So we are presenting, for the second year in a row, Struggle and Solidarity, Stories of How Americans Fought for Their Mental Health through Federal Legislation. It is related to a book that was published this past December. The cover of the book is right there. Dr. Compton and I co-edited the book, and we have two of the other presenters here are co-authors of some of the chapters, and then we have someone who's going to be moderating discussion at the end. So I'm Mark Manso. We also have Michael Compton, Flavio Kossoi, Jacob Eisenberg, and Eric Rafla Yuan is going to moderate the discussion. So we really don't have any financial conflicts of interest other than the fact that Michael and I co-edited the book, and we do get a small amount of royalty, so that's, I guess, one disclosure for both of us. So just an overview of the presentation. So I'm going to give an introduction and overview of the Social Determinants of Mental Health, because this book is related to the Social Determinants of Mental Health, and so is this presentation. Then Michael is going to, Dr. Compton, is going to discuss the chapter that he co-authored, the Agricultural Adjustment Act of 1933. Dr. Kossoi is going to discuss the chapter that the two of us co-authored, the National Labor Relations Act of 1935. And Dr. Eisenberg is going to discuss the chapter that he co-authored, the Housing and Urban Development Act of 1965. I'm going to give some brief conclusions and common themes, depending on how much time we have left, and then there will be time for discussion with Dr. Rafla Yuan. Okay, so just an introduction. So this book is about the Social Determinants of Mental Health, but it's not a purely academic discussion of the Social Determinants and the science behind them. There is some science described in the book that links various Social Determinants to mental health outcomes. However, what we really wanted to do is tell compelling stories about how policy can have a real impact on the Social Determinants of Mental Health, and we decided to focus on key pieces of 20th century legislation and tell the actual stories behind them in terms of how bad things were from a Social Determinant standpoint before the law was passed, why the law needed to be passed, the story of how various actors, various actors in history, groups and individuals worked extremely hard and fought for the passage or leading up to the passage of these acts, and then what the acts actually did and how they influenced Social Determinants of Mental Health, and then each chapter does delve a little bit into the science in terms of how the Social Determinants that were impacted by these acts actually had an impact on Social Determinants of Health and Mental Health outcomes. So just a poem that sort of, I think, encapsulates the Social Determinants of Health and Mental Health in a vivid way. It's by Bertolt Brecht, 1938, Worker's Speech to a Doctor. When we're sick, we hear, you are the one who will heal us. When we come to you, our rags are torn off, and you tap around our naked bodies. As to the cause of our sickness, a glance at our rags would tell you more. It is the same cause that wears out our bodies and our clothes. So just an overview of the Social Determinants of Mental Health from an article in 2020 that described it, that gave an overview by Dr. Shemin Compton. So you see here that the Social Determinants are sort of in the middle, and they're listed here. I'm not gonna read them all. I'm sure you've all heard about what the various Social Determinants of Health and Mental Health are. But the point here is that the Social Determinants are shaped by an unfair and unjust distribution of opportunity and resources in society. And that distribution of opportunity and resources are in turn shaped by two things, public policies and social norms, right? And so the two, social norms and public policies are interrelated and they do influence each other, but they also have independent effects on the distribution of resources, which shapes the Social Determinants and who experiences which Social Determinants of Mental Health and Health. And the Social Determinants in turn influence the options and the choices that people have. So we put poor choices here in quotes because you can only choose what you have available to you. Behavioral risk factors, physiologic stress responses, psychological stress, which then in turn finally influence the actual mental health outcomes. So how do you address Social Determinants of Mental Health? It's one thing to describe them and to summarize all the empirical evidence that show that they're important to mental health, but how do you actually address them? So should we conduct more research on the Social Determinants of Mental Health to further bolster our argument? Should we educate the public? Should we screen for health and mental health care in health and mental health care settings for the Social Determinants and then refer so those can be addressed? Should we support community-based programs? Or should we speak out and use our influence and power in society to actually affect public policies and social norms? So I would argue that we should do all of it, but we really, in this book, we really wanted to focus on the last piece to show how the power of changing society through public policy and social norms can really have a massive influence and in fact has had a massive influence. It's not theoretical. So I just wanted to give an example, and this is from the introductory chapter that I co-authored with Dr. Compton. So I wanted to give an example of a doctor, of a physician, not a psychiatrist, who actually did this work. He fought for the social determinants of health and mental health his whole life. So Dr. Jack Geiger, so he founded the first community health centers in Mound Bayou, Mississippi, in Boston, Massachusetts in 1967. It used its federal and private grants to set up a library, a farming cooperative, and educational services, as well as other social supports. And he actually, one of the things he was famous for doing is he was prescribing food using the funds to pay for the food to malnourished children. So this eventually expanded into a nationwide network of over 1,300 clinics, providing healthcare and social services to over 28 million low-income individuals at over 9,000 sites across the country. So social determinants, as I'm sure you're not surprised to hear, is not a new concept, although it's gotten a lot of attention recently. So a few quotes from Jack Geiger. So one quote from an article he wrote, so the idea that you stand around in whatever circumstances laying hands on people in the traditional medical way, waiting until they're sick, curing them, and then sending them back unchanged into an environment that overwhelmingly determines that they're going to get sick, he was criticizing. So when the federal government found out, well, actually, it was the governor of Mississippi, who you might imagine was not necessarily all that interested in spending lots of federal money to help mostly black people receive healthcare and social services. So the governor of Mississippi reported that Dr. Geiger was spending federal funds on food, not medicine, and that didn't seem consistent with the purpose of these clinics. And so some federal government bureaucrats came down to see what was going on, and he said to them famously, yeah, well, the last time I looked in my medical textbooks, they said the specific therapy for malnutrition was food, and they went home and never bothered him again and let him keep doing what he was doing. So just a little bit more about Jack Geiger to get a sense as to the true vivid story of who this person was. He graduated from high school at 14 years old, enrolled at the University of Wisconsin at 15. He became involved in civil rights activities, started the chapter of the Congress of Racial Equity at University of Wisconsin in Madison. Then he worked as a reporter for local newspapers in the evening. And then he enlisted in the Merchant Marines for World War II, as it was the only racially integrated branch at the time. And then after he served, he returned to college after the war to complete pre-med studies at the University of Chicago. He continued at Corps, doing his Corps work, and he protested the discriminatory treatment of black patients at the hospital, as well as the rejection of qualified black applicants by the medical school, culminating in a large faculty and student protest strike. So the American Medical Association was not happy about this radical activity, and they wrote a letter to U.S. Medical School's warning of Dr. Geiger's extracurricular activities, and he wasn't able to get into any medical school when he first applied. He was blacklisted. So he worked as a science journalist for five years after that, where he made contacts that eventually got him