Maggie McKay (Host): Mental health is a topic that can have a stigma attached to it. So today we're going to find out how to normalize the topic and get some more understanding about it with Dr. David Le. Welcome to Total Health Talks, your Cook County Health podcast, where we empower your journey to better health. I'm your host, Maggie McKay, and today we're going to talk with Dr. David Le, a Licensed Clinical Psychologist, about the stigma of mental health and how we can reduce it in our communities.

Today's episode brings up an interesting word and concept, and it might be a good jumping off point in our conversation. That word is stigma. Can you tell us a little bit about the meaning of stigma, Dr. Le?

David Le, PsyD: Sure thing. I appreciate you having me today, Maggie. Such an important question, since we know that 50 percent of people with mental illness don't receive the care that they need, due to, you know, stigma being negative beliefs, attitudes, behaviors towards people that may have mental health conditions, and, you know, with fears of being treated differently or potentially losing their job or livelihood.

And we know that it could appear in several forms, right? So one being public stigma, society's beliefs and stereotypes of what living with mental health or mental illness looks like. Self stigma, how one internalizes, societal beliefs. The other piece is institutional stigma, discrimination within systems, even within healthcare sometimes, limits to access to services. And the other piece is social stigma, negative treatment by friends, family, colleagues, all that can contribute to stigma and mental health.

Host: Do you have any thoughts on how we can start having those conversations? How do we talk about it with people whom we might not even feel comfortable talking to in general, either because we don't speak the language, so to speak, or we don't have the insights into their culture?

David Le, PsyD: Yeah, these conversations are not always the easiest, but are really important to have. And for me, I always think to myself, exposure, exposure, exposure, right? We have to do and try to know what works. So, just starting mental health conversations across cultural and language barriers requires a lot of sensitivity.

I think it's important to first educate ourselves, learn about others cultures, their mental health perspectives, start with universal themes perhaps. Discuss general topics like stress, emotional well being, shared values, family, and resilience, things that a lot of people can relate to, just be curious, right?

Be non judgmental, approach with curiosity and respect and then normalize the topic, right? Relate mental health to overall wellness. Um, for me, I think mental health is health.

Host: Do you find that some cultures or groups of people are more reluctant than others to seek mental health support?

David Le, PsyD: Each culture, even within cultures, people have differing views, beliefs and values, which makes us unique in ways. But also it sometimes comes with the stigma we talked about, different cultural beliefs, distrust historically, you know, discrimination has led to distrust in healthcare systems, lack of awareness, just not understanding what mental health is, language barriers at times, as you mentioned earlier, and gender roles, right?

Some cultures discourage men, for instance, from seeking help due to ideas around masculinity. Personally, myself, just a little bit of self disclosure, right? I had some learning difficulties myself growing up. It was hard to focus, hard to concentrate. I would just sort of push through, I'd be able to get things done, but it took me that much more time, and it was much more difficult than my peers.

I was finally able to get services later on in life when I was an adult, because my parents didn't believe in mental health and, just putting a name to what it was, was such a relief and I was able to receive the healthcare that helped me sort of get where I am now.

Host: Isn't that the truth? Sometimes I think parents just don't understand.

David Le, PsyD: Yeah.

Host: Like you said, you need help from the outside. So do you find that some groups of people are more in need of mental health support than others, certain groups?

David Le, PsyD: Yeah, certainly, certain groups tend to be more vulnerable to mental health challenges. We think about my work in a biopsychosocial model, right? So what's the biology and genetics that's there? What's the psychology? How do we sort of perceive the world or how do we think about the world? And then, the social aspect, right, what environmental factors influence and contribute to stress?

And so some groups are people from marginalized communities, so people of color, ethnic groups, LGBTQ+ groups often face discrimination, low income individuals; economic instability can lead to chronic stress and significantly impacts mental well being, individuals with chronic health, children and adolescents, veterans who have been to combat or not even to combat and just witnessed trauma, survivors of trauma or experienced trauma or abuse are more susceptible to PTSD, depression, anxiety, and also the elderly population. Older individuals often face challenges such as loss of loved ones, declining health, isolation, which may contribute to depression and anxiety as well.

Host: That covers a lot of groups, Doctor. I mean, it just shows, you know, how many people need help in this department. Stigma can prevent too many people with treatable mental health issues from seeking the care they need. So, how does mental health stigma affect people's lives?

David Le, PsyD: Sure. We know that stigma tends to lead to negative effects on recovery. It reduces hope, lowers self esteem, increases symptoms for some individuals, causing difficulties in relationships with others and work. It also reduces someone's likelihood of staying in treatment. It could cause people to believe that they will never succeed because of their mental health challenges. And also it impacts family and friends, right? Leading families to sometimes blame themselves or to reject a family member, which is really sad at times.

Host: Why do you think it's important for those with mental illness to share their stories?

David Le, PsyD: It's so important, right? I think it can give people a sense of hope and connection, especially if you're feeling isolated. You know, I think that in general helps with challenging stigma. Public health interventions have shown that it's been really effective to share lived experiences of people who live with mental health concerns.

It humanizes a person. Just knowing someone that has lived with a mental health illness, right, has helped with like decreasing stigma. And just in general, we live in a society that is so sometimes focused on social media, TV, following influencers. We know that four in 10 teenagers look for people that have experienced something similar to them, right? So when someone like Demi Lovato, Simone Biles, Michael Phelps, Lady Gaga shares their story, it opens up those conversations about mental health.

