Good afternoon. I'm Mark Rappaport, and it's a pleasure to welcome you to the session today. Initially, Saul Levin was going to have this role. There's a little story there. So Saul approached me and he said, Mark, I want to do a session that deals with lifting the veil of ignorance and talks about not only the wonderful work the APA is doing, but the wonderful work going on in the field so that people understand what's going on in terms of the tremendous work that's occurring right now. We're at a very interesting turning point. Tremendous work by many organizations and individuals that really will succeed in lifting the veil of stigma. And I said to Saul, OK, fine. And he said, well, yeah, I've got this CEO slot available, and I want to use it for that. I said, OK, fine, Saul. Then all of a sudden I got a note. Can you write an abstract for this session? And I said, sure. OK, fine. And I deliberately wrote myself out of the abstract. And then all of a sudden, about six weeks ago, eight weeks ago, I get a note from the APA saying, Dr. Rappaport, thank you very much for agreeing to chair this session. And then again, oh, Saul says, I'm sorry, I've got to go present this big award. And so you're now chairing the session. So that's why I'm not Saul Levin. There are other reasons I'm not either, but that's another story. The key is this. We're at a critical point in time and we're at a point because of the second pandemic, the pandemic that occurred because of COVID-19, where all of a sudden the majority of adults in the United States had feelings of anxiety, depression, sadness, feelings of loneliness, feelings of guilt, feelings in the development of trauma and post-traumatic stress, lack of a sense of agency that never existed in our society before. And what that's meant is that we're now at a point in time, whether we're talking about the wonderful campaign that the APA has with Mental Health Works, whether you're going to hear from our presenters today, we are at a point in time where our society is finally ready to hear us. Where our society is finally ready to challenge their own fears and ignorance and prejudice and shame. Where we have an opportunity to be heard in ways we have not been heard before. And there's momentum generated right now that can make it so that folks that have disorders of the most beautiful organ system in the body, the brain, that allows us to laugh and learn and love and create and think, to have memories, can be legitimated, can receive the respect, dignity, and parity it deserves. Now, you've heard me preach, but the awesome thing is we have three amazing speakers today, and I cannot do any of their curriculum vitae justice at all. But these are three amazing people. These are people whose lives are making a difference in this area. We have Seth Kahn on the end there. Seth is new to mental health. He's worked at the World Bank and did a lot of work that they did in terms of human capital and transforming the World Bank. Seth also has led five Grand Challenges. Grand Challenges are attempts to change the culture of different entities or societies. It's really difficult to do, but he's an expert in doing that. And he'll tell you more about that in a minute. Gary Mendel is really an amazing person. He is an individual who's a Wharton graduate. He built one of the largest hotel chains in the world and then said, stop. I want to dedicate my life to dealing with the prejudice and bias and discrimination with substance use disorders, and has dedicated his life to that. And then, you know, to you all, there's really no need to give Kay Jameson an introduction because everyone knows Kay. Everyone knows what an outstanding clinician Kay is, what an outstanding leader in the field of bipolar she is. I was talking with Kay and I said, the first time I met you, you were in the clinical center. You were working on what really was and is the seminal work on bipolar disorder that she and Dr. Fred Goodwin wrote together. But that's just the tip of the iceberg with Dr. Jameson. You know, not only is she the Delio Endowed Professor at Johns Hopkins University, not only has she run with Ray DePaulo the mood disorders clinics and programs there for many, many years, but she is a tremendous scholar, a tremendous author, and has authored so many books, be it her own autobiography, but so many books describing the lives of others and their growth and expertise and contributions to our society. And so today, we have the opportunity to really hear from three outstanding individuals who are involved in the process and have been for many years of transforming our society and transforming mental health. Each speaker will talk about 15 to 20 minutes, and then the goal is to have an interactive discussion with you in the audience. So please, please, please be passionate, share your thoughts, share your feelings, share your experiences. That's what we're here for. Seth, you're on. Thank you and good afternoon. It's a real pleasure to be here. I'm leading the grand challenge that Mark was just talking about, Stop Stigma Together. It's my honor and my privilege to be doing it, and I'm going to be sharing with you about how a grand challenge like this works. Before I do, though, I want to share we have a summit coming up at the end of June, which represents the apex of over three years' worth of work in this space. We have hundreds of organizations that will be participating, and I want to be able to share elements of it with you so that you can see the role that it plays in leading a grand challenge. But before I do all of that, I want to talk with you just a little bit about stigma, because stigma is what it is that we are fighting. I had to learn about stigma in order to fully appreciate the power of eliminating it in this country, because as Mark said, I'm not a mental health subject matter expert. In fact, I have a degree in mathematics. I spent 13 years at the World Bank, and my focus has been primarily on organizational strategy and innovation, sometimes with big organizations like Royal Dutch Shell, sometimes with little organizations like the American Institute of Architects in Washington, D.C. I've worked also with over 100 nonprofits, and so I had a sense of how nonprofits work, but I did not have a sense of really what were the core issues in mental health until I read this book. This is a book that you can obtain over the web for free. It's put out by the National Academies. It's a report that came out in 2016, and the name of it is Ending Discrimination Against People with Mental and Substance Use Disorder. This book reached me personally, as did Mark's work at the Huntsman Mental Health Institute, and I just want to share with you why it did, and also ask you to indulge me with some of your own life experience as we go through this, just to think about privately, not ask you to share this information, but just to think about it as we go through it. So I have lived experience in this space. When I was 10 years old, my mother developed schizophrenia. That was in 1969. We didn't know at first, when I say we, my father didn't know what it was initially for the first few years. My mother was exhibiting strange behavior that was unusual. He discovered that something was wrong when he saw that our savings account had been fully depleted, that we didn't have any extra money, because my mother was throwing out groceries as fast as she was buying them. She believed that someone was pumping poisonous gas into the food that we had in our pantry, and she was not sharing that with my dad. She was just going out and buying more groceries, and then one day he looked at the bank statement, and he said, where's all our money? And, of course, the more horrific realization he had was not the loss of money, but that something was seriously wrong with his wife, and that became the central issue in our home life until our home life fell apart. I moved out of the house when I was 16 years old. The experience that I had, the lived experience that I had as a 10-year-old, was really frightening for me. It was the woman that I depended upon to interpret the world for me, to show me what was real and what wasn't, and to take care of me, I started to realize was seeing things and hearing things that weren't there. The first big realization I had was I remember driving around in our car in Austin, Texas, and my mom talking about the red car that was following us, and I kept looking in the back window to see this red car, and it wasn't there. After three or four times of that, I suddenly realized that it wasn't there, and that something was going on with my mom. That horror that went on for years for me really baked in a stigma into my own consciousness. I felt afraid, and I felt ashamed of what was going on in my home. My home was not like my friends' homes. We had big battles in my house. My sisters and I would laugh and joke and gallows humor about when we'd find the next TV set sitting out on the curb, because my mom would put a hammer in the TV set. She thought people were watching her through it. We'd