Learning Curve

Michael Caputo:  Hello again and welcome back Learning Curve, the podcast for the Department of Health and Human Services.  I'm Michael Caputo.  I am actually the assistant secretary for Public Affairs of the Department of Health and Human Services.  I come into this job with a lot of experience in communications and not a lot of experience in healthcare.  Not uncommon for the United States government to have a cabinet agency, bring in a communicator who knows how to communicate, but is learning from the people who are experts inside their agency.

And my critics, they're absolutely correct, I come here with a little bit of healthcare experience, but I am learning from the most incredible people I've ever met.  I know -- I don't know how to express how lucky I am because I'm talking to experts and geniuses and people that I -- if you could only learn from the people that I am learning from, which is really what Learning Curve is all about.  I meet people here at the Department of Health and Human Services and I realized that I need to share their experience.  I need to share what I learned from them.

And that's why today we're going to talk to Dr. Elinore McCants Katz, who is the head of SAMHSA, an organization that you're going to learn a lot about.  We'll be right back with Dr. McCance-Katz.

We're back here on Learning Curve.  Michael Caputo, assistant secretary for Public Affairs at the Department of Health and Human Services.  And I'm sitting here right now with Elinore McCance-Katz, who is a Ph.D. and an MD.  She's the first assistant secretary for Mental Health and Substance Use.  She obtained her Ph.D. from Yale University with a specialty in infectious disease, epidemiology.  Nobody ever thought that that would be an asset when you came in to take over basically mental health, you know, programming for the United States government, the entire United States government.  But indeed your specialty in infectious disease really has come in handy, hasn't it?

Elinore McCance-Katz:  Yes, it has.

MC:  And you're not somebody who is a person from Washington either.  Where are you from?

EM:  Originally, I am from Kentucky.

MC:  Really?

EM:  I'm from a small town in Kentucky, Northern Kentucky, a little place called Dayton.  And my father was in the Navy.  My father's career Navy.  He was in the nuclear submarine service.  And so, I moved all over the country.  But we settled in Connecticut when my dad retired from the Navy.  And so, I went to college, and then to graduate school at Yale, and then to medical school at University of Connecticut.  So, all in Connecticut.

MC:  But you actually, your family, is in Cranston, Rhode Island --

EM:  Yes.

MC:  -- while you're here in Washington.

EM:  That's right.

MC:  There's a lot of people on deployment in this building.  A lot of people who -- I liken it to the military.  My goodness, we're surrounded by military here.  Every other person in the building is in uniform because we are in a national emergency.  But leaving your family behind, you have three grown children --

EM:  Yes.

MC:  One grandchild --

EM:  Yes.

MC:  How often do you get to see your family?

EM:  I go home most weekends to see my husband and my parents, who still live in Connecticut, and my brother who also lives in Connecticut near my parents.  My children and my grandson all live in California.

MC:  Oh, my.

EM:  So, I don't see them very often.  Once a year, I go out there and they will come to Rhode Island once a year.

MC:  So, you're -- SAMHSA was never around, the Substance Abuse and Mental Health Organization was -- it's new, right?  You're the first assistant secretary dealing with this.  I mean, obviously we put together some other organizations and elevated the importance of the organization as a whole to assist the secretary level.  What's it like being the first ever assistant secretary for mental health and substance abuse?

EM:  Well, I'd say first, it's a huge honor to have been selected by the president for that role and then to be confirmed by the Senate for the position.  So, I have kind of an odd background for a doctor.  I spent much of my career doing research.  And my research was in infectious disease, HIV and injection drug use, mainly heroin.  I also did a lot of work on medications development for opioid use disorders.  I was involved in the trials that were part of what FDA reviewed to approve buprenorphine for the treatment of opioid use disorder.  And I did a lot of medications development work for cocaine and alcohol use disorders.

So, in the context of doing that, I had an opportunity to also work with state governments.  And so, I spent -- I first started working with the state of Virginia, just doing some consulting for them back in the early 2000s.  And eventually moved to California, where I became the state medical director for alcohol and drug programs.

MC:  In California.  That's something.  Wow.

EM:  In California, big state.

MC:  Yeah.

EM:  Yeah.  And a great place to do the kind of work that I was doing.  Once I left California, I did so to come to SAMHSA.  So, SAMHSA is the Substance Abuse and Mental Health Services Administration.  And I was asked if I was interested in the position of being the chief medical officer.  And after interviewing for that, having a lot of conversations with SAMHSA leadership at that time, and this was back in in 2012.

MC:  Wow.

EM:  I came there in 2013 as their chief medical officer for two years.  I learned a lot about the agency during that time.  But I elected to leave after two years.  And it was then that I went to Rhode Island rather than return to California where all my kids were, because my parents were getting older in years and wanted to be near them during this time.  So, at that point, I met up with folks in Rhode Island who asked me if I would become the chief medical officer for behavioral healthcare in Rhode Island.  And that's what I was doing for the years 2015 up until I came to be the assistant secretary.

