Thanks, Dr. Gayan. As mentioned, my name is Eric Rofla-Yuan, I'm a community psychiatrist in San Diego. Honored to lead this discussion, I've had the interesting opportunity as a community psychiatrist to participate in the policymaking process at the federal, state, and local level, serving as senior staff in the House of Representatives, state agency roles, and previously as a County Health Policy Director, also here in San Diego. As mentioned, I also chair the APS Caucus on the Social Determinants of Mental Health, which was an output of the aforementioned task force, and we're fortunate to now have over 500 members. So I want to briefly introduce our other two panelists so we can get started. We have Dr. Alan Tasman, endowed Chair of Community and Social Psychiatry at the University of Louisville School of Medicine in Kentucky, a past APA President, and the Lead Editor of the Lancet Psychiatry Commission on the Social Determinants of Mental Health. And our final panelist is Enrico Castillo, a Health Services and Policy Reacher at UCLA, where he is also the Associate Vice Chair for Justice, Equity, Diversion, and Inclusion, and the Faculty Lead for Community and Global Psychiatry. So welcome, and thank you to our panelists, and thank you to our group gathered here today, as well as the APA, for putting this event together. So hopefully most of our time will be discussion, have an engaging discussion, have participants not just from us three up here on the screen stage, but from everyone in the virtual room. We have some few brief slides at the beginning, so I'm going to turn it over to Dr. Tasman to get us started with those. I'll have to stop sharing to unmute. OK. Let's try again. OK. Can people see the slides? Yeah. We can see it. We see the window itself, but we can see the slides just fine. OK. So I'm going to try to zip through these. So this is an interesting time for advocacy since Tuesday night, but I think we all know what kinds of advocacy efforts the APA has made over the years. The APA was instrumental, if not the absolute necessary organization that led to the Domenici-Wellstone Mental Health Parity Bill. So there are all kinds of advocacy opportunities. I think it's difficult when we talk about advocacy to our colleagues because they're usually swamped with work. And that's one thing I think we need to find a way around for our members to find some less time-consuming kinds of things to do for advocacy. But advocacy involves every aspect of what we do. So here's just a few examples, if you all can see these slides, of the kinds of things that we need to make institutional change about. And two things that I'm particularly interested in, and I'll talk about more in a few minutes, is the impact of early childhood adverse social determinant impacts and community engagement issues. So we'll get to both of those things in a second. But I wanted to spend a minute talking about public health because public health approaches have generally been thought of as very large-scale initiatives which deal with health promotion, primary prevention, rather than usually the secondary and tertiary prevention that we're often involved with, and addressing the gap in services. And again, this is a very interdisciplinary approach historically. So it involves the intersection of people who work in health, education, government, economic issues. And ideally, and again, mostly historically, going back to making sure there's clean water for folks to drink, or national vaccination kinds of initiatives. So these have focused on very large-scale interventions, but which involve all aspects of a community. We know these are inadequately used, and in part for a group of psychiatrists, it takes a lot of money and extended period of time to make changes at the federal level, which usually involves the federal government. And again, in the current political environment, I think we might be better off not we might be better off turning away from federal government as our major focus, and focus more on local or community-level kinds of interventions. And these can be efforts just within psychiatry, by the APA alone, or in my view, better off with collaboration with, for example, some or a number of well over 100 subspecialty groups just within psychiatry. Let me give a few examples of historic kinds of, let me shift gears now to collaboration. In order to succeed, it's hard for us to go it alone as just an organization of psychiatrists. We know we're never going to have enough psychiatrists to take care of all the mental health needs that just come to us every day, much less making systems changes. So let me give you a few, just a couple of examples of some clinical and non-clinical kinds of collaborations. So about 30 years ago, I was invited to be a member of a group called Physician National Leadership for Drug Abuse Prevention. And this was led by a couple of addiction psychiatrists, but it involved corporate leaders. We had the president of American Airlines, government leaders. We had state Supreme Court justices. We had Michael Dukakis after he had passed time for his presidential run. And that project was focused on initially intervening in state courts to develop the capacity for what are now called drug courts, which were all over the place. That led, over the next 30 years, to a group of projects. I'm a member of the steering committee of the Physicians Clinical Support