buy TVs, and they'd end up going out with the trash. We'd buy another TV and go out with the trash. She would alternate between being manic and screaming and doing things like clearing out our pantry with dishes, throwing dishes on the floor, and being drugged by doctors who didn't know what was going on and were trying anything they could. She would sleep for weeks at a time on our couch. I would never bring friends home to our house, and I didn't tell anyone what was going on until long after I moved out, because the stigma was in here. I was afraid of what it was, and I was ashamed of it, and so I didn't seek help. I think about how my life could have been different if I had sought help. Well, we know that that's only one form of stigma, and I'll be talking about three dimensions of stigma as we go through this, but I share that story with you for two reasons. One is we're about eliminating stigma, and one of the ways I eliminate stigma is by being transparent about what I've gone through in my own life. But the other reason is because I find that these experiences that we have are personal anchors for us in this work, and they're sources of energy. They give us the volition, the energy, the desire to move, to do more, to take our discretionary time, to get results, to move out into the world, and I find that most of the people that are active in the Stop Stigma Together initiative have a personal story. In fact, as I've talked to hundreds of people over the last three years in the mental health space, I really believe that 100% of the United States is facing a mental health challenge and that we certainly have someone in our close orbit who is facing a mental health challenge, whether it's a family member or a colleague or a friend. So I'd like to ask you to just take one minute privately and just think about any time in your life when you have experienced or seen stigma in action, whether it's in your professional career or in your personal life. It really doesn't matter. What matters is that you recognized it, that you saw that what you were observing was bias or prejudice against someone who was suffering from a mental health challenge or a substance use disorder. So if you could just take a moment to call that up. And identify in your own mind, who was involved? Was it something that was going on in your life or something that you were seeing in someone else's life? Was it, who exactly was involved? And just a sentence or two, again, privately, your own internal dialogue, a sentence or two, what was, what was it really about? What was happening that you were observing? Okay, we know that stigma is wrong. We know that bias and prejudice is wrong. We know that the criminalization of people with substance use disorders is wrong. But we still have a lot of work to do to turn around society. And so how do you conduct something like this, a grand challenge? That's what I want to talk about and a little bit about what I've learned. So in this document here from the National Academies, and as a result of that, we started work on Stop Stigma Together. That is the name of the movement that we are now shepherding. That name was not a name that we created. It was created by our partners as a collection. It was the name that stuck. As soon as people started saying it, they started using it. And what we've learned about stigma through the help of this report is that there are three dimensions. The first dimension is called structural stigma. Structural stigma is stigma that's baked into a law or a policy. So it's somewhere in legislation or in a policy. There's something that's codified that either amplifies or sustains existing stigma or maybe even creates it. And what we know from looking at culture change in organizations is that the vast majority of employees want to be compliant, and they don't want to understand necessarily the root causes of something that they are working, you know, against. Like, for example, I'll use misogyny or gender discrimination. Most employees don't want to get into all the details. They want to do the right thing, and they want to go back to their job, whatever their job is. Well, if stigma is baked into the policies, then simply by doing the right thing, they are continuing stigma or perhaps even increasing it. So it's so important that we pull stigma out of legislation at the local, state, and federal levels as well as the policy level. And I'll talk more about that and what that looks like and how we're doing that. The second is public stigma. Public stigma or social stigma are the ways we interact with each other, the mores and taboos in common society. So what you say to your friends at work or in the scout troop or in your place of worship or even the community center or your living room, how you act out in the world and the jokes you make and the words that come out of your mouth, all of this is considered social stigma. So that needs to be addressed as well. And then there's internalized or individual stigma, and that's how we talk to ourselves. And that was what I used in my example, was the stigma that ended up in my mind and that I used to perpetuate the relationship that I had with my mom, which I eventually was able to grapple with and change, fortunately, before she died so that we could really have a strong relationship. But it took intentionality on my part to address it. So these are the three dimensions that we see here. We've got this initiative. It's called Stop Stigma Together. And I'm going to tell you about how it works. But before I do, I want to take another moment to just go to the heart of the matter. And by the heart, I really mean that emotional place, that place inside where our passion lives. One of our partners is the Ad Council. You probably know the Ad Council's work. If you don't know who they are, right away, they did Smokey the Bear. They're over 100 years old. They did Rosie the Riveter. That was one of their first ads. They've also, Friends Don't Let Friends Drive Drunk, is from the Ad Council. When I spoke with the Ad Council three years ago, it was after their work in the pandemic had subsided, and they were doing independent research on the next major crisis that America is facing. And they came to their own conclusion that it was mental health, that America... And this was before a lot of the stuff was in the press. This was really on the heels of the pandemic itself, when it was very new. And they started mounting their own resources, and working to raise money, and looking at partners that they could engage, and talking to people who could provide them with donations in kind. And we started talking and working with them in the early stages. Well, the Ad Council is now an official, it's a bona fide partner with Stop Stigma Together, and they are releasing PSAs. They started last October with this ad I'm about to show you. And I want to tell you that the Ad Council is releasing a series of PSAs, and they're including Sesame Street. These are PSAs designed for zero to three-year-olds. And they're hitting the demographics initially that are the most vulnerable. But there's something interesting about those demographics, and I'll tell you about it after I show you this ad. This is the first ad that came out. It came out in October of last year. I've been alone in my head. I wonder if you know that I want the best for you. I was lost. I know you're going through a lot. I wonder if you know that the big homie needs help too. You can't just rebound from everything. I know you've been grinding. But how long will you fight solo? I wonder if you know that we can get help. I wonder why we waited so long. Not wondering anymore. Love your mind. Let's see how far we can go. If you go to loveyourmindtoday.org, you'll find all kinds of resources and toolkits that include that ad and more. What I want to share with you is I had the opportunity to have a ringside seat to the development of this campaign. There were focus groups. There were multiple campaigns developed, many which didn't make it very far. They were looking in particular for a campaign that would resonate with a very vulnerable group, young African American males and Latinos. Through their studies, they identified several demographics, that was one among several, that were not only not interested in mental health, actually resistant to mental health care. What they discovered, now this is a generalization, so it doesn't apply to everyone, but for many young African American males and Latinos, the idea that you can go it alone and that something tough will build your character and make you stronger in the long run was something that was actually preventing them from getting the mental health care that they needed. At the same time, they suffer from some of the highest incidents of substance use disorders and suicide. We know that that approach is not working for them. The ad council properly sought to find an ad that would resonate with that group. The interesting thing was that when they showed this ad, every demographic responded to it, not just young African Americans