentioned family members be of assistance to their friends and family.

Dr Pravesh Sharma: Yes, absolutely. I wish I had more time, then I would have gotten into more detail of digital navigators. That is a term that people use a lot these days. So, what we do when we see a person is not very equipped in digital literacy, is we try to identify a digital navigator within their house who could help us in facilitating their interview during any visit. It’s really important to have somebody in the house who is going to help us, helping with digital tools when we are meeting with the patient.

[00:45:55] Julie Lux: Thank you. Well, Dr. Fry, Dr. Sharma, thank you so much. Dr. Sharma, I'm going to take that as a commitment that we can have you back again at some point to talk with us more because there certainly are so many things that you all are doing and just the whole telehealth subject for rural America sounds like this is a great option for a number of people as it continues to evolve.

[00:46:20] So, thank you very much to both of you for being with us, but we do want to get on to our next guests this evening, who is Michael Pollock. Michael is the CEO of the Depression and Bipolar Support Alliance, DBSA. This is a mental health nonprofit with the mission of providing hope, help, support, and education to improve the lives of people living with mood disorders.

[00:46:46] Michael will give us an overview of DBSA services, including a national mental health support group network, and the addition of a new world focused support groups. So, with that, Michael Pollock, we’ll turn the floor over to you, sir.

[00:47:02] Michael Pollock: Okay. Thank you, Julie. And hello everyone. Thank you for joining us today. My thanks to Jeff and to Ditz, and to Dr. Sharma. And of course, to Dr. Frye, who is also a

member of the DBSA Board of Directors. Appreciate all of you. I am going to show you a few slides that Julie mentioned a little bit about DBSA’s mission, which is where I'm going to start.

[00:47:33] Our mission is to provide hope, help, support, and education to people living with mood disorders, specifically depression and bipolar disorder. We were founded by individuals who live with a mood disorder, specifically to provide what we call peer support towards others. DBSA was founded more than 35 years ago, when two individuals who live with bipolar, went to their doctor and said, “We want to get additional help beyond the help that you're providing by talking to other patients, by talking to other people that we can relate to and who can relate to what we're going through.” And from that experience, DBSA as a nonprofit, formed over 35 years ago. Our vision is simply to envision wellness for everyone regardless of their mental health status, regardless of their mood disorder.

[00:48:31] We specifically focused on bipolar disorder and depression. We serve three primary audiences, three primary groups. First and foremost, those with what we call lived experience those living with depression, living with bipolar disorder. But we also provide resources to parents and caregivers and family members.

[00:48:56] Those, as Julie just referenced in her question, are looking for ways to get information, educate themselves and provide support to other parents, caregivers and family members. And then thirdly, we want to make sure that clinicians of all stripes are aware of peer support and the kind of resources that an organization like DBSA provides. As already mentioned, it's not just psychiatrists and a lot of rural communities there aren't psychiatrists.

[00:49:30] There may not even be an adequate number of primary care doctors, but we want to make sure that doctors do know about DBSA. We want to make sure nurses, counselors and social workers are aware of the kind of resources that we offer on a national level and in local communities. We have five main priorities that you see listed on the screen.

[00:49:53] I'm going to focus on the one highlighted in yellow in just a minute. I'm going to talk a little bit about our peer support resources, plus a new initiative that we are excited and proud to be launching with Rural Minds. Somof the other resources that we do provide, and some of the other approaches are listed here on the screen.

[00:50:13] I do want to call out on this third one here, enhancing education and content across the lifespan for someone who is experiencing symptoms or a diagnosis of depression or bipolar resources for, even children who are beginning to develop symptoms, as well as resources for their parents, all the way to adults at different stages of life. Including older adults, senior citizens who are fortunately living longer in today's day and age, and oftentimes living alone that isolation can lead to a diagnosis of depression or bipolar. And so we want to make sure we're providing those resources across the lifespan.

[00:50:53] This is a quote that came to us from an individual who went to a DBSA support group. “This has been the worst year of my depression and these support groups have saved me. Literally.” The worst year refers to dealing with COVID and this pandemic. And we were grateful that we were able to connect this individual with peer support through one of our support groups. We did a survey in 2021 and this is what's called a word cloud. You may be familiar with word clouds. It was an open-ended question to those that attended support groups.

