Dr. Ken Duckworth of NAMI Says Mental Health Experts Are All Around Us

[00:00:00] Speaker A: A note to our listeners. This episode contains discussions about suicide from Children’s center in Vancouver, Washington. This is Hope and Healing. I’m Matthew Bude, Executive Director of Children’s center and your host.

We make this podcast in order to bring you hopeful stories and to introduce you to people who inspire hope.

They’ve inspired a lot of hope in me and among people here at Children’s center, and I hope you feel the same.

My guest on this episode believes that everyone who has dealt with mental illness has the capacity to help others. It’s a message full of hope and healing.

Dr. Ken Duckworth is Chief Medical Officer for the national alliance on mental Illness, or NAMI.

He’s been with the organization since 2003.

He is board certified in adult psychiatry as well as Child and Adolescent psychiatry, and he’s an Assistant professor of Psychiatry at Harvard University. Ken is also the author of NAMI’s first book, You Are not the NAMI Guide to Navigating Mental Health. With advice from experts and wisdom from real people and families.

He interviewed well over 100 everyday people who live with mental health conditions with the idea that expertise can come from a lot of places.

From academic study, sure, but it can also come from lived experience.

If you have dealt with mental illness, you have expertise, and that expertise can help people, just as you can be helped by the expertise of others.

Ken uses real first and last names in the book in part to demonstrate that these are real human beings willing to go on the record to help their fellow human beings. You Are Not Alone has become a bestseller and it’s really an inspiration.

People talking to people openly about mental health can be a hopeful and healing experience.

Dr. Ken Duckworth, welcome to Hope and Healing.

[00:02:06] Speaker B: Thank you so much, Matthew. It’s great to be here.

[00:02:08] Speaker A: And I’m here with my British cup of tea.

No surprise there. How about you? What are you drinking?

[00:02:16] Speaker B: You know, it’s 78 degrees on Cape Cod today, so I’m going with a lemonade.

[00:02:20] Speaker A: Oh, that sounds good. One of the things, well, many things have struck me in this, but one of the things that’s jumped out as I read your book is that you talk to a lot of people living with mental health conditions. In thanking them, you make this statement.

To be so open and so generous in sharing your experience is a game changing, shame reduction way of living.

And I wonder if you could talk more about that. How is being open? How is openness a game changing and shame reducing way of living?

[00:02:53] Speaker B: I’ve gotten very interested in this idea of people who want to Take their pain and turn it into purpose.

And of course, virtually every book ever written by a mental health professional anonymizes every person in the book. And, of course, it did occur to me, with some anxiety, as I was, you know, putting the final touches on it, that I had flipped that on its head and that I feel that I’ve met hundreds and hundreds of people who want to share what they’ve been through, to have another person feel less alone.

So, to me, I lived in a time, the 60s, 70s, and the 80s. My father’s bipolar disorder was known only to those of us in the family. And the societal pressures were so strong that none of us could talk about it, even among ourselves.

So the idea that there’s someone in this book, like Josh Santana, who has bipolar disorder, who’s found that a dog regulates his schedule, who found that music is soothing to him, hey, that’s just like me. Or in my case, that’s just like my dad. So you feel less isolated. Isolation is rough on people, both for your mental health and for your perception that you’re not part of something that is impacting tens of millions of people.

I also interviewed family members because I feel like their voices are really important too. You know, how do you learn to love somebody and talk about what you’re dealing with with somebody who’s hearing voices all the time? What do you do when the professionals have blamed you? How do you handle that? So I was very interested in this, I think, untapped idea, Matthew, of if you’ve lived with something, you’ve learned something. And that’s very.

Not part of the professional culture.

Right. But I feel like I did the full professional Monty, as you noted. Right.

To use a British term of art, I did the full professional Monty. Professional went to Harvard, trained in psychiatry, child psychiatry, adult psychiatry, forensic psychiatry.

And I always was impressed that those randomized control trials were valuable.

But there were real wisdom and actual people that I had taken care of as a doctor. And I think because of my own experience, having a loving person with a very bad illness in my own life, realized that there was some wisdom that even I had picked up through that. How do you maintain a loving relationship with somebody who’s unable to talk about a devastating illness? I’m not sure, but I figured that out. We managed to negotiate a very loving relationship in spite of the fact that we didn’t line up on this piece at all. So that was a kind of lesson for me. So the book is an attempt to integrate regulars, people’s experience while not tossing away randomized controlled trials and research. I like those things.

But there is a need, I think, to pull those ideas together when you’re.