into Case Western Reserve in Cleveland, Ohio. He completed residency in internal medicine at Boston City Hospital. And then he continued his civil rights work. He helped found the Medical Committee for Human Rights, an organization that provided medical care to frontline civil rights activists, including those who marched with the Reverend Dr. Martin Luther King from Selma to Montgomery. And he participated in the Freedom Summer in 1964, and he provided medical care, actually, for people who were hurt in some of the freedom rides. In 1961, he co-founded and led Physician for Social Responsibility, which argued that the government was downplaying the health consequences of this nuclear war, and that physicians had an ethical responsibility to help prevent such earth-shattering devastation. This organization won the Nobel Peace Prize in 1985. Then he founded and then led Physicians for Human Rights, which did a bunch of different things in terms of human rights, including landmark work on landmines eradication, and that won the Nobel Peace Prize in 1997. So another quote from Dr. Geiger, and this is a picture of him shortly before he died. He died on December 28th, 2020 at 95 years old. Right now, we health professionals are standing in the middle of an endlessly revolving door, doing some good on a short-term basis, but we cannot go on providing health services without regard to the system in which the roots of poverty, sickness, and many other social ills are embedded. We have to be willing to identify the real problems and confront them. We have to create new social institutions appropriate to the problem. And finally, we need a sense of passion and commitment to bring about the changes that are so urgently needed. This is in 1969. It could have been from a social determinants article in 2023. So the rest of the presentation, I already told you who was gonna present what. So without further ado, I'll introduce Dr. Compton. Good morning. So who would have thought that one of the most important mental health laws in this country was the Agricultural Adjustment Act of 1933? I wouldn't have thought so, but once I started really digging into it, I realized that it actually is. This was, as we'll see, the first farm bill. So the first of four federal acts that we'll be covering this morning, or actually three, though there are seven detailed in the book, is about farming and food policy, the Agricultural Adjustment Act of 1933, which was one of FDR's landmark first 100 days pieces of legislation designed to pull the country out of the Great Depression. What had gone wrong, from the perspective of the economics of farming at least, was an imbalance between supply and demand. Too much supply, that's right, too much supply, even during the Great Depression, along with not enough demand, or just static demand, and thus very low prices. Prices were lower than what crops could be produced for. 1932 was not like the so-called golden years of 1909 to 1914, when prices were high enough that farmers had adequate purchasing power. They could buy the equipment and the supplies that they needed. And what we're really talking about here is agricultural commodities. These are relatively non-perishable, storable, and transportable crops that are traded, like wheat and field corn, cotton, tobacco. Commodity crops require processing before consumption or use. Today, such crops are what most really large farms grow. They're grown in very large fields, massive fields, with long rows cultivated and harvested with very large machinery. The end uses of commodity crops include livestock feed, ethanol for our cars, flour, food additives, et cetera. We're not talking about fruits and vegetables here. Fruits and vegetables are referred to by the USDA as specialty crops, and they comprise a very small portion of the cultivated land in our country. So this is what the collapse in commodity prices looked like after the golden years and after World War I. The A here is the Agricultural Adjustment Act, just at the very beginning of the Roosevelt administration. You can see that for wheat, corn, and cotton, there was a major decline in crop prices from the golden years, ending in 1914. So plummeting crop prices, and then there was the dust. The Dust Bowl, another problem impacting farmers, which we won't unpack this morning, but it was occurring at the same time. So it's 1932, and the farmers, like much of the country, are really cash-strapped and nearly starving. They protested. They went on strikes called Farmer's Holidays, and they wanted Hoover out. It was reported that in South Dakota, for example, the grain elevators had corn priced at minus three cents a bushel. There were entire fields of cotton in the South that remained unpicked, as its selling price was not worth the cost of labor. Wheat was being burned in lieu of coal because it was cheaper and it had little or no market value. Milk was dumped, as it was too costly to store. Hogs were slaughtered, as they were too costly to feed. The governor of New York, who would be the next president, stated his commitment to being the farmer's president, unlike Hoover had been. He said, we advocate for the restoration of agriculture, the nation's basic industry, better financing of farm mortgages through reorganized farm bank agencies at low rates of interest. He said that we needed effective control of crop surpluses so that our farmers may have the full benefit of the domestic market. And as we know, FDR won big time. He would continue to rely on his so-called Brains Trust, a group of close advisors, some of them shown here, including professors, to help him craft the New Deal. In the book, I highlight the contribution of one of these, Rexford Tugwell, in particular, a Columbia University professor of economics. He had a rather wild idea that's called voluntary domestic allotment. He felt that this was the central planning policy that would be needed to pull the farmers out of their dilemma. It was an experimental central planning approach to fix this supply-demand-price problem. Farmers would be given payments for restricting their production. Money for those payments was raised by taxing the processors of the commodity crops, like the factories that turned wheat into flour and wool into yarn. FDR explained this policy maneuver to the country in his third fireside chat about six weeks after the law was passed in 1933. He explained it to the country, saying, we have been producing more of some crops than we can consume or sell in a depressed world market. The cure is to not produce so much. Without our help, the farmers cannot get together and cut production, and the farm bill gives them a method of bringing their production down to a reasonable level and of obtaining reasonable prices for their crops. This method, he admitted, is, in a sense, experimental. Now the act had three titles, and it was just 26 pages long. As I detail in the book, though, it may have saved many farmers. There were many actual built-in inequities in this first farm bill. For example, the landowners were not required or enforced in sharing the payments with sharecroppers or tenant farmers who tended to be African Americans in the South. So what does all of this have to do with mental health? Well, even though the first farm bill was about economic stability for farmers, later iterations, which are reauthorized about every five years, become more and more about improving food security in America. It's well known that food security or food insecurity is associated with a multitude of poor mental health outcomes. Multiple studies, I'm writing a review article right now, and there are 400 articles that link food insecurity to poor mental health, depression, suicidality, generalized anxiety disorders, substance use disorders, behavioral problems in kids. Multiple studies have shown that food insecurity at the individual or the household level is associated with poor mental health across the lifespan, as well as specific mental illnesses like depression. This is my own conceptualization, if you can see this, about how food insecurity is linked to mental health outcomes. Food insecurity in our country, unlike in low-income countries, is really a financial problem. It's about unequal access to healthy food. The financial problem leads to a dietary problem, which I'll describe. That leads both to a mental health problem, but also a physical health problem. Then we have a food policy problem that adds to the mix, and finally, a healthcare problem. Let me walk through this briefly. In our country, food insecurity starts with impoverishment or constrained financial resources. That's almost always the driver of food insecurity. It's basically a problem of limited food dollars. When you have limited food dollars, you need to rely on low-cost food to get your calories. This results in a change in dietary patterns, a