and Latinos. Different ethnicities, different age groups, different socioeconomic statuses. What you're going to see in the months ahead is Sesame Street using Love Your Mind. You're going to see Love Your Mind ads targeted for women. Love Your Mind ads targeted for all kinds of different demographic groups. We're very excited to have the ad council as one of our partners in this process, and they will be at our summit on stigma. Let me talk a little bit about how a grand challenge like this works. How do you turn around the entire country? We studied work that was done that looked at other movements that turned the entire country around 180 degrees, including recycling, breastfeeding, seatbelt usage, and tobacco cessation. What we know is that you have to start somewhere with what's called a backbone organization. The backbone organization is the organization that takes accountability for strategy, leadership, administration, and coordination. Mark Rappaport, who is leading this session in Saul's absence, is the CEO of the Huntsman Mental Health Institute. It's the Huntsman Mental Health Institute that hired me to lead this grand challenge. They stand with those resources, the ability to convene and support and administrate, taking accountability for the vision and the strategy, and convening the leaders. One of our first activities was to bring together the leaders of all the organizations that we believed needed to be involved for us to succeed. That's usually how a grand challenge will start. You ask yourself the question, who needs to be involved for us to succeed? We brought together executives from these organizations in Salt Lake City, Utah. They traveled far because Salt Lake City is a far travel for most people. The reason they did was because they knew that stigma kills and that stigma is a barrier to so many things, especially to people getting the treatment that they need. We had these folks in the room. There were about 30 of them there. I asked them if they would be interested in partnering to help lead a grand challenge on stigma. In fact, we've got two of those folks in the room right now. Gary and Mark were both there on that day. It was almost instant. Really, in less than half an hour, everybody in the room had agreed to do this. That's highly unusual. From the other grand challenges I have led, it's usually a half a day of discussion and also a lot of skepticism. That was not the case in the room that day. What I heard was that most of the organizations present already had stigma initiatives because they knew how important it was. They felt that they had reached the limits of what they could do as a solo organization and were very interested in joining forces for a national initiative. We brought these folks together. Then our next step is to start to solicit organizations from all over the country. We envision a time in the not too distant future, in the next couple of years, when we will have thousands of organizations. Today, we have over 300 organizations as partners. By the way, there is no barrier to entry to being a partner. There's no financial commitment involved. Really, all you need to do is say, I want to eliminate stigma. We'll take you. Whether you're an individual, a small, medium, or large size organization, it doesn't really matter to us. Initially, the focus is on the keystone organizations, the organizations that's required to have participation in order to succeed. Then it begins to spread out more widely. You'll see here that at the bottom, we have it with the text here because we're not allowed to use their logo as their federal agencies. We have SAMHSA and NIDA, as well as organizations that are large and well-known, like the American Psychiatric Association, NAMI, the American Psychological Association, and organizations that are up and coming and becoming major players in the field, like Shatterproof, that you're going to hear about in just a little while, or the Jed Foundation, and others. All of these organizations have partnered together now, and they're part of our National Leadership Steering Team. We're building communities of practice across the country. These are groups of people who are interested in a particular area or field. We have Rural, for example. This is the initial group in Rural that you see here. We have the American Foundation for Suicide Prevention there on the bottom, or Southern Utah University. Above that, the Jed Foundation. Over to the left of that, you see that Native American Shield, and it's the Utah-Navajo Health System. One of the things, of course, about Rural is that it contains many, many different communities. Even though they might all fit under the word Rural, they are so different when you really get down to them. Each one of the rural communities that we reach out to requires somebody who acts as a bridge between our movement and that community. For example, at our summit coming up in June, we are going to have members of the Utah-Navajo Health System. In particular, there'll be one gentleman who's going to come who's acting as a bridge. He's a Native American elder, a Navajo elder, who is a healer, and he's also a mental health care worker. He acts as the bridge between Stop Stigma Together and this community. One of the things the Ad Council told me early on was that if you have the right message with the wrong voice, it's the wrong message. This is why it's so important to have people who are members of these communities participating with us. In journalism, we have another large group of people, including the Carter Center. Rosalind Carter, who recently passed away, has for almost 30 years led an annual fellowship of journalists, reporters, from around the country to teach them how to report on mental health so that they do not create additional stigma. That movement is growing, and they are the key player with the journalism group. We'll be having reporters from across the country, including an award-winning reporter from the Seattle Times in the mental health space, who will be talking about what it's like to report on mental health journalism. Also, Anita Everett of SAMHSA will be sharing a report with us on—what's the word? Mass shootings. I think it's called mass shootings. What is the relationship between a mass shooting and mental health, and how do you talk about it after the fact? That will be presented in the journalism section. Workplace is our largest group. Not only do we have all of these different organizations, but we have Douglas Parker, who is the Assistant Secretary for the Department of Labor, the head of OSHA, who is an active participant in this community. I've met with him myself four times in Washington, D.C. He is committed to the idea that psychological safety is part of worker safety on the job. He's funneling free resources to everyone through the robust OSHA channels that they have, some of which have been around for decades. The only requirement that they have is that whatever materials they send are publicly available and free and evidence-based. All of our partners have been funneling their content into them. That's one of the things we can do as a coalition. Anytime a partner like Mental Health America or the Jed Foundation or the Carter Center has a toolkit, then we give it to OSHA, and OSHA sends it out to all of the places of work. We also have the SHRM Foundation in the upper left there, the largest collection of HR professionals in the world. We have Healthy Action Alliance over here in the upper right next to the Jed Foundation. That's a consortium of over 300 private sector organizations, many of whom you recognize. They're public names. Down here, we have ASTHO, the Association of State and Territorial Health Officials, 49 members, one for each state and each territory. Of course, you can see the American Psychiatric Association there. Over in the bottom left, we have CPWR. That's an organization that focuses on the construction industry. You're probably aware, if you've seen the news as I have, that the construction industry has a multiple of suicides. I believe it's three times the number of suicides than the national average. We get into entertainment and media. We know that we have to work with media. All reports on fighting stigma show that the media is essential when it comes to shaping the public's eye around what mental health and substance use disorder looks like. We will have the USC Annenberg Inclusion Initiative presenting two reports about how television producers and movie producers work to accurately represent mental health and substance use disorders. You may have seen some of that on shows like Ted Lasso. In fact, we may have the executive producer of Ted Lasso. It's possible that she'll be there, or the television show Shrinking. These are television shows that have actively worked with the Annenberg Inclusion Initiative to ensure that the way that they're portraying mental health and substance use disorders does not promote stigma. And children, youth, and family. Of course, we need to have that. We actually had a summit here in New York last