System for Opiate Use Disorders. And there have been a series of grants from SAMHSA for about the last 15 or so years. And we are now a consortium of 40 national clinical organizations. And it's now coordinated officially by the Addiction Psychiatry Organization. But this includes social workers, nurses, psychologists, addiction counselor organizations. And we have trained well over 40,000 clinicians in the last 10 or 15 years. So there's an example of something which has a substantial public health impact through clinical collaboration. I also think we have, let me use early childhood adverse determinants of the impact of that. We know there's substantial research literature that these have the greatest long-term impact. They affect school success, personal health, personal mental health, job success, engagement with criminal justice, et cetera. And I think we have some opportunities, especially with the Child and Adolescent Psychiatry Group, Pediatrician Group, the family physicians on a number of social determinants issues, but especially because everyone deals with families and children to deal with adverse impact of childhood adversity. We also have substantial opportunities with local public health departments. If we can't do something nationally, certainly local public health departments are always looking for people to help. And when Obamacare was just getting implemented, I called the head of the health department and I said, what could we do in psychiatry? And she said, well, do you want to be on the implementation committee for the city? So Family Courts, United Way, Homeless Advocacy and Service Groups, there are all kinds of opportunities there. I know Enrico is going to talk about homeless issues shortly. We can also participate and sometimes take leadership in implementing local community engagement programs, such as integrative community therapy. Ken Thompson, who is one of the folks from the psychiatry community, who's not on the panel, but Ken's on the call today listening to us. Ken has played the leading role in bringing integrative community therapy to the US and also in bringing what's called asset-based community development to the psychiatric community. Let me just illustrate a little bit about ICT. This was started in the favelas in Brazil by a psychiatrist who wanted to address the problems of social discohesion and social isolation in those most poverty-stricken areas. If any of you have been able to visit any of these favelas, I have. Many of them are much, much worse than any of the worst neighborhoods in our country. It's built on a participatory structure based on more or less a neighborhood in which community building and interpersonal cohesion through discussions, monthly discussions of problems of daily life, have a salutary effect on mental health. And not to dwell on this, but there's been one research study that looked at the results from over 12,000 participants. So that's a pretty big number. And what this study found was that over 85% of people who attended four monthly ICT neighborhood-based sessions dealing with problems of daily living reported that they had either resolved or substantially diminished the intensity of their primary mental health concerns and no longer felt they needed to seek consultation or treatment for a mental health problem. There's a website up here. It's visiblehandscollaborative.org if any of you would like to learn more about this. And I think there's still a video on the website. I know there's another group coming on advocacy for changes in education, so I won't spend a lot of time talking about this. But one of the things the APA, I think, has a substantial opportunity to do is what's outlined in red here, which is to develop some better screening tools that clinicians can use to screen for adverse impact of social determinants. There are a number of screening tools out there, so we wouldn't be the first ones to do it. But having looked at a number of these, I would say that none of them are ideal. And for example, nearly all of the ones I looked at, about 15 or so, did not have exposure to violence as part of the screening. So we know that's a major impact. And that's a big opportunity for the APA. So that's my last slide. I just wanted to give a quick overview of issues related to advocacy, collaboration, and community engagement. And I will turn this back to Eric. Thank you, Ellen, for that introduction. And my first question, I feel like you've stolen it a little bit. But I want to make sure that everyone has the opportunity to give some input. As you mentioned, this session is titled Advocacy, Collaboration, and Community Engagement. It's a bit of a leading question, but how do you see these as connected? And how would you recommend? So you've given a couple of examples. Are there things that you really recommend or see opportunities out there for psychiatrists to lend their expertise to support already existing efforts and coalitions around different topics that are of importance to psychiatrists, APA members, and their patients? I'll just give you an example of Louisville. We have about a million people. The largest poverty population is the Black community. They are mostly living in two census groups in central, sort of the urban core of the city. And there's an organization called the Central Louisville Community Association. And that group started, I think, maybe 20 or 30 years