MC:  And when did you start here?

EM:  I started here on August 21st, 2017.

MC:  It's been a rough three years.

EM:  It's been.

MC:  A lot going on, not only -- and the interesting thing is, as the first assistant secretary, you have a blank state -- blank slate to start with.

EM:  Yeah.

MC:  Of course, so that's a really strong point.  But then there's the other side of that, you have to start with a blank slate.  So, there has -- there's a lot of positives with that, but there's some negatives, too.

EM:  Yeah.  Well, so the 21st Century CARES Act provided a lot of instruction guidance around what Congress had in mind for SAMHSA.  Now, SAMHSA had been in place for, I don't know, 25-ish years plus.  But was not doing everything that it could be doing particularly on the serious mental illness side.  So, when I was at SAMHSA, I developed some pretty specific ideas about things that should change, that would that needed to be done differently at the agency.  Never imagining I would have the opportunity to come back and do it.

So, when I came back, I really did have an agenda.  So, I had been quite involved in the opioids crisis from my roles in California, my role in Rhode Island, and because I had done so much work on buprenorphine and continued to be one of the main teachers of physicians and other practitioners who were providing office-based treatment of opioid use disorder.  So, for me, the opioids crisis was really going to be front and center if -- on my return to SAMHSA.  The Department, of course, chose that course as well, but certainly something I agreed was a priority.

This -- the other priority of course had to be serious mental illness.  It was really the expressed will of Congress.  SAMHSA had not been doing some of the activities that we are doing now that I think have been very important to helping the most seriously, mentally ill among us.

And then the third area, which is one that I think is really kind of a unique contribution that a federal agency like SAMHSA, the only federal agency that is charged with addressing and reducing the impact of mental and substance use disorders on Americans and American communities, really we’re the only agency to do this.  And what I mean by that is, it was my goal to really greatly expand the training and technical assistance programs that the agency had.

Prior to my coming, training and technical assistance had really been a function of if you were a grantee, SAMHSA would provide you training and technical assistance if you asked for it.  I really expanded that to the entire nation in terms of practitioners, in terms of peers, and even with outreach to the general public to take advantage of new programs that we put in place.  Those included Mental Health Technology Transfer Centers that also include supplements to address school-based mental health issues.  It included a substance abuse prevention, technology transfer system.  And that went along with what SAMHSA had already existing, which is a very good program, the Addiction Technology Transfer Centers.  So, we had these three types of programs that were required to work together, that were placed in each of the 10 HHS regions that the nation is divided into, and we had special -- specialty programs for Native American Alaskan natives, and for Hispanic-Latino people.

So, that was a huge expansion of SAMHSA's training and technical assistance.  We provide training on all aspects of mental health and substance --

MC:  You're training doctors and healthcare workers.

EM:  Not just doctors.  Doctors, any healthcare workers, peers, and the general public can participate as well.  And we provide free continuing medical education credit and free continuing education units to non-MD practitioners.  Because when you do that, you're providing a great resource.  All of us who have licenses to practice some aspect of medicine have to keep up on our training and education.  We usually pay for it.  We pay for continuing medical education credits.  We offer them at no cost.  And so, we get literally thousands, tens of thousands of practitioners who can choose from many, many, many different offerings on various aspects of psychiatric care, mental health care, substance abuse prevention, substance use disorder treatment, really wide array.  And we're expanding it even further now.

We have a funding announcement out now that will make national centers for mental and substance use disorder care and treatment for our elder Americans, because your needs do change as you age.  And the best practices also are nuanced as you age.  We are putting one out for the LGBTQ community, and also one for the African-American community.  What we want is for our providers to be able to access training and technical assistance on any kind of topic that they need to help them better care for Americans, and particularly addressing mental and substance use disorders.  Not only is this a way to increase the knowledge base of our practitioners, it's a way to bring parity about.

MC:  Right.

EM:  So, when you --

MC:  So, that's a real disparate mental -- I'm sorry -- mental as well as physical health.

EM:  Yes.

MC:  It treats different sectors of society differently.  In fact, you -- before the pandemic, opioid overdoses were decreasing very much because of the focus that you and others within this administration were putting on the issue.  SAMHSA played a pivotal role in the administration's response to this epidemic of opioids.  What successes have you seen in this whole response?  I mean, to the opioid epidemic, which the president declared an emergency.

EM:  Correct.  He rightly declared it an emergency.  And I will say that I also was very impressed that Donald Trump spoke about the needs of our people in terms of the ravages of opioid misuse and opioid use disorders, as well as the needs of individuals and their families with serious mental illness.  And that has continued through this administration.  So, in terms of opioids, there were -- and SAMHSA's role.  There were two really big things that, in my view, had to happen.  One was we had to use evidence-based approaches to treatment.

