(gentle music) - [Michael] COVID-19 has killed hundreds of thousands of Americans.

But there's another disease among us, one that all too often we chose to ignore.

- I think that people with mental illness have been forgotten, that it's not considered a priority for them to be in recovery.

- [Michael] No one is immune to mental illness.

- I've got everything that I've ever wanted in my life.

I should be happy all the time, but I'm not.

- [Michael] It can strike at seniors... - And I'm telling you, this is a good reason for a mental breakdown.

- [Michael] At children... - So I'm just kind of floating in and checking in with a handful of kids to see how they're doing.

- [Michael] Fire chiefs... - But we also have extrication equipment on here.

- [Michael] College students...

Farmers... - I hope my story can inspire somebody to, to be brave enough to go out and ask for help.

- [Michael] In this film, we'll hear from people living with a mental illness, who refuse to let it control their lives.

- I just want to describe it as pure darkness.

I was literally in the dark.

- One in five people will live with a mental health condition.

Some people will say "suffer from," I choose "live with" because I chose not to suffer.

- [Michael] And we meet health-care professionals inside the system, frustrated with its failings.

- People are making decisions based on their insurance company as opposed to making decisions based on their life.

- [Michael] As America reels from the COVID pandemic, are we ignoring another pandemic that's been with us for longer?

- It was a hidden pandemic before the pandemic, and it's even more of a hidden pandemic now.

(gentle music) - [Narrator] Support for "The Hidden Pandemic" is made possible in part by CommunityAmerica Credit Union, the William T. Kemper Foundation Commerce Bank Trustee, Husch Blackwell, the Hall Family Foundation, Marlese and Robert Gourley, and from the generous financial support of viewers like you.

Thank you.

(birds chirping) - Douglas County is a really wonderful county in Kansas.

It's about 122,000 people, almost a 100,000 of those folks live in Lawrence.

- [Michael] Douglas County lies west of Overland Park in Kansas.

For 12 years prior to January, Nancy served as one of its county commissioners.

Over time, she became aware of a worrying trend.

- Something is going on in Kansas that makes our farmers vulnerable to the deepest kind of depression.

- I was taught as a young farmer, a young child, that we're supposed to be tougher than everybody else, we run from sun up to sundown, and go days without seeing our family and this is the lifestyle that we've chosen.

- [Michael] Lowell grew up farming with his father in northwest Kansas.

17 years ago, he left to help run his wife's family farm, not far from Nancy.

- [Lowell] My brother in law and I are fifth generation on this farm.

I find that a big stress in our lives because we don't wanna let that legacy down.

- [Michael] For most of us, sustained heavy rainfall is an inconvenience.

But for farmers, it can lead to financial ruin.

- They were pretty dry when we planted but with all the moisture we've had in the last month, month and half, most of those spots have drowned out.

That's loss of production.

- [Michael] 2019 saw extreme storms and fluctuating soybean prices.

The stress on Lowell's mental health became too much.

And he developed depression.

- It's kind of hard if you're going through something like this to go and get in a tractor and be by yourself for 12 or 14 hours a day 'cause I mean, that gives you a lot of time by yourself.

- [Michael] Eventually, Lowell sought help from his primary care doctor.

His treatment is covered by his insurance.

- One of my biggest regrets is not asking for help sooner.

Luckily I had some strong people in my life to kind of nudge me in the right direction.

Looking at where I'm at in my journey now to where I was before, didn't realize what kind of toll it was taking on my family, my co-workers, my kids, myself.

- [Michael] Lowell caught his illness in time.

But, sadly, many farmers don't.

- There's no shame in depression or a sense of isolation, or hopelessness, there's no shame in needing help.

- Yeah, there is a huge stigma, and I don't even think it's just in the farming community, I think it's nation wide, that it's kind of looked down upon almost to seek help.

- [Michael] Research published last year on the mental health of young farmers and ranchers in the Midwest, found that nearly three quarters of those surveyed met the screening criteria for an anxiety disorder and just over 1/2 for a depressive disorder.

- As with most medical conditions, early intervention is the most effective.

- If you don't have the treatment for it then you're not sure how to help navigate your life.

- [Michael] And if you can't navigate your life, you can lose everything.

- Our homeless tend to occupy these vacant buildings in an effort to get some type of shelter and some type of safety, so we're going to go up here and see if we can find anybody in the building.

Hello.

You can tell there's been people staying here, a lot of times they'll build a fire in these vacant buildings in an effort to stay warm.

There's several little, like these little make shift stoves.

A lot of people, they just don't get treatment for their mental health.

It tends to spiral out of control and they end up losing everything, and on the streets.

It's pretty sad.

- [Michael] The days are getting colder in Missouri, and the Kansas City Police Department is working with mental health specialists to try and connect homeless people with services.

- A lot of the homeless people are homeless because their mental illness isn't letting them go get the services they need on their own.

- [Michael] Nearly 1/5 of Missouri's homeless are severally mentally ill.

The figure for Kansas is nearly 1/3.

And if left untreated, mental illness can lead to other tragic circumstances.

- I'm trying not to cry, but this is what's left of my baby, who shot himself in the head right here in my house.

- My brother had been dealing with mental illness probably all of his life.

He was bi-polar, I don't remember all the different diagnosis he had, made it difficult in school, learning, trying to get along with other kids, and trying to just learn in general.

- Depression is when you feel like, well, my definition is when you feel like you're all alone.

You're trapped in this black hole of nobody understands.

- He'd tried for years to follow a program with the medication, and then towards the end, he started doing more self-medication.

He'd gotten off the medications.

- A lot of people are so good at covering it up, and it can literally kill you.

I was on the verge of killing myself.

I have a tattoo here that I represent for strength.

I tried to kill myself.

- We didn't find out until several hours later that he'd actually killed himself.

That was pretty rough on us, really rough on my mom 'cause she had spent so much time and energy trying to get him the help he needed.