dependence on what we call ultra-processed food, also fast food and junk food. The diet is high in refined carbohydrates, added sugars, fats, and salt. The diet is low in whole foods, fruits and vegetables, and micronutrient-rich foods. This diet can be associated with poor mental health outcomes. It's obviously associated with physical health outcomes, including obesity, diabetes, cardiovascular disease, hypertension. By the way, food policy plays into this because those very ultra-processed foods that I mentioned, everything that comes in a cardboard box and has a food label on it to tell you the ingredients, those are actually more subsidized, and they're also more reinforcing, whereas the whole foods are not subsidized by the federal government, and they're not as reinforcing. Of course, the constrained financial resources also leads to a healthcare problem in that it becomes hard to adhere to medications. Disease self-management becomes difficult. Add depression on top of that, and diabetes becomes very hard to manage your diabetes when you have limited food dollars and you need to rely on this type of diet. So what does all of this really have to do with mental health? These are some of the studies that I mentioned, many studies, both in the U.S. and around the world. Most of these are published not in the psychiatric literature, but in the public health literature, in the nutrition literature, and so we don't really see a lot of these studies unless we're actively looking for them. Nowadays, the Farm Bill, which is 12 titles and 530 pages, as opposed to the three titles and 26 pages of the original Farm Bill, covers nutrition, rural development, and many other facets of food and farming beyond just commodity price stabilization. In fact, nowadays, the Farm Bill is largely about food and nutrition assistance programs. It funds SNAP, which is the largest USDA program, but also nearly a dozen other food and nutrition assistance programs, like the school breakfast program, the school lunch program, et cetera. So I hope that I've been able to begin to demonstrate how food and farm policy, like the Farm Bill, is actually mental health policy, and I'm going to stop now and turn it over to Flavio to talk about labor relations. All right, hi everyone, Flavio from New York. And thanks for the introduction, thanks for the discussion of the Farm Bill. You know, labor is interesting, I think, because, you know, it's, from my point of view, work and production is really the wheel that turns history. I mean, every big historical development is, you know, closely tied to how people produce and how people work. And I think that the main thesis that I wanna provide is that the history of labor in the United States is the history of the United States. You know, what people do is closely tied to trying to extract value from the work, you know, of others and so forth. So, I mean, if you think about it, you know, the first African slaves arrived in New York, in New Amsterdam at the time, in 1626, and then in Boston in 1636. So from the very, very beginning, we began to have unfree labor. And immediately, there was resistance on the part of these individuals who were brought over to sort of have more control over their working conditions. 12 of the original passengers of the Mayflower in 1620 were indentured and came in voluntarily. And after 1630, more than half of the, you know, pilgrims who came to the Massachusetts Bay Colony did not come for religious reasons. They came because they needed to work and they could not find work in the old country. In fact, one of the main drivers of the 17th century British policy of colonization was to find a place to send their poor workers. There had been a lot of wars on the continent. There were all these sort of veterans roaming around the English countryside, many of them armed. And it was difficult to reabsorb them into the labor force and London needed a place to send them. And the colonies was a really, really great solution for that. And for the initial charter holders of the colonies, there was a desperate and constant hunger for more labor, more unfree labor of individuals who had no rights. In fact, there's all, you know, if you look at the historical record, there's letter after letter of sort of colonial leadership writing back to parliament, asking for more indentured service to be sent over. A lot of orphan children, a lot of children had been abandoned or, you know, sort of did not have the means to, you know, to sort of enter the lowest rung of the ladder in Great Britain were shipped over. And the conditions were terrible, grueling, frequent physical and sexual abuse, and there was no recourse for justice. And that's from the very beginning. So enslaved labor, indentured labor, and almost the, you know, all of the economic activity of all of the 13 original colonies was almost entirely based on unfree labor, right? That is the historic origin of our country. And the consequences of, you know, the exploitation and the enslavement of Native Americans, the transatlantic slave trade of Africans, and the indentured sort of white servants still resonates, and I would argue is the main political driver of our society today, right? This is what drives almost everything that we're having to deal with this fraction of country. So there was, throughout the colonial period and into the early republic, so much time and energy was dedicated to this continual struggle between wealthy landowners, poor workers, and slaves. And the legislatures of the colonies did a lot to keep workers divided. And, you know, the original sort of creation, I think there was another talk earlier in this conference about zero-sum mentality. You know, what creates the need? How do you separate, you know, poor white individuals from African Americans so that they don't sort of organize, you know, across, you know, in their class difference? You know, there was this whole creation of this sort of hierarchical racial identities and castes in the Americas, directly related to the need to keep workers separate. The Civil War was fought for many reasons, but the primary in chief was to end slavery. And slaves themselves took one of the primary leading roles to, you know, to fight their own enslavement. And this struggle sort of continues to have ramifications to, you know, in history today. So then the Civil War happened, independence has happened, we're coming into a more modern period. And what develops is, you know, there's always a risk of there being too much democracy, right, if you own all the means of productions and you have too much democracy, you're at risk. So the courts become the primary determiner of labor policy in this country. And the dominant legal theory in the post-Civil War period was that the right to property was a bodily right. So if workers organized to improve their conditions to get a bigger slice of the pie, this was considered a bodily threat on the employer, a threat of violence considered to be similar to attempted assault. And you could be criminally tried for sort of attempted violence. And of course, a lot of people ended up going to prison for this. It was a desperate attempt to keep workers from organizing. Going towards the end of the 19th century, progressives are beginning to pick up steam, there's a recognition that the combines and the monopolies are squelching even, you know, the myth of the democratic ideal in this country. And there is popular pressure to pass the Sherman Antitrust Act I don't know if folks have heard of this, as a way to break up the monopolies. But immediately, as soon as this passes, the courts interpret the formation of worker organizations as the formation of labor monopolies, and they apply the punishments of the Sherman Antitrust Act to workers. And of course, the penalties in the Sherman Act are for large, large corporations and cannot be borne by individuals. So it impoverishes and sort of, you know, harms a lot, a lot of people. So, the tension, the division continues to, continues to intensify, the crisis worsens. In the end of the 19th century, there is a growing realization, in part because of the emergence of a different type of press, you know, the McCracken Press, that begins to understand sort of the desperate conditions of child labor, gross exploitation, and the vast income inequality. And we begin to see a sort of a new awakening, sort of moving towards more progressive political activism. And this is the first progressive age that we see in this country. And Congress responds, and they shift in a more progressive direction. And we begin to see sort of laws come into, into rigor, you know, at the national level and at the state level, to protect the rights of workers. In 1894, there's a giant rail strike, the Pullman Strike, I don't know if folks know this history. It's a strike that happens on the rail system that is