Podcast Episode 5: Sagar Parikh and Stan Kutcher Interview Part 2
In this episode, Dr. Sagar Parikh interviews Canadian Senator Stan Kutcher on his journey in becoming a psychiatrist, getting involved in teen mental health, and discussions on how the school system can take part in providing mental health care.
Dr. Wegdan Rashad: Hello and welcome! You are listening to the CAN-BIND podcast and I am your host, Dr. Wegdan Rashad. This is our 5th podcast episode and part 2 of a riveting interview between Dr. Sagar Parikh and Canadian Senator Stan Kutcher. Did you get to listen to part 1? There we talked about Stan Kutcher’s career as a psychiatrist and teen mental health specialist and then Senator. Also, we explored how the school system can contribute mental health care delivery. In this episode, Dr Parikh and Dr Kutcher discuss the social determinants in depression care, the role of policy in enhancing teen mental health, technology and finally, some tips for parents and teens. Happy listening!
What is the role for policy to enhance teen mental health?
Dr. Sagar Parikh: You started on a journey of personal encounters and hearing the life story of many individuals who had more serious disorders and you could trace some of their troubles perhaps as adults, maybe even as geriatric individuals to difficulties they faced as teens. You trained in Child Psychiatry. You worked with teenagers and then you worked in schools. So you’ve gone along this road from the individual to the school and now you’re in government. What is the role for government? What is the role for policies as a nation to enhance adolescent or teen mental health or proper growth for the teenage brain?
Dr. Stan Kutcher: Well, I think that therein lies the rub. And because the path to doing what I might think is the right thing is a challenging path, I think that government has the capacity should it choose to do so. Big issue. Because government isn’t a monopoly. It’s made up of thousands of moving pieces, some of which are constantly colliding with each other, right? So you talked about the art and the science of Medicine. Well, parliamentary work is an art to try to get consensus, to build consensus to do something positive. So I think that it comes from, my perspective is: How can we work to create a society in which we substantively address the social determinants of health, in which we as a society choose to use our wealth and our ability to distribute that wealth equitably to improve what we call the social determinants? So that we work assiduously to ensure that at least everybody has a similar opportunity so that we don’t ignore the most marginalized and invest in the wealthiest which we’ve been doing for a long time.
For our first task, is to really do something about social determinants. Now in Canada, we have begun though there were nascent discussions of this earlier a policy model called basic income, guaranteed annual income which is a construct, it actually has some interesting evidence behind it, that would level more or less, there’s never perfect, but better level the playing field for everyone. And I think if we don’t start there, that’s not going to solve all the problems of the mental illnesses, but if we don’t start there, we’re never going to play, we’re going to be constantly playing catch-up. Because if you live, if you’re a person who is negatively impacted by the determinants of your life, you will never get the same quality of care, you will never get access to the care, you will never get to a job that you need to do. You will be constantly put into a system which has structural inequalities in it. That I think we have to deal with first.
Considering social determinants in depression care
Sagar: Right. But you know, one of our program foci within our CAN-BIND Research Program is depression. And we mainly work on trying to identify, prevent and treat adult depression. We have some initiatives which are at an early stage in terms of identifying and working with and understanding depression when it comes up earlier in life, particularly in the teenage years. So from that perspective when you try to tie social determinants into the onset or the recurrence of depression, are there some key lessons?
Stan: Well, I think a couple of things really stand out. We know that social circumstance — Depression, as you and I both know as a major depressive disorder, okay, has a genetic component and a non-genetic component, right? And the genetic component is not the majority of the components.
So where do the other components come from? And a lot of them come from the social determinant components. So if we want to do prevention, I think that we need to start at that level. That being said, I think there is more nuance than finer directions that we can go. So there are things that we can — And again we’re coming back to the school systems or families or through primary health care. My gosh, we have to change how primary health care is delivered because most people interface with primary health care as their point of contact to the health system yet it is woefully inadequate for dealing with people’s mental health and mental illness. So enhancing the capacity for people to touch pediatricians — Look, you and I both know Myrna Weissman’s work still holds that if you take a cohort of girls whose mothers had a major depressive disorder, 40%, that’s four out of every 10 of those kids, is going to develop a major depressive disorder by the time they’re 25. And yet how many family doctors or how many pediatricians who are working with those kids are actually putting into place potential preventive interventions or at least following them closely and saying “if this and this happens, you come for treatment immediately”? It’s not that we don’t know.
Technology and public health interventions
Sagar: Yes. So you’re speaking again from a very broad public health perspective. You know, what do we know about when problems arise? How can we identify people who may be at risk? And then how can we intervene? A lot of your comments and mine too are in the words of, you know, so 20th century. But we are in the 21st century and we have the internet, we have apps, we have telepsychiatry, and all that. Can we have public health interventions that are delivered or somehow facilitated by the use of technology that can help our teenagers? Or are we just in TikTok trouble?