MC:  Can you tell us what that is?

EM:  That means you use FDA-approved medications, pharmacotherapies to treat opioid use disorders.  They are life-saving.  And they must be offered to patients and patients must be given, and their families, given enough information that they can make the choice that is best for them around how to address opioid use disorder in their lives.  That was not happening with regularity through any SAMHSA-funded grant programs.

One of the reasons we were seeing these big increases in opioid overdose deaths is because for so many the treatment was to go to a facility that would detox you or medically withdraw you from opioids, but you got no -- you were not near home.

MC:  Right.

EM:  You got no medication-assisted treatment afterwards.  And you lost your tolerance to opioids in the process of being detoxed.  So, when you go home to those familiar people, places, and things that were associated with your use and you relapse, with these potent opioids on the street, you have a great risk for overdose and death.  So, one of the first things I did was to say that any federal funds from our programs -- that were used for our programs, that were funded by SAMHSA, medications had to be a part of it.

If you're a facility -- so there are some organizations that don't themselves either have the people that can offer it, or don't themselves offer it for some reason.  We said, "Okay, but you must partner.  You must partner with practitioners who can offer it and who can talk to individuals and their families about the importance of consideration of this kind of treatment."  That's worked well.

One of the things that we know is that over the course since 2017 to the present, we have seen very substantial increases in the numbers of Americans that are getting medications to treat their opioid use disorder at this point.  We also knew that we needed to really make sure to the very greatest extent possible that first responders, family members, individuals with opioid use disorders, could learn about naloxone, the opioid overdose antidote; learn about it and learn how to use it.  And our grant programs at SAMHSA provide that training and make naloxone available.  We pay for naloxone.  And that has saved tens of thousands of lives as well.  We think somewhere over 30,000 lives have been saved because of this work with naloxone.

We also are analyzing our most recent National Survey on Drug Use and Health.  And that will be coming out in the next few days.  And that's going to show a significant drop in the numbers of Americans with opioid use disorders and the number of Americans that are misusing opioids, including prescription opioids and including heroin.  So, those are very, very positive --

MC:  Even during the pandemic there's less usage?

EM:  No, no.  This is for 2019.

MC:  Oh, okay.

EM:  So, we're always --

MC:  Right.  We're in a different spot now.

EM:  We are in a different spot.

MC:  I started thinking about this a lot when I was working in Pennsylvania for a variety of issues there.  And I was in a town called Towanda, right?  And Towanda has had a very serious issue with opioid abuse, opioid use disorder.

EM:  Yeah.

MC:  And I remember there were some terrible, terrible circumstances where one man, his son was an opioid user and came home after a night out with his friends.  His friends dropped him in the driveway as he was passed out.  It was the middle of winter.  And his father pulled out of the driveway in the morning for work and saw a pile of snow, which was his son.  Later, a young lady who had opioid use disorder was out with some of her friends who were involved in the same thing.  And they dropped her off after an overdose in front of the courthouse where she froze.

And Towanda is just one example of so many towns.  I come from a beautiful little village in East Aurora, New York, outside of Buffalo, where we have this train tracks that go through town.  All of us kids who grew up there, you know, thought it was a haunted train tracks.  No trains ever went down that track.  We had one late at night, every night, that would go by and everybody thought it was haunted.  But it was also a place where young people hung out.  And there was a 20-something lady who was found dead on the side of the tracks, who had been up there using opioids.  Fell out, and somebody tossed her aside and she died in the bushes.  This is happening among 13-year-olds and 14-year-olds.  And I've seen tremendous strides from the time I first started paying attention to opioid usage to now.  But then I got to know a lot of people who were involved, not just those who had been sick with it, but also those who were treating them.

It's in my family, right?  It's among my friends and their children.  But it's climbing up again, because now they're locked down in the middle of nowhere, right?  The only person who's visiting you is your dealer.

EM:  Yeah.

MC:  It's not your mom and dad.  There -- they can't be exposed to the virus.  These people who were in recovery are -- have succumbed because the -- here's the thing I wanted to ask you.  I saw you stand up in a White House event and talked about this, and it really moved me.  It moved a lot of people.  The Secretary started talking about it's not a health versus the economy, it's health versus health.  I mean, we have to take care of the coronavirus.  We have to be healthy, but we can't forget about the people, who because of the lockdowns and the things we're trying to do to mitigate the effects of the coronavirus, they're locked at home and their dealers come and they succumb.

I've never seen anything like it in my life.  And it's just really hollows me out.  And I saw your face when you were talking on camera at that White House event and I realize you're as hollowed out as I am about this, because you actually fought this back to a certain level and then the virus -- the bottom fell out, didn't it?