integrated, it's cross-race. You know, workers are able to get together, overcome sort of this racist legacy, and sort of fight for better conditions. This results in the Ordman Act, the beginning of the rights for rail workers, and all workers to form a union. But the Supreme Court immediately weakens this. And we begin to see a pattern that we see today, you know, with the Supreme Court overturning important laws and precedents that protect the rights of individuals. You know, the courts in this country have had this history of overturning rights when sort of democracy gets out of hand, if you will. And we see that happening with significant implications, you know, in the Dobbs decision and so forth. So, and then you also see an increase in the level of intensity and violence that employers respond to workers organizing. There's a federal report in 1915 that comes out that finds that two million children in the U.S. were working instead of going to school, earning an average of $2 per week, which in 2021 dollars was $55, right? So adjusting for purchasing power. Half of these children were working 10 hours a day, seven days per week. Women were earning an average of $6 per week. Two thirds of men were earning less than $15 per week. And half of all men worked 12 hour days, seven days per week. Another report from the federal government in 1914 found that there was 35,000 workplace deaths in the previous year, population of less than 100 million. And the federal government determined that half were fully preventable, right? So this, so work was dangerous. It was deadly. And at the same time, there were 700,000 non-fatal but disabling workplace injuries. In 1914, you can see the pictures here of sort of this sort of bombed out camp and sort of these individuals sort of standing in front of this tent. Has anyone heard of the Ludlow Massacre? You heard it, well, you wrote the chapter. It's like, not fair. There was a coal mine in Colorado owned by John D. Rockefeller. And the workers went on strike for better pay, better working conditions, better housing. They weren't paid in money. They were paid in shits for the company store. They could only pay it at the company store. And they were almost always unable to afford the full price of what they needed to live. So they were constantly in debt. They went on strike. They wanted better working conditions. They wanted to be paid in currency. And since they all lived in company housing, they all had to leave the town. And they sort of set up this tent city in Ludlow in Colorado. And the company called her house and hired this sort of private security company. The Colorado National Guard came out and ended up sort of opening fire on the strikers, killing a lot of individuals, 21 people, including 11 children. And this caused a major, major outcry in the country that resulted in a whole bunch of sort of progressive legislation and greater sort of drive for people to organize and fight sort of this oppression. So the tension continued to increase, increasing conflict at the workplace. And then in 1929, the stock market crashes. And this just rolls over the country. Oops, wrong way. This just rolls over the country. And it's a massive moment of despair. I mean, people are alone, unemployed, at home, year after year, four years of this sort of depression where people are despairing and unable to take care of their families. And there's sort of all this breakdown. But there is an increase in organizing. There's an increase in solidarity. And there is sort of mass unemployment organizing. To support individuals who are still employed, which is a very interesting chapter in history. Things like in 1932, there's the Ford Hunger March. I don't know if folks have heard of this history. Ford Hunger March, sort of a lot of unemployed workers sort of went on a march to support sort of striking Ford workers. And there was a police massacre of these individuals who were just sort of protesting. So the same thing that we still see today has been happening for a long time. In 1932, also, World War I veterans had this mass march on Washington asking for a bonus that was supposed to be paid in 1945 to be paid earlier. Tens of thousands of people came from all over the country to Washington. They camp out in Anacostia Flats. The idea was they were gonna request appointments with the representatives and senators to ask for them to vote for this bill that would give them this early bonus. And Uber Panics calls, there's too many people in Washington. Who are all these people? They're all kind of like dirty and kind of like they're not supposed to be here. Calls the active army. The active army who opens fire on these veterans and sort of a lot of them sort of die. There's this massive national outcry. The press is sort of all over this. And this results, in large part, on the election of Roosevelt in 1932 who takes office in 1933. And I would say one of the main early pieces of legislation along with the Farm Bill is the National Industrial Recovery Act, NIRA, which is the first national law that explicitly creates the right to form a union. Before there had been some sort of narrow sectors that could form unions, but this is the law that allows the mass formation of unions. And organizing just explodes. In 1933, 900,000 workers went on strike. In 1934, it was one and a half million. And the ferocity of the response of the employers is enormous. There's all these sort of private security companies that form to attack the striking workers and sort of governors call out National Guards and it's a very intense time. And then here in San Francisco in 1934, the closest we've ever come to a socialist revolution happens. Harry Bridges is a longshoreman here in San Francisco and there's this horrible system. So the pay's terrible, the work is backbreaking. And the longshoremen in San Francisco in May 9th, 1934, go on strike for better pay, hiring halls, because they had to bribe the employer to hire them. So they would get paid, but then they had to give part of their pay back to the employer so that they'll be allowed to have a next job. And sort of a 30-hour week, because this was such backbreaking work, they sort of unloaded the boats by hand. On July 3rd, the San Francisco police attack the striking workers. There's a riot, two-day riot, where there's sort of hand-to-hand combat on the streets of San Francisco. July 5th, the National Guard calls out. Harry Bridges tells the longshoremen to go home. We're on strike, but we're not picketing. National Guard comes out, attacks a lot of the workers. July 6th to 12th, many other unions join. General strike in San Francisco. Huge military response by the governor and National Guard. Break up all these union offices, along with newspaper presses, bookstores. Anyone who's perceived to be too woke gets attacked in this period. But the strike holds, a national strike, all over the region. No one is working. July 30th, the workers win, and there's, no, there's a success. No, then, in 1935, Naira gets struck down by the Supreme Court, just like we see here today. And the next piece that happens is Roosevelt is able to work to pass the next installment, called the National Labor Relations Act. At the heart of the NLRB, crafted in a way that could withstand the Supreme Court scrutiny, is this language that employers shall have the right to self-organization, to form, to join, or assist labor organizations to bargain collectively through representatives of their own choosing, and to engage in other concerted activities for the purpose of collective bargaining or other mutual aid protection. And there was an explicit ban for employers to interfere, restrain, or coerce employees in any way that interferes with their right to join a union. So, landmark historic decision. Federal government is explicitly in favor of workers forming unions. It's what builds the middle class. It's what gives us the weekend, and so forth. The process of the National Labor Relations Act is pretty simple. You have to define a bargaining unit. The bargaining unit can be based on the type of work that you do, who your employer is, but it has to be as broad as possible that will include as many individuals as possible. For example, you can't have, I want a union of psychiatry residents at a hospital. You need a union of residents. You can't sort of have a narrowly defined bargaining unit. It has to be sort of broad and logical for the work, the type of work that's done. It cannot include both professional and non-professional workers, unless there's the majority vote by both supporting that. Cannot include security guards, because security guards are responsible for enforcing the will of the employer, and does not apply to sort of workers that are protected or covered in other labor laws. You need 30% of the employees in the proposed bargaining unit to sign a petition. Then there's