Breaking the Silence: A Conversation on Mental Health with Dr. Ashley Zucker

In honor of Mental Health Awareness Month, Erin sits down with Dr. Ashley Zucker, a board-certified psychiatrist with Kaiser Permanente, to explore the importance of mental health care, the stigma that still surrounds it, and what we can all do to support our own well-being. Together, they discuss practical tips for managing stress, recognizing signs of mental health challenges, and fostering a culture of openness and compassion in our families, schools, and communities. This is a must-listen episode for anyone who believes mental health matters—which should be all of us.

Transcript

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Unknown: 0:00

Erin Brinker,

Erin Brinker: 0:10

welcome everyone to the making hope happen radio show. I'm Erin Brinker. I hope you like the new intro music today. It's peppy for spring. And you know, I like to change things up, as is my practice. I love to start the show with gratitude. Today I'm grateful for time off. My husband and I recently took a weekend away in Vegas, and it was so great to eat out, sit by the pool, sleep in, visit friends. I'm not a gambler, so we didn't do that, but we did lots of other fun things, got our toes done and took walks. It was great. Mostly, it was great not to think about obligations and my seemingly endless to do list, and every single one of us needs to do that, loud family gatherings, girls night out, or guys, long phone calls with old friends, and other times when the burdens of life are lifted are so good for the soul in the US, we don't take anywhere near as much time off as they do in much of Europe. Honestly, I think all of Germany shuts down in August, because I'm exaggerating a little bit, but everybody goes on vacation in the US, we don't take anywhere near as much time off as they do in Europe. Like I said, and I think it's a mistake. We all need to unplug and make time for travel even nearby. I mean, we're so lucky here in Southern California, because we have the mountains and the beach and the deserts and so many great places for shopping and things to do, shows, to see, museums, all the fun things to do. But we need to do that and gather together with friends. So not just go, but Take someone with you. So today I'm grateful for connections, for relationships and time off. Okay, on to our guest. Well, I am thrilled to welcome back to the show, Dr Ashley Zucker. She is works for Kaiser Permanente, is a mental health professional, and is here to talk about mental health awareness month. Dr Zucker, welcome to the show. Thank you

Dr. Ashley Zucker: 1:49

so much for having me. So first of all,

Erin Brinker: 1:54

talk about mental health awareness month. We mental health seems to be, well, let's just say that there's a lot of discussion about what mental health is, what you know, what, what it means to take care of your mental health. Let's just define mental health.

Unknown: 2:11

Oh, well, like you said, it can be hard to define,

Erin Brinker: 2:14

right? It's kind of big. It's a blog. It's a big one,

Dr. Ashley Zucker: 2:17

yeah. I mean, I think, you know, as a psychiatrist, if I think in more of the medical space, and you know, we're thinking about sort of your your mental well being and your emotional health, I think is one way to think about it. And even though we call it mental health, it's really kind of whole body health. You can't just focus on your emotions and ignore the rest of your body, and you can't just focus on your body and ignore your brain, either. So I think they're all interconnected. But I think when we talk about mental health awareness month, I think we're thinking about sort of the big picture of mental health. And so, you know, how do we really make sure that we're taking care of ourselves, our well being, our emotional well being, and all of that to say that having good mental health or good emotional health doesn't mean that everything is perfect or that you're always happy or things are always going well. It means you've got awareness of your emotions and you know how to navigate things when they get difficult, because for everybody, no matter what, they will be challenging at times. So

Erin Brinker: 3:21

I wonder, because it's, it's as though, in our culture, we have an expectation that everything being just fine is the norm and the reality over the course of a life, and now the course of your life. And I have to, you know, I'm on the on the far end of farther end than maybe a lot of people who are listening of mental health, you realize that no, that, that, that everything being absolutely, you know, perfect, that's not the norm, right?

Unknown: 3:46

Absolutely? Yeah. I mean, I always talk to even my own patients, about how, you know, life is a little bit of a roller coaster emotionally, and that's okay. You just don't want your roller coaster to be one of the, you know, craziest ones in the world that's got 55 loop de loops prefer more of like a kitty roller coaster, exactly, preference, but it's still going to have its ups and it's still going to have its downs, and that's just part of being a human,

Erin Brinker: 4:12

right? And that's the good stuff, right? Because you can't, you can't feel the highs if you don't feel the lows. Now, obviously, we're not talking about bipolar highs and lows, but your average human highs and lows, right? So, so how can individuals so the big problem with mental health, especially for men, is, you know, how is the stigma surrounding mental health? So how do you have those conversations again, especially for men, but how do you have those conversations about stigma and overcoming that stigma? Yeah.

Dr. Ashley Zucker: 4:42

I mean, I think one of the best things we can do is just to talk about it in general, right? So those of us who feel comfortable, the more we have these conversations and the more we talk about it, we open up that space for others. But I also like to really reflect on mental health if we were to compare it to physical health, because the way we talk about physical health. Is very different. And there's actually some cartoons that sometimes I'll show patients to and, you know, they'll show somebody with a really big wound on their arm. And, you know, saying to them, what you tend to say to somebody who has maybe a mental health issue would be, you know, oh, just suck it up. You'll be fine. But if somebody had a big wound on their arm, that's not what we would say to them, you know, we would offer them help. We would tell them to clean it out. Maybe they need stitches to get care right and to take care of it. And so I like to kind of bring that back to mental health and really think about it is, you know, your brain is part of your body, and your emotions are part of your whole physical health. And so we really have to think about it like just part of our medical health in general. Let me

Erin Brinker: 5:44

ask you that you bring up a good point. You know, I wonder if brain scans for people who come in with pretty significant mental health issues, whether it's major depression or bipolar or schizophrenia or borderline personality disorder, maybe there's an injury, maybe there's, you know, been an illness that's happened to brain scan, to our brain scans, a part of mental health treatment. From a psychiatrist standpoint,

Dr. Ashley Zucker: 6:10

not typically, but I say that with a caveat, that if somebody comes in with like, sudden onset symptoms that just aren't really making sense, maybe aren't at the right time of life, like we know, certain symptoms tend to present at certain times in somebody's life, so sudden onset symptoms at an odd time in life, then sometimes we do maybe a CT or an MRI scan of the brain, but that's really to see if there's something else going on, like maybe a stroke or something like that. Unfortunately, there aren't scans that we can do that can help us, like, diagnose depression or differentiate between bipolar disorder and depression. And so, you know, we would love to be able to scan your brain and tell you everything that's going on. Would that