ago. But they now provide meeting space for over 150 small community groups, smaller and larger. And also, I think one of the things, again, in my experience, are the United Way programs. So about 10 years ago, I approached the head of our United Way to ask about early childhood development opportunities and what they were focusing on. And they said, well, we think Head Start sort of takes care of that. And I said, well, yeah, but Head Start's more for five years old and some four-year-olds. And there are a few cities that have programs for three years old. But what I'm talking about are dealing with adverse impacts from prenatal time birth to three years old, so much earlier than traditional programs. So we spent about three years talking about this. They started talking to other community groups. And now there are a whole range of programs. I'll just give you one example that got started around that time is one of the groups that uses the Central Illegal Community Center. And I can't remember the exact name, but it's for four to 10 to 11-year-olds who want to play doctor. And so they give them scrub suits, they give them white coats, they have little doctor kits, they bring in doctors from the med school or out in the community to talk to them. This is a afterschool program. And one of these days, these kids are gonna be old enough and some of them are gonna become doctors, but all of them will be more aware of health issues than they would have been without that program. So they're just a couple of examples, but wherever you live, there are community groups, small community groups who don't get in the newspaper, you've never heard of them, but they're out there and the United Way usually knows who they are. So I think that's an easy way. If somebody wants to spend an hour now and then or an hour a week or more time, I think there are tons of opportunities. We just don't have time today to discuss what they all are. Yeah, I can add a little bit to that. That's a wonderful question about how advocacy, collaboration and community engagement are connected. And the two things that has come to my mind is that it takes a community to address the social determinants of mental health. And so collaborating with those non-clinical organizations, social services, nonprofit organizations that do so much of the important work in addressing social determinants of mental health, that's really important. And also these organizations do a lot of advocacy at the local and state and sometimes the federal levels as well. And so allying with them and adding our voice to their efforts is really important to give them resources, but also to help our patients. Because as we know, advocacy as a team always works better. And then also I think it's important that for many communities, physicians and psychiatrists aren't looked at as trustworthy. And so it's again, building this community, working with these organizations who do this work day in and day out with communities that sometimes feel left behind by healthcare that can help us address the social determinants of mental health and become more trustworthy. Thank you, Enrico. And then I agree with your framing there. And some of my experience has been that when APA members hear the word advocacy, they jump to lobbying or that's what their mind jumps to. And then specifically like federal level lobbying. And there's so much more to advocacy that we can do, both because federal work takes a tremendous amount of time and bandwidth to do, which an average member may not have, as well as the fact that, as Alan mentioned, the federal landscape is going to look very different and our time may actually be better spent focusing on state, local, community level initiatives or advocacy community building. The second question. So we talk a lot about the social determinants of health, but there's a parallel lens, which was initially proposed by Dr. Dawes, which discusses the utility of a paternal, sorry, so many words, political determinants of health model. And so this model states that if social determinants of health are the social factors that impact our health, political determinants of health are the policy choices that lead to those social determinants of health in the first place. Another way to say this is that most, if not all social determinants of health do not arise in a vacuum or from an underlying biological cause, but rather are driven by policy and political decisions. So I wanted to get both of your opinions on what utility this model may have, as well as post-election, how should the APA as a non-partisan organization, how can they help support members and the patients that APA members take care of? Do you want us to just volunteer? I wanna give you another example of something that very much pertains to this, which is reimbursement for telepsychiatry services. So our medical schools, public medical school, we serve predominantly a Medicaid population, well over 50% of our patient population. And again, in Louisville, a large percentage of that population is black that lives in the downtown community in these two census tracts. So historically, I was department chair for a long time, had more hair when I got started. So the no-show rate in our clinic was about 30%. Year in, year out. The only solution was to overbook. And that worked. Most days, some days, everybody showed up. So given that the most significant part of our