- His name is Thomas Joseph Gillespie.

He died May 29, 2017, at the age of 42.

At least he suffered no more.

I don't have to worry about nobody mistreating my good-looking boy no more.

- [Michael] In the 20 years prior to 2018, the suicide rate in the US increased by 35%.

Between 1999 and 2019, nearly 800,000 Americans took their own lives.

Stigma, and a reluctance to seek help, plays its part.

But here in rural Missouri, the story of one family shows that the care system itself may be letting people down.

- So it's really just like a friend group that we all understand what's going on each other's lives.

- [Michael] As part of the National Alliance on Mental Illness, Michael and his sister Amanda have set up a support group for people living with a mental illness.

In the room next door, their mother Angela is advising families.

- When a family member has a mental illness, it affects the entire family dramatically.

- Well, when I hear you talk about your son and he's 28 years old and he's living at your house and all I wanna do is get rid of mine.

- [Vicky] But you've also been through a different situation.

- [Michael] Angela has a message for families struggling to navigate the care system.

- I would tell them not to give up, and do not accept anything but recovery for your loved one, because it's possible.

- [Michael] And it was possible for Angela's son, Michael.

But only after she fought a relentless campaign.

- She has been my brother's biggest advocate for sure.

He has a great doctor right now, but he only has a good doctor because my mom found someone in New York City, and we're in Missouri.

- [Michael] Michael is recovering from schizophrenia.

It's something both of his grandfathers had had.

And when Michael was around 15, Angela started to recognize in him the same symptoms she'd seen in her father.

- My father would sit for hours and do nothing and didn't wanna go anywhere and didn't wanna do anything, and so I just thought that that was attributable to his alcoholism, but whenever I saw Michael start to show these signs then I realized this is all part of brain illness.

- I started having these delusions and so I went to the doctor and they thought, well, maybe its schizophrenia, but you're not hearing voices, right?

And I'm like, "No, I'm not hearing voices."

Well, a few weeks later, then I started hearing like people in my head, not my internal voice.

It sounds like another person entirely.

They'll have different ways their voice sounds, they'll have different things that they'll say, and it's kind of scary.

- [Michael] Michael's symptoms had worsened while he was away at college studying computer engineering.

In 2016, he came back home and Angela put her business on hold to focus full time on his recovery.

- I decided I need to learn everything that I possibly can about this illness, about the medications that he's being prescribed, about the side effects.

- [Michael] The therapy they tried didn't work.

And neither did the prescribed medication.

- They would prescribe whatever the new pill was on the market and it's supposed to be a cure for everything.

Well, the pills weren't working.

In fact, they were making him worse.

And they had terrible side effects.

- I was so bad that I was sleeping on my parents' floor because I was hearing voices that were very, very loud and very, very mean, and they would tell me that I wasn't supposed to be hearing voices so I shouldn't tell people that I was hearing voices.

- [Michael] Within an 18-month period, Michael was hospitalized four times.

Life was becoming unbearable for him.

- I started finding like little notes about suicide and ways that a person could kill themselves without having any pain.

- [Michael] One afternoon, Michael tried to take his own life.

Fortunately, Angela was with him.

- So I took him immediately to the emergency room and he had overdosed, he was in ICU for a couple of days and he did come out of it.

The doctors would not listen to us and consult us about his medical care, and that was our only way that we could get him proper medical care was by getting guardianship of him.

- [Michael] Angela insisted Michael be prescribed a medication called clozapine, which can be used to treat the symptoms of schizophrenia.

He immediately began to improve, but there were powerful side effects.

Eventually, Angela looked outside of Missouri to find a doctor who'd balance Michael's medications to where he could have a future.

- I asked her if there was any way possible that my son could be their patient and they said sure, they would be willing to give it a try.

So we started flying to New York and at that point was when Michael really started to get well.

- It's just that it stinks that we can't do it in Missouri.

I know that there's a lot of people that aren't able to take their family members to New York City to get treatment.

- Instead of hearing like a lot of voices and a lot of mean voices, I hear one voice and that's it.

And it's really a nice voice, so... - [Michael] Michael is now in recovery and plans to go back to college.

- I wanna study social work because I wanna help people.

I wanna see people that were struggling like I was to be able to get better and lead a meaningful life.

- [Michael] But shouldn't Michael's recovery have been easier to come by?

Despite a slight dip in 2019 in both states, overall, the suicide rate for Missouri and Kansas has risen dramatically since 2005.

- [Interviewer] What's happening here today?

- So today we are working on simulations with our nursing students.

We have one patient suffering from paranoid schizophrenia.

- Okay, I'm safe, I feel safe.

- [Michael] Here in Kansas City, Missouri, student nurses are learning how to treat a patient in a mental health crisis.

An actor plays the role.

- I didn't tell them anything, they keep asking me questions, I didn't tell them anything.

- [Michael] Holly has over 20 years experience as a psychiatric nurse.

She's also living with a mental illness.

- I found myself when I ended up going to nursing school really being drawn back to mental health.

So now I get a different one?

With the major depressive disorder, I have everything that I've ever wanted in my life.

I have a husband, I have a son, and I have a career that I absolutely love and there's days that I wake up and it just doesn't seem worth it.

Focused mental health assessment...

The anxiety is something that has progressively gotten worse as I've gotten older, there's times that I just feel like there's so much and I just kind of start shutting down and it's like I can't do this.

If I'm having crisis time, I may have to fill it up a couple of times a week, but that doesn't happen very often.

- [Michael] Crisis time is when a mental illness overwhelms the person living with it.

- And Thomas stopped last night and brought me somewhere and I (indistinct) - [Michael] It can raise the risk of suicide.

For many, regular and timely medication, prescribed by a psychiatrist, is critical to prevent them from reaching this point.