[00:05:59] Speaker A: Inviting folks to share their stories. Given the societal pressures that still seem to exist to some extent around keep this secret. You make this statement in the book, we quote someone saying that if you go into inpatient psychiatric treatment, then keep it secret. Don’t tell anyone. So there’s still this pressure. How did you find inviting these participants into the conversation, into the book?

What did it do for them?

[00:06:25] Speaker B: I want to say I like privacy. Some people don’t want to disclose their story. I’m all for that.

But being the doctor for the national alliance on Mental Illness, I’ve literally met hundreds of people who take pride and pleasure in becoming a kind of expert to other people. Why? I went through that whole misdiagnosis thing too. I was told I’d never get better, too.

I was told this medicine couldn’t help me. I was told I was not a candidate for psychotherapy. Whatever people were told. The idea is you can be a guide for another person. That’s quite empowering.

So how I did it is I’d be giving talks to NAMI groups. I gave a talk to NAMI Wisconsin. I say, hey, by the way, I’m writing NAMI’s first book. NAMI will get the copyright. All the royalties will come to nami. It’s a love gift from me to this organization that has been so fabulous for me to work for.

And if you want to be in the book, you’re going to have to use your name.

So I want you to think about it and I want you to talk about it with your family over the dinner table.

Anybody who’s mentioned in the book, like, people are going to know that it’s you. And you can’t rely on me to change your identity and your make you anonymous. So I only stopped at 130 people, Matthew, because I ran out of time. I was on a deadline. So then I’m on the book tour and people say, hey, wait a minute, I want to be in your next book. You don’t have anybody from the Cherokee Nation. And I think that’s an important story to tell. This is the kind of feedback that I’m getting. So I have a whole folder of people who want to be in the possibly, who knows, next book.

[00:08:09] Speaker A: Sounds like many books, Ken, maybe. I think you may have many volumes.

[00:08:13] Speaker B: Coming if you’re interested in learning from real people. I was never taught once how a dog could help somebody, how a Service dog could be helpful for a trauma survivor. I wasn’t taught much about becoming a peer and how becoming a peer is a kind of mastery of the experience you’ve been through while also providing service.

I was really not fully equipped to, you know, teach people all these things as a. Just as a trained psychiatrist, you have to listen to actual people. How did you negotiate your relationship?

I had a man tell me. With schizoaffective disorder, the father took a NAMI course called Family to Family.

The father learned to let go. He was hovering all over his son all the time. Son is now 30. He’s hovering over him every single. Patrick, what are you doing? Patrick, how are you going? What’s going on today? Did you take your meds? Patrick and George took the class. The father and he said, I learned I really had to let go.

And that was painful and difficult and challenging.

Patrick, who’s also quoted in the book, every quote went to every person, and I said, are you okay with this quote from your name? Because I interviewed people for an hour and a half, and I’d listen. That’s a lesson that could help another person. So basically, Patrick experiences George’s letting go as following.

Do you know how when two people are drowning and the one person’s making it worse for you? My father made the decision to get back in the boat and let me swim.

Well, there it is.

So that’s a man with schizoaffective disorder, addiction, all kinds of vulnerability.

To me, that’s a lesson in how you communicate. So to me, I was never taught anything about this in my training other than what I would say in a family therapy session. Right. How do people actually work these problems? So the book was a joy to work on.

I ate, slept, and dreamt about the book. I worked on nothing else for a whole year. I did nothing but the book.

And people would, you know, just keep coming to me, hey, here. Now that I would get here. I hear you’re writing a book. I want my story in the book.

Like, this is fantastic. It was an unusual project, Matthew.

I think I was well positioned to do this kind of work based on my own experience.

You know, first as a family member, and then I did the full Monty in the training. And I just noticed that there was a gap in what we learned.

[00:10:53] Speaker A: One, it seems that there are. There are a few places where you have the voices of everyone in this area. Those that living with mental health issues, their family members, professionals, researchers. I mean, you have to have the whole range together, which I think Is a gift there for anyone that’s willing to know.

[00:11:12] Speaker B: I don’t think any one person has the answers currently. The state of biological brain understanding is not. It’s just not enough.

So you live with these conditions, which are syndromal descriptions. This sounds like a bunch of other people that have a thing we call bipolar disorder. We don’t know the cause of it. We don’t know how lithium works. We don’t know how the other medicines work. Okay, you’re in this giant bin of millions of people.

How are they coping? What are they learning? What are the patterns that they’re recognizing?

So to me, it was a very fun project because this has been my.

[00:11:47] Speaker A: Core interest given people willing to open, willing to share their stories, those in the book and those that would like to do so in the next five books.

What about folks who are hesitant to tell their story? What would you say to them?