clinical population was in these two predominantly black census tracts, I had the idea that maybe we should go to the historically black churches in town because there was a mythology in the medical school. When I arrived, and I think this is a mythology in a lot of places actually, the mythology was that black people did not wanna go see a psychiatrist. And I said, well, why don't we go talk to them? So I asked our faculty who were black and our trainees if they'd be interested in working on this because I'm an old white fat guy and going to talk in that part of town is not the best approach. They said, you're right, we'll go do it. So we did this outreach program for about two years. And the result of it was that they said, they said, when we go to one of these churches, people swamp us after saying, can we come to see you? And we just can't even possibly accommodate even a small fraction of the number of people who wanna come and talk with us. So that's our culture. And that culture's view of providing psychiatric services, at least in Louisville, Kentucky, but I think in a lot of places, to black citizens. So I said, but this no-show rate is 30%. And we started talking to people about that. That was one of the topics of conversation with these church meetings. They said, listen, in order to get to your clinic, even though it's right downtown, it's only a couple of miles from here, it takes 30 to 45 minutes on public transportation each way. And if we happen to have cars, it takes 15 or 20 minutes, try to find a parking space and then you have to pay for parking. And that costs some money. So there's a lot of disincentive to be able to come to the appointment, even though we want to. So the pandemic comes along. This is a pandemic story, which actually has a good ending. So pandemic comes along, the whole medical school closed all their clinics to in-person visits unless it was an emergency and the feds started paying for telehealth outpatient care. So within about six months, the no-show rate of our population went down to 9% and it persisted, it still persists because we still are getting reimbursed for telehealth. 9%, so I asked some of the other department leaders in the medical school and they said, yeah, we don't know why, but our no-show rate's down about 9% or 10% too. I asked the chief of staff at the hospital who was vice chair of the Department of Medicine. She said every single subspecialty in the Department of Medicine had a no-show rate of 30% before we got started with the pandemic and now it's 9% or 10%. So access to care is a major social determinant and there is something where a public policy, which was to reimburse for telehealth because as I think everybody knows, before the pandemic, telehealth reimbursement was either non-existent or extremely restricted. And what it shows is that you're able to see more patients to do a better job of minimizing secondary and tertiary prevention and that has a major public benefit, personal benefit, but in the long run also is a major cost saving. So there's a good illustration of how public policy intersects with sort of conventional mythology and how we historically intervene, which is we're in this nice building here, you come to us and see us. And that means 30% of the people can't show up. Yeah. Thank you so much. It's a good example of that link we're talking about and I also think it's important to highlight there that the policy lever is what made some of these available or available to continue because if those reimbursement pieces didn't change, then even if you were able to offer these services, they wouldn't have been at the scale that are offered or of the time length. And so really it was some of these policy changes that led to these changes in sort of the transportation or these social factors. Absolutely. Yeah. Dr. Sorry, Enrico, I cut you off, but I know you have things to add to on this topic. No, no, that was a great reflection. And I love the question and Dr. Tasman, I really appreciate your leadership on this topic and the anecdote that you shared. You know, the question about social and political determinants of mental health, I think those frameworks go hand in hand and it's a topic that I'm really passionate about. You know, I was fortunate to be the primary author on the original position statement on mental health equity and the social and structural determinants of mental health. So even at that time, I saw them structural or political, I saw them going hand in hand. So I think that they're really important complimentary approaches to this work. And I just wanna share the, you know, another example of the Flint water crisis is a good example where the health inequity was lead poisoning, the social determinant was exposure to water, but the public policy was the infrastructure, the pipes in the city of Flint, Michigan. And it's important to work at all levels from the patient all the way to the pipes in legislation to address that inequity. So I think it's really important that when we're seeing social determinants at a group level, you know, what is at the root of that social inequity in the conditions that our patients are facing and then to address that in a federal state and local advocacy. But I agree with Dr. Tasman is that in this moment, I hope that the APA can continue its work at the state level and hopefully broaden that work. Because I think at the state and even at