the election that's held. The employer can appeal, and then there will be a hearing at the National Labor Relations Board. The ballot is secret, so folks can join, can sort of vote without fear of retaliation, and the employers can appeal decisions through the Federal Appeals Court system. And as soon as the National Labor Relations Act and IRS sort of come into play, you see an explosion of union activity in this country, and you see a significant decrease in income inequality. I mean, it's directly related. But shortly after, you know, the employers take back over, and you see the beginning of a weakening of the NLRA. In 1947, the Taft-Hartley Act passes, and you see when Taft-Hartley sort of gets passed, you see a decrease, an end of the increase of unionizing, sort of it flattens out and then as more anti-labor sort of measures come through, you see a decrease in labor density and again an increase in income inequality in the country. So as the federal government moves away from this sort of process, this position of being explicitly pro-labor, you see the union density in the country beginning to fall. Most important note is that a lot of states in this country no longer require or require unions to be open shop, that is you can be represented by a union without having to contribute dues to its maintenance, which makes it very difficult for unions to operate and makes it very difficult to organize. I know I'm running out of time, but I will say one thing that happened recently is three days ago, the Mount Sinai Elmhurst residents went on strike for pay parity with the big Mount Sinai Hospital for better working conditions and so forth. They were on the picket line for three days. A lot of politicians sort of came out in support of them, including Alexandria Ocasio-Cortez, lots of the New York delegation, and they won. As of this morning, they settled on a contract, there still hasn't been a vote, but these residents that were in a hospital that served primarily immigrants were underpaid compared to the flagship hospital that served white, wealthy people. They were able to get a fair contract, pay parity with their peers. So there's still individuals who are sort of fighting and winning. This was the first resident strike since 1990. So I think we're back in a change in a different moment. I left the slides in the deck that explain how labor connects to social determinants, so you can download that from the app. I won't go into that now, but it's also in the book. But I'll pass it over, thank you. Thank you. Morning, it's nice to see everybody. My name is Jake Eisenberg and I'm actually local here in San Francisco. I primarily work in the county jail and I'm on the faculty at UC San Francisco. So I think it's pretty fitting to be talking about housing here today in San Francisco because this is, I think, arguably the epicenter of what's really a national, ongoing national housing crisis. I don't know how many of you are visiting versus from local. I know at least some of the folks in this room are visiting from other places. And walking around the streets of San Francisco, you may have noticed that we are dealing with a lot of issues around homelessness. And this is not unique to San Francisco, obviously. And it really ties into a sort of web of housing policy and other economic issues that have been really affecting this country for generations. And it's disheartening at times to see the extent to which they still do. Although, as I'm gonna discuss in the next few slides, there has been quite a bit of policy progress and innovation over the last 80 years or so. As you may have been noticing, there's a trend in this workshop where a lot dates back to the 1930s. Not surprisingly, the New Deal was sort of the fountain of a lot of social policy in the United States that we still live with and has been iterated upon over the last number of decades. So that's gonna be true for what I'm gonna talk about as well. And this picture, just point of reference since we're in San Francisco, is near a neighborhood called Visitation Valley. That's in sort of the southern, southeastern corner of San Francisco. And you're looking out at the port of San Francisco, which is actually a relatively minor port compared to the port of Oakland across the bay. So I wanna take us back to 1965, and it was a hot summer in LA. And in Watts, which was predominantly, is to this day, a predominantly black neighborhood, an uprising exploded, lasting roughly five days. The uprising started with the arrest of a young black man in Watts, allegedly for drunk driving. And actually his mother, he was stopped near his house and his mother came out. And it sort of escalated into an altercation through allegations of police brutality. And pretty soon the whole neighborhood was out and things just kind of got out of hand very quickly. Over the coming years, there will be similar uprisings in a number of major American cities, all sort of centering around a lot of anger emanating from the experience of being black in American cities. There had been years of segregation, disinvestment, over-policing, political and economic marginalization. I'm gonna talk about some of this shortly, but the grievances held by blacks in American cities were numerous and the anger was very deep. In 1968, the Kerner Commission was appointed to look at what was happening in American cities. And their report was quite long and is sort of a famous assessment of the condition of American society in the middle of the 20th century. I just wanna quote one part of a chapter in the report on housing. They wrote, quote, federal programs have been able to do comparatively little to provide housing for the disadvantaged. In the 31-year history of subsidized federal housing, only about 800,000 units have been constructed, with the recent production averaging about 50,000 units a year. By comparison, over a period of only three years longer, the Federal Housing Administration, which was instituted to guarantee mortgages and make it easier for working people to access a mortgage to buy a home. By comparison, over a period of only three years longer, FHA insurance guarantees have made possible the construction of over 10 million middle and upper income housing units. So just to give you a sense of where the energy and where the productivity has been in American society frequently. So I brought up Watts and the very valid grievances of black communities across the country. Because a lot of those grievances had to do with the condition of neighborhoods and the accessibility of adequate affordable housing. You have probably seen a map something like this before. This has been very popular. I've noticed in a number of talks that I've been at to talk about redlining. I think with good reason, because it's sort of, redline itself was basically derived from this process whereby this sort of quasi-governmental collaboration between the federal government and a number of banking organizations created these residential security maps during the 1930s. The idea was to help investment organizations determine the level of risk in making investments in various communities. And they rank ordered neighborhoods based on the perceived risk. So red was the highest risk, and that's where the term redlining comes from. The actual original redlining maps were not all that influential. I think there's a sort of a misconception, but some of the recent history on this has sort of shown that the original homeowners lending corporation maps were sort of created and then kind of sat on a shelf and collected dust for the most part. However, the principle that race equals risk, in particular black neighborhoods equal high risk, and do not merit investment and money and an effort to sort of maintain them and to provide things like home insurance, mortgages, and so forth. That principle is, I think, really what redlining stands in for, and that's been a through line in the last, well, really throughout American history. But particularly in the post-1930s era when there's been a lot of investment otherwise in American cities. This, by the way, for those of you who are maybe familiar, this is Essex County. I use this map because I did some work looking at main streets in Essex County with a professor by the name of Mindy Foley Love, who some of you may be familiar with. We went all over the county looking at different main streets and trying to understand how this legacy had sort of affected the urban fabric in Essex County, so new work is kind of right at the bottom right there. So I wanna turn now to a sort of a related but separate issue, which is public housing and the housing crisis. So housing for low income Americans has been a perennial issue, but it really became a crisis in the Great Depression, like a lot of other things. I think a lot of folks who were living on the margins economically were able