- I have lots of different kind of medications, they all kind of work together in different ways, so it's not just like one pill and you're done.

- I have started using a pill planner to make sure that I get my meds in every day like I need to.

- Different pills for different aspects of the illness.

- [Michael] We know that Michael had to fly to New York to have his medication fine-tuned.

Surely, it was easier for Holly, who actually works in mental health.

- I was in the process of switching care providers because of insurance.

One of the psychiatrists that was recommended to me had a five-month wait period.

- [Michael] And she also encountered delays as well for her son, who also has a mental illness.

- To get him into a psychiatrist, our primary insurance didn't cover that, so we had to switch and it was a four-month wait.

- [Michael] Federal regulations state that the ratio of population to psychiatrists should be 30,000 to one at most or 20,000 to one if there are unusually high needs in the community.

Under 4% of Missouri's population sees this minimal ratio.

Kansas fairs better with around 30%.

Last year in Missouri, the Kansas City Police Department had over 10,000 call outs to Emotionally Disturbed People.

And attended nearly one attempted suicide per day.

Should the police have to be doing this?

- We absolutely should not.

When I first started law enforcement almost 29 years ago, it was pretty rare that you would go on a mental health call or someone in a crisis situation, maybe once or twice a month.

And that's changed with these officers of today are doing two or three a shift.

Without the bed numbers increasing, the problem is gonna keep persisting.

- A mental health crisis can come in many ways and the ERs, the emergency rooms are the ones that see these people probably before anybody, other than maybe a primary care physician.

- [Michael] Many of Dr. Hill's patients have been dropped off by the police at his hospital's ER.

It's a large medical hospital in the Kansas City area, which doesn't want to be identified.

- A mental health crisis would be someone who is suicidal, we also see people that have very bad anxiety attacks, panic attacks.

The other are where people lose touch with reality, and then of course people needing substance abuse treatment, that's another whole realm of this.

- [Michael] Dr. Hill will attempt to stabilize the patient.

And then with his team, in serious cases, try to get them a bed in a specialist psychiatric unit, which would then work out how to get them into recovery.

But this transfer isn't always straightforward.

- There are just not enough psychiatrists for one thing, and there's not enough psychiatric beds available.

- [Michael] And because these facilities are run privately, they can always decline to take patients from Dr. Hill or his team and oftentimes it's the more difficult patients they choose not to take.

- But once a facility sees that they're refusing medications or being aggressive with staff or maybe inappropriate with staff or anything like that, it's almost an immediate denial.

And I understand that psychiatric facilities may not have the staffing to take on five high-acuity patients.

I understand that, but it's hard for us at a medical hospital to treat patients they way they need to be treated when they should be at a psychiatric hospital.

- We have patients now that sit on a medical surgical floor who are not getting the inpatient psychiatric care that they need while they wait for days, sometimes a week or more to get into a psychiatric hospital and we never get them in.

And we end up discharging them home or to follow up with a mental health center and it's very, very frustrating.

- [Michael] So is there a state psychiatric hospital that would take patients who haven't committed a crime?

- The problem in Missouri, and this is a good example of where the system is broken, is that there is not a state mental hospital.

- [Michael] So people are not being helped to break the cycle of crisis, and Dr. Hill sees them again and again.

- In fact, this one gentleman has been here at least seven times in the past six or seven years all for the same thing.

- [Michael] In your view, is the mental health care system broken?

- Yes.

Unfortunately, it is, I mean, there are a lot of people that need mental health support, but they can't get it.

- [Michael] Holly is doing whatever she can do to manage her illness and avoid the horror of a crisis.

- I have an app on my phone that I use.

It's got different meditations on it, it's got a check in that I can do that it'll track kind of my feelings about things.

This is one I use, an anti-stress one.

- [Michael] Crises should not be inevitable.

With the right ongoing treatment, they can be kept at bay, allowing people to lead the lives they want to.

Gabriel is building a successful career in IT.

- So my primary diagnosis is bi-polar disorder one, some people will know that as manic depression.

It's a mood disorder.

It's kind of being like the weather, like I have no control over it.

Some day it's gonna be rainy and I have to learn to live with it being rainy.

And then other days it's going to be mild and nice and then other times it's gonna to be, I don't know what the manic equivalent of that would be, maybe really windy and I've gotta learn to walk calmly instead of running with the wind or being carried away.

- [Michael] Gabriel has learned from a therapist how to read the weather of his moods and how to cope with it.

And together, they keep a close eye on it.

- So I see my therapist once a week and have been doing for almost three years now.

And that's way beyond what my old insurance would have paid for at previous jobs.

There's no perfect solution in this because I have been in the hospital since being in that therapy program, but it has definitely kept me out and kept me stronger and out of the hospital longer than I was able to do by myself.

- I have spent 20 years dealing with mental illness, and for the first time, this therapist, I felt like I had hit the jackpot.

She changed everything for me.

She was the first one that we would actually talk things through and she's like, "Here I want you to try this exercise."

- [Michael] Perhaps just as important as being prescribed the right medication is being connected with the right therapist.

- And another thing that made it super uncomfortable was, I got put with a gal that had never really done anything with farm people before.

- [Michael] But once Lowell got used to his therapist, she taught him some useful coping strategies to avoid a crisis.

- She gave me a lot of different ways to come at stuff that maybe my farm mind wasn't quite used to thinking like that.

Then she actually took a job out of town and I kind of stopped having some therapy for a while then, this past year, it got pretty bad for quite a while and... - [Michael] But he started with a new therapist, and with the help of medication, he's in recovery.

Holly was desperate to keep her therapist.

- When I'm in crisis modes, sometimes that means paying the $100 for a visit with her every two weeks.

When I'm doing well, it's $100 every six weeks.

- [Michael] But toward the end of 2020, she had to stop for three months after she started spending more on her son's treatment.

For some, the cost involved is another obstacle to be hurdled.