[00:51:41] What inspired you to get involved? And the larger the word on the screen, the more people indicated that type of response. And so, you see these bigger words, “Support,” “I need help,” “Depression,” “Being diagnosed,” and “Dealing with my mood disorder.” These are the kinds of reasons that individuals come to DBSA and tap into our support groups and the resources on our website, resources I might add, are almost entirely free. And you see that website address there in the lower right-hand corner. I invite you to check out our website @ www.dbsalliance.org, in terms of peer support and our support groups. We now offer over 550 weekly support groups that meet, mostly now because of the pandemic virtually, but before the pandemic, it was a blend of local community support groups, coupled with some online support groups. As a result of the pandemic most of our support groups transitioned to online. And then out of our national office, we went from offering seven weekly support groups to more than 40 every week through our national platform. And you can find those support groups, both the national and the local level on our website. Just go to www.dbsalliance.org and click on find support right off of the homepage. In terms of the work that we're about to embark upon with Rural Minds, as a way to diversify and broaden our audience and provide more resources to individuals with mood disorders and their family members in rural communities, we're taking a two-step process. The first is we're working with two of our DBSA chapters, one in Urbana, Illinois, and the other in Louisville, Kentucky. These are established chapters of DBSA, who offer a weekly support group in a virtual online setting, kind of like we're doing today. But in a smaller, more intimate way. The support groups are run by volunteers.

[00:53:55] The volunteers live with a mood disorder themselves. So, it's individuals helping individuals with similar lived experience like themselves. The support groups are a safe, respectful place to provide support, get support, and share experiences with people that may be going through experiences like yourself. These new support groups that will be facilitated out of these communities will be online and available to people in rural communities, regardless of your geography. You don't have to be from Illinois or Kentucky to participate. So, we look forward to the soon-to-be-launched of these new support groups, which will be available specifically to people who live in rural America.

[00:54:43] The second phase of our project is to identify individuals who live in different rural communities across America, who would like to be trained to run support groups. DBSA has a training

program for volunteers. It's free, where we provide you with the background, the tools and the resources on how to facilitate a group and engage other participants. So that we can add over time, more support groups, again, specifically for rural and farming communities.

[00:55:21] DBSA’s motto is “We've been there. We can help.” We were started by people with mood disorders to provide support to people with mood disorders. I have my email up on the screen and you are invited to contact me. If you'd like to learn more about our resources. You can also find them on our website again in the lower right-hand corner at www.dbsalliance.org. Julie, I'll turn it back to you.

[00:55:49] Julie Lux: Michael thank you. Thank you so much. We do have a question for you if you'll stay with us for a moment, but first we are going to turn to Jeff Winton, the founder and CEO of Rural Minds, to talk just a little bit more about the organization. So, Jeff, turn it over to you, sir.

[00:56:09] Jeff Winton: Hello again, everyone. And thank you for being with us this evening.

[00:56:13] I don't want to keep you much longer than our allotted time. Much information on Rural Minds can be found on our website, which is RuralMinds.org. And there is a lot of information, including some of the information that you've heard about tonight. When we launched this organization back in October, we wanted to be mindful that there is a lot of great resources already out there, groups that, like DBSA, T.U.G.S., MHA and NAMI, and other long established organizations have been producing for many years.

[00:56:53] And we are in the middle of an emergency. We look at this as an emergency of what's happening in rural America. We didn't want to divert our resources and our time to be recreating the wheel, to be creating material that already exists. So, if you go to our website, you will see a long list by category, of materials that already exist, that are applicable regardless of if you live in a small town of 400 people, or if you live in New York city, for example. So, our goal is to collaborate with groups, such as T.U.G.S, such as DBSA, such as the Mayo Clinic. We're doing work with the National Grange right now. We're in conversation with the American Farm Bureau and our worlds are really the intersection of the healthcare industry and the agricultural industry.

[00:57:45] So we're hoping to bring together these groups of people that don't always have the opportunity to interact and to meet. Just quickly and personally, the reason that Rural Minds was launched, back in October, was my 28-year-old nephew, Brooks, who worked here on our farm at one point, where I'm talking to you from tonight, in upstate New York, died by suicide.