to sort of skirt by in one form or another until the Great Depression really brought a lot of these inequities to the fore and created a crisis for many, many lower income Americans. And that was true for housing. In response to this sort of Great Depression era housing crisis where increasingly people were at risk of becoming homeless or unable to afford basic shelter, as part of the New Deal, raft of legislation, FDR passed, or the Congress passed and was signed by FDR, the 1937 Housing Act. There was another Wagner, there was a mention of Senator Wagner, who was very influential in a lot of the New Deal legislation, and that was true for the Housing Act as well. So this law, which I'm not gonna dwell on too much, basically created public housing as we know it today. It established a role for the federal government in subsidizing the construction of housing units for low income Americans. And not only funding the construction, but also the operation. This was done, as much of federal legislation is, through sort of local partnerships, so the creation of what are called public housing authorities. These authorities still, to this day, operate public housing across the country. So essentially all public housing in the US is operated by these local public housing authorities, so in New York, NYPHA, we have public housing authority here in San Francisco. And basically, down to the smallest communities, there are local public housing authorities. However, the initial growth in public housing was pretty anemic. So from 1937 to 1965, only 600,000 units were built. Why is the number so small? Because the need was much, much greater than that. And the issue and the vision for the number of units that would be built when original housing legislation was passed was much larger than 600,000. One of the issues had to do with the compromises that were made in passing the original housing legislation, which basically bestowed a large amount of authority on local communities to decide whether or not public housing would be built in the first place. And not surprisingly, there was a lot of pushback, particularly in wealthier neighborhoods and particularly having to do with, in many cases, with race and the fear of the other black and brown Americans moving into otherwise white neighborhoods. And so public housing authorities used their power to block a lot of housing construction. So if we move forward now, in the interim, I'll just mention, and this is discussed more in the book chapter. In the interim, the 1949 Housing Act was passed. That Housing Act was incredibly important. So I don't want to give it short shrift, but I'm not going to discuss it here in detail. But it expanded the original 1937 law by quite a bit. It also instituted something called urban renewal, and I will talk about that a little bit. If we go forward to the 1960s, we have Lyndon Johnson, who's elected on the heels of, or not elected, originally comes to office after the assassination of JFK in 1963. And then is elected to his first and only full term in office in 1964. The 1964 election also brought a massive democratic wave, sort of powered by, I think, a lot of sympathy for the JFK agenda and sort of a lot of energy behind liberal politics in that moment. So 1964 to 66, in particular, was a time of massive policy change, and that's what we now call the Great Society. And LBJ, when he came to power, brought with him the man who is pictured in the center here, Robert Weaver. And Robert Weaver was his, eventually, when the Housing and Urban Development Department became a department in 1965, he became the first secretary. And this was notable because it made him the first African-American cabinet secretary. And then in 1965, incidentally, five days before the Watts Rebellion broke out, the Housing and Urban Development Act of 1965 was signed into law. I'm gonna talk about that a little bit. No, somehow the formatting is off here, so I apologize. But the Housing and Urban Development Act of 1965 is the law that sort of this book chapter focuses on. But in some ways, it's, I don't wanna say arbitrary, but it's really just one in a series of major pieces of federal housing legislation. And so I could have sort of looked at any one of them, but I think this act is noteworthy for its pure size and its scope. I do wanna clarify, there's some confusion out there when I was doing some research as to whether this act created the Housing and Urban Development Department, which it did not. There's a separate law, but they basically happened at the exact same time. So this law had a number of provisions, and I'm actually just gonna focus on four of them. Title I is special provisions for disadvantaged persons. Title III, urban renewal. Title IV, compensation of condom needs. And Title V, low rent public housing. So I'm gonna try to move somewhat quickly here. So Title I created, did a number of things. Well, I think one of the most interesting things that it did is that it created rent subsidies for the first time. So this is very controversial politically, but it was the first time that the federal government got into the business of paying people to live in private housing, and also subsidizing the development of private housing. The actual provisions in this law were relatively short-lived, but that principle has become the sort of, actually the foundation for federal housing support today through what's now known as Section 8, which many of you may be familiar with. So I mentioned urban renewal earlier. This is really a sort of dark chapter, I would say, in the history of federal housing policy. The idea of urban renewal was to sort of reform cities, and thereby reform the people living in them by creating newer, cleaner neighborhoods where there had previously been sort of blight, so to speak, and disinvestment. The problem was the neighborhoods that were primarily disinvested were black neighborhoods in particular. And the way in which cities chose to deal with those neighborhoods was rather than invest in them and help them rebuild. And many of these neighborhoods, despite being disinvested, were very vibrant. You can tell the story of any number of neighborhoods in the US. Fillmore District is a classic one here in San Francisco. It was known as the Harlem of the West. There was music, there was energy, there was a vibrant economy. Nevertheless, the city of San Francisco, in collaboration with the federal government using urban renewal funds, decided that the Fillmore District was blighted, and in the 60s and 70s basically destroyed the bulk of the neighborhood and drove a major boulevard, Geary Boulevard, through the neighborhood. It basically looks like a highway. And that's what they did in most places. They put highways, or they put civic centers and arenas and other kinds of things that really didn't replicate the housing or the community in any way, shape, or form. One thing this law did do that was positive is it did establish a more regulated system of compensation for those who lost their housing to urban renewal. But this is kind of a pittance next to the damage that was done. And then really quickly, Title V was public housing construction, and really this law doubled down on public housing construction. You can see that reflected in the growth in public housing over the subsequent years. Before public housing really fell out of favor, and I just want to mention, public housing is, this is again discussed a little bit more in the chapter, but I think public housing's gotten, unfortunately, kind of a bad reputation because of some high profile failures that happened in the middle of the 20th century. Things like Pruitt-Igoe houses in St. Louis, and some of the major housing projects in Chicago as well. But what a lot of people don't realize is that most of public housing that exists is actually sort of scatter site, small units, and they house a lot of very vulnerable people, about close to 2 million Americans. And I think it's really important to remember that public housing actually plays a very important role for many people. As a matter of fact, I live in East Bay, in Emeryville, and I live next door to a public housing development. And it's very much defies the stereotype of public housing. It looks like a small apartment block. It houses four or five families. And as far as I can tell, the families living there are really thriving. So it's really, I think, to me, the image of public housing that we should try to carry in our minds. I'm very quickly, in about one minute or two minutes, going to try to quickly touch on the relationship between housing and mental health. So, again, I apologize, for some reason the formatting has gotten wonky here, but I'll try to explain this. So there are really two ways that I think about housing in relationship to mental health. One is tenure. Basically, do you have housing or not? Is it