Erin Brinker: 6:53

be great? Yeah, make diagnosis a lot easier. Yeah. So is, you know, if you know, if anybody's working on that kind of level of brain mapping,

Dr. Ashley Zucker: 7:05

yeah, there's a lot of work that happens in the research world where they are looking at brain scans and they may identify, you know, some things that may be more common in, say, somebody who has a diagnosis of schizophrenia, but it's really just not at The level where we can use that diagnostically. Maybe someday we'll get there. But I don't know that our scans are quite sophisticated enough to truly get out what's happening in our brains. Our brains are way more complicated than I think sometimes we're willing to admit. So I think there's a lot more at play than just what you could see on a scan as well. You know, I think a lot of this happens really, you know, at a cellular level, and that may be really difficult to find just by, you know, a brain scan. So

Erin Brinker: 7:49

what role does self care play in maintaining good mental health? And I'm not just talking about going to the spa, or, you know, whatever people think self care is, how is, how is? What

Dr. Ashley Zucker: 8:05

role does self care play? Yeah, I mean, I think of self care a couple of different ways. You're right. It's not about going to the spa, although that's, that's pretty awesome. You can do that great. But I think of self care as an everyday task that we really need to do, and it's really about making sure you're addressing the basics. And you know, we always make fun of what they say on airplanes. They tell you to put your mask on yourself before you put it on somebody else. And the reason they say that is the same reason for self care. If you can't breathe, you're not going to be able to help anybody else, you're going to be able to put that mask on them. And so if you're running on fumes, you're running on empty mentally, then to be able to take care of your family or to take care of things at work is going to be really, really challenging. And so just making sure that we're doing again, it can really be some of the most simple, basic things that we need, like making sure you're getting enough sleep, making sure you're, you know, getting some movement in and you're eating well. And self care can also be little, kind of tiny things you do throughout the day. So maybe, maybe it's taking a deep breath before you walk into the office, or taking a deep breath before you walk back into your house, even that moment of just sort of, kind of wiping the slate clean, or a little bit of self reflection can actually go a long way in self care. And so I think the point being, really that you don't have to spend, you know, hundreds of dollars at the spa to take care of yourself, you know, it can be a very small amount of time, and it can be free.

Erin Brinker: 9:38

So I have to say, and I know that I'm not the only one who does this. When I get when things get really busy at work or there's something really stressful going on, I eat junk food because that's what I crave. I don't get the exercise that I need because I'm glued to my chair or whatever. By the time I get home at night, I just sit on the couch and I zonk because I'm working long hours and but then my sleep. My My quality of my sleep is not good, because I might wake up in the middle of the night or whatever, and so I at a time when I need to be engaging in self care, I do it all wrong.

Unknown: 10:12

Yep, not, not uncommon.

Erin Brinker: 10:15

So, so, you know, I, I know it's like I hear the right things to do, but I doesn't mean that I do them

Dr. Ashley Zucker: 10:23

right. So, and I think that's that's okay, right? We have to make sure we're also not being too hard on ourselves, like no one expects perfection. And I rattle off a list of a bunch of different things, but you may not be able to accomplish all of those things. Maybe you can only accomplish one of them, and maybe you can only accomplish it for five minutes. So maybe it's like getting really overwhelmed at your desk and just putting stuff down and just doing a lap around the office or a lap around the parking lot. Maybe that's 510 minutes, but that's movement, and that gave you a break, right? And so again, it's not about perfection. It's about even just the small, incremental things, I think sometimes also, when we start to just practice a little bit, we start to see the benefit, and then we start to want to do more of that, right? So that can be helpful too. Just think of a small increment that you can implement and start there. Don't start with I'm going to get perfect sleep tonight, and I'm going to eat great all week long, and all that stuff, because as soon as you, you know, have a misstep, then you feel like you've lost it all, and you might as well just give up on everything well, and

Erin Brinker: 11:29

that's what I do, yeah, that's what I do. Is, is like, well, forget it, I already ate. You know, we had cake at the office. I already had cake, so I might as well have a double cheeseburger for dinner. I don't eat double cheeseburgers, but you get my point. Yes, yeah,

Dr. Ashley Zucker: 11:41

exactly right. So have the piece of cake at the office, you know, and just say, alright, you know, I'm going to try to do better the next, next meal. That's it. You know. That

Erin Brinker: 11:51

really impacts, you know? I will tell you that the times when I am able to get out and move especially, I always feel better. I mean, it, it really, you know that, you know I always feel better and I and I've read that, you know, for cognitive ability, especially as we age, having regular movement really helps, yes,

Dr. Ashley Zucker: 12:12

and it can be, again, small increments. So I think the worst thing that we do is we all sit down in front of our computers, especially if your job is in front of a computer, and then you just don't move all day long. And so even just, you know, standing up periodically can make a huge difference. So just a little bit of movement throughout your day can actually help you focus better, too.

Erin Brinker: 12:32

So what are some warning signs that someone may be struggling with their mental health?

Unknown: 12:37

Yeah, I think, you know, there's a lot of different warning signs. The big ones that we look for is if people really start to feel like they just can't kind of keep up with their normal routine. So maybe you're really noticing big changes in your sleeping patterns, or your your eating habits, things like that, where, you know, you're just not your usual self. It's not about, you know, we talked about, kind of the ups and downs. It's not about just one, you know, bad day, but really, if it seems to be persisting, you know, kind of a key time frame we look for in mental health world is about a two week time frame of really just feeling like you're not yourself. Those can be some of the like starting warning signs that, you know, you might be struggling a bit and might need more help.

Erin Brinker: 13:21

You know, I'm thinking about the things that the diagnoses that you see people around you struggle with, and I know, actually many people who have been who have been diagnosed with major depression, and when they go quiet is when I go when I get worried. So I send them a text, Hey, you okay? Just checking in. And sometimes they say, you know, I'm in a rough patch, and sometimes they say, I've just been really busy, but it's the, it's the checking in that matters, I think,

Unknown: 13:47

absolutely, absolutely, and even if they're not doing well, and they don't tell you, the fact that you checked in actually matters a lot and can be really meaningful. So don't feel like you're not doing anything if they're not responding, you know, dramatically to your check in.