EM:  It did. It did and what's been so discouraging about the response is that there's been virtually no attention paid to anything, mental health, substance abuse, aside physical health care.

MC:  Yes.

EM:  You -- no attention has been paid to the many, many needs that the American people have.  I mean, I can talk to you about what we're seeing and hearing in terms of the increases in calls to our Disaster Distress Helpline.  It's gone up 1,000 percent.

MC:  Really?

EM:  Yes.  And while we don't collect individual data, we know from the people answering the phones that the majority of calls are related to some aspect of COVID.  Throughout the country, you can see there are various places where the calls to the Suicide Prevention Lifelines greatly increasing.  We know that suicide attempts -- we've seen an increase in the proportion of emergency department visits that are due to suicide attempts.  This is a time when nobody wants to go to the ED.

MC:  Nobody.

EM:  They're all afraid of COVID.  It's only COVID going to the ED.  If you go to the ED because you've made a suicide attempt, you have done serious, serious, probably life-threatening harm to yourself, which means that Americans are showing us just how distressed they are.  Just how traumatic this is.  And by the way, we do this before these decisions were made to lock down.  We knew this.  We knew that there was an entire literature that speaks to quarantine isolation, and the mental health effects that can be long lasting.  Years out, you can still see effects in some vulnerable people.  This is -- it's no small matter.  We will see and we are seeing huge increases in mental health needs of our people.  And that often translates into initiation of substance use or increases in substance use.

CDC just put out an MMWR a couple of weeks ago showing 40 percent of the respondents met criteria for a mental health issue, a mental disorder, a substance problem.  People reported if they -- that they were new users of substances or increasing their use of substances.  A substantial numbers who were suicidal, and this was people -- this was done with people who could answer a survey on the internet.  What about our people living in rural America, remote America?  What about our people who don't have the resources from before COVID to even afford internet in their homes?  These people are very stressed, very traumatized.  Those numbers that CDC told us, I promise you they're larger.

MC:  Oh, no doubt.

EM:  They're larger.

MC:  You know, it's interesting because I think first time I ever reached out to you, it was right after you spoke at that White House event.  I think it was something that Kellyanne Conway was doing.

EM:  Yeah.

MC:  And you stood up and you stunned everybody, talking about how really, in a lot of ways, you can expect very serious illness and death from people who don't even have COVID because they're locked down and their mental health impacts.

EM:  Before we -- before COVID, if you were to just look at a year and look at drug overdose deaths, deaths due to alcohol misuse and abuse, and suicides, you're talking about over 180,000 deaths a year before COVID.  So, what's been lost in all of this response to COVID and the constant nonstop 24/7 horrors of COVID, and if you can't find something to talk about, it appears to me they make things up.

MC:  Right.

EM:  Okay.  It just does.

MC:  That's right.

EM:  It just does.  But this is what was happening prior to, you can just imagine what's happening to people now.

MC:  In your experience, what do you think the number?  I mean, I know you don't want to speculate on numbers.  Scientists don't do that.  But do you think it's doubled?  Do you think it's increased by half?

EM:  I don't think it's increased that much.  But I think it's increased by thousands.

MC:  Significant.  Thousands.

EM:  I think it will be by the end when we see what the numbers are.  I do believe that.

MC:  I've seen so much of it coming from upstate New York.  I mean, there's a young man in our village who is recovering from an addiction to opioids, who had been in recovery for years.  Before I left, I saw him walking down the street.  It was very clear, very clear that he was using again.  You know, I have friends who didn't even know where their son or daughter was because they hadn't spoken to him and so long.  And they knew that they were using again because they called and they were clearly using.  And then they disappeared, just disappeared.  They didn't know for weeks where they were.  And then they found them and they were alive, but not much.

I -- when you stood up and you spoke in the White House event, I knew with that moment I had to get to know you and I would eventually invite you in here.  Thanks for taking the time.

EM:  Sure.

MC:  I sent you an email and I said, "I've never --" and it still remains the same.  "I've never gotten so much reaction to somebody's public statement and -- that I got from yours."  And it was the first-time people really started thinking about the non-COVID impacts of COVID.  And the Secretary soon after they started talking about, you know, health versus health.

People didn't even know.  They didn't even realize that in defense of our health against COVID, we could be putting people in danger and we are, aren't we?

EM:  We are and I'll just take it even further.

MC:  Oh, please don't.

EM:  Well, you know, the people who make these decisions, the people who say, "It's safer at home.  Stay at home," tend to be people who are fairly affluent.

MC:  Yes.

EM:  Yeah, it probably is safer at home for them.  They go to some nice house, some big house with all the amenities.

MC:  They go to the shore.