Would you encourage that?

They’re still feeling that societal pressure to hold back, but clearly there’s some benefit to being more open about it. What would you say to them?

[00:12:14] Speaker B: When you’re in that place where you can be open about it, you can feel that your full self is engaged in the conversation or the world around you. But I don’t encourage people who work in work cultures that are unhelpful to go in and say, hey, I’m living with addiction and bipolar disorder.

You have to assess the culture. And I don’t think in every situation you want to lead with this.

You kind of have to pick your spots. Somebody at work says, you know, how was your weekend? You don’t say, well, I really struggled because, you know, I’m living with schizoaffective disorder. Like, you know, I wouldn’t lead with that, but I respect people’s right to privacy. And I think this is important.

And this is more British, I think. Right. You just keep it to yourself and you mind your own business.

Right. I think there’s something positive about that, too. Some people develop chronic medical illnesses and share it. Some people don’t share that. They prefer not to have that involved in their conversation.

And so I’m very respectful of however people come down on it. I’ve just been impressed for the people who make the decision to go public with it or to tell their story, they seem to enjoy a certain piece about being who they are.

But that doesn’t mean that it’s for everyone, nor would I encourage people to go on Channel 5 and tell their story.

Right. I think everybody has to assess this for themselves.

I Will tell you, Matthew.

I naively wrote in 1986, When I was becoming a psychiatrist, I wrote the truth.

And this was not very welcome in the field of psychiatry.

So they said, why do you want to become a psychiatrist? Ridiculously, I told him the truth. My dad had bipolar disorder. He was a loving person. He’d periodically become very ill, psychotic. The police would come, he would disappear, nobody would talk about it.

Then he would reappear and take me to a Detroit Tigers baseball game, which I was happy to have him back. I didn’t want to talk about it. I wanted to have a normal dad. He didn’t want to talk about it for all kinds of shame reasons. It was state hospital for a long time. I wrote this essay. I went to the best psychiatry programs in America.

Everybody ignored this essay. They wanted to talk about my volunteer work or medical patients that I’d seen. I went to the University of Michigan. They wanted to talk about college football. How did they think the team was going to be? People were just ignoring my experience. I then went to a world famous hospital which shall remain nameless.

And I was told by was world famous psychoanalyst that this was a terrible reason to become a psychiatrist.

And I asked what a good reason to become a psychiatrist was. Now I’m 26 years old and I know no one. I know family members who are doctors. I got nothing. I just graduated from medical school. I’m graduating from medical school.

And he paused and he said, well, maybe if your father is a psychiatrist, that’s a good reason. That’s the reason I was not worrying about the workforce shortage that we face in mental health.

So I thought, this is over. I’m going to become a cardiologist. Those guys drive nicer cars. You can talk to people about their hearts. They all seem to have BMWs. They get paid more. Okay, fine. I’m going to let go of this whole dream. I’ve accumulated quarter million dollars of debt in medical school. So I’m going to be a doctor. I’m just clearly I’m not welcome in my own field.

The next day I had the last interview of the entire process. Matthew and I went to a place and this guy says, I read your essay. This is fantastic.

You understand things that no one else will understand.

I hope you allow yourself to enjoy the experience of this added knowledge you have.

I moved to Boston to train with this man and I’m still on the faculty of that facility because one person looked at my essay and said, hey, this is interesting, because nobody was doing that. So I’M sharing that experience because you’re asking the question, Matthew, you know, what about sharing or not sharing? I think many people chose to say the right answers, which is, I’m interested in neuroscience and how people tick and I naively told the truth. So this just may be my nature to be honest about what I’m going through. But I did find a place. And then in the national alliance on Mental Illness, I stumbled onto this organization where people want to talk about it, they want to help other people talk about it. They don’t think silence is particularly helpful.

[00:16:52] Speaker A: I’m curious if you were to apply for residency in psychiatry today. You wrote the same essay. I don’t think it would be received within the academic community.

[00:17:04] Speaker B: Now I think people would say, ken, that’s fantastic. You should probably connect with nami. So there was a period of time, Matthew, in the 90s when I was at the program that I’m still on the faculty of, that I was the specialist. I was like the left handed relief specialist. I don’t know if you have such a thing in cricket, but you know, you have a player that comes in to do one thing in baseball.

So they say, oh my gosh, this person, mom died by suicide. Ken, can you interview her? And I’d say, well, of course I’ll interview her. I’m interested in who this person is and what their motivation is. Can this brother, this, this applicant’s brother has schizophrenia, Ken, can you interview that person? So There was about 10 years that I was the specialist in self disclosure and applications.

