DAVID FEINBERG: Hi, everyone.
David Feinberg here.
Really, really excited to spend some time with Dr. Barbara Van
Dahlen to talk about mental health,
to talk about mental health and COVID,
to talk about what we can do to help our veterans.
Barbara has had, I think, a pretty impactful one-woman
force on really improving the lives of folks with mental
illness, depression, anxiety--
a host of things-- post-traumatic stress disorder.
So Barbara, why don't we start by you introducing yourself
and then we can just get into a casual conversation.
BARBARA VAN DAHLEN: Sure.
Well, thank you, David.
It's really a delight to meet you
and to have this opportunity.
So I'm Barbara Van Dahlen.
I'm a clinical psychologist, and I
am the executive director for the PREVENTS task force office.
And PREVENTS stands for the President's Roadmap
to Empower Veterans and End the National Tragedy of Suicide.
That's the PREVENTS, and it took me a while
to be able to do that without having to think about it.
That's what PREVENTS stands for.
I know we'll talk about that and what came before and after,
but that is the office that I now hold.
DAVID FEINBERG: It breaks my heart
as somebody trained in psychiatry,
who spent a lot of my time at the VA in my training.
You get to know veterans.
You get to know the VA system, which I'm a big fan of.
But the suffering and the access and the aloneness and the shame
are such big, powerful things that I
think drag veterans to feel like they don't have a place
to reach out.
So this program, can you tell me more about it,
what it's supposed to do, how you're measuring,
and actually how we can help?
BARBARA VAN DAHLEN: Sure.
When I got a call literally May last year
asking whether I would step into this role
to be the executive director-- and I was incredibly honored
and also trying to get my bearings.
And I read the executive order.
I was very impressed with the vision.
And my first thought was, and my first request,
was if we're going to do this, if we're
going to try to end veteran suicide, the only way we
can do that is to tackle suicide more broadly in our nation.
And so this effort is intentionally aspirational.
It is intentionally focused on public health,
and we can talk a little bit about what
that means in particular.
But I think folks will understand,
once we talk about a few examples of what that means,
there is a focus on research, gathering information,
but not for research's sake.
It's really about, how do we break down silos
so that we learn what is working for what kind of individual?
We focus on a lot of high-risk groups,
not only our veterans but other communities
that are at high risk for suicide.
And there's a lot of focus on developing, sharing,
implementing programs at the community level
because that's where the magic happens.
Last thing I'll say is, that's what was happening until,
oh, two months ago.
And then when COVID hit, we've continued to focus on that,
but we've also pivoted to really focus on very serious concerns
that many of us have around the impact of the COVID crisis
on mental health in general.
DAVID FEINBERG: So talk about the public health piece
that you mentioned.
And I think you could talk about that pre-COVID
and now COVID because it fits for both.
BARBARA VAN DAHLEN: Absolutely.
So a public health approach really
is an approach that focuses on everyone.
So we want to reach everyone with basic information.
So if we think about what we've done
in some of our other public health, public safety
kinds of efforts, like friends don't let friends drive drunk.
Everybody has learned before COVID
to cough into their sleeve, into their elbow.
That message was for everyone.
So public health has a basic message for everyone.
And then there are certain individuals in our society
who are at higher risk because they have risk factors.
And so there's a more targeted approach
to that group of individuals.
I'll use myself as an example.
I know that I'm at risk for heart disease.
My father died of heart disease, both of my brothers
have had heart attacks.
So because I know, I've gotten the information
about what to do because I'm at high risk, that's
one of those targeted efforts of information
that goes to people like me around heart disease.
And then public health, also, we think about it like a triangle.
At the top is everybody, in the middle
are people who are at high risk, and at the very tip
are the people who are at very, very, very high need--
people who have severe mental illness, people
who have other very high risk factors,
people who have attempted suicide before.
So we then go after those folks to reach them, outreach, wrap
around them.
That's public health.
So it's about early prevention, early identification,
early intervention, targeted for folks in need,
and very, very intensely and intentionally targeted
to people who we know are at the highest risk category.
DAVID FEINBERG: Can we talk about access for those folks
in the VA system?
And I love your perspective because you
talk a lot about beyond the VA.
But even access for mental health in general,
can you talk about access and how you think about it?
BARBARA VAN DAHLEN: No, no.
That's a great point, David.
And that's actually some of the work
that we're doing as part of PREVENTS.