Erin Brinker: 14:03

So, so, how can family and friends, you know, like the check in, how can family and friends provide that meaningful support? What can family and

Unknown: 14:12

friends do? Yeah, I think, you know, the biggest thing is just sort of being available, and, you know, letting people know that you're there for them. And, you know, maybe people don't want to talk, or they're not ready to talk, but, you know, just letting them know, Hey, if you ever want to talk, or you ever want to go for a walk or grab a cup of coffee, just let me know. You know, happy to help out. Just that offer can actually go a really, really long way. You know, if people are struggling a little bit more significantly, you know, I think it depends on the relationship to right? But if it's somebody you're close to, maybe you can say, you know, Hey, can I help you set up an appointment with your primary care doctor, you know? And really kind of working through it with them that can, that can be a great way to help, but it's really about just being there and. And being available when they're ready.

Erin Brinker: 15:02

You know, I think of, and I'm thinking about men, because women are more likely to go to seek out mental health support, whether it's a group or therapy or that sort of thing. Men typically do things together, right? So it's some activity that they're that they're doing together. And I, I, you know, when my husband was going through a time where he just wasn't connecting with friends, and I was like, Okay, you're going out with so and so today. And you know, he's like, You know what, I haven't seen that person in a really long time. And that was that level of activity. And he'd go out and they'd have fun and come back and he felt better, you know, kind of have to pay attention to those around us, like, maybe they haven't, maybe they haven't, maybe they haven't connected with their friends in a while.

Unknown: 15:43

Yeah, and that's that key piece you're looking for, right? That change in baseline, right? Something was off, that's not the normal for them. That's when that reach out can be really powerful.

Erin Brinker: 15:53

So how can communities and organizations play a role in promoting better mental health care?

Unknown: 16:01

I mean, I think the key aspect is it goes back to the stigma reduction. The conversations are critical, I think, for both in our communities, in our workplaces, especially people who are in a position of influence or leadership, if they are the ones that are talking about mental health, and that doesn't mean they have to, like, disclose all of their medical information, but, you know, even just like, Oh yeah, I'm so excited for my vacation next week, I can't wait to just turn things off and take a break. Like, even that type of sharing can actually be really powerful, because you're setting that example that, like, it's okay to take a break to, you know, do things and take care of yourself. And that can be really, really powerful for again, just sort of setting that atmosphere, that that's an important thing for you, and so it's important for other people too. So I think that's really critical. It's the conversations and that, setting the tone, setting the example.

Erin Brinker: 16:59

So as I think about, you know, different workplaces and different, you know, because there are some where it's work, work, work, go, go, go, you know, all the time. And people may be afraid that, that if they, if they did slow down for a second, they did take that time off, they took a mental health day, or they even just let the letting them, let it, let people know that they were going through something, that they would be seen as weak, and they would be seen as, you know, being unreliable or less reliable. What do you say to that patient?

Unknown: 17:32

Yeah, I mean, I think about how much strength it takes to actually reach out for help. And so I try to really remind people of that, you know, saying that you need help or that you're not doing well is usually the hardest part, and it's not a weakness. It's really a strength, and it really takes a strong person to be able to do that. So I try to remind patients of that it can be challenging. You know, different environments may be, you know, more welcoming and less welcoming than than others when it comes to really talking about that kind of stuff. And so I think what's also valuable is knowing maybe I don't feel super safe disclosing it in my workplace, but I do have a friend I can talk to. So kind of, where are some of those outlets? Who could you reach out to? It doesn't have to be, you know, every single person you know has to know what's going on. But just finding at least that one kind of person, individual that you can connect with can can be helpful, even if you don't feel like you can do that. Maybe in your kind of work space

Erin Brinker: 18:35

well, and sometimes that maybe, if your work space is toxic, maybe it's time to find another work space could be, you know, if you're if your work is making you making you sick, you know, if you have the ability to find something else, I, you know, maybe that's the right answer,

Unknown: 18:49

yeah. And I think that's important to really recognize too. Do I only feel really terrible at work, right? So if it's unique to like a certain situation, that should really kind of raise some flags for you in terms of, okay, it's very situational. And so what do I need to do to address that situation? And it could be finding another job, if that's possible,

Erin Brinker: 19:10

if that's possible. So let's talk about children's mental health. You know, I don't think as I was growing up, I ever heard about children needing a mental health professional and I, and I'm inclined to believe that it's not that they didn't need them. It's just that nobody thought they needed them. It wasn't part of the the thinking of the day. So kind of what's going on in the arena of children's mental health?

Dr. Ashley Zucker: 19:35

Yeah, I mean, there's a lot going on in the arena of children's mental health, but to your point, I think there always was, I just don't know that we were as aware of it, but I do think there's been kind of a shift that we've seen sort of overall, where we might be identifying and seeing some mental health challenges in younger and younger kids. I think there's different reasons for that. I think some of it's awareness, some of it's. Reduction in stigma. You know, kids just talk differently to one another than they did, you know, when we were growing up, it's kind of a normal part of their their conversations now, where certainly wasn't when I was a kid, to talk about your mental health. And so I think there's that is innate in the sort of children's culture, so to speak, that there's just more conversations happening. You know, a lot of people want to kind of blame technology for a lot of what we're seeing. I think it does play some role, but I don't think it's the like end all be all of why we might be seeing people, you know, at younger ages, having more challenges. I think there's a lot of things at play, and some of it may just be that we're just talking about it more, but I think we'd all agree that being a child now is very different than being a child, you know, 20, 3040, years ago. Yeah, I

Erin Brinker: 20:54

would agree that the world that existed in the 1970s 80s and 90s, doesn't exist anymore, right? Exactly, yep. And I wonder how much of it, because, you know, think about technology, and technology comes in lots of forms, but kids aren't moving. I mean, I remember being a kid and being outdoors all day long, and we were riding bikes, we were climbing on monkey bars, we were we were moving all day long. And kids don't necessarily have that. They may have it in the in the confines of soccer practice or dance class, but it's not the same of this unstructured time to get out and move their bodies and use their minds and problem solve with their friends and all of that. And I wonder how much of a role that plays.