- I can definitely say actually that there have been numerous individuals who have walked into my office who I would say are medically in need of treatment for their symptoms of depression or anxiety, who can't afford it and have to not continue in services.

- [Michael] Jenny and Nicole work at the Bert Nash Community Mental Health Center in Lawrence, Kansas.

You'll find centers like this across the US.

Their roots go back to 1963, when President John F. Kennedy signed the Community Mental Health Act.

The hope was that people with a mental illness could lead normal lives in the community.

As President Kennedy said, "The mentally ill need no longer be alien to our affections "or beyond the help of our communities."

But it seems that someone forget to tell the insurance companies.

- We find that people are making decisions based on their insurance company as opposed to making decisions based on their life and what they need.

- Most insurance companies do not cover case management services or our community-based services where we're helping people to access resources.

- A person could have a very high deductible and have so much out of pocket costs before their insurance would ever kick in.

- Some insurance companies will restrict the amount of treatment you can get or the frequency, so they'll say you get this many sessions or you can only have sessions every other week instead of weekly.

- [Michael] And the story is the same on the other side of the state line in Missouri, where Dr. Hill is trying treat patients in crisis.

- Sometimes playing with an insurance company, and I use that term loosely, is you have to compromise your quality of care and I just won't do that.

And so will fight with insurance companies tooth and nail to get the coverage that the patient needs.

- [Michael] And this is despite federal laws requiring health insurers to cover mental health the same as other conditions.

- But to get insurance companies to actually abide by it is very difficult.

- [Michael] Because of the need for social distancing during the COVID pandemic, the Bert Nash therapists have had to improvise.

- I'm setting up right now for a telehealth sessions, so we have accounts with Zoom.

- [Michael] Telehealth, or online, or phone therapy sessions, have proven to be popular with clients.

- And it's been very helpful for us to stay connected to all of our clients.

- [Michael] But there's a hitch.

- What we've learned is in this public health crisis, there are whole sectors of people who aren't served because they can't get connected to the web.

They don't have access to broadband, rural broadband.

- [Michael] At the moment, fast broadband coverage in Kansas and Missouri is patchy.

The Bert Nash Center has tried to adapt.

- Yeah.

So if there's any client that doesn't have access to the technology they would need to engage in telehealth, they can come into the center and use our technologies.

- [Michael] But the future of telehealth doesn't just rest on broadband access.

It also rests on the policy decisions of insurance companies.

- For us to do telehealth and provide the services like we did when COVID-19 really hit, we needed the cooperation of insurance companies to say that if we're delivering services differently, they would still pay us for those services.

And they did.

- Yes, it is (sighs) a little anxiety provoking to think about the day might come when the insurance companies tell us, "We can't do this anymore" and that might be a really difficult transition for a lot of our clients.

- [Michael] Unlike Kansas, Missouri has chosen to expand Medicaid.

And this should mean around 40,000 Missourians will become eligible for free treatment for their mental illness or substance use disorder.

And extra money has flowed into some of Missouri's mental health centers under the Excellence in Mental Health Act, which Kansas may adopt later this year.

Nonetheless, every eight hours or so in Missouri someone takes their own life, leaving behind loved ones traumatized.

- So this is the apparatus bay.

We have two ambulances, kind of give you an idea of how much room we have in the back of one of these.

- [Michael] Eric is fire chief for the Claycomo Fire Department, to the north of Kansas City, Missouri.

- This is what we treat patients in.

Can be very close quarters.

- [Michael] He's married to Holly.

And around 10 years ago, his younger brother, Mark, took his own life.

Many of his fire department's call outs are to people in a mental health crisis.

- I knew that whenever we'd run a suicide I was a little bit more cautious about going in there and seeing what I might see 'cause I didn't want to see something that brought back what my brother had done.

- [Michael] Eric has experienced a trauma.

And trauma like this can be one factor that raises the risk of mental illness.

- It was a take over situation.

They jumped the counters, I was working as a teller at the time.

- Whenever I was 17, I suffered from a traumatic experience where my life was in danger.

- Some of that led from losing my father.

I mean, that was a pretty dramatic part of my life.

I never thought I'd lose my dad at 67 and... - Very deep depression was, ended up being diagnosed with post traumatic stress disorder.

- I was at gunpoint and I was bleeding and I remember just thinking, "Okay, this is how we're gonna die."

- Yeah, then the sleepless nights and then, I mean, just the constant worry led to anxiety and then the anxiety led to just a mild case of depression.

- Trying to cope with that experience is probably one of the things that contributed to my first real major suicidal depressive episode.

- [Michael] For Eric, the suicide of his brother began to play on his mind.

- It didn't escalate like within a month or two, it was a couple of years.

And then it finally hit me and I got to a low point where I needed to reach out for help myself.

I got medication just after a little bit and that made the world of difference, and actually just talking about it, talking about it with my wife, Holly, that's helped a lot.

This is probably the happiest I've been in a long time, and I mean, I just, if I hadn't gotten help, I might not have been here.

- We're standing in my living room, and I'm gonna give you a tour of my humble abode, abode.

- [Michael] Deborah Gillespie, who goes by the name Gillespie, lives by herself in east Kansas City.

Around four years ago, her son took his own life in front of her.

Her other children live out of state.

- As you can see, there's nothing up here, but they still come up here and crap all over the floor.

- [Michael] What comes up here?

- The rats.

They ate up my mother's clothes, my mother died, they gave me her clothes, they ate 'em all up, I had them in a garment bag.

They won't let you have nothing.

- [Michael] As a survivor of years of domestic violence, Gillespie has been diagnosed with PTSD, and anxiety and depressive disorders.

- You smell the mildew?

- [Michael] But around 15 years ago, she stopped receiving treatment.

- I quit taking the medication, 'cause they had me on so many pills, I don't weigh but 105.