MC:  Yeah.  They may have -- yes, they may have other homes they go to to get that additional isolation and protection.  But for the majority of Americans, they can't do that.  And so, what are you doing when you say stay at home and you can't leave your home and you should not go out?  What you are doing is for people who must go out, who are first responders, people who are essential workers.  I hate that term, but people who've been deemed essential workers.  They go out, they get exposed, and what do they do?  These are not the high-paid jobs.  They're going back to often a cramped apartment, a tiny house --

MC:  Congregate living, right?

EM:  -- with elders, with multi-generations.  And guess what's happening?  Those are the people who are getting infected and dying.  And when you shut down an entire healthcare system, when you do that, you want to talk about the vulnerabilities, the obesity, the diabetes, the cardiovascular disease, the pulmonary diseases that put you at greater risk for morbidity and mortality from COVID.  But you take away that people's ability to get any health care?  All you're doing is making certain that if they do become infected, it's going to have the maximum possible negative effect on them.  And it will end in death for thousands, which is what we're seeing.  And it's just awful.

When the President agreed to this back in March, it went on for six weeks.  And then it was supposed to stop.  What was the American people told?  The American people were told that this was to reduce the spread, stop the spread, and give us time to get our hospitals ready, to get treatments in place, to make sure --

MC:  Right.  To make sure we weren't overwhelmed, yeah.

EM:  -- exactly, to make sure we weren't overwhelmed.  There was never any discussion of getting the virus down to some absurdly low level for what is a very contagious infectious disease, which in most people, by the way, is a mild to asymptomatic disease if you are below ages 45 and younger.  There was no agreement to this, to this non-stop restriction and quarantining and isolation and taking away anything that makes people happy.  You can't go to a movie.

MC:  Even human contact.

EM:  Yeah.  You can't go to a movie, you can't go to a football game, you can't --

MC:  The things that low and medium -- you know, people who are in the lower strata of our economic system do.

EM:  [affirmative]

MC:  You know, because the wealthy people with the house on the beach, they're watching Netflix --

EM:  Yes.

MC:  -- and every other streaming platform, whereas people who are in Queens who have to go to work at the hospital or at the construction site because they're essential workers, they don't have access to these subscriptions.  This is over and over.

EM:  Correct.

MC:  Let me tell you something.  I have a very close friend back home whose son had a lifelong battle with mental illness.  Not knowing, not saying what it is, but his son, it was just so hard on the family.  I'm sure you see this all the time in mental health services that the family suffers almost as much and sometimes more than the person who's suffering the mental health problems.  But he was okay it seemed.  You know, he was of late 20s or early 30s.  I don't remember.  But he wanted to, like, try himself out.  You know, get out -- you know, I think his medication was balanced out.  He felt good.  He wanted to try his own life and had some independence from his family.  I think he moved out and moved away, and then COVID hit.  And his father and mother called as often as possible, but he ended up taking his own life.

EM:  Wow.

MC:  And I've never seen anything like that.  It really upset me because it fundamentally destroyed his father and mother, destroyed them.  And his father, he is the kind of guy who just like, "Woah, wear a mask."  I'm being told to wear a mask, I'm going to wear a mask.  I'm being told to stay home, I'm going to stay at home.  And this is a man who believed in the government's capacity to respond to a pandemic.  And suddenly his son is dead because of the response to the pandemic.  What is -- what do we do for these people?

EM:  The -- well, for one thing, I think we need to keep talking about the need to balance response to the virus and the other mental health, substance use, and medical -- general medical needs of the American people.  We need to -- I think we should always be looking at whether what we're doing works.  Does it make sense?  There are other approaches.  Other nations are using different kinds of safety measures and they seem to be doing well.  Shouldn't we be looking at those things so that we can get back to providing care for people who need it.

For people with mental and substance use disorders, one of the things we've done that I think has been really important is we have made telehealth available.  We've used our technology transfer centers to train over 300,000 practitioners because behavioral health was not using telehealth and telemedicine before this happened.  So, we realized quickly they weren't ready.  We developed an entire series of trainings.  And now, that is a way that that our folks are getting the care and treatment that they need.  So, telehealth is important but I will say this, it is not enough.

MC:  No.

EM:  People need -- we are human beings.  We are social beings.  We need contact.  We need emotional support.  We need to be able to be with one another, to live our lives, and to enjoy our lives.  The idea that we would hold our people this way, with these restrictions for so many months, to me, I -- it's hard for me to even think about it.  And I'll just --

MC:  Go ahead.

EM:  I'm going to say it.  We shut down the entire country before the virus, in my opinion, had a chance to get around the entire country.  Why?  Because 24/7 we were seeing these horrible pictures of hospital emergency rooms and hospitals being overrun in New York and New Jersey.  We were hearing what was going on in Washington.  We heard these things.  And, of course, we reacted to that and decisions were made.  But when that's over and you've kind of destroyed people's -- you've taken the floor out from so many people because now they don't have jobs.  They have no source of income.  They're in risk of losing their homes.  They're at risk of losing their apartments --

MC:  Or they already have.