Dr. Ashley Zucker: 21:34

Yeah. I mean, I think there is a big part about movement, right? We know that just moving in general on I like to say movement instead of exercise, because exercise, I think we all think of bad things or things we don't need a gym or a CrossFit or whatever, running a marathon, but yeah, movement is really critical to just our well being. So I agree. I think some of it too is that a little bit more of that isolation, right? So you mentioned, you know, being able to kind of run free in the neighborhood or hang out with, you know, friends on your block or things like that. Some of it is just we're a lot more spread out than we used to be. Some of it is, I don't know the best way to phrase it, but maybe a culture where we're just a little bit less comfortable with our kids kind of being on their own. It's true, you know, we're, I think, a little bit more protective of children than maybe used to be the case, and so there's less opportunity for them to do those things. And then, of course, you know, you can blame technology there, if they're inside playing video games together, but at their own houses, right? Right? That's true. That's true. They're interacting, but it's different. And he may or may not involve movement, probably doesn't, probably

Erin Brinker: 22:46

doesn't. It probably does involve junk food, right? So I think about, you know, think talking about social media. I think about, there's a phenomenon of people talking about their diagnoses, whether it's official diagnoses or they've self diagnosed. You know, people talk about, I have bipolar disorder, or I have, you know, borderline personality disorder, or, Oh, I have this, or Tourette's. And the people there was a, there was a trend with so many people saying that they had Tourette's, who were on social media and taking what it appears to be from the outside, people taking on diagnoses that they don't really have, and then, and then, kind of wearing them, and I say wearing them, because it then becomes defining who they are, which is a problem, you know. So if you, if you have borderline personality disorder, which is a terrible, difficult, debilitating diagnosis, it's still not who you are. It's something you struggle with. And that, and that differentiation, to me, makes a big difference on your ability to see yourself outside of that diagnosis. What do you think?

Dr. Ashley Zucker: 23:49

Yeah, and I think that we see, you know, certainly, there's actually been a lot of research that's been done, like on the Tourette's kind of contagion through social media. I think that's a really kind of interesting sort of case study, so to speak. But we do see where people are really, I think looking for connection, you know, I think of teens in particular that, like developmental time of life is when you're trying to figure out who you are, and so you're trying on different identities, you know. So, you know, maybe back when, when we were kids, it was, you know, how you dressed, and the music that you listen to, and I think that's still applicable today, too. But

Erin Brinker: 24:25

are you a goth or a punk or whatever? I think of

Dr. Ashley Zucker: 24:29

this as sometimes, like a different iteration of that, like you're kind of trying different things on, I think also, like, we have to remember that social media has these, you know, algorithms that sort of feed us specific information, and so you kind of go down these rabbit holes. And so if that's all you're seeing or All you're hearing about, then I think that's more likely to kind of influence sort of your your thought patterns, especially at a time when you're looking for an identity. I do think it's important, though, that you know, no matter. Matter the illness, the diagnosis, it doesn't define you, you know. So somebody who has cancer, for example, they're not cancer. No, they're a person that has cancer, but that's not who they are, you know. So I like to also reflect back on on that, that it doesn't have to define you, nor should it really define you either. But there's also a lot of misinformation out there too. There are a lot of symptoms that overlap diagnoses, and so you'll see a lot of information on social media that makes people think they have X diagnosis. Maybe it's ADHD, maybe it's autism, maybe it's borderline personality disorder, and there are subtle differences between those. And so it's really easy to kind of, again, go down that rabbit hole towards one diagnosis that starts to maybe kind of sound familiar to you, and so you kind of grab onto that one and, you know, carry forward that way.

Erin Brinker: 25:57

You see videos, you know they'll see, you know, five ways to know that you have autism or you have ADHD. I'm thinking, hang on a second. The diagnosis process for autism, and I have a son on the spectrum, the diagnosis process is not you can't do this in a quiz or after watching a video. It takes a professional working with you over time for these, for the for the issues to manifest themselves and be diagnosed. It's not, it's not an easy thing. You can't click a few buttons and have the diagnosis Right

Unknown: 26:29

exactly. Yeah, there's a lot more to really figuring out the correct diagnosis. I always think to you know, we have diagnoses. We have kind of names and labels for things, and that's just sort of human nature to want to kind of categorize things, but it's not like every one of us fits into some pretty perfect little box either, right? You know. So that's important to remember too, is that these are ways for us to kind of conceptualize different you know, mental health disorders, but they're not the end all be all, and they certainly don't define who, who we are, nor do they define all of mental illness, right? No, well,

Erin Brinker: 27:04

they said, for autism, for example, they say, if you've met one kid with autism, you've met one kid with autism, Yep, absolutely, you know. And, and I, you know, it's, I'm trying to remember back to middle schools, and you know, we're talking about kids. You feel uncomfortable in your own skin. You just do, and everybody feels uncomfortable in their own skin, but they project that they don't right, because they're trying to seem cool, or they're trying to see seem like they have it all together. And so, I mean, I understand this desire to kind of get some definition around all of the things that you're feeling because it's messy. Yep,

Dr. Ashley Zucker: 27:39

absolutely, yeah. And everybody thinks they're the only one, right? I'm the only one that's uncomfortable or nervous or feels bad about myself. And guarantee you everybody else, everybody

Erin Brinker: 27:49

does. You know, as a matter of fact, I had with one of our without it, we have some high school aged interns here at the making hope happen Foundation. And, and she, she was really nervous for leading up to our gala. And, and I said, I said, Do you know who else feels like they have imposter syndrome? And she's looking at me very nervous. And I said, everybody. She looked at me funny, like, No, literally, everybody, right? You don't know, especially at her age, you know, maybe if you get to a certain point, you feel more comfortable, but you're always working up to the next thing. And the next thing is a place you've never been before, right? You know, when you're 55 you've never been 55 before, right?

Dr. Ashley Zucker: 28:26

I think too, like, we tend to think so much or worry, especially teenagers, right? They're so worried about what everybody else thinks. And so I'll often try to remind patients too, like, well, what are you thinking about when you walk in the room, you're thinking about yourself. Why do you think they're thinking about you? Yes, they're thinking about themselves too.