October that was well attended. And of course, you'll see Sesame Workshops right there, prominent. We're very proud to have them involved, and they are very involved, as are so many of the other organizations there. And the last one I wanted to show you is our policy task force. We're bringing together organizations that are active now in the United States to look at local, state, and federal legislation. And we're proud to be working with the Kennedy Forum, with the National Council for Mental Wellbeing, again, the American Psychiatric Association, AFSP, and Inseparable, and others. There are many others that are not on here. So you start to see how a grand challenge works. We build the anchor organizations. We build a network of leadership. We kind of harmonize the messages that are going out, coordinate activities, share back and forth. When someone does something amazing, we make sure the others know about it so that best practices are traveling. And then we start to build out these communities of practices that create a network across the United States. And we're looking to have a network eventually that will have a couple thousand organizations in it. The goal is that every single American, 350 million citizens, will be getting the same message, whether they are turning to their public schools or turning on their TV set or looking to their political leaders. And that message is that mental health is health, and that stigma should not stop you from getting treated for any mental health or substance use disorder challenges you have. That's my presentation. Thank you. Thank you very much, Seth. And again, we'll have time for comments and questions at the end. Our next speaker is Dr. Kay Jameson. Kay? Thanks. Very, very interesting work. Terrific. I'm going to be talking at a slightly more general and personal level about stigma. Oh, sorry. Stigma against mental illness is deeply ingrained. It makes itself known in the decisions that society makes and in the behaviors that society tolerates. Newspapers and television print or broadcast remarks about people with mental illness that would not be tolerated if made about any other minority or disadvantaged group. Stigma insinuates its way in decisions about access to health care, health insurance, job discrimination, and research priorities. Those who have mental illness also stigmatize themselves. They do not or cannot demand of their lawmakers the health care systems they deserve. Their expectations of society are low and not consistent with the large voting bloc they represent. Such self-stigmatizing has damaging consequences. It inhibits acknowledging illness, it decreases the odds of seeking treatment, and it makes less likely the acceptance of treatment once it is sought. The inability to discuss mental illness in an informed way, to deal with it as the major public health problem that it is, cannot be justified in the 21st century. There is stigma against mental illness within the clinical community as well. From doctors, psychologists, nurses, and social workers who have had no serious cause to examine their own beliefs because their professional communities have not thought it important enough to see to it that they do. Indeed, I would add a few more academic and medical schools and hospitals to your list. Most clinicians are compassionate, but there are many who are not. There is another group that contributes, albeit unwittingly, to stigma. This is a group I think of as the silent successful. People who get well because they receive good clinical care, because they can afford good clinical care, and because they are the beneficiaries of a first-rate research enterprise, but who are reluctant to speak out about their mental illness for fear of personal or professional retribution. This fear is understandable, but their voices certainly would be helpful. Silence perpetuates the misperception that people with mental illness do not get well. As a result, what remains in the public eye are those individuals with mental illness who are untreated or inadequately treated. Newspaper accounts of violence, the mentally ill who, without homes or on the streets, and the untreated mental illness that people see in their friends, families, and colleagues. What is not seen is those millions of individuals who have been successfully treated, who compete, who succeed, and who live full and meaningful lives. Everywhere I go in America to speak, in city after city, I see the suffering of those who do not avail themselves of treatment because of fear, because of a lack of information, and stigma. So what can be done about stigma? First, find another word. I hesitate to say this given this campaign is about stigma, but I do think we ought to examine our language. The word stigma stigmatizes. The word discrimination, on the other hand, has a satisfying legal ring to it. Discrimination against those with mental illness is a civil rights issue and it should be treated as such. Second, it is essential to understand why stigma exists. Just saying that stigma is wrong or making people feel guilty is not enough. It does not work. It will not change the way things are. Thus, the study of animal behavior teaches us that animals discriminate against other animals who show even subtle differences in appearance or behavior. Almost certainly, there are ancient hardwired reasons for fear and discrimination. We, like other animals, fear that which is unknown, unpredictable, or potentially dangerous. It is important to acknowledge this, to acknowledge it and to address it through information, social and research priority, and when necessary, the law. The emotional, financial, and physical costs of untreated mental illness are high, not only for those who are ill, but for their family members, friends, employers, and colleagues. Legitimate concerns must be dealt with forthrightly, far more so than has been done to date. Third, individuals with mental illness and their families need to recognize and take advantage of their political strength. We are a significant percentage of the population. We are a very, very, very large block of voters. Fourth, we need to make more effort to address discrimination that exists in the medical and mental health communities. There needs to be more honest and intelligent discussion about mental illness within the ranks of those who are responsible for treating those who are ill. We need to make it easier for doctors, house staff, and students to receive good psychiatric care without being professionally penalized for seeking help. We need to be unambiguous that within our profession, mental illnesses are common, painful, and too often lethal. We need to be clear that these disorders are treatable and that we will extend a hand to those who need help. Finally, we need to convey to the public, as well as to our colleagues, how extensive our scientific understanding of mental illness really is. We know a lot. One of the things I am consistently struck by when I speak to the public is how little awareness of how serious the science is, how exciting the science is, how real it is. This is not just a mumbo-jumbo field. It's not just put somebody on the couch field. Public awareness of the science underlying mental illness lags decades behind what science has taught us. We should campaign for better and more science in an enthusiastic and positive way and try to captivate the minds of the public about the excitement and wonder of brain and behavior. Instead of frightening people or trying to make them feel guilty, I think we need to capture imaginations. It's easy to do. The brain is fascinating. Adolescents are intrigued, as most everyone is, by aberrant behavior, by depression. We are fortunate to live in a time when genetics, brain imaging, and the development of new treatments have radically changed the lives of those with depression, bipolar illness, schizophrenia, and other psychiatric disorders. Research has been, always will be, and will continue to be the most potent de-stigmatizer of all. Most people, although still frightened and misinformed about mental illness, know much more now than they did five years ago. Public education campaigns and the widely advertised availability of effective medications and psychotherapies have made an impact, finally, on public attitudes, but not nearly enough. All of us need to recognize how vulnerable so many of our family, friends, and colleagues are, and we need to reach out. Then we need to reach out to the rest of society and to let them know that we will not tolerate the intolerable. I'd like to end with just a few personal remarks about stigma. I have taught in academic psychiatry departments all of my professional life, and as someone who has suffered from bipolar illness since the time I was 17 years old, I have been painfully aware of the kinds of jabs and wounding stereotypes that mental illness elicits in many people. Yet, it was only when I wrote a book about my own illness that I became truly aware of the extent of discrimination and hatred that many people with mental illness face. The