EM:  -- or they already have.  They can't get medical care.  This is -- we used a sledge hammer when I think we needed a scalpel.

MC:  No doubt.  And you know what?  To me, the damage is done.  You know?

EM:  Yeah.

MC:  You know, I have a 6-year-old and a 7-year-old, very playful young kids.  We live right about -- right around the corner from the playground.  They haven't been on the playground in six months.

EM:  Yeah.

MC:  My 6-year-old and 7-year-old thankfully get along well, and they play Barbies all day long, two young little girls.  But the next-door neighbor's kids, they're best friends, they couldn't speak to them.  They couldn't see them, right?  So, they developed this thing in our neighborhood with beautiful places in East Aurora, this village, old homes, arts and crafts style homes, you know, not expensive, but nice old homes with porches on the front and porch swings.  You know?

EM:  Yeah.

MC:  I put a porch swing on our front porch because I wanted my daughters to date on the porch swing and nowhere else, right?  So, they developed -- they wanted to play with the neighbors, so they developed this game with Legos.  They called it Lego challenge.  I guess everybody does that.  And they would get a picture and let's make this with Legos.  And then they would hold it up from porch to porch.  And you could see this happening all the way up and down the street.  You know, we cut our bushes back so they could do it.

EM:  Yeah.

MC:  My kids are different now.  I'm telling you, I see a difference in them.  When they see a friend of theirs on the street, when they're walking, they run up and then they stop because they know we say six feet, six feet, right?  You can't be around them.  They can't even see each other.  They have to play from porch to porch.  You know, my kids are going back to school in person at the Catholic school where they go across the street from our house.  But I don't know how long it's got to be open.  Honestly, what are we doing to our children?  And are they ever really going to recover?

EM:  Well, I think -- well, a couple of things.  One, I think we need not to do any more shutdowns.  I think that's just too much to place on the American people.  The restrictions already that remain in place are very, very difficult.  But we should not be shutting down again.  We need -- and I just wish that the media would get honest about its coverage of COVID.

MC:  Oh, no way.

EM:  We know that children -- for children this is not a life-threatening illness.  There will be a few -- some cases, rare cases, and I don't mean to discount because the severity and the stress to a family should that happen.  But for the great, great majority of children, this is not a serious illness.  That's a good thing.  Our children need to be in school.

MC:  They do.

EM:  And when we put them in school with safety measures in place, why can't they go to school?

MC:  No doubt.

EM:  What is this nonsense that somehow it's unsafe to return to school?

MC:  I have my opinion on that.

EM:  It just doesn't --

MC:  I think it's political.

EM:  It makes no sense.

MC:  It's political.  You know, from my perspective, I don't know what to do for my children.  I don't know what to do.  You know, I'm -- you know, they're back in Buffalo.  They're not here with me.  But I think they're pretty resilient.  Kids are, you know.  My -- they have a wonderful life, our children, you know, so did the children next door.  They're actually adopted.  They came from a terrible circumstance and they're with great parents now.  These kids who play this Lego challenge.  But what about the kids that aren't in that kind of a situation?  The kids who's abused, their enduring from family members is not being recognized by school -- by their teachers.  What about the kids that need more than what their parents are capable of giving?

EM:  Right.

MC:  And they're developing serious problems.

EM:  They're regressing.

MC:  You're right.

EM:  These children who needed special education resources, children with autism, children with learning disabilities, children with various types of developmental disorders, who go to our schools and who get educated but they also get about healthcare.  Many of them will get mental health care.  They'll get special kinds of services, speech therapy, occupational therapy, to help them to develop to their greatest potential.  These children are regressing.

MC:  They are.  Completely.

EM:  For children who don't have those kinds of issues, they're never going to make this time up.  This is what I've read anyway, that that this is lost, and they will simply be passed on to the next grade.  And we know now that virtual learning is poor to none for many children.  You cannot expect young children, particularly elementary and middle school children, to sit in front of a computer for hours on end.

MC:  Not at all.  And I'm teaching second grade math.  Let me tell you something, I didn't do well in math in second grade.  So, if I'm having a problem teaching my kid at home, I mean, I was actually teaching my daughter second grade math when the President called me and asked me to come here.  And I was looking at the math book in front of me and I said to myself, "Self, you can stay here and teach this or you can go and try and fight COVID with the President."  I thought it was going to be easier to come here.  It wasn't.  This is the worst job I've ever had in my life.  I'm blessed to be here.  But all of us who are parents know that our kids are not getting the education they deserve.

EM:  Absolutely.

MC:  Most schools phoned it in, in the spring semester, phoned it in; and still charged you, your taxes or whatever.  And now here we are going back into school.  Some of them worked it up and tried to get better at it, but a lot of these students are still going to learn at home.

EM:  Yes.