Then I noticed a couple years later I’d gone to another job. I’m like, hey, I’m not getting any requests for interviews. And what I was told was, oh, Ken, anybody can take that on now. This is considered part of the human condition. And I thought, well, that was 20 years ago, Matthew. So in the 1990s though, it was, oh, Ken, you have to, you’re like our designated person who’s lived something. You’ve got to talk to this person. And I found those people to be fantastic. And they had the same grades and the same scores and they just had a slightly different orientation for what their motivation was. And of course they have to take care of themselves. They have to get psychotherapy and support.

I would have a few patients that would activate me in ways that I don’t think was happening to my peers. I knew that I would attend to that with my supervisors.

So it isn’t like I didn’t have a vulnerability in this regard. But I would now say, this is an ordinary human process.

This is a logical motivation for why you would seek a mental health career.

But there is more going on in neuroscience. There really is. And so that essay, which, when I was there, there was nothing going on in neuroscience. So I don’t know why people were buying that. But now, Matthew, there’s neuroscience. Extremely exciting genes and, you know, mental health conditions, the possibility of new drug models. I mean, like, there is actually a lot going on. So now if somebody wrote a neuroscience essay, I’d be interested in that, too.

[00:19:25] Speaker A: And the, the fact that he’s doing so well. This is the book people need. I mean, the title itself, I think so, so perfectly describes anyone living with mental health issues. The loneliness, isolation, and this reminder you are not alone. And all these voices in the book remind you that they. They’re in that same place. And, and, and that recovery is possible. And I think that’s interesting that you use that word frequently in the book.

Can you share a little bit? What does that mean in the context of mental illness? What does recovery mean?

[00:20:00] Speaker B: So this is a very personal thing, which is why I didn’t add my take on it too much.

But, you know, somebody would say, well, when I really accepted that I was hearing voices every day, I really accepted it. This is an interview I had with a man from Montana, lives with schizophrenia. Then I could realize that I have a great family, that my brother’s a high school football coach, and I have a game to go to every Friday night. I have a best friend. We go to these junk stores. He’s looking for certain memorabilia, and he’s a Meals on Wheels volunteer. And all these women are in love with him. Right?

But he says when you wake up and you’re fighting voices, once I realized that I was going to hear voices when I woke up the next day, he’s on the best medication. He’s got a great caregiver. He’s fantastically well attended to by his family.

Once you really accept that you’re going to hear voices, when you wake up, you let go of that. I fought it for 25 years is what he told me.

That was this moment of like for him.

That’s recovery. A doctor would typically say, you’ve recovered if your symptoms have remitted. But we’re not that good, Matthew. We don’t fix all the symptoms. Our tools are imperfect side effects, residual symptoms. So that would be his example. He hasn’t become a mental health advocate. He’s just a lovely human being. And for him, that was the center of recovery. I met A woman who lives with borderline personality disorder. And she found dbt, dialectical Behavior Therapy, the right treatment. And for her recovery is a lot about staying married to the same man for 40 years, which many of us were not able to accomplish on our own lives.

And so here she is, a proudly married person. To her, that’s what recovery has done, because DBT gave her coping skills, gave her husband coping skills.

And they still have their issues, but they’ve worked it out.

So the beauty of this is it’s kind of do it yourself recovery.

You know, there are definitions of it, but when you listen to people, they’ll tell you, right. Whether it’s accepting your symptoms, really accepting them, whether it’s finding some creative avenue to help other people, or whether it’s as simple. Simple in our society as staying married. Like she said, this is part of my recovery. Jim and I are a married couple. We’ve separated a few times. We’ve had troubles, but the coping skills that I’ve learned have made a difference for me.

And Jim is on the interview too, with me, and he said, and it’s helped me, too. These coping skills are things that I need, too. I may not have this diagnosis, but I find, you know, it really benefits me to work on affirming somebody, not criticizing someone, for example.

So recovery is a really interesting thing. And I think one of the challenges, Matthew, that we have as practitioners is we see people at their sickest, right in the hospital.

You work in an adolescent psychiatric service. People are cutting themselves and coming into the hospital. You don’t see them six months later trying out for the theater group, making friends, coping, going to their sessions like they’re doing well.

So the other point of the book was to remind us all that this is a marathon, not a sprint. And so if you’re having a really difficult time right now, that is a really difficult time right now. It may not be determinative that you’re going to feel like that down the road.

So I was always interested in this idea of people’s narrative stories of how they learned to live with things.

[00:24:02] Speaker A: Yeah, I think that’s such a beautiful picture of what recovery is and how individual it is for each.