stable? Are you cost-burdened? And so forth. And then the quality of the housing. Is your housing of decent quality? Is your neighborhood of decent quality? When I say, particularly with the neighborhood, when I say the quality, I mean the physical fabric of the neighborhood and also the social environment in the neighborhood. And just to really quickly show you some evidence, and there's a vast, vast body of literature on this, but everything from housing and homelessness to eviction to cost burden are associated with negative, in some cases very negative, if you look at actual homelessness outcomes with respect to mental health. And on the flip side, if you look at positive changes or improvements in quality and then positive features of the social environment, such as collective efficacy, which describes sort of community cohesion, those are very, very strongly associated with positive outcomes. So just as far as today is concerned, more than half of California's renters and over a third of homeowners with mortgages have high housing costs. So this is just to show you that despite the positive developments in the 20th century, we continue to have a major housing crisis. This law and others that have sought to tackle housing have done a lot, but they have not come anywhere close to getting us where we need to be, particularly for renters. I do have some hope that certain developments will yield positive impacts. Recently, a lot of public housing has been built through what's called the Low-Income Housing Tax Credit. That's a tax credit that incentivizes developers to develop low-income housing. This is a project in Harlem, I believe, called the Sugar Hill Houses. Yes, it would be Sugar Hill, so I think it would be in Sugar Hill. Yes, it would be Sugar Hill, so I think it would be in Harlem. That was built through the Low-Income Housing Tax Credit, and it's quite an interesting building. It has a school and community space in the bottom. They brought in a really famous architect from London, I think, to design it. So there's a lot of energy in it, and it's all affordable housing. Some of you may have seen an article in the New York Times just like a day or two ago about Vienna. I just want to point out there are other models in other parts of the world that handle public housing really effectively. One is this Vienna model where basically public developers get really good deals to develop on government-owned land, but they have to agree that they're going to make a large number of their units available to low-income families. And one of the really neat tricks that they do in Vienna is that if your income as a family goes up, you don't have to get kicked out. That's not how it is in the U.S. If your income gets too high in the U.S., you have to leave public housing. There you can actually grow. Your family can grow, your income can grow, and you don't have to leave. I'm happy to talk. I'll stop there in the interest of time. But I'm happy to talk about other developments in the Q&A, which hopefully we'll have a little bit of time for, and additional housing policy issues because there's obviously a lot to talk about. So I'll stop there. Thank you. Yeah. Okay, so I kind of anticipated that I wouldn't do my conclusion because we need time to have Eric lead the discussion. But just the final chapter of the book just sort of sums it all up and sort of brings themes out. And it describes how psychiatrists and other mental health professionals can actively participate in the policy change process. And I just want to plug an organization that I co-founded, Psychiatrists for Gun Violence Prevention, which is an example of actually activism and advocacy that psychiatrists can do. I thought I had a slide showing all the other chapters, but I guess I don't. This was only three of the content-based chapters in the book. So there's four others that really go into depth in a similar way in terms of how policy change and policies in a very real way can affect mental health. So I encourage you to check it out. So Eric, I'll pass it off to you. Do you have another slide deck? So I had prepared some slides, but in the interest of having a discussion, which I think will be more interesting, we'll just skip to that. I hope that we were able to give you a sense, really, of the human element present in all of these stories, the role of the voters and public opinion in changing these policies by putting in place elected officials who either understood the importance of them or at least were responsive to the public pressure and the ongoing process of policy that was implemented. And so in terms of what we just heard about psychiatrists being involved, I got the opportunity to live this. And so my name is Eric Rothle-Yuang. I'm a psychiatrist. From 2021 to 2022, I was senior staff in the House of Representatives working on things like the Inflation Reduction Act, the next five years of funding and program design for SAMHSA, and very kind of importantly to me, I was the staff director for the 988 and Crisis Services Congressional Task Force, a bipartisan effort to implement and fund the 988 program across the country that we've successfully seen over the past year. And so with that, I'm going to open it up to questions and see what folks have to say. If anyone has comments, questions, if you could use the microphones in the aisle, that would be helpful. I do have maybe one slide. Okay, so in some of the history I think it's really interesting to see exactly when sometimes they say the same thing they did hundreds of years ago and then they say it again now. So just like quick disclosures, I'm not making any money from this, I'm not an author in the book. So, excitingly, I think that the 988 lifeline represents a sea change in how we respond to psychiatric emergencies. The idea that it's not just a number but also an initial piece of a crisis continuum of care is the idea that the agencies are hoping to promote across the country and we are seeing states start to implement this. And so as part of that I designed the 988 Implementation Act, working with more than 115 major organizations across the United States. So this got a lot of media attention, some of it's featured up here. So I'll skip through some of these to the most interesting parts, but one of the key points is that the government has a role to play in the health and wellness, in the Constitution it says that the role of the government is to provide for the welfare of the American people. And so throughout history we've seen, we've heard lots of examples of when government chooses to step in and when they choose to not step in and sometimes when they choose to prevent these changes. And so the very first time that this happened was in 1798 when we had our first version of a nationalized health service providing for sailors on the eastern seaboard who were basically ferrying goods between the different colonies. And so here there was a strong economic incentive for the government to intercede. Some of you may know that for a very brief period in history we actually had a federal agency, the Freedmen's Bureau, whose purpose was to primarily provide for the health, welfare, housing, and social needs of newly freed black slaves. There also was a role for it for poor white farmers in the south as well. The issue with this is that it was only in existence for seven years and of those seven years was only funded for about a year and a half. And so these arguments here were the arguments that the president had in his letter vetoing the reauthorization of funding for this. And so these arguments were the same exact arguments that I encountered from Republicans when we were trying to fund health and social services in 2022. And so you can see these are common patterns and as we try and advance health equity in this country the same arguments come up. And so throughout time and throughout this book I think it's highlighted in the talks we've heard today, the need for champions advocating to advance health equity. And so that's a role we can play, whether it's we educate our community members, our colleagues, the policy makers themselves, the importance of timing and seizing the political opportunity because you need a time when the voters and public opinion is there and the right elected officials are in place to put into place those policies. And to make sure importantly that those policies are implemented. Because if you have an administration that's unfriendly to policies, often they're not going to be implemented in a way that actually gets the intended outcome. So the importance of elections and participation in the political process. We can make sure that we ourselves vote and that our patients have the opportunity to register to vote. Framing arguments, we'll have one more slide on that and the importance of building coalitions. And so for an example, this was the coalition