MC:  I don't know what a parent's supposed to do to save their children.  I mean, we know what to do to protect them from the pandemic.  But what do we supposed to do to protect them from the things that the pandemic does?  It has nothing to do with what virus.

EM:  Yes.  It's really very -- I don't -- it's challenging.  I don't have all the answers.  But I do think that Americans are smart people.  And I think that they need to start asking questions about why is it this way?  Why can't my child return to school when children -- even if you don't know the literature, which says that this is a mild illness to and a asymptomatic illness in many children, and if we put things in place to protect teachers, and I do think we need to protect our teachers.  I'm not suggesting that we not do that.  They've done this and they're doing it very well in Germany.  They're doing it in other European nations, the U.K., why -- Canada.  Why can't we look at what's going on there?

MC:  Right.

EM:  Have you heard any reports on what's going on in Germany?

MC:  No, no, because there's nothing to do with knocking the President of the United States.

EM:  Because in Germany, they're not even making them social distance.

MC:  You know, I can't tell you how many times I booked a doctor on television to talk about important public health information.  And you never get to talk about it because they want to talk about politics.  I don't think the United States media gives a damn about public health information.

EM:  I don't too.

MC:  They do not, you know.  And from my perspective, it's causing terrible, terrible impacts, especially in the mental health arena.  And I want to talk about this before we end.

EM:  Okay.

MC:  Ladies and gentlemen, I'm talking to Elinore McCance-Katz, who is the assistant secretary for Mental Health and Substance Abuse here at the Department of Health and Human Services.  Dr. McCance-Katz is one of the angels of the department.  We have a few.

EM:  We do.

MC:  SAMHSA, your organization, has been really instrumental in building the nation's suicide prevention strategy.  And this is the point I wanted to get to, the support systems that curb suicide, prevent suicide.  And this 988 is the new suicide hotline number.  What was the -- and you put this together.  What was the process to make that happen?

EM:  Yeah.  So, SAMHSA did a study that -- at the direction of Congress.  So, this was a report that we were asked by Congress.  Do we need something like a 988 number?  Do we need something like a three-digit number for mental health crisis suicide prevention?  So, we looked at the literature, we looked at our own resources.  So, SAMHSA, for many years, has supported the Suicide Prevention Lifeline.  And we have other help numbers as well, our Disaster Distress Helpline and our overall helpline that helps people to treatment.

MC:  But they're long numbers.  There's area code --

EM:  They are all -- exactly.  They're all long numbers.  So, we did some work to see what professional opinion was in the field, what people think of the three-digit numbers.  And we suggested that in fact, yes, a number that's easy to remember that people would be able to access support much more readily.  And the other thing -- so we made this recommendation in our report.  We gave that report to the Federal Communications Commission.  They studied that report.  And in July, they voted affirmatively to implement a 988 number.

MC:  It's only been a month?

EM:  Yes.

MC:  Wow.

EM:  We've been working on it with them for, oh, gosh, well over a year.

MC:  Oh, sure.  But it's only been actually working, is it?

EM:  Yes.  It was in July that they -- that their vote was.  And it will be implemented over the coming somewhat better than a year it will take.

MC:  Well, people say it's going to revolutionize suicide prevention.  Is that true?

EM:  I hope that it will.  I think it could.  And the reason is that it's so easy to remember that I think people will use it readily.  And what SAMHSA has been doing, we've been doing some things to increase and enhance services for people.  What I mean by that is we now -- when somebody calls and they're suicidal, not only does that person who receives the call provide support and assistance, they follow up with them afterwards.

MC:  Right.

EM:  So, we go out and we --

MC:  That's key.

EM:  Yes.  People need that follow-up.  They need to know that somebody knows they're there, and somebody cares enough to come out and try to assist them further and make sure their needs are being met.  So, that's one very important part.  Another very important part is something that actually was put in place a few years ago.  And that is the connection to the Veterans Suicide Prevention Lifeline.  They have their own.  But if a veteran calls, we can immediately get them transferred to the V.A. system that has a peer that can talk to them.  And I think that's very important, as you know.

MC:  Sure.

EM:  This is a terrible situation for some of our veterans in terms of suicidal thinking.

MC:  Right.  I think veterans have problems with joblessness.  I'm an Army veteran.  You have problems when you get out with joblessness because, you know, you're doing a different kind of job in the military.  Maybe you're walking with a rifle in a warzone, you come back, what kind of job have you got ready for.  And joblessness actually leads to terrible mental health issues and all -- and one of them is one of the drivers of suicide.

EM:  Yes.

MC:  Especially among veterans.

EM:  Yes.  And let me just say one other thing about that and that gets to these lockdowns and the closing of businesses, and the difficulty businesses are having restarting because of the continuing restrictions.  There was a study published just a few months ago that said, for every 1 percent increase in unemployment, we will see an additional 1.3 percent jump in our suicides.  So, this is going to be a hugely terrible but important issue for us to address.