decision to write about my illness was difficult. I'm a clinician and an academic. I was well aware of the potential loss of my state license, my hospital privileges, my job, and the unavoidable changes in how my colleagues would see me. But I was also unavoidably aware of the suffering experienced by those with mental illnesses such as my own. I looked inward and then around me. It did not take much to grasp that privacy and reticence made life more difficult than it needed to be. Silence about mental illness bred a quiet ugliness and set in place the conditions for unnecessary suffering and death. Privacy was of deep concern to me, but it came at a cost. My parents had taught me to keep private matters private, but they'd also taught me to think for myself and have a sense of responsibility toward other people. Yet, I could not but dread the actions of my academic and clinical colleagues. Those who specialized in psychology or psychiatry presented a special set of problems. I risked newly vigilant eyes observing my actions and appraising my moods, newly honed ears that would listen for skips in reason, real or imagined anger. It was an entirely unattractive prospect. I knew, too, that for many, the question of professional impairment would be a critical issue. This would be a completely legitimate concern. Legitimacy didn't make it any less disturbing, however. I would also be giving live ammunition to competitors or to anyone I had irritated over the years. I had hallucinated and been delusional on more than one occasion, been paralytic with depression for months on end. By anyone's standards, I had been severely ill. I had tried to kill myself and nearly died from an overdose of lithium, the same medication I had written about in medical journals and strongly advocated that other people take. In the early stages of my illness, I had taken lithium only fitfully and with reluctance. One could hope for understanding, but certainly not assume it. I spoke with the chairman of my department at Johns Hopkins in part because I respected his judgment and in part because I had to. I told him I hoped it might be helpful to others to write about my intersecting worlds, those of researcher, clinician, teacher, and patient, but that I did not want to put the Department of Psychiatry or the Johns Hopkins Hospital in an awkward position. There were very real and obvious legal, educational, and clinical issues. My chairman listened carefully as I laid out my concerns. When I finished, he looked at me and said, you know, Kay, you have it completely backwards. He mentioned the legendary surgeon, William Halstead, who was the first chief of surgery at Hopkins. It was known by Dr. Osler and others that Dr. Halstead was a cocaine and a morphine addict, he said. When he was impaired, his colleagues took it as their responsibility to protect Professor Halstead's patients, but he added, they also looked after Professor Halstead as best they could so that he could continue to do his research, write, and train young surgeons. If Hopkins can't do that for you, he said, Hopkins has no business being in business. He could not have been more intelligently sympathetic. He made it clear that I had his unequivocal support, and I should let him know if anyone on the faculty or house staff made things difficult for me. He arranged for me to have lunch with the president of the Johns Hopkins Hospital, who likewise gave me his complete backing. He stated that Hopkins should be at the forefront of lessening the stigma against those with psychiatric illnesses. Both he and my chairman were unambivalent in their message that they would back up my decision in whatever way they could. They gave me the blessing of a great teaching hospital. I'm not so naive as to think this is usual in medical schools and hospitals. I know that it is not, but it is exemplary, and it's from the exemplary, not from that which is done badly, that one learns and moves forward. Thank you. Thank you, Kay. Our next speaker is Gary Mendel. Gary? Good afternoon, everyone. I'm going to follow that lead of both previous speakers. I'd like to start with a personal story. The story is about two boys who were growing up in a small town in Connecticut where I was raising my family. Both boys were in high school. The first is about Mikey. Mikey was in high school was diagnosed with cancer. As you'd expect, his family was easily able to access the highest quality medical care, all based on science. Our town rallied behind Mikey and his family. Parents came to their home with cooked meals, drove carpools. The kids in our elementary school held bake sales on the weekends for Mikey and his new charity for cancer research. The whole time Mikey was sick, he received all the love and compassion that anyone with a disease could ever dream of. Two streets away, my son Brian was also struggling with a medical condition. For Brian and our family, it was different. His mother and I looked for medical care for our son, but unlike Mikey's parents, we couldn't find any that was based on research. We had nowhere to look or that we knew of. Unlike Mikey's parents, I didn't tell too many of our friends what we were struggling with, probably almost none. To be honest, I was ashamed. I felt like a failure as a father. Our community didn't rally behind us. No cooked meals, no carpools, no bake sales. But when I look back on those years, most important, when Mikey came home to visit from his treatment, he found a loving community. When my son came back from his treatment, he got silence, disdain. The disease my son struggled with was a disease of addiction. Over eight years, my son tried his hardest. I remember visiting him one time in his sixth treatment program. Over eight years, eight different treatment programs. I flew in really late the night before, and I got up early the next morning, seven o'clock in the morning, and I walked into his room. I hadn't seen him yet. To be honest with you, I just wanted to watch him sleep. I hadn't seen him in five months. If you knew Brian, it was really surprising to find him up at seven in the morning, laying on his bed, flipping through his treatment book. As he heard me walk into the room, he looked up at me with that big smile of his and said, Dad, don't worry. I got this. I'm going to beat it this time. But addiction always doesn't work that way. A few years later, I went to visit him out in California to celebrate for the first time one year substance-free. We had a wonderful weekend. First time he'd hit one year. Then five weeks later, I was woken up in the middle of the night. When I picked up the phone, I was told that my son had just died. He was 25 years old, and he hadn't used a substance in 15 months, excuse me, 13 months. Equally tragic or more tragic, it wasn't addiction that took my son's life. To use Kay's word, it was discrimination. It was the feeling of shame he had every morning when he opened his eyes, of all day long feeling like an outcast that caused him to wake up that morning, research suicide notes, write a note of his own, light a candle, and take his own life. Alone. Why are these stories so vastly different? Both boys had a medical condition, a treatable medical condition. But our society doesn't think so. In the weeks that followed Brian's death, my wife had framed the serenity prayer, placed it on my nightstand. And the only thing that was keeping me alive was reading that first sentence over and over again. God, grant me the serenity to accept what I just can't change. As the weeks went on, I began to think about that second sentence, the courage to be able to change what you can. And as I thought about those two sentences, I really began to ask myself two questions. The guilt, what could I have done differently as a father? How did I let this happen to my son? But I knew I would have to accept that. But that was question number one, what could I have done differently? And then number two, what can be done to help others? The courage to change the things that you can. And with Brian in my heart, I got back into my office, pulled my top team together and said, run the business for three months. I'm going to go travel the country and figure out the answers to those two questions. And that's what I did. I was at SAMHSA a lot. I was at the National Institute of Drug Abuse. I was at federal agencies, CDC. I was meeting with experts all across the country. When I came back after three months, I'm kind of old school. I print everything out at three ring binders across my walls. But I took out a piece of paper and wrote five things. How big it was, third largest cause of death in the country, one quarter of Americans have it in their family. Two, eight out of 10 of those with a substance use disorder became addicted before their 18th birthday when their brain is not fully developed. And then I wrote number three, which changed everything. I wrote the word tragic. And when I wrote that word, I felt like it was like a minute ago writing that word. It wasn't because my son died. It was about what Kay just spoke about. I learned that our federal government had given grants of about $20 billion in the two decades before my son died to researchers all across the country. And those researchers had successfully used that funding and as Kay said, created wonderful bodies of knowledge. Knowledge that had proven without any doubt through randomly controlled trials. If our healthcare system and our families and our communities did certain things, depending on which trial you looked at, 20 to 40% less of our loved ones would use substances and develop this disease. 