the local level, the district branch level, that's where so many social determinants happen, you know, and the example of, you know, for example, to criminalize or not to criminalize homelessness, that's largely decided in city council meetings and with local law enforcement rather than with the federal government. So that's just one example, but I think addressing the political determinants and then doing it at a very granular local level, I think will be really important for the APA. The bouncing off of that, so I agree with you that, you know, all of our APA members are a part of a district branch, it's part of how APA works. Traditionally, APA members have sort of relegated the idea of APA as a national organization that is federal work, and then you have district branches which do local or state level work. And so how do you all have recommendations of how the APA might partner with district branches or state level organizations or provide resources or support district branches to do that work? So even if it's not the APA out in front, APA position statements or APA resources are available to district branches or APA members who are doing some of this work. And I can give an example. So housing, homelessness, and the relationship between both of those and mental health is a really pressing public policy issue. In fact, it generally is in the top three public policy issues for both Democratic and Republican voters, whether they're looking at it from homelessness or rent prices or housing availability. However, APA didn't have much or any policy on this until very, very recently. And shortly after they did, it was included in New York Times article, which just shows that these things are, people are paying attention when APA puts something out, especially when it's something that the general public or the media thinks has a relationship with mental health. And so that position statement seems like it then could be very useful. And so are there other places where you feel like APA could have a really supporting voice at a more local level, especially as we're talking about the importance of advocacy and community building at the state, local, community, neighborhood level? Enrique, I'll let you go first. Yeah, no, I think that's an excellent question. And thank you, Dr. Rafliwan, for your work on that. That position statement on homelessness that you're talking about is work that you led, and I just really appreciated that. I think that the APA can be really helpful by providing toolkits, very practical guidance to district branches on the top five social determinant legislative advocacy options. You know, for example, I think the APA does an excellent job when it comes to many advocacy issues, for example, parity as an example, giving district branches resources on how to advocate for that or scope of practice, how to advocate for that at the local or the state level. But similarly around the social determinants of mental health, giving a top five approach of resources, I think would be really helpful because sometimes district branches don't know where to turn. So for example, rent protection to address housing instability and mental health issues related to that housing instability. So making those connections for the district branches I think would be great. Yeah, I'll stop there. But yeah, I think it's an excellent question. Let me give an example of something that both of you guys spent way more time doing, which is dealing with homeless issues. Enrico and I were talking about this yesterday, that the homeless population is not a homogenous group. It's very heterogeneous. And yet, for example, in Louisville, Kentucky, the homeless shelters are basically big dormitories. And it doesn't matter why you're homeless. If you've got chronic schizophrenia and are paranoid, if you've got a bad substance abuse problem, if you lost your job for whatever reason, et cetera, et cetera. Everybody's in the same place with the same structure and the same programming, if there is any programming, the same assessments. But then what happens after those assessments are made? So again, an example from my experience, there's a freeway overpass about two blocks from the medical school that in all seasons, but especially in the winter, a lot of people camp out underneath that overpass because it's about 12 lanes when you consider both directions. And between that and the medical school, there's a very large brand new state of the art, at least whatever the state of the art is, homeless shelter. So sometimes folks who are camping out get brought to our emergency room by the police. They end up in the psychiatric emergency room. They're given an appointment to our clinic and they come to the clinic. And sometimes an obvious question is, how come you don't use the homeless shelter? It's right here. Somebody who may have gotten beaten up one night, somebody who's extremely paranoid and agitated. How come you don't stay in that safer environment? So depending on who you ask, you get different answers. So the subset of homeless who are not psychotic, who don't have a major substance abuse problem say, I don't want to stay there because I have all my stuff. And if I go to sleep, I'll wake up and some of it, or all of it's gone, or it's dangerous in there. There are people who get beat up in there all the time because they don't have enough supervision overnight. So there's a policy