for the 9-8-8 initiatives that I led. So we not only had basically every organization in the mental health space including the APA but also major medical organizations like the AMA and all the other specialty societies. The National Association of Counties representing the 3,000 plus counties in the United States. The National Criminal Justice Association representing the major judges associations and public defenders and prosecutors. We have law enforcement groups, religious groups, the National Education Association. So this was really a large coalition that was not limited to just the mental health space. Looking throughout history, these arguments are the only ones that have been successful in advancing health equity legislation. And importantly, that number one, the moral argument, has never been successful on its own in sustained efforts. And so that one is paired with the idea that this new policy will have improved outcomes or performance. It's often paired with an economics cost savings argument, the idea if we do it better, it will be cheaper. And so the Affordable Care Act is a great example of this. Also at times the national security argument. And so one of the earlier slides I skipped through, but in 1946, the period of World War II, the Army released a report to Congress saying there were not enough able-bodied men to enlist and one of the big reasons for that was because of mental illness. And so Congress responded to this, passing the first ever federal legislation in this country for mental health, which created what became the NIMH and later also gave rise to SAMHSA. But really that stemmed from this argument here. And so in conclusion, kind of wrapping up what we've been talking about, I think it's important that we think about the ways that we can look for these windows of opportunity that we can act as psychiatrists, whether we're in D.C. or in the communities across the country that we live and work in. So thanks for coming. Thank you. We're plugging it, you know, not because Michael and I make a tiny bit of royalties. I actually purchased a few photographs for one of the chapters, so I'll definitely be in the red. When you're in debt, it's in the red, right? I'll be in the red. But you know, we plug it because I think we're really proud of this book. I mean, it really tells some great stories, and it's very readable, but also makes rigorous arguments. So I'm probably more proud of this book than any other book I've been involved with. I think, you know, one theme is, and please, if anyone has any questions or comments, stand up and interrupt me, but I think one thing in editing this book and really thinking about how all these laws came to be, I realized, and Eric sort of touched upon this, that nothing ever changes in the United States. You know, it's always the same themes and the same barriers and the same groups of people blocking progress, but also at the same time, we somehow do make progress. Like these laws represent massive progress, and there's been some other recent laws, you know, during this administration, such as the Inflation Reduction Act that I think also represent great progress, but there's always threats, so we always have to fight. For instance, we're maybe going to default on our debt, who knows, and the deal might actually tie work requirements to SNAP, which would be actually, would undermine the SNAP program massively. So I hope that's not the deal that gets made, but it might be. So I think it's, there's always work to be done. Any other comments from the panel? Oh, we have a question, good. Hi, this is more of a comment than a question, I guess. I just, you're talking about the things that psychiatrists can do to kind of help make change. So I'm with UC Davis. I'm also with Students with Psychosis, but I work on the EpiCal Project with the California Early Psychosis Network, and I have lived experience with psychosis myself. Your presentation really resonated with me, because as someone living with psychosis, I am able to work, obviously I work with UC Davis, but there was a point in time where my symptoms were so severe that I was only working part-time, yet I made too much money for public housing, I made too much money for SNAP, and so it was a great struggle, and it really significantly worsened my symptoms, significantly worsened my depression. The one thing that I'd really like to see psychiatrists do is help raise the voices of people with lived experience, because we were talking about this, I'm on the lived experience integration team at UC Davis, and we were talking about this recently, when providers speak, when family members speak, people listen, people think, oh, this is so great, this is so nice, but when people with lived experience, especially with psychosis, speak up, when we try and talk, when we yell, we're considered crazy. We're the ones who are overreacting, so that is something that I would really like to see more psychiatrists do, is help support and lift the voices of lived experience, and I guess my question would be, I guess, how can we do that? Thank you for your comment, and I really appreciate the work you're doing, and bringing your own experience to that, and I think, I couldn't agree more, you know, with housing, I think I'm not deeply involved in sort of the grassroots housing advocacy here, but I have been involved in it to varying degrees, and in conversations over the years, and when it comes to housing policy, I think the lived experience of people who have struggled with housing, with homelessness, is incredibly important, and a lot of the most powerful coalitions in San Francisco really draw on that, so I think partnership, really, you know, is looking for the people who, and a lot of times if you go to the organizations that are fighting, you're going to find those people involved in those organizations already, so it's really about just having the humility to like, go in as a partner, is sort of my sense of it, but I really appreciate your comment. Yeah, again, thank you for your work. I think it needs to be reframed a little bit, you know, when one person speaks, it can be easily dismissed, and, you know, a person can be made to sound crazy, but when you have many people who speak, you know, I think it's different, and I think we've seen, you know, the emergence of the peer movement, you know, I don't know if, you know, people with lived experience need psychiatrists to make space. I think what's happened is people with lived experience have taken the space that's rightfully theirs, right? I mean, like, the degree to which you can exert influence politically is the degree to which people take it, you know, and I don't think people need to be polite about it, you know, I think it's just pushing. Can I say one, just mention an approach that we used when we were doing interprofessional approaches to more integrated care through community engagement and focusing on social determinants of health. We built the curriculum in such a way that we had seven different health professions with the first year and the professional part students involved, so it was 575 students at the university across seven different health professions, and there were 16 faculty involved and those faculty each had four teams of interprofessional students, and I made sure that my team had someone with lived experience as one of the faculty members who was on our team. That meant that she was there for all the faculty meetings on a weekly basis for years as we were reviewing, developing, implementing the curriculum, but was also there as a member of the team when we were in the simulation center working with the interprofessional students, so it's just, I think, to some degree being intentional about when you've got an opportunity to do X, make sure that you're bringing along someone with lived experience as part of that initiative. Thank you. Oh, there's, apparently there's online, this is the first time the APA has done this as far as I know, there's online comments from people who are virtually participating, and Dr. Sunny Aslam says, I hope more people in mental health will run for public office. I learned so much about how public health and local public services are provided and who speak with, to get things done. We had a small group of dedicated volunteers bringing the message of public health and fighting poverty in a very poor area, yeah, so that's one of the many ways, you know, people can run for office, but I don't think I'll be doing that, but, you know, some people can and will. I think we're out of time. I think we're out of time. Yeah. Thank you, everyone, for participating.

mental health

federal legislation

social policies

Mark Manso

Michael Compton

Agricultural Adjustment Act

National Labor Relations Act

Housing and Urban Development Act

social determinants

health equity

policy advocacy

lived experiences