20 to 40% reduction. And a second body of knowledge that had proven without any doubt, again, without any doubt, if our treatment system followed certain protocols, those with this disease would not cycle through treatment programs. They would recover at success rates on par with any other chronic illness like diabetes and heart disease. But I wrote the word tragic because it wasn't being implemented. It was sitting in medical journals. I'm reading about information as a father that could have saved my son's life and millions of others. And all it had to do would be lifted out of the journals. Not rocket science. The science was already done. I asked myself, how can this be? And I wrote number four. No national organization. American Heart Association, Autism Speaks, American Cancer, Susan Komen, Alzheimer's Association. For every major disease in this country, there was one well-funded national organization leading the fight to protect our families. And no such organization existed for addiction on any scale like the others. And I asked myself, how could this be? I wrote number five. Stigma. But I like that word discrimination better. I always say unjust stigma. I could have walked into any restaurant in America, walked down any main street in America in 2012 and said, I have a charity for addiction. Would you donate a dollar? People would have looked at me like I had six heads. Are you kidding me? Just throw them in jail. A charity? Are you kidding? They're criminals. Throw them in jail. But I could see this could change. I could see it could change. So the next day I left my business, promoted my CFO to run it, and I spent a year and a half drafting and developing a business plan to launch a national nonprofit related to substance use disorder on par with the others. As I stand here today, talking to all of you, I miss my son like it was, like I can't imagine. But I also feel blessed because I've had the opportunity to meet so many wonderful people all across our country, and together we've created significant change. I'm going to have Seth show a short video. If he can, and if it doesn't work, that's okay. And then I want to talk about the things that we're doing specifically related to stigma. [♪upbeat piano music playing♪♪♪♪♪♪♪♪♪♪♪♪♪♪♪♪♪♪♪♪♪♪♪♪♪♪♪♪♪♪♪♪♪♪♪♪♪♪♪♪♪♪♪♪♪♪♪♪♪♪♪♪♪♪♪♪♪♪♪♪♪♪♪♪♪♪♪♪♪♪♪♪� ♪♪♪♪♪♪♪ ♪♪♪♪♪♪♪ ♪♪♪♪♪♪ We are coming together to increase awareness and funding for the prevention, treatment, and recovery of this disease. We are here for friends. We are here for family. We are here for community. And we are here to bring the disease of addiction out of the darkness and into the light. We are Shutterproof! We are Shutterproof! ♪♪♪♪♪♪♪ My oldest son, Brian, struggled with addiction for eight years. And during that time, he went to eight different treatment programs. Shutterproof is currently developing public databases in multiple states that, if successful, allow the public to identify, evaluate, and compare substance use treatment programs. I would like to extend my appreciation to President Bill Clinton, Chelsea Clinton, and their Health Matters Initiative. I'm very grateful to be here today at a critical time to talk about why we must tackle this issue and what Congress must do to tackle this issue. We need to start treating people in this country, not jailing them. We need to give them the tools they need to recover, because every life is precious. Every life is an individual gift from God. And we have to stop judging and start giving them the tools they need to get better. I don't think about this issue as a public official or as a health care guy. I think about it as a father. I've talked to people who've been in the middle of this, and they're among the grittiest and gutsiest people I've ever met. And they deserve our respect and our love and our support. Let's create that world that Brian didn't see. Let's create that world for the next young man that comes along, the next young woman that comes along, the next family. Let's drag addiction out of the shadows and into our hearts. I can't imagine a more perfect expression of humanity. Thank you. Thank you. So what are some of the things that we're doing at Creating Change? We have three pillars of work that evolved over the last 10 years. One, transforming the treatment system in the United States. First national standard of care in this country for addiction treatment. First quality measurement system. First assessment to determine whether you need outpatient or residential. President Biden signed into law 15 months ago a bill we worked on with the American Society of Addiction Medicine for almost four years that now requires every doctor in this country to have eight hours of education in the treatment of addiction if they want to keep their DEA license to prescribe controlled substances. And we've expanded across the country the collaborative care model so that every person who has Medicaid can get treated with a payment model that improves outcomes by almost 50%. That's transforming the treatment system. And our quality measurement system is now in almost half the population in the United States. And I'd like to get it out to the APA so everyone knows about it and get it out if you're in those states. Two, educating and empowering our families with information they need that I didn't have on prevention, treatment, stigma, and empowering families if they want to engage with us to help others. And then number three, stigma, ending stigma, starting with the book that Seth showed, which turned me on to it as well. All backed up by the leading arm in public policy related to this disease, 47 state laws in the last 10 years in 26 states as well as five important clauses in federal bills, all related to these three things. So let's talk about stigma. When we were ready for it five years, six years ago, we worked with one of the leading consulting firms in the world. They did all the work pro bono for us over a course of a year and a half, 15 months. And we studied 11 social movements. Those 11 social movements, we studied over 100 pieces of published literature, 50 interviews for an hour and a half each with experts who had gone through those movements. And what were the key success factors? And we built a business plan to do it for addiction. We focused on three things that needed to be done, 80-20 rule. Three things, six sectors of our society. Three things, educate in a certain way where science research has shown to work and change knowledge, attitudes, and behaviors, change language, and change policies. Six sectors of our society. Healthcare, the public, partnering with states. So the public, partnering with states. Healthcare, employers, criminal justice system, media entertainment. And in those six sectors of our society, those three things. But before we started, anything you do has to have measurement. Are we achieving results? So we developed with Indiana University, the leading researchers in the field of addiction, the most comprehensive measurement of addiction stigma ever done, ever developed. Fielded it and showed the results. Not to create a baseline so we can show improvement, but to also call our attention to how this cause, this issue is so important. So what did we learn? What did we learn to call attention to this issue, to get people engaged? 75% of the public, public stigma, what Seth talked about, 75% of the public doesn't think this is a disease, 75%. That's public stigma. 60% of the public, 60% is not willing to be a friend, a co-worker, or a neighbor of someone with substance use disorder. That's what Seth mentioned, public stigma. But even, take this one. 33% of the public is not willing to be a friend, a co-worker, or a neighbor of someone with a substance use disorder who hasn't used a substance in a year or longer. They're in recovery. Public stigma. Structural stigma that Seth mentioned. 60% of doctors in this country do not, excuse me, 65% of doctors in this country do not think this is a disease, 65%. That's structural stigma. 45% of our healthcare system doesn't think that medications are effective. In fact, my son was doing the best he ever did after his fifth treatment program, excuse me, after his sixth, and the seventh, they pulled him off the medication, they didn't think it was effective, and then he died. And he wrote about it in his suicide note. In addition to the stigma. And let's talk about self-stigma that Seth also mentioned. 35% of those with this disease are ashamed of themselves. 