issue and an implementation issue for the people who are supporting that program that might do better when they're collaborating, consulting with, getting some advice from a psychiatrist or mental health person, if it's not a psychiatrist. So that's a very concrete, somebody would say, well, gee, that's too small, but there's nothing too small. And it's one thing I want to add. Public health projects, historically, as I said earlier, are viewed as big, giant things. And I think we need to start looking at public health interventions as small things, sometimes a micro-intervention. So this is an example of a very small kind of public health problem that might benefit from a small psychiatric collaboration or intervention. Yeah. And I agree with you there. And I think how access to housing, homelessness, and the relationship to mental health is a great example, because even predating this election and how things are, the current landscape, is an issue that hasn't been managed at the state or local level. But it is a national level problem in that it's occurring across the nation. And so there are these windows where the bandwidth that APA has with the expertise and the staff time and the development of reports or resources, which local district branch might not have, where the APA, with its extended expertise and bandwidth, can support these local issues, which really are national issues that are just addressed at a city council or county or state level. So thank you both for your input there. Yeah, that's a great way to put it. It's national issues addressed at the local, city, state level. And I just wanted to share, while we were talking, I recalled the APA resource document on advocating for anti-racist mental health policies, which can have some useful guides for this group on which of the top five, for example, legislative priorities we can share with district branches. And two that I would put forward as examples are renter protections and also implementation of rearrangement, mental health diversion programs, like the LEAD program that's evidence-based. So those two are really powerful social determinants interventions. Thank you. And I just mentioned one more thing, which is educational programming directed towards family courts. So we just had an election for a new family court judge up here in Louisville. And two of the candidates had no prior experience being a judge. And a different two of the three candidates had no previous family court experience. And so if we could develop, and this isn't something just for forensic psychiatrists, because many of the problems that family courts are dealing with regarding kids are not legal problems. They're problems impacted by adverse impact of social determinants. And we could develop some kind of program to collaborate with family court people. Wouldn't be necessarily very time consuming to do a seminar for family court judges and staff. And it's kind of parallel to what happened 30 years ago. What I'm thinking is with this physician's leadership for drug abuse prevention, because the most effective things that happened were not just that SAMHSA grant, but the judges who were in that group went back to their national associations of judges and said, hey, these guys have some information that we've learned and everybody ought to be learning. So that's another educational opportunity, I think, for the APA too. Yeah. And I see that beyond just family courts as with recent Supreme Court decisions, courts by and large will have an increasing influence in the policy arena. And so this will be a shift both locally, nationally, and in terms of how policy is made. And so we need to make sure that our APA members are aware of that, as well as sort of some of the APA and district branch advocacy efforts. So APA can help support some of those resources. I do want to mention, I believe the APA Foundation has a program that does really specifically target in on relationships between judges and APA members with expertise to help bridge some of these things that you're talking about. But I don't know that it's as expansive as it needs to be or if enough folks are aware of it. So definitely more work can be done there. We probably have time for one last question. And so this one I'm bringing from the lens of being the chair of the APS caucus and the social determinants of mental health. So over the past year, it's been a recurring theme that we've had a large amount of caucus member energy and distress around sociocultural issues, including global conflicts, which they feel are impacting their own lives as well as the lives of their patients. So both physical health, mental health, financial security, family well-being. However, what we have found is there are not many venues at the APA for these discussions to be had and even fewer venues where APA members can feel like they can have some input or some action can be taken towards to support some of these issues. Do you all have thoughts about how the APA might better support these members? And is it useful to conceptualize some of these larger issues as something that the APA might be able to address, even if in a very targeted way? And so an example that comes to mind is so some of you are familiar with NAMI, the National Alliance on Mental Illness, another major national nonprofit organization with a kind of a national overhead with local chapters, also nonpartisan, also member