But I’m one of the things you were talking about there. What about when someone really is in survival mode, when they’re in those depths of despair or however we want to describe it? How do you give someone hope that recovery is possible for them when they’re in the midst of that?

[00:24:27] Speaker B: Yeah, I mean, it’s really hard, and I think being with people and being with peers, people like you, is also beneficial.

So, you know, as a psychiatrist, I’ve had patients say, I’m going to kill myself.

And I’ll say, listen, nobody can take that away from you.

But I want to encourage you to consider that you haven’t tried four or five treatments that have been helpful for people.

And I really want to encourage you to take some time with this, like a few years, and try things.

Obviously, I can’t stop you. This is very humbling. I’d love to be able to say, I will protect you from this impulse.

Rather I say, let’s not ignore it. Let’s acknowledge it. Okay, you’re feeling desperate, but in the context of depression, you haven’t tried abc. In the context of your life, you haven’t tried giving to others through this mechanism. You’ve never been to a NAMI meeting. You haven’t found others like you. You’ve never been to dbsa. Right. Depression, Bipolar Support Alliance. So, to me, I love to offer people a perspective that’s just wider than the immediate desperation, but I don’t deny that they feel that way now.

So this might be on an inpatient unit.

And you, you know, you might say, okay, you know, I really want you to try A, B and C, you know, before you act and give this time.

And then I would show them this book now that I’ve written it. There’s some people in this book that are incredibly desperate.

You read the story of Kimberly Comer. This is a woman who decided she was going to die by suicide. She was homeless, living out of her car, and she was in a psychiatric hospital for the n 15th time.

And Kimberly says to me, and you can’t believe that the social worker said, you have to go to one more group the night before you’re discharged. She’s like, this is such bullcrap. I could run these stupid hospital groups. I’m going to leave the hospital tomorrow. I’m not telling a damn person I’m going to die by suicide. I can’t live out of my car anymore.

I’ve lost a relationship. I’ve lost everything. I have nothing. She’s a woman in her 40s at this time.

A woman who comes to the hospital is an In Our Own Voice presenter. This is a NAMI program where people share what they’ve been through and the journey they’ve been on. And of course, the woman is in her late 40s, had lived out of her car, had lost a relationship, had nothing to her name.

Kimberly Comer looked at me and she said, that woman saved my life.

[00:27:06] Speaker A: Wow.

[00:27:06] Speaker B: It wasn’t the treatment, was it the social worker? It was another person who had been exactly where I was.

Kimberly Comer is now the director of a NAMI affiliate in Florida. Like, she’s unbelievable. She’s an unbelievable person. So the doctors, this is important from the earlier idea, Matthew, that there’s many ways to help each other.

The doctors didn’t have what she needed.

The social worker, the nurses, psychologists, treatment team didn’t have it. And in this moment, the peer, the person just like you, who’s five years ahead of you.

Oh, yeah, I was there five years ago. Let me tell you what I tried. A, B, C. Kimberly had tried none of them. And then she said, well, come to a NAMI meeting with me. And so Kimberly goes to a NAMI meeting. I was like, oh, my God, I’m not alone. There’s dozens of people just like me. And she’s an amazing person and an amazing story. So I think hope comes in many forms. It might come in a new treatment, it might come, you know, from a loving podcast like you do.

Right. It might come from a peer.

And this is the beauty of, you know, this journey that we have something a family member says might be the key thing, a co worker who’s understanding when you confide in them. Like, to me, this is a very interesting area and this is why I’m not a surgeon. You know, surgeons, you remove the knee, you take the knee out, you put the knee right. You know, I at least would have done cardiology because you could talk to people about their hearts and what it means to them, that sort of thing. So I had that backup plan just for one day, Matthew, and then the next day I found the right place.

[00:28:56] Speaker A: And then hope came just a day later.

And it’s impacted all of us.

It came one. You just had to hang in one more day.

[00:29:04] Speaker B: One more day.

[00:29:05] Speaker A: Really is the message around that, given what you’re saying, like it can come from so many places. Yes. Highly trained professionals such as yourself, that many staff have in this building, but also from a neighbor or colleague, peer support.

And I guess it sends a message to me as I listen to that is, well, I have a role in that. Not just in my workplace. Well, my workplace where. Yes, here or if I’m working somewhere else.

So can you say more about that? Like, how can the non professional in a culture now that definitely higher acuity, more and more people living with mental health challenges. What can I do if I’m listening to this. And I’m. I’m not a highly trained psychiatrist, but I’d like to help. What could I do?

[00:29:49] Speaker B: Yeah. It’s interesting. So first I would evaluate your relationship to the person.

