Supporting Parents through a Youth Mental Health Crisis
by Nathaniel Hundt, in conversation with Gene Beresin, MD, MA and Khadijah Booth Watkins, MD, MPH, Associate Directors of the Clay Center for Young Healthy Minds, Massachusetts General Hospital
Nate: Gene and Khadijah, as child psychiatrists, you have seen mental health and wellbeing challenges on the rise since the beginning of the pandemic. In response, you have contributed to a library of “Shorts” — evidence-based mental health education videos designed to support overwhelmed clinicians and patients — now available on Dr. Katz.
We have made a series of Shorts on Parenting available to the public to support people looking for self-help — anyone can get started by watching Overview: Parenting.
But some might wonder, how exactly are Shorts helpful for clinicians?
Gene: Having led the Clay Center for Young Healthy Minds for ten years, and collaborated with Project TEACH for the State of New York, we found that when patients, parents, and caregivers are well-informed, they have a better idea of what to look for, when to worry (when it is not just a phase), and what to do. They have more detailed, informed and sophisticated conversations with each other. This improves patient-centered care.
Khadijah: Many parents do not know the signs or symptoms of psychiatric disorders. Some of that is due to stigma — for many, understanding mental health is new. So they may go to websites online, and who knows what kind of information they will get. Shorts are inspired by questions we are often asked in our practices. Videos in the Parenting series will cover topics such as the importance of making regular conversations a consistent part of the family routine, even when they are difficult ones, talking about loss, challenges our planet is facing, and the threat of violence.
Gene: Shorts touch on the importance of adopting collaborative problem solving with children, being on the lookout for signs of ADHD and potential learning disabilities, as well as other psychiatric disorders and mental health challenges. We provide information for parents and families on lifelong skills, like self-care and knowing when to ask for help. Videos feature clinical experts from across Massachusetts General Hospital’s Psychiatry Department. Dr. Katz is a trusted resource, as is the Clay Center, to equip parents, caregivers and patients themselves with sound information that can be very helpful.
Nate: Dr. Katz allows for sharing Shorts with patients, parents, and family members in a variety of ways — providers can assign Shorts directly to patients they are seeing or access a public link and share it securely through a MyChart message, email, or text. Gene, how might this be useful in practice?
Gene: That kind of flexibility gives us what we need to get information easily into the hands of patients and their loved ones. For example, if there is an elderly member of the family who is developing dementia, others at home will understand the signs of sundowning and know what to do. Also, patients themselves, such as young adults with social anxiety or an eating disorder will understand some of the methods of getting better.
Khadijah, why do you think education is important?
Khadijah: There are so many things competing for our time and attention as clinicians. But education helps streamline a conversation. When a patient comes in with all the signs and symptoms of ADHD, panic attacks, or depression, a baseline of education and shared understanding helps the clinician go into greater depth to develop a diagnosis, or multiple diagnoses.
Second, since there is so much more than a diagnosis, patients will know for a range of conditions, the kinds of causes, associated disorders and treatments that may be helpful. Parents that bring in a child, teen or young adult with these symptoms will know how these conditions impact daily life at home, with friends, in school or the workplace, and in their communities.
Nate: Gene, why do skeptics think education doesn’t work?
Gene: This is important. Let me give you an example of a migraine. If someone understands what brings on a migraine, they can prevent it from coming on, and they know what they can do about it. The same is true for all psychiatric disorders, for the patients and parents and caregivers. The more a patient knows about their condition, the better they can take care of themselves. There is no rationale for skepticism about health education. This is true for all medical, surgical and psychiatric conditions.
Nate: Khadijah, what about the style of videos? How does it support clinical aims?
Khadijah: The conversational style videos we produce may seem informal, but patients have told us they are more relatable than what is generally available from health systems. And though casual in form, they are all backed by the latest evidence.
Nate: This brings up a point that Gene is passionate about: making Shorts engaging. Early in our collaboration, you brought up the importance of integrating music into videos. And now you’ve written a book on music. Why is music so powerful? Can it be therapeutic?
Gene: Music has the power to heal, to comfort, to connect others together. It is particularly useful to promote wellbeing, which consists of positive emotions, engagement with challenges, personal meaning and a sense of accomplishment. It goes beyond health, because one can be seriously, even terminally ill and in a state of positive wellbeing.
Music is universal as one means of fostering wellbeing, whether you play an instrument, sing, dance or simply listen. Music provides connections with others. We all remember “our song” in our first romantic relationship. It is instrumental (pun intended) in adolescent identity formation, defining who we are, how we are unique, and emblematic of who we want to be, or become. Even the blues helps us in hard times. Consider the chants of prisoners in a chain gang. Their singing diminished their physical and emotional pain and brought a sense of deep connection.
In this way, music, to quote Dick Clark “is the soundtrack of our lives.” And considering soundtracks, just think of how important it is in the films we watch, amplifying the action, the characters, setting the mood and impact of the scene.
Khadijah: Gene, we’ve created a ton of content here on Dr. Katz, and all of it sounds great, thanks to your musical touches. How would you suggest that our fellow providers use this information?
Gene: There are many details about psychiatric disorders and treatment methods that patients often forget. Remember how easy it is to forget what your doctor told you after you leave the office, or questions you forgot to ask? A great example is what the components of CBT are. An assignment can be made while you are visiting with a patient — it’s easy. You can watch a video together during a session with a patient. Afterwards, they can leave you feedback and let you know if they have any questions.
Khadijah, what can you learn, as a clinician, from knowing whether someone watched a 2–3 minute video that was assigned as homework? How could you bring this into practice?
Khadijah: If they can teach me about what they have seen in a coherent fashion, I would know they watched the video and internalized the key messages. But we need to remember that most patients, even doctors as patients, don’t always do their homework without a nudge. Having videos available on an app provides a resource they can have in their hands when they are ready. There is no need scour the web and get all sorts of answers. We want people to have material we are using in our practice. We want to understand whether the information we share is useful, understandable, accessible. We want to know what else they are curious about, what interests they have. Above all, we want to be a trusted resource for patients and clinicians. This information helps us understand our patients better and doesn’t take us any extra time. In fact, it saves us time.
Gene, what kinds of questions might you get from a patient that’s done their homework? How can you address these with patients?
Gene: After a patient watches one or two educational videos, they may have more sophisticated questions. Questions aren’t bad; they move our practice forward. For example, patients may know the range of side effects of medications they have received, and if they have something listed, they can ask you what they can do about it. They may have questions about something they learned about while doing their homework, such as meditation or CBT, and ask specific questions about this. For this reason, I would tell my fellow providers that it’s useful to have taken a few moments to familiarize yourself with Shorts that are available, so you can know what might be useful to assign and what follow-up questions to expect.
Khadijah: I just favorited your video on cognitive behavioral therapy, Gene!
Nate: I think you are going to be a favorite of many! People also ask me about the video length. They ask me, ‘Why are they called Shorts?’ We found in our research that brief, to-the-point videos were actually much more likely to get watched all the way through.
Khadijah: What do you think, Gene? Are shorter videos, in general, more effective than longer videos?
Gene: I think so. Most folks don’t want to spend endless time. Think of YouTube or Instagram videos you have seen. Don’t you appreciate the concise, 1 or 2 minute videos? Studies have found this is the sweet spot in terms of the modern attention span.
Khadijah: I hope people will give Overview: Parenting a watch and use the platform to quickly leave us feedback afterwards.
Gene: That’s exactly right! Khadijah and I would love to hear whether you find the Shorts easy to understand, helpful, and what additional questions you have. This will help direct our focus as we make more. Until then, best wishes for a happy, healthy new year.