35% who are with this disease. I often wonder, my son was living in L.A., did he happen to look at his Facebook feed one time and say, wow, they're doing a big walk for cancer research. I don't know, he never told me about it, but did he think about it? Maybe a month later, turn on a 10 o'clock news, wow, they're doing a big bike ride to raise money for research for autism. And did he think subconsciously, they don't do that for me. I'm not worth it. That's self-stigma. So what have we done? What is our business plan? I mentioned what our business plan is, and you can see it on our website. What did we do? We started with public stigma. The research showed certain messages, 90-second videos with certain language and messages of people with this disease to share with people without, who are not touched by this disease, to change their knowledge, attitudes, and behaviors work. So we tried it. We got the state of Pennsylvania to pay for it. We ran it for a year, and we reduced stigma in the state of Pennsylvania than has ever been documented. The state was so thrilled, they extended it for three more years fully funded. We then picked up the states of Kentucky, California, and Georgia. Kentucky first. We reached 15% of the public in 12 months. Over 450,000 people changed their knowledge, attitudes, and behaviors. Public self, medications, structural, by averaging 11%. Better than Pennsylvania. More than has ever been done in 12 months. While we were finalizing the one-year contracts with California and Georgia, they saw the results in Kentucky. They made them two-year contracts. I'm thrilled to say we're just finishing the one-year survey results in California. They've been so impressed what we've done, they just extended it for a third year. We haven't even finished the first year. Actually, they extended it for another year and a half, so it's now going to go three and a half years, and I'm sure it will keep going as we show the results. So that's our public stigma that we're doing with states. A year and a half ago, we got a $5.5 million grant from Anthem Foundation, now called Elevance, to go into a second sector, healthcare professionals. Remember that 65% and that 45%? We're attacking that directly. We spent a year and a half. We brought in Yale as our partner, and we developed four and a half hours of content. Starting two weeks ago, we're now going to engage 3,000 healthcare professionals over the next 12 months. Now 11 and a half months. Show before and after knowledge, attitudes, and behaviors. Change that 65% who doesn't think that's a disease. Change the 45% who don't think medications are effective. Show the results and then scale it across the country with the help of all of you and so many others once we can show the results. We're now looking at the criminal justice system. We're now looking at media entertainment. We're getting interest from companies. We just started with Hilton. I can go on and on, but my time is running out. We just started a campaign with Hilton. Their employees are changing. We're creating a recovery-friendly workplace at Hilton. In closing, and then we're going to be here for questions and answers. The last time my son came home for a visit, four months before he died, we had a great weekend. That last day, last full day home, had a great morning, feed him with a 20-foot putt, get the family over for a barbecue, and that night we're sitting on the back porch talking about his favorite topic, the New York Giants and Eli Manning. Then he turned to me and he said, Dad, 300 years ago they used to burn women at the stake in Salem, Massachusetts because people thought they were witches. Then they learned they weren't, and they stopped. Dad, I wish. I wish that someday people would realize I'm not a bad person. I'm a good person with a bad disease, and Dad, I'm trying my absolute hardest. You're all here to listen about this. Every person that joins our movement, we will end renamed stigma to discrimination. That's what we can all do together. Thank you. Thank you. It's your turn. Please come up. Please ask questions, make comments. Hi, panelists. Thank you so much for sharing your stories, and I want to thank you in particular for the work you're doing in Kentucky. My name is Megan Good. I'm a fourth-year resident at the University of Louisville. My question, so I am chief resident, and in that role, I have the honor of mentoring medical students and residents. Some of my fourth-year medical students disclosed mental health diagnoses on their residency applications, some out of necessity, some out of choice. When they came back from their interview season, they sort of filled me in on what that experience was like, and I have to say there's some really cruel physicians out there, psychiatrists being some of the worst. So my question, what can I do as an aspiring academic to protect my future medical students and residents from this discrimination? Do you want to start, Kay? Yeah, that's a real problem. I spend a lot of time with the medical students and residents and junior faculty with exactly those kinds of questions. Should I be honest? What should I say in an interview for them? I always try and make clear that there are no obligations to disclose. There may or may not be good reasons to disclose, but you ought to think about it really hard and long with people who are close to you and who have good judgment, whether it's their doctors or their priests or their family members or friends or colleagues. Because a lot of people are quite wonderful, an awful lot of people are not. And that's just true. I mean, you know, one would like to think that there's less cruelty and less just misunderstanding always around. But it's not true. And you've got to live with the consequences. At some point, you have to be honest because of licensing and hospital privileges and that's a whole sort of thing. But, you know, people can find a lot of reasons not to accept you into the residency and they don't have to say it's because you've said you had mental illness. I mean, if you've got 100 people applying for 10 slots or 15 slots, there are a lot of reasons. First of all, you don't have to give a reason. But secondly, you just, you know, there's no protection there. So I don't know. A person I would be inclined to punt this question, which is a really important one for any number of reasons, would be to Dr. Karen Schwartz, who's from Johns Hopkins and ran the residency program for a long time and still is very close to the house staff. What are your suggestions? Two things. One, if someone has mental illness and they got a horrible reaction somewhere, I think they have to really think about whether they want to train them. I mean, I understand that it's competitive and it's a problem, but the nature of training means that it's unlike you're going to get prepared or developed. And so you have people that say, you get it. If you have a medical problem, you deal with that. It's not a big deal. That means a lot. And it's all the work that the panelists have been talking about, because it's, it's a discrimination. Well, you know, I'm having been a bureaucrat for 20 years, but let me tell you a quick story. When I interviewed, my mother suffered from really severe depression. In fact, the day I got into medical school, my dad was at the American Board of Internal Medicine meetings. My siblings were away. The only person I could tell was my mom. And so I waited for visiting hours and told her she was getting ECT at the time. So when I was interviewing, I disclosed, I was transparent and honest, and I could watch all of a sudden the faces of one program, people after another, after another, oh, he's here to cure his mother. Oh, he's going to have depression. And so I learned not to tell that story until about 10 years ago when I was speaking for Mrs. Carter at the Carter Center to their journalism group, because the discrimination in this field is huge, and we have to address it, and we have to address it head on. But I think you're right. If a program or anyone that a person interviews with cannot be accepting and understand it's a disorder like any other disorder, it's the wrong program to be at. Very moving presentations, every one of you. My name is Raymond Reyes. I'm a prison psychiatrist in Northern California. I'll just start by saying that I also have experienced discrimination. I have family members, some of whom are gone, who have also been discriminated against. But here's my question. If we really want to end or reduce discrimination, shouldn't we work on some of the terminology, specifically, why do we still say mental illness? Rene Descartes died 400 years ago. We've known for a couple hundred years the mind and body are not separate, and yet we still say physical health, mental illness, when there's only illness and you don't have to agree. Analysts, anyone want to comment on that? Well, I could not agree more about language. We developed a language guide for substance use disorder, the right words and the wrong words, and you can find it on our website, shatterproof.org, in the stigma section, approved by National