driven. And they have recently put together a voting initiative where they help get people registered to vote and explain to people the connection between voting and mental health and provide resources to folks who are want to learn more about this. And as part of that, they also highlight electoral candidates which they feel are supportive of various mental health initiatives and might give some history on some of that track record. But they're very particular and they're not telling people who to vote for, just trying to make sure people understand that they have the right to vote as well as the connection between voting and mental health and support them in being a participant in that process. And so this is just an example because often people say, oh, these things are political and APA can't do that. But there are ways where a nonprofit or nonpartisan organizations can be involved in this process and improve these things. So again, coming from that caucus member perspective, are there ways that you think that the APA, either in a leading role or in a supporting role with a coalition of other organizations, might be able to support our membership better? Yes, that's a really important question. And I appreciate your leadership on this in the caucus, the Social Therapy to Mental Health Caucus. There's been a lot of conversation in that caucus about these topics. But my perspective is that for many of us and for many of the members, politics is one of the leading forms of identity for us. And also it affects us on a daily basis, affects our families, et cetera, communities. And I think it's really important to have these conversations within the APA because if we don't, then for people who hold this as so important for them, then they're going to leave the APA. They're going to have these conversations elsewhere if they feel they can't have it within the organization. And these conversations aren't easy by any means, but I think it's really important that we have them. And I know that it's been, I think the suggestion that you brought up, Dr. Raffaleon, is really great. And I think there's also been a suggestion about an APAP's Conflict and Psychiatry Caucus. I think that that would be an excellent resource as well. But I think these are really important. It's really important to bring these conversations into the APA. Please, Dr. Chan. I would put this in the context of burnout because not that this should be sort of put in a little box, but I want to make it a bigger box. Like everyone else, we're affected by all the stressors from the pandemic and the current culture of our country, the current political scene of our country. We don't have any venues as professionals, really, to talk about it very much. So, I don't know what the answer is, but before the pandemic, you all will remember that talking about physician burnout was a major topic of conversation. And then along came the pandemic, and nobody had time to talk about it. Everybody just had to do 30 to 50% more work just to deal with being overly swamped with care. So, I think that's one thing that we might think about well-being issues for our own members. I don't know what the answer is. It requires a lot of thinking through. So, that's one aspect. The other aspect is public education, especially about things that influence policies that affect people's health or mental health. And I don't mean to be hypercritical, but my wife, who some years ago was extremely active, actually led what used to be called the APA Alliance, which was a spouse and significant other group. And something would happen, and they'd have somebody on TV from the American Psychological Association, or a social worker, or a total non-psychiatrist. And just think about what happened when the Surgeon General put out his report about the public health emergency of social isolation and loneliness, and how few psychiatrists were out there publicly responding to that publicly. So, I think we talk a lot about... Well, we don't talk a lot. We used to talk a lot about the need to get out there. I think that's kind of gone away some with all of the stresses that we've faced just clinically over the last five years. So, I think there's a big opportunity for the APA as well in public education. And we've got psychiatrists everywhere in the country. And it used to be some people would come to... There would be public speaking kinds of workshops at the Institute for Psych Services or fall components meetings, and that would be about... That was it. So, I don't know if those still exist even, but it was completely inadequate because more likely a psychiatrist is going to be at somebody's house party some night, or a dinner party, or somebody's birthday party. And somebody's going to come up to them and say, hey, you're a psychiatrist, are you? What about fill in the blanks? So, it's not just a select few who might go on CNN or something. It's something I think maybe could help all of us. Well, thank you to both of you. I think we're about at time. So, I'm going to turn it back over to Elvis. I didn't see any questions in the Q&A box. So, if I missed any, feel free to address them or bounce them back. But otherwise, I'll hand it back over to you. And thanks again to our panelists. Thank you.

mental health

advocacy

collaboration

community engagement

public health

telepsychiatry

social determinants

policy decisions

grassroots advocacy