Erin Brinker: 28:44

Yes, like, Oh, see, right. Are

Unknown: 28:48

you worried about everybody else? No, you're worried about yourself too, right? That's right. You're

Erin Brinker: 28:53

worried about tripping in front of everybody or whatever, right? So, so what can you know you want to be and you want to walk the line right where you validate whatever your child is feeling, but you'd also don't want to make it so they make the whatever they're feeling so big that they it seems impossible to grapple with their deal with. So how do you walk that line? What does that look like? Yeah, I mean,

Dr. Ashley Zucker: 29:17

I think we have to take our kids really, you know, seriously, if they're expressing that they're feeling a certain way, or maybe they're worried about it a certain diagnosis, you know, we don't want to shut them down or have them not want to, you know, talk to us about things, and so maybe that's, you know, not the right diagnosis. But that's a great opportunity to say, well, really sounds like you're struggling. Maybe we should go and talk to somebody. I think also sometimes people worry too, if their kid say does have a diagnosis, that they're kind of walking on eggshells around them or having to tiptoe or treat them differently. And I think it's really important to remember that you need to treat them the same, right? It doesn't mean that they aren't the same person you know. Just with a diagnosis, but same expectations should apply in terms of going to school and getting their work done and and that actually can be really helpful, because having that same like structure, expectation schedule, those are things that we really know help with our mental health. And so, you know, really trying to just keep things as is, but also, you know, recognizing and acknowledging what our kids are telling us is is really important. So it is kind of a line to walk, right? You don't want to push them away and say, like, Oh no, that's stupid. You don't feel that way. Go walk it off. Good, yeah, Buttercup.

Erin Brinker: 30:38

So, but, so let's talk about, you know, you know, thinking about walking it off or not walking it off, you know, what about trauma? What if there's something or real loss, like, you know, maybe a parent or a grandparent dies, or, you know, a friend moves away, or, you know, something serious going on in the child's life? You know, how do you help your child through those difficult times, especially if you're nursing your own grief. Yeah,

Dr. Ashley Zucker: 31:02

I think it can be very challenging if you're struggling yourself. I think it goes back to role modeling, though really critical as adults and as parents, but even not as parents, just recognizing that, you know, it's okay for us to show our own emotions. You know you don't necessarily want to be, you know, a crying, upheaving mess all the time, but it's okay to cry in front of our kids. It's okay to tell them, you know, I'm really struggling with this too, because, again, it's setting that example for them that it's okay to feel bad and to have emotions. It's really recognizing them and figuring out what to do with them. That's important. I think similarly for you know, kids, who we know are going through a really difficult time, is same that we talked about with adults, right? Is just reaching out to them and just offering an ear, right? So I'm here if you want to talk. I'm, you know, checking in with them if they're not ready to talk, just telling them, you know, I'm here for you. If you ever do want to talk about it, just let me know. Happy to happy to chat. Or maybe there's times where you don't want to talk about it and you just want somebody to sit with you. I'm happy to do that too. So I think that role modeling, that just leaving that door open, are some of the really key components that we can do for for for kids and adults. Really, it kind of goes both ways.

Erin Brinker: 32:24

It's, it's hard. I've had some, some friends who have lost their husbands and and with with kids at home. And, you know, it's, it's, I think, setting the expectation that the grief will come in waves over time. It's not going to be done. You're not going to be done in a year, you're not going to be done. In two years, it'll be, you know, you create a system where you can cope with it as the as the waves come, because they will come, yeah, absolutely.

Unknown: 32:51

And they'll comment different times and weird times, and everybody grieves differently. And so I think acknowledging that's important too.

Erin Brinker: 32:59

So what if your child, so when you're when you're a late teen, early 20s, when serious mental illness starts to manifest itself. So, you know, schizophrenia and bipolar disorder, for example, what if you start seeing those signs in your own child? How do you deal with that? Yeah,

Dr. Ashley Zucker: 33:17

I mean, if you're seeing signs, and, you know, just so folks are kind of aware of what some of those signs could be for something more serious like that. You know, if they're what you talked about, withdrawing or isolation, right? That can be a key sign for depression and anxiety, but also for things like schizophrenia, for example, we see a big kind of pullback, isolation, really withdrawing into themselves. If you know, you see things like they look like they're responding to things that aren't there. They're talking to themselves in kind of a different way, like some of us talk to ourselves, right? And some of us see things, shadows, noises, things like that. That's normal. But if it seems like it's kind of like they're living out a dream, almost, that can, you know, potentially be a sign. And I think with bipolar, it's really those huge swings that we start to look for. But one of the key components can be and sometimes the first thing that we see is people have a reduced need for sleep. So not like they're staying up all night on, you know, social media or playing video games, but they just have so much energy that they just don't need to sleep at all, and they start engaging in behaviors that just seem really out of the ordinary for them, so really kind of strange things that you might be noticing, like they've never done that before. And obviously that can make you also worry about substance abuse too, right? Yeah, that's part of screening it all all out and figuring out what's what

Erin Brinker: 34:41

well, and it could be that they're experiencing both of those things, those, you know, they're self medicating and and, you know, I've heard of stories of people, they'll give away the family car like an adult. They'll, you know, spend money. They're sexually promiscuous, acting out in all kinds of crazy ways that. They're, you know, run to Vegas, you know, all kinds of things in ways that they're normally a responsible person followed by a crash.