Right. And then I would ask people what would be helpful to them instead of saying, ken, I think you’re living with depression.

After my brother died, my sister had also died of cancer. So I lost both my siblings, and I had a run of time, which was either grief or depression, depending on when you looked in the dsm and the people around me were loving to me. But it was a group of friends that I went out to dinner with once a month. Right. They happened to be psychiatrists. They looked at me and they said, ken, you look like hell.

Now, this is exactly what I’m not encouraging people to do. Ken, you got to get on meds, bro.

Then you can barely walk.

Like, I was in a deep state of grief. Loss, depression. Psychiatry hasn’t figured out where depression and grief overlap. We haven’t figured this out at all.

So that was interesting because it’s completely counter to what I’m about to say. That was trust. I loved and trusted those guys. And when they looked at me and said, ken, we haven’t seen you in a month, what happened?

Several of them came to my brother’s funeral in Philadelphia. They drove all the way to Philly. For me, these were wonderful friends.

When they said, are you kidding me? What is going on with you? You have to get help.

That isn’t how I would usually start it. I would usually. But because I trusted them and they actually knew this field, I got on meds, and I got a lot of relief from that. I went back to my therapist, but I was unable to see it for myself.

I knew I was having trouble getting out of bed, and I knew I wasn’t functioning at a very high level. But I’m like, well, I just lost my brother, and I guess it’s just going to be a little bit of a rough patch, when in fact, I was functioning, you know, at the bottom level of my entire life.

So the concept of motivational interviewing.

So instead of you, Matthew, saying to me, can you look like hell? Get on some meds? Which is what my friend said. That’s because we have a lot of trust. Yeah. Mostly they would say, ken, I’m wondering how you’re feeling, because you look. You look upset. You look distressed. And, you know, let’s talk about that. And then I would develop my loss and my suffering and all that stuff. Well, Ken, what kind of Support might you want for that?

So in the book, I interviewed Bill Miller, who invented motivational interviewing. So instead of saying, ken, go get help, he describes this idea that human beings are a committee, and when one person pushes down on it, go get help, the other part of you is like, well, wait a minute, who are you to say, I need help, I’m not getting help. Right. He calls this the writing reflex. You push on one side of the boat, the other side of the boat comes up, but then it comes down.

So being as directive as my friends were with me only worked because we had long standing, trusting relationships. And actually they like to prescribe medication. So it’s very unusual in most situations, I think, you know, listening to a person trying to understand what they want, trying to make sense of how we could get there together through the strength of our loving relationship.

You typically don’t win on the strength of your arguments. You win on the strength of your relationship.

And if a person feels that you’re beside them on a bus stop, for example, looking off into the world together, how can I, riding side saddle for you, help support you? That’s kind of the image I want you to have instead of two people facing each other and you being directive. Now, motivational interviewing takes more time, right? So you might say, oh, my God, I don’t have time for this. Well, this is somebody you love. You’re going to spend time with them, think about what is it that they want? And if they can’t say the words, I think I’m depressed, they say, I, I need help with sleeping. Sleep is a, you know, is a real measure of how our mood states are doing when people who are sleeping two, three hours a night are not likely to do well with their mood symptoms anyway.

They say, well, let’s figure out how we could get you help with sleep. Could we go for a walk together? Could we call your primary care doctor together?

Right. So now we’re not necessarily. This is for the person who might be sensitive about a mental health diagnosis. Wait, are you saying I’m depressed? No, no, no. I was listening to you and you said you’re not sleeping well. And I’ve heard you, you know, patting around in the kitchen at 3am You’ve woken me up a few times, actually. So I’m wondering if we together could figure out how to improve your sleep.

Well, Dr. Carson is a good guy. I guess I could talk to him about it. But that’s not mental health, is it? Right. And I’m like, well, we’re going to start with Dr. Carson. And then we’re going to see what Dr. Carson has to say about helping you with your sleep.

But also, you might need support because you’re under a lot of stress, and support can take many forms.

Well, I used to have a therapist. I don’t know if I could call that person again. Well, let’s give it a try.

So it’s. There’s an art to this, and I don’t think it’s easy.

And don’t beat yourself up if your efforts are unsuccessful.

Be gentle with yourself. Just as you’re going to be gentle with the person you’re trying to engage and help.

They have internal barriers that you may not understand.

It may be cultural, maybe based on their past history, there may be something they don’t want to share with you for whatever good reason.