MC:  998 -- 988 is the new suicide hotline number.

EM:  Yes, that's right.

MC:  Now, I've been here now for, I guess, nigh on four months.  It feels like a year.  It feels like 10 years.  I find myself every morning, the first time I use my voice, I'm talking about death.  Because I live by myself a little apartment I've rented because I just go back and forth to work 24/7.  The first time I use my voice in the morning is to talk about death.  And we're talking about deaths.  We hear reports in our meetings, you know, the COVID sink, phone calls.  These people they drown in their own fluids.  And the doctors have told me that it is the most profound fear that one can have.  And that the looks on their faces when they're dying is just something that they can't forget.  These doctors can't forget it.  And the way -- and I talk -- this is the first thing I talk about in the morning, every one of us do.

You know, honestly, I completely believe that the scientists are going to cure the COVID virus.  I think I see a vaccine coming.  I see therapeutics coming up.  You might hear the media trampling all over it because they have no interest in a vaccine or treatments for COVID.  But I think the scientists, I mean, we know them all, you know them all.  You worked with them right and left.  I think -- I believe in them.  I believe the president and the United States government has a raid and an incredible group of experts.  And I've been able to -- so blessed to be able to learn from them.  I also believe that the President and the people of the United States government will solve the economic crisis created by the coronavirus and its response.  I'm completely convinced.  I've known Larry Kudlow, for example, since I was a kid.  I know these people are going to do the great work that it needs to rebuild the economy.

But Doc, who's going to fix the despair?  It's pretty profound.  I mean, the virus, it's science.  You develop countermeasures, you box it out, it dies.  The economy, you cut some taxes and you rebuild the economy very carefully with sound economic theory.  But the despair, who's going to fix it?

EM:  I think that the American people are very resilient.  And I think as the things you've just talked about -- I also believe that we will get adequate treatments, that there will be a vaccine.  I do think we have some of the best minds working on this.  And I am very grateful to know that that's happening.  And I think that the economy will be fixed as well.  And because of the resilience of our people, the despair will abate as those things happen.  But what will also be a reality is that there will be people for whom there isn't recovery.  There will be people for whom but the depression, the anxiety, the traumas is just too much.  People who have needed to have more in the way of one-to-one service available to them in terms of support, in terms of in terms of their treatment needs, who will not do well.  Their illness will worsen.  They may pass away from these mental and substance use disorders.  I don't think that's an exaggeration.  Not everyone is going to get better, most of us will.

MC:  Right.

EM:  But this virus will exact a terrible toll and it's more than the number of deaths that are directly attributed to infection from the virus.  It's going to be far more than that.

MC:  It's not health versus economy.  It's health versus health.  And when you stood up in the White House and basically said that it absolutely turned my head and a lot of other people's heads.  And I got so many emails I knew that I had to have you here for Learning Curve. So, if you're actually suffering because of this pandemic, or for any reason if you feel that you have no way out even though the new suicide hotline numbers do, thanks to the work of Dr. McCance-Katz and her people.  If you need help now, please call 911 or contact SAMHSA's National Suicide Prevention Lifeline.  That's one 1-800-273-TALK, 1-800-273-8255.  There's help for you there.

EM:  Yes.

MC:  It's not too late.  Everything is going to get better.  The despair, we will resolve it just like we'll resolve the illness and the economic issues.  But Dr. McCance-Katz, if you had to say one thing to a person who feels like this is just too much, what would it be?

EM:  I would say that things are going to get better.  Things are getting better that we can see the progress that's being made in terms of addressing infection from the virus and the safety of treatments and the development of new treatments and vaccines.  But in addition to that, if you're feeling anxious, if you're feeling depressed, if you're feeling suicidal, there is help available.  And our facilities are available by telephone, by telehealth, and increasingly they are opening their doors again to treat Americans with these illnesses.  And that is so important.  I've talked to state officials.  I've talked to providers across this country.  And the one thing that you hear in every conversation is that very sincere desire to help our people to get through this.

MC:  Again, SAMHSA's National Suicide Prevention Lifeline is 1-800-273-TALK, 1-800-273-8255.  Dr. Elinore McCance-Katz, the assistant secretary for Mental Health and Substance Use.  I've been waiting for you to come down here.  Thank you so much.

EM:  Thank you.

MC:  This is Michael Caputo.  I am the assistant secretary for Public Affairs here at the United States Department of Health and Human Services.  This is Learning Curve.  Dr. McCance-Katz is one of many, many people I'm spending a great deal of time with and learning so much from.  And thank you for helping people here in the United States to understand what's going on with mental health and substance abuse during this time of COVID.  We'll be back next week with a new and important person for you to learn about, for you to meet, and for you to listen to.  We'll talk to you next week.

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