Stan: The question is yes and maybe and maybe not and who knows because the research that will tell us that this intervention has this impact on this group of kids is not there. And you and I both know that the apps are a Wild, Wild West of marketing nonsense. How many apps are there for depression? Last time I looked, there were over 800. How many of them actually have substantive evidence that they would either prevent, modify the course of or treat? Zero. Okay. So I think our big — All that is shiny and new is not necessarily helpful. But in that shiny and new, there may be things that are helpful. So I think that one of the things that really, really challenges us now is to be able to look at this whole new, lots and lots of new stuff and say, “what is it that this can help with? Or what is it that this can have a negative impact on?” Because we haven’t even considered that. So we’re still in very, very early stages of a brand new world but I think the way that we have to approach this world is through solid research asking difficult questions and not having the market drive our responses to what we’re doing.
Sagar: So you’ve raised some question of both potential benefits from new technologies but also potential harms. Are there any particular harms? Or, you know, the amount of time that people spend on the internet or the way they engage with shooter games or something like that, are there any particular trends or habits, you know, based on internet or computer-based interactions that really worry you as far as teenagers go?
Stan: I’m very aware of the construct of moral panic.
Sagar: Tell us about that.
Stan: Well, you know what, something is new and we figure it’s going to be bad and therefore we panic. It’s the Chicken Little thing. You know, I look back, comic books were going to destroy the entire health and well-being of all kids who read comic books but they didn’t do that. Okay. Same with video games. They actually haven’t done that. So same with spending time on the internet, it’s (0:40:43). Now, within that, the question is: Are there vulnerable groups that actually this kind of interactions might not be very helpful for? So we know that kids that spend more than six hours a day on their devices at the expense of family relationships and other social relationships who may also have the propensity for a mental disorder, they may do worse than kids who aren’t that. But it’s that kind of nuanced understanding that we have to get to and not just a couple of studies which followed a cohort for kids or did a cross-sectional analysis of 240 wealthy college freshmen. I mean, that’s the kind of stuff we’re getting now and it’s just bad research. So we need to have a very much more nuanced approach to this, a better understanding driven by a need to understand and not a need to define, finding data that will teach us instead of justify a position that we already have. In the early days of the research on video games, I could tell what the conclusion of the article was by reading the authors’ list. We want to get away from that.
Where should the government invest for teen mental health?
Sagar: Okay. So you know, here we are. We’re thinking about this from a public health perspective. You have an additional view based on your broad international experience in terms of policy and how governments react and so on. When you think about helping teenagers, in an ideal world, should the government be really fostering much more research in the technology-based approaches as it applies particularly to teens? Should it be investing much more in schools and more traditional face-to-face encounters but perhaps delivered at schools? Because you know, governments are always having to choose with limited resources where to invest. So here’s a choice. Technology or schools? What do you say?
Stan: It’s a false dichotomy to put those things together as being one or the other because they’re not one or the other. Yes, governments have an option to choose but they have an option to choose that we invest in a nuclear bomb or do we invest in a warship or do we invest in kids. There is a whole plethora of choices that governments make. Governments can choose to increase taxation on the wealthy if they choose to do so. You know, there are all these different kinds of choices that governments can make. And so I think it doesn’t help us to say, well, government is going to choose one or government is going to choose the other. So the way that I would look at this is in a more wholesome perspective and say that the growth and development of young people is fundamental, should be a fundamental focus for all governments. How can we assist young people to grow and develop to be the optimal human being that they are? Not the kind of person that the government wants them to be. I mean, we’ve seen that already.
Stan: And it does not work out very well. Okay. So the difficulty here is: How do you invest in the structures that will assist young people to do that? So there are a number of structures that we can assist with. One is in the family itself. And that’s where the social determinants come into play. So if you’re a single parent and you got three kids and you’d have to hold four jobs to keep the family together, that’s not going to help optimize their outcomes. If we have school settings in Canada and in the United States, you and I both know that one school is not the same as another school and that the resources available for kids in school A are completely different than those that are available in school B. So the importance of investing in those social structures that we have created, okay, that actually will level the playing field. But also, here I think what’s important is that we have to modify the social structures so that they actually keep up with society. And maybe people who are going to listen to this are going to get pissed off. What are they going to say next? But the basic structure of the school system has not really changed since the 1800s when Egerton Ryerson set it up. The framework of the system is the same. It’s time for a change.
What government policies can do to help teen mental health- International experiences?
Sagar: Okay. Fair enough. And many of your comments about the social determinants really would address issues of helping prevent disorders by strengthening the growth and development of individuals. But let’s move it a little bit now to people who actually have disorders and think about you know — Are there model programs? Are there examples from your travels around the world where you’ve seen really innovative clinical services whether they’re delivered in schools or — But really, I’m speaking to what government policies can do to help teen mental health? Do you have a couple of examples from around the world?