Dr. Ashley Zucker: 35:08

Yeah, I hear a lot about folks who really start to develop a lot of paranoia, so really thinking like somebody's watching them, following them all of a sudden, like, extreme distrust of their spouse, but again, it's that, like, significant change in behavior. It's not somebody who was always just really worried. It's, you know, big, dramatic change. And

Erin Brinker: 35:31

how does a family member, how do you how do you deal with that as a family member, if you start to see those kinds of things happening? Yeah,

Dr. Ashley Zucker: 35:37

I think what can be really challenging is that oftentimes when those things are happening, the person who's struggling may not recognize what's happening or recognize that they're struggling. And so it can be hard as a family member to really try to help them see that or point that out. It, of course, depends on the relationship, but you know, even just trying to get them to their primary care doctor can be a great place to start. Like, hey, let's just go check in with your doctor. You haven't been in a while, you know. But also just talking to them about, like, do you feel like anything's different? Is there anything you're concerned about? But with certain diagnoses, it can be really challenging, because they can also become very guarded, and again, if they're very paranoid, that can certainly be be difficult, you know, if it's getting to like extreme behaviors where you're worried about their safety or your safety, obviously, 911, is always there, right? If it's not quite as serious as that, you know, bringing them into an emergency room for an urgent evaluation can often be a good option as well. I've heard

Erin Brinker: 36:41

that people with when they're in a manic phase, they like feeling that. They like it's euphoric. They want to be manic and and so that's, you know, maybe you wait until they're, they're coming down off of the man, if they're not in danger, you know. Maybe you wait till they come down off that manic phase when, when things start to look a little more bleak for them. You know, how they're how they're seeing the world. Maybe that's the right time. Yeah,

Dr. Ashley Zucker: 37:03

it's challenging to know, but you're right. A lot of people, when they're in that manic phase, they enjoy it, and they feel like they're, you know, super productive, and they're very creative. And, you know, there are a lot of famous artists who, you know, probably had have bipolar disorder, and they're at their most, you know, productive and creative at that point. And so it can be really challenging to get them to get help at that point. Not that you shouldn't try, right? But sometimes it is a bit bit harder. But again, you really want to try to get them before things get to the point where it really starts to become very, very dangerous. So it can sometimes, the earlier we catch it, the better it can be.

Erin Brinker: 37:43

So what role do schools play in in the promoting good mental health in practice, you know, habits and that sort of thing. What can schools

Unknown: 37:53

do? Yeah, I think, you know, schools hold a lot of responsibilities, so I certainly feel for them, but they also spend a lot of time with our children, and for some kids, that may be the adults that know them best, and that may be the adults that they're more comfortable with, or it may be the only sort of stable environment in their lives. And so I think we can't stress enough how important schools are for our kids. I think, you know, it depends on what schools are able to offer based on their resources. But I think the you know, I think we do a pretty good job with educating our teachers about signs to look for, things to, you know, be aware of. There are a lot of partnerships with schools. You know. I know KP does a lot of partnerships with schools. They have a thriving Schools initiative to really try to bring some of that mental health to the schools and support the schools. I see in my own school system with my kids, they do different like teaching sessions for parents too. That can be really great, but I think it's, you know, the key piece I always think about with schools is, again, they can be that like stable environment, that maybe the only stable environment that kids have, and so really keeping it a safe place for children, I think, is really important. And I think that communication with parents and caregivers is also really key for schools too. I

Erin Brinker: 39:20

know that there are schools that have developed like lounge areas for students to to go and decompress, that they've have peer kind of counseling. I don't want to call it counseling, because it's, you know, kind of peer support that they that they offer for students. And you know, it really depends if there's a champion on campus that can help them do that, if they if they if their counselors or their school psychologist has the bandwidth to be able to do that for them, but I have to imagine that it's that it's really helpful.

Dr. Ashley Zucker: 39:48

Yeah, there's actually really good literature that supports peer programs, the peers should be trained. So to your point, right? It can't just be like everybody get in a room and chat with each other. Oh. Yeah, yeah. What could possibly go wrong? Right? It'll be fine, but there's definitely ways that, you know, you don't have to have, you know, a specific license to still be helpful. Obviously, there's a role and a place for people who have more formal training. But that's not to say that peer programs can't be a really significant asset to, you know, helping kids with mental health.

Erin Brinker: 40:21

Have you seen any? And this just popped into my head. I you know, have you seen projects where maybe college students come down to high schools and lead that peer support, maybe psychology or social work students, so that there's kind of a you do have some training. They're a little bit older, but they're not so old that the high school students would blow them off. Yeah.

Dr. Ashley Zucker: 40:41

I mean, I think there are programs that exist like that, or there may even be maybe a little bit less mental health geared, but I think about like college students that are in training to become teachers, right? Sometimes they're doing, you know, teaching assistant types of roles, and even though that's about learning how to teach, you're still that like extra observer in the classroom. So that can be key. You know, there are certain situations, certainly where I've seen that maybe therapists who have finished their education at graduate school but are still working towards their license. So sometimes they're called associates. So they're they have a degree, but they don't have their license yet, and so schools use them often, and I think that's a great resource, because while they're still learning, they already have a lot of, you know, lot of information, a lot of education. And so that can be just a another way to kind of beef up the supply, so to speak, of mental health care clinicians

Erin Brinker: 41:40

well, and you bring up a good point, because nationwide, but especially in low income, urban and rural areas, they're just not enough clinicians. There are not enough especially if you are in an area where there's a lot of refugees or a lot of immigrants or, you know, there's just not enough people to support these populations that that need a lot of support. So how do we make it easier? Or, how do we remove barriers for people to become mental health professionals?

Dr. Ashley Zucker: 42:09

Yeah, I mean, I think that your peer support programs are a great way to kind of extend that network. I think really trying to think kind of broadly about the types of folks that can help, right? So again, you know, is there a space for that kind of pre licensed individual? They can be in a kind of, again, an expansion of the of the workforce, I think, really providing that education, also, of what are the warning signs when somebody really needs to seek that professional level of care? So, kind of knowing how to almost triage, in a sense, right? Maybe people just need a support group or a couple of resources versus they need, you know, formal ongoing therapy, for example. And that's not to say everybody doesn't deserve help, but what that help looks like might depend on what a person's going through. I think the other piece, and this is where technology can be great, is there's so much technology now that we can utilize so whether it's virtual care as an example, right? That you know, has really, really helped to bring clinicians into environments where, maybe historically, there just wasn't access. But there's also some really great opportunities in terms of like apps and different online programs that people can utilize and and again, I would recommend that more as you know, somebody who's maybe has more mild difficulties or maybe as an adjunct to professional treatment, but it does kind of extend the the bandwidth, so to speak, you know, to really round out the options for folks, and can be really helpful for people who maybe are sort of dipping their toe in the water too, right? So maybe they're a little bit nervous about doing, you know, therapy, for example, but they're willing to, you know, learn some skills and some, you know, coping strategies through an app, so it can kind of open that door