So I would just say be gentle with yourself. Motivational interviewing. 200 studies have been run using randomized control trials, which is the highest form of science, showing that this technique of listening to the person and finding out what they want and helping them get that tends to be better than what my friends did to me. What my friends did to me. Ken, you look like hell. You need meds. Well, that only works if they’re friends of 30 years, right, who prescribe meds, or it wouldn’t work for many of us. So this is not what Bill Miller would recommend. The inventor of motivational interviewing. He would say, now, Ken, let’s just talk a little bit about what you’re going through, and then let’s figure out what could be helpful for that. I can’t get out of bed in the morning, guys. Well, Ken, you know, we could do stuff for that. Do you know, Dr. So and so, like, we have treatments for that. You know, I just treated a patient just like you, so they have a different perspective. But I think also, Matthew, this is a marathon, not a sprint, this life. And if a person isn’t ready for help now, they may be ready for help later.

And help doesn’t have to mean a psychiatrist. It could be a support group or a pastoral counselor or couples therapy. Right. It could look different ways for different.

[00:36:40] Speaker A: People that remember that many paths to recovery that you described. But there are ways we can at least try.

[00:36:48] Speaker B: You can increase your chances that your support will result in a better outcome, but you’re not responsible for their recovery. It’s complicated, isn’t it? Like, it’s a lot to integrate. Your best effort is welcome, and it may make a difference. But fundamentally, your role as a support person.

[00:37:11] Speaker A: Well, I Think in that context it is still very difficult for people to reach out for help. And I’m very mindful of the the parents and youth that come into our building because I think it takes a lot to reach out and say you need help. And I love what you were saying that you’re a child and adolescent psychiatrist, that one of the things that you prescribe to your parents is equal parts self compassion, support and grit. Can you say more about that? I think particularly the self compassion. You do hear about it a bit, but it feels selfish. Particularly I think parents who feel like what I should self something for me? I don’t think so. It needs to be just directed towards the case.

[00:37:52] Speaker B: If you go to a Nami family to family group randomized control trial, hundreds of people showed that it improves hope and empowerment. Or you go to an al anon group which is a family member of a person with addiction, one of the first things they take up is your self care. The oxygen mask goes on you first.

You are the person providing them housing, shelter, love, direction. In the case of an adolescent, you’re modeling for them all these things while financing and supporting them so your well being.

And if the child is reluctant to get help, I encourage parents to get support for themselves around how to problem solve.

For the child who refuses help but doesn’t mean it’s going to work, it means you need to be supported. Oxygen masks for the parents. You’ve got to deal, you know, with running the entire endeavor. So family to family has a lot about compassion, self care, taking breaks, the willingness to set boundaries.

Right. Like, you know, there are certain things that you’re allowed to say we actually can’t do that.

You know, that’s not acceptable. That behavior is not acceptable. And in al anon of course, these are. Now we’re into the addiction space.

You’re not the agent of the person’s recovery, they are.

You didn’t cause it, you can’t cure it, you can’t control it. But what you can do is be a supportive presence.

So obviously the children we’re discussing here don’t necessarily have a severe mental health condition or an addiction vulnerability.

But I do think it’s okay to attend to the parents because without the parents, the kids really do have a challenging situation if the parents are in trouble.

Right. I think the idea is you keep the parents, you know, as engaged as humanly possible.

Also, given that you run a facility, you know, look at it when you walk in in the morning. Look at it through the eyes of a family who is scared to bring their child in. How does it look? How does it feel?

Places I’ve worked, I’ve tried to make them less institutional per square inch. My efforts have been mixed, of course, and you can’t always have it be like a welcoming environment.

You know, it’s underfunded and it’s all those difficult things. But what are the pictures on the wall conveying? Right. Are there books or things for kids to read to entertain themselves while they’re waiting to be seen?

Are there resources for NAMI or another group that you find compelling, available, so a person could flip through it? I mean, this is the moment where the parent is actually ready to get help or as close as they’ve ever gotten. Right. So I just always think about that too.

And not all the clinics that I’ve worked at or, you know, than the medical director of have had that kind of culture. But I always try to think of, all right, I’m a scared parent coming in for the first day. What’s the vibe here? Why is that plant dying? It doesn’t convey hope, right? To have, you know, plants that haven’t been watered in three months, Somebody’s job has to be to water them.

[00:41:15] Speaker A: Yes, that’s. It’s not a good look. It really is not. It’s not a good look. It is not. I’m curious for personally, someone’s been in the field for a while. What sustained you? What’s helped?

You briefly mentioned a little bit ago, the shortage of mental health professionals. We’re all aware of that. We feel that very much here.

How have you been sustained in the work and what kind of words of wisdom, encouragement for colleagues such as mine that spend a lot of time in this space that I’m sitting in?

What would you say to those two things?