I tell them 50 milligrams is too much and she raises it to 100, so I had to quit taking it.

And she said, "Why you quit taking it?"

'Cause you're not giving it to me so I can function and take it.

Dirt seeps in from the foundation, see 'em on the wire, on the pipe.

- [Michael] Gillespie rents this property through the Section 8 Federal Voucher program.

In recent years, her living conditions have deteriorated.

And it's adding to her stress.

Oh my gosh!

Phwaw!

Rat!

- Yeah, see, and I'm telling you this is a good reason for a mental breakdown.

I have gotten sometimes so discouraged that I could just take my bags and just walk away.

- [Michael] Gillespie has had to throw her mattresses away because the rats nested in them.

- Voila!

- [Michael] She now tries to sleep in a chair in her front room.

But the rats won't let her rest.

What is it?

- Rat blood.

Where they've been fighting at night.

I hear 'em fighting.

(coughs) And a couple of times, when I sleep in the chair, I've had this rat run across me and got me up.

I said, "You suckers are doing too damn much for free."

- [Michael] Rats pose a medical health hazard, with around eight diseases linked with them.

What's done that?

- The rats.

- [Michael] Gillespie may not have sought help for her mental illness, but there are supposed to be safeguards in place to guarantee minimum health and safety standards for tenants.

To find out how bad the rat infestation was, we installed a trail camera in the basement.

Any movement in front of it would trigger it.

On the first night, nothing.

But on the second night, we put it in Gillespie's bathroom, then her kitchen and finally her walk-in cupboard.

On one night in July, 2020, the camera was triggered 90 times.

What's this doing for your mental health, living with rodents like this?

- It's not easy.

It's a test of my faith for real.

I am not complaining.

- [Michael] In October 2019, around nine months before this, the Kansas City Housing Authority inspected Gillespie's house.

It failed to pass for a number of reasons, including evidence of a rodent infestation.

The Housing Authority found the landlord to be the responsible party for exterminating the rats.

And when it reinspected in the middle of March 2020, and found the rats were still there, it canceled the payment of rent to the landlord, and issued an emergency voucher to Gillespie, to help her find another place to live.

But she can't find one anywhere.

- And ever since they gave me this certificate, I have been looking.

I've spent an hour at least two on my phone everyday looking for a place.

My voucher is 585 and they've got studios going for 650 to 750.

Where am I gonna live?

- [Michael] In the fall of 2019, two weeks after the Housing Authority's inspection, Gillespie's property was inspected by the Healthy Homes Program, which is part of the Kansas City, Missouri Health Department.

These are some of the pictures the inspectors took and footage they recorded.

Their report found a number of violations, including pest harborage conditions throughout, and infestations of mice, rats and roaches.

Although the report doesn't explain who is to do what, its says that the clutter and the infestations should be corrected within five days.

The landlord provided evidence of the traps he'd laid and the runs he'd blocked, and then at the end of November 2019, Healthy Homes closed the file.

They told this program they didn't reinspect because they would have charged Gillespie the $150 cost.

Nine months later, and she's still living with rats.

Her friends are trying to help, and they're steadily moving some of her belongings out.

- She's a brilliant woman.

She doesn't mince words, and those are the things I love about her, is that whatever she says, if it comes up, it comes out.

So... (laughs) - I can't get a case.

I'd bring cases (indistinct) - And with any person that's having mental health challenges that's the one key thing to do, just to listen and be there for them.

I bring her food, I take her on rides, and just sometimes, like when we came and we cleaned up and threw things in the dumpster, my son and my grandson and myself.

And now my encouragement to her, and I'm gonna talk to her about it, is the stuff that she has in her house.

It needs to go.

- [Michael] Trauma can leave people vulnerable to mental illness.

The care system was already struggling, and then the COVID pandemic hit.

- You've got people that literally have not left their house in eight or nine months, who were a little depressed before but now they're isolated from their family, nobody knows how bad they're suffering.

- [Michael] During the COVID pandemic, around four in 10 US adults have reported symptoms of anxiety or depressive disorder, up from one in 10.

Millions have lost a job.

Domestic violence calls are up by nearly 10%.

And COVID has claimed the lives of over 500,000 people, who've left behind how many traumatized loved ones?

And the most vulnerable to the type of trauma that can lead to mental illness is often our children.

- Things like early childhood abuse.

So physical, sexual, emotional abuse.

And what we see is, the more experiences that you have, the more likely it is that you will have issues with mental health, you're going to have issues with your physical development, with your ability to learn and concentrate.

- [Michael] Recent research surveyed adults in the nine-county Kansas City metro area.

It found that the percentage of those who hadn't had any adverse childhood experiences was just over 10%.

But those who'd had four or more was over 50%.

These people are at greater risk of developing a mental illness.

And it's prevalent among all races.

Our schools are on the frontline.

- They're here with us during the day, and then when they leave, that's where my anxiety goes up because I worry about them.

What environment they're living in, who they're with.

- [Michael] Summer teaches at Liberty Academy in the suburbs to the north of Kansas City, Missouri.

It specializes in students who need an alternative to mainstream high school.

- When students come to us and they've experienced traumatic events in their life, they have a much harder time building relationships with us.

- [Michael] A strong and reliable support network in someone's life, be it family, friends or teachers, can mean they're more resilient to the effects of trauma.

- Resiliency is really the opportunity to prepare for, cope with and grow through adversity.

- [Michael] How do get them to open up?

How do you build those relationships?

- I think patience, grace, empathy, all those things that they really don't get from anyone else.

- Because when you listen to somebody who's been through these traumatic situations and how they've come out the other side, they usually turn back to, I had this person who believed in me, so now I attribute some of my success to those moments where they would care about me even when I didn't care about myself.

- [Michael] To the south of Liberty Academy, in the center of Kansas City, is the Gordon Parks Elementary School.

Like Liberty, it's determined to build kids' resilience to trauma.