[00:58:12] Again, when he was 28 years old, leaving behind three-year-old twins. Who are now 13, which is so hard to believe. And it was really a wakeup call for not only my family, but for a lot of people in this area of New York, that we had this silent epidemic that had been occurring for so long, but yet no one was talking about it. As Jeff Ditzenberger told you, the stigma still exists in many parts of this country, especially in rural America, where people are ashamed to talk about it.

[00:58:48] They don't feel that they have the ability to share their feelings. Unlike if you're diagnosed with cancer, people readily talk about that. If you're diagnosed with diabetes, people talk about that, but mental illness is still an area that is forbidden in a lot of parts of this country. So, in my nephew died, and if you go to, again, RuralMinds.org, you'll see a video that we produced that talks about my mother's courage. In the fact, that it was my mother, Elaine, who is now passed away, who finally said, when my nephew died, "Enough is enough. We are going to talk about this and we are going to talk about this in detail," and that we did at my nephew's funeral.

[00:59:37] And that opened up a lot of conversations with a lot of people, not only people we knew, our neighbors, and our friends, and our relatives who had all been struggling with similar things. But yet, no one knew because no one was talking about it, as well as people from all over this great country. And I dare say, other parts of the world that reached out and said, thank you for finally talking about this.

[01:00:01] We need to have the same ability to talk about this as we do other diseases. And we've got some very unique challenges. You heard about that from our distinguished guests, from the Mayo Clinic. The broadband issue is an issue that we're all trying to overcome. Here on my farm, where I'm talking to you from, I've been hoping and praying for the last hour that my service doesn't go down.

[01:00:24] And so I know firsthand what it's like to live in a rural area where broadband is not readily existed. As Jeff Ditzenberger mentioned, growing up in a rural area and I grew up on a farm like he did, you're taught to pull yourself up by your bootstraps and get over it. Just move on and don't think about it.

[01:00:48] Well, it's an illness. You can't do that. You don't do that with other illnesses. You can't do that with mental illness. So, I would encourage you to go to our website and take a look at a lot of the resources that exist. We've been out there doing a lot of media work. And one thing that's been very telling for me, is to a person when we start conducting media interviews, the reporter that's interviewing me or one of our colleagues starts to share their story about their own family or their own friend's journey.

[01:01:23] So this is an issue folks. We appreciate you being with us. I'm going to turn it back over to Julie for some closing remarks but thank you again for being with us. We hope that you will begin to follow us on our various social media channels, as well as our website. Thank you, Julie.

[01:01:39] Julie Lux: Thank you, Jeff.

[01:01:40] And, we wish we could have gotten to more questions because we have gotten a number, but we're going to, we're going to end here with a question. Michael, we have some questions for you, and I want to get to at least one of them before we close. And we'll, use this one quickly. What do you see as the similarities and unique differences of peer support groups for people living in rural communities compared to support groups for people in urban and suburban areas?

[01:02:10] Michael Pollock: Well, I have a saying, “We need to make mental health talkable.” There's a lot of stigma across our society, regardless of geography, when it comes to talking about mental health. But I think in rural communities where people are geographically separated, they may be farther apart. There may be limited in opportunities to engage with a medical professional around mental health. I think these are just reinforcements that make it harder to make speaking about mental health and disclosing what one is experiencing or when a loved one is experiencing with others. People go to support groups, in general, because they want to be with individuals with whom they can share relatable experiences.

[01:02:57] And I think that's why it's so important to start support groups in rural communities and for people who live in rural America, even if you're not geographically near one another, thanks to technology. There are some unique experiences that exist only in rural cultures and people want to be around people that understand what that experience is like.

[01:03:20] At the beginning, Ditz talked about wanting to talk about farming, men, and mental health, and some of the barriers that he faced. Those were very real, and those are the kinds of experiences that coming together in a support group with others from a similar background, from a similar day-to-day life, can really relate to and offer and get support from one another.

[01:03:46] Julie Lux: People like me. Thank you so much, Michael. And we're just about out of time here, but I want to remind everyone that this presentation tonight has been recorded. So, for those of you, tell your friends and neighbors and others that would like to hear this great information, it will be available soon on the ruralminds.org website. Our sincere thanks to Jeff Ditzenberger, Dr, Mark Fry, Dr. Sharma, Michael Pollock, and our CEO and founder Jeff Winton; but especially to all of our audience for joining us this evening. We really appreciate it. Wish we had time for more of your good questions but thank you so much for being with us this evening and goodnight.

RuralMinds.org