[00:41:49] Speaker B: Well, there’s few missions more meaningful than working in a mental health space.

I mean, I think it’s very meaningful. Now it’s hard on us.

So you have to find ways to get oxygen to yourself, take breaks, work part time.

Like, you can’t do all inpatient work. Many of us can’t do that. I can. Could not do only inpatient work. I did that part time.

So all my friends in mental health love their jobs. All of them.

None of them are even thinking about slowing down or retiring. They’re in their 60s. They love their work. They believe in their work. They care about their work.

You talk to people in other fields of medicine. I have a friend who’s a radiologist. He’s done. He couldn’t wait to retire. I have a friend who’s an allergist. Couldn’t take one more patient who was ready to have an anaphylactic reaction in his office. Just the anxiety of it. So I guess I would say the work is obviously hard.

There’s an old Hebrew expression, you don’t have to complete the job, but you don’t have. You’re not allowed to set it down either.

Like, stay with it. You’ve chosen this path.

There’s things that have brought you to this work, and you run into a lot of vulnerable people.

You do have to take care of yourself, and you can’t do everything wrong all the time. The field has been weak on back to self care. The field has been weak on that.

And the idea of, you know, how do you take care of yourself? Was a. Was a core concern of a. One of the presidents of the American Psychiatric Association. She was like, we have to deal with burnout. We have to deal with how to sustain people in this work.

That was Anita Everett. She did a whole year project on how to support people in different ways. I think like recovery, it looks different for different people.

So I would take policy jobs to sustain my limbic system. You know, the emotional stuff that could get hard. I would take a leadership job. I was the commissioner of mental Health. I was always interested in how the big picture worked.

Writing a book was a different kind of thing. Bad for my tendons, but good for my little soul.

Right. I worked at an early psychosis program for five years as a volunteer, and I found that working with young people at the very beginning of the journey was incredibly good for my little soul.

And I did that for five years until it closed at Covet. So, you know, you have the families and you have the individuals. So that’s what worked for me.

And I think everybody has to sort out, and it’s too simple to say go running or, you know, be physically active, but you have to figure out for yourself what makes it sustainable. And I think the core thing to acknowledge is that working in the mental health space is both heroic and can be very stressful and taxing. And I think that’s just the reality that we live with.

And so you’ve chosen this path. How do you sustain yourself?

You know, to have a nice long career so that when you have gray hair, you can look back on it and say, I really did my best. I want to say to anybody who’s listening, who’s interested in the mental health field, pursue this field. This field has great demand.

People have a Lot of control over their time.

Psychiatry is hot now in residency, psychiatry is hot. All the spaces get full. When I applied 100 years ago, Matt, nobody wanted to do psychiatry and they would make fun of your essay. Right?

[00:45:25] Speaker A: Right.

[00:45:25] Speaker B: It wasn’t cool. Now it’s cool. People recognize this is work that’s meaningful.

You have some control over your time. You might see your family from time to time. You know, in this way, it’s an upgrade over thoracic surgery. You know, you might get to know your children.

Right. So if you’re interested in the mental health space that you really thought about it, people are happy in this space and they can do any number of different things.

[00:45:52] Speaker A: Tremendous amount of variety working.

And you mentioned that sense of mission, which I think is we can’t find that in. In every space or.

But it brings teams together. And I think that’s one of the things that I see here and so grateful for. Working here is just that strength of community that you have. I mean, and we spend a lot of time investing in that and making sure that people feel that they are not alone.

[00:46:19] Speaker B: That’s leadership.

That’s leadership. Your practitioners can’t feel alone. They can’t feel blamed when things don’t go their way.

You have to have some kind of interstitial support to sustain you through this work.

[00:46:34] Speaker A: Dr. Ken Duckworth is the Chief Medical Officer for the national alliance on Mental Illness.

Ken, thank you so much for being with us today. We’ve really enjoyed chatting with you.

[00:46:44] Speaker B: Matthew, thank you for having me and for all you do.

[00:46:48] Speaker A: You’re Not Alone is available wherever books are sold. Lots of information about about NAMI and all their programs can be found at nami.org Hope and Healing was produced by Jenny Hoheisel and John Moe. Music by concert rock violinist Erin Meyer. This podcast is presented by Children’s center in Vancouver, Washington.

Children’s Center’s mission is to serve children, youth and families through comprehensive community based mental health services.

A reminder, as we mention on every episode, the 988 Suicide and Crisis Lifeline can be reached in the United States by calling or texting 988 it’s free and available 24. 7 I’m Matthew Bute and thank you for listening.

[00:47:43] Speaker B: SA.