- And basically it's a survey that kids fill out every morning and they answer three questions: "How are you feeling today?

How's home?

How's school?"

And they just answer with feelings faces.

And say, "I'm feeling happy, "I'm feeling mad, I'm feeling scared."

And then teachers are able to look at the report from that and just be able to kind of recognize where their community is at and they can adjust lessons, they can check in with kids if kids would like to share more about why they're feeling what they're feeling.

- [Michael] It's part of an early warning system that helps teachers intervene before an issue starts to affect a child's performance.

- [Mike] What kind of things did you guys act as?

- [Michael] And it's asking the children to step back from their feelings and evaluate them.

- Ultimately, we want kids to be independent and recognizing what they're feeling and then how to manage those feelings, and how to be in control of their body.

- [Mike] We have some great dancers in here.

- [Michael] The school has made building resiliency central to the curriculum.

- [Mike] And gentle breeze.

That's why theater is extremely important, not just theater but all of the arts.

If you've experienced trauma, a lot of times, you don't know how to let that out.

Theater allows you to in a safe and accepting atmosphere.

And freeze!

- It's more than just coming back to base line.

I think it's more than just not suffering.

Although that's, like that's amazing.

It's that where there was a hurt before, where there was something that was hurting them before, a strength can grow, a beauty, a gifting, a quality can come into place.

- And I left a note on it saying, "Don't eat my grilled cheese."

- You even left a note on it?

- Mm-hmm.

- That when we meet kids in the midst of whatever they're walking in and they can heal and share what they're going through, they won't ever be the same as they were before but they might be even more than they would have known they were gonna be.

- [Michael] Gordon Parks will provide what support they can do to the whole family that's experienced trauma.

Khris shared custody of her two daughters with her ex-husband.

One day, he beat one of them with a belt until it broke, and the other daughter witnessed it.

- It was horrible when I found out.

I was pregnant of my last son and my heart broke in pieces.

It's hard seeing your kids go through this.

I went automatically into second stage of pre-eclampsia, I had my youngest son at 30 weeks.

It was an experience that I would never, not even to my worst enemy, hope they would go through.

- [Michael] In part, because of the support of the school, both daughters are moving through the phases of recovery.

- The school is my family.

I know all the teachers.

I feel comfortable with everyone here.

The school to me means more than anything.

- [Michael] Michelle is another parent of children at the school.

She survived six years of domestic violence.

Sometimes, her three young children would witness it.

- My oldest son especially, I see in him, he has the anxiety.

He being only 10 years old about to be 11 has actually suffered with this since he's been in the womb, and I know this because I would get physically hit when I was pregnant with him.

- [Michael] Evan and the rest of the school team have worked closely with Michelle and her children to help them on the road to recovery.

- Just to have that extra person to say, "Hey, Michelle, "you don't have to deal with this by yourself."

- [Michael] The issue may seem overwhelming.

We have a care system that's failing too many.

And a society that was creating the conditions for some types of mental illness even before COVID hit.

So what can be done right now?

Perhaps we should take something from how Liberty Academy and Gordon Parks Elementary are helping their school communities.

And there's Michelle's story.

One night, after she'd escaped her abuser, she fell into crisis.

And a friend saved her.

- She literally came knocking on my door and she wasn't going away until I opened the door up.

And it was the night before that I had slept in the bed with a bunch of knives, I wrote suicide notes to my mom, I explained to her this is what the kids like to eat, this is how you have to prepare it... She uh, they came in and they had prayed with me and literally just kind of saved my life because at that point, I didn't think anybody gave a crap about me or my k...

I didn't even give a crap about me.

And to know that they cared, you know what I'm saying, somewhere in me I was like, "Okay, you can't do this."

- Find somebody to talk to, one of my, I call him a friend now, I saw on Facebook where he was kind of ranting one morning, and so I sent him a personal message, I said, "Hey, this is my number.

Call me."

I said, "I know you've got a lot going on, please call."

And so he said, "Hey, I'll call you this afternoon after chores are done."

And he called and we talked for like two hours.

- Everyone needs to know that they're not alone and that there are people out there who understand and who know what they're going through.

- For me, the most important thing is to remember that we need each other.

As a people, the only way we achieve things is by working together.

And so it doesn't matter who you voted for, what church you attend, if you don't attend church, what matters is that we take care of each other.

(gentle music) ♪ A human heart can only hold ♪ ♪ So much pain ♪ ♪ It took you spark ♪ ♪ It took you laugh ♪ ♪ It took everything ♪ ♪ I can see your eyes and I can tell you're sinking ♪ ♪ Can I come close ♪ ♪ You don't need to be anything ♪ ♪ I won't let you feel alone ♪ - [Man] Right now you belong, huh?

- Now I belong.

♪ I won't let you feel alone ♪ - And I'm optimistic that I'm on a good path and will continue on a good path.

- I'm still here.

I've found a way to get rid of some of the rodents.

They're not eating me out of house or home anymore.

- Some of the other changes that we've had are to my medications due to insurance coverage.

I've had to change medicine.

- I'm currently studying social work at college.

I'm very excited to be back.

This is proof that people living with mental illness can have recovery, and it is possible.

♪ I won't let you feel alone ♪ ♪ I won't let you feel alone ♪ ♪ I won't let you feel alone ♪ ♪ I won't let you feel alone ♪ - It's been a year in the making, a big thank you to filmmaker Michael Price for bringing "The Hidden Pandemic" to Kansas City PBS.

Hello I'm Nick Haines, good to have you with us.

Doesn't this film brings up so many questions?

Well, we're gonna try and answer as many of them as we can right now.

And we're also gonna offer you some tips and workarounds for navigating what can be an incredibly frustrating mental health system.