Host: That's so great. I did not know that. Four in ten?

David Le, PsyD: Four in ten, yeah.

Host: Wow. So do you have thoughts on how we can all do better at that as clinicians or simply as people to help promote the acceptance that mental health is real and it's okay to have mental health issues?

David Le, PsyD: Of course. Modeling an open conversation, right, so discussing mental health without stigma to make it more approachable is the first step, I would say. Using respectful language, so avoiding stigmatizing terms like crazy, insane, using compassionate language is so important. What we say, what we think really influences how we feel, educate, advocate, spread awareness, create safe spaces for people to share their experiences. I think empathy is so important.

Host: And it can be really hard when someone we care about is experiencing anxiety, panic attacks or any mental health illness. But are there things we can do to help? Can you provide some tips?

David Le, PsyD: Sure. Usually sort of my first tip is just keeping in mind, anxiety is not bad. We're really resilient as human beings. Anxiety can be helpful in ways. It helps motivate us to get things done. It also forewarns us of any physical dangers, right? So, there's that. So just not labeling anxiety as bad is really important.

 One strategy is breathing. I know it's really silly to sort of like teach people how to breathe, right? My patients always say, why are you teaching me how to breathe? I'm living, I'm right here, right in front of you, right? But it's one of the best tools to manage anxiety. I tell people to take a few deep breaths, it helps ground us.

So breathe in four, hold for four, exhale as long as you can. It causes something called vasovagaling that helps with relaxation. The other thing is utilizing our five senses, right? So, it helps ground us, right? So we forget that they're there. So focus on five things you see, four things you could hear, three things that you could touch, two things that you could smell, one thing that you could taste to help ground yourself.

And then the final one, if you're experiencing acute anxiety or panic symptoms; what happens is our heart starts racing, our temperature starts increasing, we get distracted, shortness of breath. Decreasing our body temperature is really helpful. It's called the diver's reflex. And so some of my patients will go outside and they'll just stand in the cold Chicago winter, or they'll submerge their face in an ice bath, or they'll hold ice cubes, which helps with activating the parasympathetic nervous system which helps with relaxation. So it reverses of those symptoms.

Host: What are your thoughts when you hear this statement, you only need to take care of your mental health if you have a mental health condition?

David Le, PsyD: I think the idea that you need to take care of your mental health only if you have a diagnosed condition is somewhat a misconception. Mental health is relevant to everyone, not just those with specific conditions. Mental health is a part of our overall well being. I think prevention is really key, right?

If we go to the doctor once a year for an annual physical, why not also maintain good preventative mental health care as well, and our mental health fluctuates, right? So everyone experienced ups and downs in their mental well being. There's life events, relationships, work stress, family stress.

So it's important to care for all those pieces. And I think it also helps with destigmatizing mental health in general, if we go receive treatment on a regular basis.

Host: Dr. Le, do you have any words of support for anyone listening who's facing mental health problems?

David Le, PsyD: Absolutely. If you're facing mental health challenges, know that you're not alone. It's okay to seek help and your feelings are always valid. Taking those steps to care for yourself and your mental health is a sign of strength and not weakness. Reach out to friends, family that you trust, professionals can offer support and understanding as well.

And, just remember that you know, mental health is a journey. The progress is not always linear. There's ups and downs and seeking help is really courageous. Hopefully by listening to this you know, that you deserve to feel supported and cared for.

Host: Absolutely. What are some resources out there to start taking care of your mental health? What resources are available at Cook County Health?

David Le, PsyD: So a few resources that come to mind, there's organizations like NAMI. Great resource out there. Reaching out to your local hospital system or organizations that have behavioral health services is also an option. If you have health insurance, many insurance providers will provide a list of referrals there.

If you're employed, many human resources departments have Employee Assistant Programs, EAPs, instead of, for medical emergencies we call 911. Now there's a suicide prevention hotline, 988. That's a great resource. And also there's a lot of free resources out there on the internet.

So meditation apps, a quick Google search or sometimes even like, again, like having this conversation with family and friends, they may have some referrals as well themselves. Within the department of psychiatry, we offer bunch of outpatient services. So individual, group counseling, including, skills groups, for both adults and children and adolescents.

 We have psychiatric care, medication management with our psychiatrists and advanced nurse practitioners. We have neuropsychologists that provide testing, and services come in all different forms. So individual therapy, specialized care for pain management, bariatrics, oncology, a lot of comprehensive services.

Host: Is there anything else in closing that you'd like to add?

David Le, PsyD: No, I think just keep in mind that mental health is health and hopefully continuing to have these dialogues helps bridge the gap in care and also just brings hope to our community,

Host: Right, and I think it's so important what you mentioned about even if you haven't been diagnosed with any mental illness, we still always have to be aware of our own mental health and take care of it before something may become a problem.

David Le, PsyD: Absolutely. Prevention is key.

Host: Right. Well, thank you so much for sharing your time, and I'm sure you've given a lot of people encouragement and hope on this very delicate topic.

David Le, PsyD: Appreciate it, Maggie.

Host: Again, that's Dr. David Le, and to find out more, please visit cookcountyhealth.org/podcast. As we wrap up another insightful episode of Total Health Talks, make sure to visit cookcountyhealth.org/podcast and subscribe to our podcast, share and connect with us on social media as well. Stay tuned for more engaging discussions.

This is Maggie McKay signing off from Total Health Talks. Stay well.