Academy of Medicine. For example, if we call it an illness, it's a treatable illness, big difference, huge difference. I can go on and on, but to save time, we have a language guide there, could not agree more that language is so important. Hi, thanks everyone. You inspired me to stand up. Last time I saw you, Dr. Jameson, I'm going to cry, it was 15 years ago at an EPA conference, I think it was San Francisco. I was just finishing medical school and I had gone through a very difficult time. I had bipolar disorder that they didn't diagnose for a long time, almost didn't make it out. Instead of becoming an orthopedic surgeon, I decided to go into psychiatry. I asked you, I said, should I write about it in my residency application? I believe you gave a similar answer, be careful, maybe you don't want to do that. I thought a lot about it and ended up, I did write about it. No doubt, I was discriminated against. But where I got accepted was they saw it as a strength. I wouldn't do it any differently now. I mean, everyone's different, but looking back on it, I surrounded myself with people that supported me. It continued to blossom, I just kept doing that. I mean, now I'm the chief medical officer at a pretty large community mental health center, so I did okay. I am not silent successful anymore. I had to be careful with that. This kind of gets into my question or thought. Along the way, I've been very strategic about who I've talked to about my mental illness. I wouldn't say I've necessarily kept it to myself, but I haven't been broadcasting it. I've found that the people that seem to have the, almost to me, most surprising, but yet not, based on what we're all saying, reaction are my colleagues. The last day of residency, when everyone was saying goodbye to the people graduating, myself, one of the third years said to me, he's like in front of everybody, Karen, if you hadn't told me you had bipolar disorder, I would have never thought anyone could get better from that. I do think, even though we should know, we psychiatrists should know more than anyone, we perpetuate the stigma so badly. I also, I think just in the House of Medicine, you think about, it always struck me that as a psychiatrist, I had to do an emergency medicine rotation, yet the emergency medicine residents who, half the people that walk in their door have mental illness and substance use, they don't have to do psychiatry rotations, or at least they didn't 15 years ago. I really, I think that we do have to do a better job getting to our colleagues in the medical profession, and really, because it has to start there. If your psychiatrist doesn't, and I had, this is why I became a psychiatrist, my own psychiatrist didn't believe that I was ever going to get through medical school. I applied for disability, I got it, I was written off. So that's, I'm not that psychiatrist. But we have to start doing better, even within our own profession. I am Jim Lynch, I'm a physician from Annapolis, Maryland. I'm actually a family physician, and I love that comment, because I was required to do rotation in psychiatry, and actually, a good chunk of my practice for the past 20 years has been psychiatric care. So I found myself, after 30 years in the Army, now performing a procedure called Steli-Ganglion block for anxiety and PTSD. I just wanted to say thank you for sharing your courageous stories, and I happen to suffer from mental illness myself. I'm doing great, I've been treated, I've sought care, but I think that that's a helpful thing, and I consider myself a self-professed psychiatrist. Self-professed stigma disruptor. I would love to help in any way I can, and I have to present something, I'm sick, so I'm going to run out of here and drop some business cards. But I have a call to the group, maybe, that may be a little bit weird, because I'm a family doc. But in the past 12 years, I've been performing a procedure that some of you are familiar with, maybe some of you are not, but it's a 100-year-old procedure to block a nerve in the neck that treats PTSD and anxiety by numbing the cervical sympathetic trunk. It's got plenty of evidence behind it, including level one studies, and I constantly interact with my behavioral health colleagues all over the country. And I find skepticism and a lack of teamwork sometimes within the behavioral health community, and I'm hoping that we can turn the tides on some of that. And particularly, there seems to be a lot of silos in this area of medicine, and as a family doc, typically I have to, I reach across the aisles all the time, so I'm always talking to physical therapists or other specialists, but I find in psychiatry and in my psychology and social work therapist colleagues, I find a lot of silos where people just are not accustomed to collaborating in care with their clients. And I hope we can change that. I don't know what we're going to do about it. I just wanted to say it out loud, because to me it's been frustrating to try to do something in the same spirit and get kind of pushed off when we're trying to do the same thing. So I think that we actually have an opportunity for a lot more collaboration within the medical community, and the APA doesn't have to do it alone. And there's a whole mess of family docs out there and nurse practitioners and PAs that would probably be on board as well, who just, you know, jumped in together. Thank you very much. I've been prescribing buprenorphine for 20 years for opiate addicted people, and I used to train a lot of medical students, and medical students would be amazed to see these addicts come in who've been clean for 5, 10 years or more, who spent 20 years or 30 years addicted to heroin. And they said, we didn't know you could treat heroin addicts. We had no idea. Their whole experience to addiction is in the emergency room seeing people coming in overdosing over and over and over again and being sent out with a referral to some program that they have to go on a waiting list for 6 months. So we are doing a terrible job of training medical students about addiction. Yes. And I even have people who get admitted to the hospital for medical reasons and who are on methadone, and the physicians want to take them off their methadone. Cold turkey. And the guys say, I'm not staying here and going through withdrawal. I'm signing out AMA. I mean, the level of ignorance on this subject is overwhelming in the medical profession, and it doesn't surprise me that 45% of doctors think that medicines don't work for addiction. You know, we're almost at the end of the time. What I'd like to ask each of you to do is say one thing that you'd like our audience to remember about today. Kate, do you want to start? I don't know that I could say one thing. Not my long suit. You know, I just think it's great that everybody's looking at these issues, and you're doing what you're doing, and you all are doing what you're doing. I mean, to me, it's heartening. I find it not so heartening, the experiences of the discrimination from psychiatry and medicine. I mean, I got such vitriolic hate mail, death threats, I mean, really bad things that I am well aware of that and how painful it is. I do think it's improving, and I would say everything about that. I mean, about psychiatry and medicine and about what you all are doing. I mean, everything is improving. For anybody who's halfway impatient, and that's sort of my middle name, it's not as fast as one would like. Thank you. Gary? For me, I don't think there's anyone. I would think that everyone in this room agrees that discrimination and stigma is wrong related to substance use disorder and mental illness, and I'm thrilled to say that this can be changed. There's just no question. There's no if. It's just a question of, and it is changing, but it's a question of can we do it a lot quicker than it's being done right now. So any of you, my last comment, I would like you to remember, any of you that would like to work with Seth, with Kay, with Shatterproof, with the Grand Challenge, please engage. Every person can help, and we can do this faster. I brought a bunch of business cards. I'm going to leave them right here. I'm going to leave them right here when we're done. Anybody that wants to grab my card and reach out to me, we'd love to get you involved. The work that Seth is leading here for the Huntsman Institute, underneath Mark, I'm speaking for Seth, Kay. So thank you. Thank you all for listening. Seth? Well, you said several of the things that were on my top list, so I will say if you have any interest in attending the summit, if you'd like to be part of the Stop Stigma Together movement, go to StopStigmaTogether.org or come and see me. And we do have scholarships if money is an inhibitor. Otherwise, we'd love to have you there. Well, I want to thank our panelists. I told you they were awesome people. And thank you all for being here today.

mental health

substance use disorders

stigma

discrimination

Mark Rappaport

Seth Kahn

Kay Jameson

Gary Mendel

Shatterproof

Stop Stigma Together

COVID-19 pandemic

public education

policy change