Checking in with us is filmmaker Michael Price, the head of Johnson County Mental Health, Tim DeWeese, on the front lines of mental health care at Children's Mercy Hospital, Trista Perez-Crawford, Dr. Linda Moore is a psychologist in private practice here in Kansas City.

She's also the author of tons of books about helping you cope.

We also invited some of the people you just saw in the film to join us.

Dr. Todd Hill is the passionate psychiatrist who has prodded and poked the insurance companies to get the proper treatment for his patients.

And also from the documentary, we invited Nicole Rials to join us.

She's the Director of Urgent Care at the Bert Nash Mental Health Center in Lawrence.

But news flash, in perhaps a sign of how fragile our mental health system is right now, I've just been notified that Nicole's job has just been eliminated this week and she is no longer able to join us.

We wish you well, Nicole.

Thank you for bringing such passion to your job.

But we are not skipping a beat here in the studio.

Michael Price, first of all, again, congratulations.

This was a pandemic year.

You were shooting all in the field, going into people's homes.

We always as reporters have certain assumptions as we approach a story.

What did you not expect when you ended up finishing this film?

- The one thing that really struck me was the high rates of suicide that we see in our area of America and across America.

And as I said in the film, in the 20 years prior to 2019, we've lost in the US just under 800,000 people to suicide.

And the question really is, "When are we going to start "having a national conversation about suicide?"

- Well, we're gonna start a bit of that conversation this 1/2 hour, but Michael, the other thing is we can always learn about, of course, is stigma and mental health.

People don't wanna tell you their stories, yet I was amazed at how many people let you into their homes.

It always looks so easy when you see it on television like that, but were there lots of people who said, "Absolutely not.

"I'm no way am I talking to you, Michael?"

- There were people who said that and some of the people you hear from in the film, struggled with the decision as (indistinct) not to talk to the camera, but they bravely made the decision to do so because they wanted to help others overcome that hurdle of stigma.

And they see it as something that we should be talking about.

We should be talking about mental illness, it's prevalence, and we should be taking the issue of stigma head on.

- Dr. Linda Moore, when we started this pandemic a year ago, you were one of our very first guests on our Kansas City Week in Review program.

And at that time you talked about all of the issues that may come up during the pandemic, at that time, just the first few weeks, so we were talking about a 300% increase in the number of calls coming to the suicide hotline.

But what has happened in that 12 months in your practice?

What happened that you didn't expect to happen during that period of time?

- I would have to say the surprise in increase in numbers of incidents that people had trouble coping with.

For example, I have dealt in my practice with five divorces this year.

I've never had a year where that happened.

I think the trauma of everybody being confined in the home has increased the level of conflict and from individual issues to family issues, it's been very dramatic.

- Trista, there were concerns very early on in the pandemic that this was gonna be a huge spike, not just in divorces that Linda Moore talks about, but in our domestic abuse cases, for instance, child abuse cases.

Were those cases overblown?

- No.

Actually we are seeing a lot more family conflicts than divorces during this time, because for all the reasons that you just stated, people are stuck in the homes and so families that were having trouble before the pandemic are having more trouble because they can't access the help that they need.

Kids are not able to get to schools and get support from teachers and services that they would have been able to get support from prior to the pandemic.

- Tim DeWeese, I was surprised that for all of the statistics that Michael presents, and we've seen those on a national level, but in Johnson County, youth suicide didn't go up in 2020.

It actually went down.

How can that possibly be?

- It actually went down as well as the entire rate for deaths by suicide went down.

And I think that is a point that's important to make is that in Johnson County, we started the conversation about the suicide epidemic in 2012.

And we created a Johnson County Suicide Coalition that has more than 500 community members involved.

We also started our Zero Reasons Why campaign, which is a youth campaign to disrupt youth suicides.

And so we did a lot of work upfront that I frankly think created a resilience in some levels within our community to make sure that people knew where to reach out for help, how to act, ask for help, and as a result we saw fewer deaths by suicide over the last two years.

- Dr. Hill, again, we had all these assumptions at the very beginning of this pandemic.

What did you see that you weren't expecting after the, basically now a year of a lockdown in Kansas City?

- To be quite honest, what I wasn't expecting was that a lot of the psychiatric hospitals will not accept patients who are COVID positive.

And I was hoping that they would set aside at least a few rooms or a unit for people that are COVID positive because COVID affects everybody.

And so that was a surprise for me.

And if we didn't have enough of a difficult problem getting people in a psychiatric hospital to begin with, then this was also an issue.

Another somewhat of a surprise, I did expect an increase in substance use and substance abuse, but we really have had an increase in substance abuse.

And believe it or not, primarily alcohol, alcohol abuse, intoxication, and dependence has really increased.

Really along all age groups, the severity of alcohol use and the number of alcohol relapse in patients who have been sober for five, 10, 15 years, was something that did surprise me.

- A year ago, yes, businesses closed, museums and entertainment venues all closed, restaurants and bars, but also, you couldn't go to the doctor's office the same way.

And Dr. Moore, you were on that first program and I remember you saying, well, you're not seeing any patients anymore.

You have to see them online.

Tell me about that right now.

Are you seeing patients today in your office or are you still online?

- No, I'm still online and I do some Zoom sessions, but one of the things I've discovered about Zoom therapy, is you have to be in the client's space.

They're used to being in my space.

And so when I am now in their space, frequently they're uncomfortable and they have difficulty with privacy.

I've had a client go park his car outside a grocery store and have a session with me because he did not wanna talk at home.

- Tim, how about in Johnson County?

Do you still see clients or is this still all online?

- We never actually stopped seeing clients face-to-face.

There's definitely was a need for us in our community.

Not everybody had access to Zoom technology or technology and so we maintain the ability to see people face-to-face.

The far majority of our work did shift overnight to a televideo capability, but we also had to maintain a level of face-to-face capability so that we could handle those situations.

And in some situations with people that didn't have technology, we provided them the technology.