And one of the things that we did as soon as COVID--
as soon as it was clear that COVID was as huge, as massive--
and I think even when we started this messaging campaign
on March 27 called, More Than Ever Before, even then we
had really not yet completely understood how big,
how massive this crisis is and the long-term impact.
But on the 27th of March, we launched #MoreThanEverBefore--
to your point, a messaging campaign
that really is encouraging every American
to pay attention to their emotional health
and well-being.
More than ever before, we need to do that every day.
And we need to look out for our loved ones every day,
and we need to reach out to those who
are struggling in our network.
So we launched that.
We've got some great ambassadors who are helping.
And the reason we did that is because we knew, to your point,
that access to care was going to be
a huge issue because our mental health delivery system
has been disrupted.
So inside the VA, the VA has done
a very good job of switching a lot of their delivery
to telehealth.
So just as you and I are working together right now,
we know, thank goodness, over the last many years,
that telehealth is a very effective way
to deliver mental health services, so counseling
sessions.
And there are some other non-VA entities out there
who are delivering care, whether it's by text,
whether it's telehealth.
But we knew that the system was going to be disrupted.
Not all mental health professionals
who saw clients in communities were telehealth ready.
And so the message with MoreThanEverBefore was--
there were many different layers to it.
But one is, we really can't solve this,
this need to care for our mental health and the mental health
of those we love, by waiting to see professionals.
There aren't enough of us-- you, me, and all of us--
nor do we necessarily need every individual
who is struggling to see someone like us.
So what we're working on is trying
to ensure that we move everything back up,
we back it up so that we are talking.
It's so good to hear that people are-- the 94%
rate of completing the screeners, the activity
that you're seeing on YouTube.
We're seeing it too.
So what we're trying to do is continue to educate people.
We're trying to develop and point them toward other tools,
whether they're self-help, whether they're peer support.
And there'll be more coming through PREVENTS and toher
initiatives that we're working with over the next months
and years, frankly.
Because then, that means that the people who are really
struggling, the people who, like my mother,
who suffered from schizophrenia her entire life and didn't get
help because she fell through the cracks--
we want to make sure that the people like us who
are the trained folks can be there to serve
those who are most in need.
We're not there yet.
But this is where we're heading.
And the more that people do what you are offering--
the screening, the sharing, the talking to each other--
the more we will ensure that people get the kind of care
and support they need early to prevent
that serious deterioration that ultimately,
sadly, sometimes leads to a death of despair,
whether it's substance abuse, opioid death, or suicide.
DAVID FEINBERG: I think it's great that, to me--
and I don't mean to minimize the suffering
that the world's going through right now, as we all
seem to be sharing this virus.
But the silver lining is people talking about mental health.
It's like, we've got to capture this opportunity
to make sure that we prevent things,
that we screen those right folks,
and we get the right folks to treat them.
BARBARA VAN DAHLEN: Agree, and I feel the same way
that I feel this tremendous sense of urgency.
I'm very concerned about our at-risk populations--
veterans, other people who are marginalized already.
But then there's this other interesting phenomenon,
and we're leveraging it as much as we can, which is now,
for the first time, maybe, there's
a huge chunk of our nation, and frankly,
the world, that can relate to anxiety in a way they never
could before.
And so it's opened up some hearts and minds.
One place that we're seeing it that I'm really
excited about and grateful is in our corporate partners
and the corporate sector.
Employees going back to work, the leaders in corporations
are recognizing, wow, we have to address this.
We have to look at this and respond to the emotional health
and well-being in a new and different way.
And so I completely agree.
And one of the things that we're doing during Mental Health
Awareness Month through our MoreThanEverBefore campaign
is that we're asking all Americans to join the challenge
and to share, what do you do to take
care of your emotional health and well-being.
And we've gotten some great responses from people,
because what we're trying to demonstrate,
it isn't just one thing.
And the goal is for people to learn what it is for you,
so learn the signs that you're struggling,
know your risk factors, and know what works for you so that you
can then engage in that behavior, that activity
before you end up either behaving
in a way that makes you very upset,
causing damage to a relationship.
So we're seeing, as you said--
and I'm so grateful to work with Google on this effort
because I agree with you.
This is massive, and we have to pull together and focus
on this.
DAVID FEINBERG: One thing that helps
decrease my anxiety is connecting
with like-minded folks.
So this has been therapeutic for me.
I just want to thanks for what you're doing,
and I look forward to continuing this discussion.
BARBARA VAN DAHLEN: Thank you, David.