Erin Brinker: 43:58

indeed. And I'm and I'm and I'm thinking about, and I know Kaiser Permanente has some programs in both in Northern California and Southern California to to make it easier for like, low income, you know, people of color, to go into the mental health professions in in supporting them during that time when they're I think it's 3030 504,000 hours something, in that window of as an associate, to be able before their license, to be able to see people on their own, and they don't make much money. I mean, it's, it's, they're a great, phenomenal resource, but they're just not getting paid enough. And these are highly skilled professionals who, they have families very often. And so, you know, that is a significant barrier. I think you know, what would it? What would it mean if, if you know we're talking about how governments spend their money, or how organizations spend their money, I think that supporting those individuals would really help. Yeah,

Dr. Ashley Zucker: 44:55

absolutely. But I think it's also making sure that. Opportunity is there for them. So, you know, just like you said, as an example, it used to be, several years ago that Kaiser Permanente didn't use associates. We only use licensed professionals. And we really recognized an opportunity to really build and expand the workforce and actually be able to help people who are trying to get to that place where they have a license, where they can earn, you know, a significant, you know, better income. And so that was really kind of a win win for everybody, indeed. So, you know, just offering those opportunities so people can get in those hours and get them in pretty quickly, helps take them to that, that next level. But I also think it again, it expands that access for our patients and and honestly, I'll tell you, sometimes, some of our associates are the best therapists I've seen. They're eager, they're ready to go. You know, they do an amazing job, and they have, we have that built in kind of support network and, you know, supervision for them as well. So I know, and I have full confidence that, you know, if my patients seeing an associate, they're getting equal, if not, sometimes better care, because again, they're, you know, they're ready to go. They're learning, but they also have a supervisor to kind of run everything past, too. So it's almost like you get two for one,

Erin Brinker: 46:17

which is which is excellent. I've heard about people graduating from getting their master's degree and then not being able to find a clinical supervisor, which means they can't do their hours. So the fact that you all are hiring them is fabulous, because then, you know, I'm sure that they're then loyal to Kaiser Permanente. They've, they've learned the system. They they know the patients, and so for them to continue on in Kaiser Permanente makes perfect sense for them. Yeah, it

Dr. Ashley Zucker: 46:43

kind of creates this great career pathway too, because they might start it as an associate and then become a licensed therapist and then eventually become a supervisor themselves. So it's kind of cool to see them kind of progress through through their careers.

Erin Brinker: 46:57

So you chose psychiatry when you were in medical school, and what led you in, because we have just a few minutes left, what led you into psychiatry? Why was that? Was Was that always where you wanted to go? Or is that, was that something that you as you were going through residency, or whatever you decided that you wanted to do?

Unknown: 47:18

Oh, that's a good question, and that's hard to answer quickly.

Erin Brinker: 47:22

We have about eight minutes. Well,

Dr. Ashley Zucker: 47:25

I would say, actually, I became interested in psychiatry in high school. I think it was, you know, just seeing a lot of my peers that were struggling mentally and wanting to be able to help them. But by the time I got to medical school, I actually thought I was going to do OBGYN, so, which is very different than I agree. But in medical school, you know, you do your coursework in the classroom, but then you start to do your rotations. And so when I did my rotations in OBGYN, I was like, hmm, maybe this isn't what I want to do. And so you do get that opportunity to kind of experience each of the different specialties. And when I did psychiatry, I still wasn't quite sure, but it's actually my husband who was like, you have the most fun telling me your stories from psychiatry. And he's, you know, kind of pointed out, like, you really love that patient population and really love connecting, you know, with those folks. But I always really knew I wanted to be more geared towards adolescence. And so it also just kind of opened up that possibility to be able to do psychiatry, but also to, you know, to see kids, to see adolescents. And so to do that training, you actually have to get trained in adult psychiatry before you can do child and adolescent psychology. So that's also really helpful, because, yes, I take care of kids, but kids come with adults. They

Erin Brinker: 48:50

do, and some of those adults are stuck at being kids. They're mentally they're emotionally stuck at 16.

Dr. Ashley Zucker: 48:57

Yep, absolutely. And sometimes the it's the adult that actually needs the help. So, you know, being able to recognize that and help them through that is, it was also really rewarding, too, but that's kind of how I landed there. That's the short version. But that's

Erin Brinker: 49:11

awesome. That's awesome. I know, again, there's just not enough. I i love that there are multiple medical schools popping up all over the or, you know, that are, that are that have popped up in the Inland Empire. So in addition to Loma Linda, there's now UCR and there's the California University of Science and medicine out at the hospital in Colton. There's one in Pomona. There's, you know, and so and Cal State San Bernardino is opening a physician's Assistance Program, which is a different, different thing. But it's, it's, I love that we're building this capacity in the Inland Empire to to have mental, mental health and physical health professionals here, because we need them here.

Unknown: 49:51

Yeah, I think what's important to note one. I should note that KP has a medical school now too. But

Erin Brinker: 49:57

really I didn't know that. I didn't know that. That tell me about it. Well,

Dr. Ashley Zucker: 50:01

so it's the Kaiser Permanente School of Medicine. It's based out of Pasadena, but we actually have the students. They rotate out with us in San Bernardino for all of their rotations, not just psychiatry, but they kind of go all over Southern California, but especially to to San Bernardino, because we do have our kind of tertiary care center, so we have a lot of different specialties there. And then, you know, they it. We've only had two classes graduated. We just graduated our second class. So it's, you know, relatively new medical school, but we have seen a, you know, fair number of med students who are really interested in psychiatry. Excellent, exciting, excellent. We don't, you know, we don't streamline them straight into KP residencies. You know, KP does have a number of of our own residencies, and we have a psychiatry for a psychiatry residency for adult and for the child in Fontana, actually ourselves. But we don't say they have to stay. We're happy to have them go out and learn, you know, and expand the, you know, medical field elsewhere too. But it's also just a great opportunity for, you know, those of us who love to teach too, because a lot of medicine is about teaching. So it's kind of a great sort of feedback loop. But the other key piece is that we can build all the medical schools in the world, but if we don't have the residency program. So for folks that don't know you, you know you go to medical school and then you actually go to residency, which is where you specialize, and you you're paid, but not very much. It's almost like a paid apprenticeship. But if you don't have those opportunities, then you can't become specialized or board certified, for example. So if we have too many medical schools and not enough residencies, we're still not creating enough doctors. And so that's really a challenge that we're seeing kind of nationwide, particularly in certain specialties, where we don't what determines

Erin Brinker: 51:57

that? What? What determines how many, how many places spot slots you have, so

Dr. Ashley Zucker: 52:02

residencies are usually sponsored by the government. So, like most things, it comes down to dollars, right? So that that's been an issue that I know a lot of folks have been working, you know, not just in California, but also, you know, federally in Washington to to try to increase that funding for for residency programs.