Stan: Well, one of the things that I have been sadly disappointed by is that oftentimes examples tend to be one-offs. It might work in a particular setting. But are they scalable? And examples I think need to be embedded into this institutional and social structures of the society for them to be able to persist. And I have seen this over and over and over again in my works in low-income countries. Great idea. Rolled into place. It works. Funding ends. Program gone. All right. So I’ve learned that if it’s not embedded into the structural components of a healthcare system or the education system, whatever the intervention is it’s not going to last when the money runs out. So I look at it in a slightly different way. And I say given that we have this particular structure, what can we embed into the structure given what we know might work? And let’s work at embedding it into the structure instead of setting up another silo and let’s see if the silo helps. So I’m really anti-silo and I’m pro-integration. And from where my money is, it’s that the integration has to happen at the primary care level. Because everybody has primary health care but we don’t have really good primary health care. And that provides the institutional and operational framework to put this stuff in.
Tips for parents and teens to improve mental health
Sagar: So if I can summarize in a different way, this is an important message for the two different silos of government and academia. Academia may create model programs which then are not sustained. And government needs to work in partnership and academia needs to be receptive to doing the work of transforming whatever may be a model program into something that’s sustainable. In the final few minutes, I want to return back to your roots and everybody’s roots and come back to the individual person. I’ve got a couple of teenagers. I know you’ve had teenagers. What are some tips? What are some tips that you could provide to teenagers? What can they do to improve their mental health whether it’s preventative or if it’s dealing with stress? What are some tips you could provide either the teenagers or the parents to tell their teenagers to improve their mental health?
Stan: Well, the first thing that I would do and I would focus on parents and I would just be really clear and honest that there is no manual that comes with any child.
Stan: Maybe it’s a great thing. And that being a parent and it doesn’t matter how old your child is but being a parent is really tough. And that anybody who’s a parent who’s had more than one child realizes that you don’t parent each child the same. So it’s figuring out — Being a parent is really tough. It’s figuring out how your parenting style. And if you’re lucky enough to have a parenting partner, how that — And it could be a spouse. It could be your partner. It could be a grandparent. It could be an aunt and uncle, whatever. A parent has some of these as a parenting partner. How to work together with a parenting partner to be able to (A) understand the child and meet the needs of the child while at the same time letting a child fail which is one of the hardest things you can do as a parent because you want to protect them, right?
And letting them fail and then helping them learn from their failures because you’re not going to always be there as the parent that gets in the way to solve the problem. Your kids are going to have to solve it themselves and there will be anguish and tears and weeping and wailing and gnashing of teeth as they go through the failures because that’s how they learn. And I think that’s one of the most difficult things for parents. So part of being a parent is realizing that the fit with your child is important, understanding where the boundaries are to allow them to fail successfully and not to try to get in the way to prevent that successful failure but at the same time being very aware that if they’re failing unsuccessfully, you’re going to have to move in and you’re going to have to do something to try to assist them. It’s so, so complex. And as for kids, you know, find out who you are. Don’t be afraid to fail. Don’t think that who you are is determined by the people you are with all the time. Learn to trust yourselves. And think of life as a journey that you don’t know where the destination is but allow yourself the opportunity to learn the skills that you’re going to need that wherever that journey takes you, you can use those skills. So it’s very general but you can’t get more specific than that.
Sagar: Senator Kutcher, that’s a marvelous thought to end on. And I hear an echo of something, that echo of that student who couldn’t quite complete his Ph.D. in History, who went on a journey and this journey took him to medical school, took him through exposure to individuals in distress and suddenly into Psychiatry and then into Psychopharmacology and then to the East Coast and the school system and the world and now, trying to finish that Ph.D. by making history as a senator. I see a journey there.
Stan: I see a psychotherapist talking to me.
Sagar: All right. Well, Dr. Kutcher, Senator Stan Kutcher, it’s been a real pleasure to go on this voyage with you. I think that parents, in particular, will enjoy your thoughtful comments and how to accept and facilitate the growth of their teenagers by tolerating their attempts to fly and flop and fail and then fly again. And also, to teenagers, you know, for your advice to them to keep on trying. It’s really been quite a journey on this podcast. And on behalf of CAN-BIND, we really wish to thank you for spending the time with us and for all you do for mental health and for teenagers. Thank you.
Stan: Well, thank you very much for the opportunity and the best of the upcoming season to you and yours. Stay safe. Have fun.
Wegdan: And that concludes today’s episode and part 2 of our interview with Senator Stan Kutcher. If you have any comments or reflections on any of the topics discussed today, feel free to reach out to us at firstname.lastname@example.org or tag us on Twitter…our Twitter handle is, “The CANBIND Program”. Thanks for listening and we hope to see you next episode on yet another riveting discussion in the realm of mental health and depression research! Until next time, goodbye.