Erin Brinker: 52:25

So if you have, you know, I know that residents, they have to, you have to match. You graduate from, from your medical school, and then you have to match somewhere. So you could go to go to, you could go to medical school here in Southern California, but be matched in Minnesota or Illinois or Mississippi or wherever, and and so the number of slots nationwide is determined by funding from the government. Is that what I'm hearing? Yep, wow, yeah. We need to make I mean, think about things that that a government would invest in, that would seem like was a pretty important one seems obvious to me. Yeah, right. Kind of a no brainer. Wow. Well, that's, that's good. So when? So if, if a, say, a high school student, is interested in maybe going to medical school, what? How should they train themselves? And I know this is a little bit outside what we, you know about mental health awareness, but I if we want to improve the the capacity for clinicians and the capacity, just in the in general, for mental health, this is an important piece. Yeah,

Dr. Ashley Zucker: 53:25

absolutely. I mean, I think the best thing that people can do is just get themselves a well rounded education. You know, I think of all the things sort of, I've been through and in kind of getting to medical school, and it wasn't just do medicine, right? You have to have kind of life experience that makes you a better person. I think too, you know, I wouldn't want, you know, especially somebody in high school, to not do the things that they love in high school, you know, you got to get into college. So there's that, right? But even once you're in in college, you know, not all medical schools are looking for a bio major. For example, there are prerequisites you have to do to get into medical school, but it doesn't mean that that has that science has to be your your major. So I think it's important people really continue to pursue their passions and not just get too narrowly focused on on medicine. But you know, the more experiences you can have within healthcare, it can be very helpful. But that could be, you know, volunteering or, you know, volunteering at a hospital or a clinic or even just a community program, you know, those types of things can be really, really helpful.

Erin Brinker: 54:37

Yep, because public health hits everything right, hits everything absolutely so as a kind of, we have about a minute and a half left. What is, if you could say one thing about mental health on a community level, and kind of where we're going and what to what to look, what to think about, what would that be?

Dr. Ashley Zucker: 54:57

I think the number, well, it's hard to pick one. I'll say that, but I think the number one thing that I think about, that we really have to do a better job communicating is that emotions are not a bad thing, that it's okay to feel bad. It's okay to have a bad day. It's really what you do with it. I think we, in sort of trying to destigmatize mental health, we've somehow landed on this message that, like everybody's supposed to be happy all the time, and that's not reality. So I think that's what I think about too, is how do we build that conversation? So it's not about, how do we make sure you're happy all the time, or that you feel good all the time, to how to make sure we we have the supports in place for when things are not going great,

Erin Brinker: 55:43

cuz very often, if you're just having a rotten day, just sitting with a girlfriend or sitting with a family member and saying, You know what, today just was terrible. And these are the things that happen and you, you know, and you have that conversation over a glass of wine or a whatever, and you feel better, yeah, you wake up the next day and you have a new day,

Dr. Ashley Zucker: 56:03

yeah? And sometimes we kind of torture ourselves, right? We have a bad day, and we beat ourselves up for it, and that just makes us feel worse, as opposed to, you know what? Today was just a bad day, a bad

Erin Brinker: 56:13

day. Oh, you know, I'm the queen of beating myself up, so I gotta stop that, right? Well, Doctor Ashley Zucker, board certified psychiatrist from Kaiser Permanente here in San Bernardino County. Thank you so much for joining me today. Thank you so much for having me. It was a great conversation. It was a lot of fun. Always is, and I look forward to having you on again. Yes. Well, that is about all we have time for today. I'm Erin Brinker. You've been listening to the making hope happen radio show, and if you're listening to this on Memorial Day weekend, when it first airs here on local radio in Southern California, I hope that you take the time this weekend to remember those who paid the ultimate price, made the ultimate sacrifice, the men and women in uniform who have ensured that we have lived prosperously and freely, prosperous and free since 1776 so to all those men and women who have fallen, thank you for your sacrifice. To the families who are left behind and the loved ones who are left behind and the men and women in uniform who are left behind, you are in our thoughts and prayers. Thank you for all you do. You've been listening like I said to the making hope happen radio show. I'm Erin Brinker and I'll see you next week. You

Noraly Sainz: 57:40

Hi. My name is Nora Lee science and I am Program Coordinator at uplift San Bernardino, a collective impact initiative at the making hope happen Foundation. And this is my story. In November of 2017 my husband, our four young sons and I moved away from our families to San Bernardino with the hope of reaching our goal of home ownership in 2018 as our oldest son started kindergarten, I connected with the school district and learned about making hope happens Kids program with my oldest in kindergarten and my twins at preschool. I had the opportunity to tote my youngest to the kids parenting classes. In January of 2020, my husband and our family's breadwinner unexpectedly passed away, I found myself in a pandemic with my sons in an uncertain future. It was then that that oasis that I found at kids turned into my support system, as the staff and friends rallied around me while my sons and I struggled to find our new normal. In October of 2020 after seven years as a homemaker, I joined the making hope happen foundation as a program coordinator for uplift San Bernardino. This career opportunity reignited my family's dream of home ownership in November of 2022 through the mutual support of the uplift San Bernardino Housing Network, my family was able to buy our first home in my role as program coordinator and as I connect with other families in our community, I can wholeheartedly attest to the opportunities that the foundation is bringing to our community and truly making hope happen. For more

Erin Brinker: 59:31

information about the making hope happen foundation and to make a donation, please visit www.makinghope.org That's www.makinghope.org your donations make our work possible. You.