I think we've given out more than 200 tablets to individuals and actually help them learn how to use it.

Not only so they could use that for their mental health wellbeing, but also to be able to connect with their physical health care as well.

- So how did that work?

You were dropping them off at people's homes?

- We were dropping them off at people's homes, or they would be coming to us, but we wanted to make sure that people had the tools in their hands to be able to maintain connections.

And that was the big piece for me originally, is that we said right off the bat that we need to be socially distanced from one another.

And that is absolutely not what we needed.

We needed to remain physically distanced from one another, but we had to keep socially connected.

And so doing whatever we could to help people keep those social connections, I felt was more important than anything we could do.

- Did we miss a lot of people, Trista, because you couldn't see people face-to-face?

- Yes, and, Tim, you brought up a great point that there are families who don't have access to Zoom technology or internet access or who don't feel comfortable with us meeting them in the home.

And that's what we're recognizing.

And actually I've co-authored a paper with some of my colleagues at Children's Mercy, that we are seeing that some of our families don't feel comfortable using the telehealth technology.

So we're needing to do in-person visits.

We're needing to figure out how to provide help for some of these telehealth services to meet these families' needs, because it seems like this telehealth technology is going to keep going beyond the pandemic, and these families are gonna need to be able to get mental health services after this.

- I'm just curious, how does that actually work?

From an insurance company point of view, do you get exactly the same amount of money for doing an online session as you would a face-to-face one?

- We have not been able to get a straight answer on that yet.

So I am interested to know from my colleagues, have you all been able to say here, whether or not we're getting paid the exact same thing?

- At this point, my experiences is that we haven't gotten paid the exact same rate.

Problem from the public mental health system is that unfortunately, these types of mental health services, the types of services that we provide, aren't typically reimbursed from most insurances anyway.

So, in our regard, we're providing the service because that's what we need to do for our community.

- I want to show a clip from the film.

There's some things that were infuriating to see in the film, Michael, and that was including huge waiting lists.

We heard from Holly, who's a psychiatric nurse, she's in your business.

- The psychiatrist that was recommended to me had a five-month wait period.

- [Michael] And she also encountered delays as well for her son, who also has a mental illness.

- To get him into a psychiatrist.

Our primary insurance didn't cover that.

So we had to switch and it was a four-month wait.

- Did we just find one isolated example there that shows how egregious things are, or is that what's happening?

- That is not an isolated example.

A lot of psychiatrists aren't even taking new patients.

So there's not even a waiting list.

They're just not taking new patients.

And, or they'll say, "Well, we'll put you on a waiting list, "but it could be three to four months."

That's unacceptable.

Mental illness is just as severe and causes as much or more morbidity as mortality as the medical illnesses that we deal with, heart disease and cancer.

For us providers, it's just very, very disturbing and demoralizing.

- We also heard, Trista, of Holly's son who also needs help, four-month waiting list.

Is that what would happen if you were trying to get help from Children's Mercy?

- At least.

I was gonna say it could be longer than that, depending on whether you need testing or therapy.

In our particular clinic, there's myself and one other psychologist.

And so we're charged with seeing every single referral in the clinic.

And so it's very difficult.

- [Nick] Tim.

- From our standpoint, we definitely do have a difficulty having people see a psychiatrist.

There's absolutely a shortage of psychiatrists in this country.

There are fewer and fewer being trained, and it's gonna continue to be a problem.

- Michael Price, you have actually a line in the documentary that says, "Federal law requires health conditions "to cover mental health as the same as other conditions."

So why isn't that happening?

- Unfortunately, it seems that with some insurance companies, they are reluctant to cover the essential health that's needed.

I mean, what I did try to flag up in the film as well, is this idea of a crisis.

Now, if I'm having a heart attack, I know I've got to go to the ER now.

If someone's in a mental health crisis, they need treatment now.

It can be the difference between them taking their own life or not.

They don't need to be told that there's a four or five-month waiting list.

I just, if I major as well, there is a dearth of mental health providers, psychiatrists and therapists in this part of the country.

Now, telehealth, one of the things that telehealth can offer those community mental health centers that are unable to recruit, is that they can link up their clients with people who live on the East and West coast and that therapy or that consultation takes place over telehealth.

But as we saw in the film, the future of telehealth rests upon the policy decisions of insurance companies, not those who want to provide the health or those who need it.

- What was striking to me about the documentary too, though, that even if you have health insurance, you still have a lot of costs.

- [Michael] Holly was desperate to keep her therapist.

- When I'm in crisis modes, sometimes that means paying the $100 for a visit with her every two weeks.

- [Michael] But toward the end of 2020, she had to stop for three months after she started spending more on her son's treatment.

For some, the cost involved is another obstacle to be hurdled.

- If I don't have money to give right now, how do I get help then, Tim?

- Right now, if you don't have money or it's an issue of cost, that's where you have to look for your community mental health centers.

And in Johnson County, that's where we serve.

So we're gonna provide services regardless of a person's ability to pay.

The other piece is the cost of medications.

Someone may be able to get therapy.

They may actually even be able to see a psychiatrist, but then being able to afford the medication, that makes almost impossible to do.

- Is that an issue for your patients, Dr. Moore?

- I think insurance is always a big question, but I wanna raise a related issue.

I think we are not paying enough attention to the dropout rate among therapists.

I have colleagues who are seeing fewer people because they're exhausted and fatigued and perhaps less likely to talk about it.

- In the film, we hear from a mother in rural Missouri, who has been taking her son to New York to take care of her needs.

She's even given up her full-time job to help with his schizophrenia diagnosis.

- I started having these delusions.

And so I went to the doctor and they thought, well, maybe it's schizophrenia, but you're not hearing voices, right?

I'm like, "No, I'm not hearing voices."

Well, a few weeks later, then I started hearing like people in my head.

- I decided I need to learn everything that I possibly can about this illness, about the medications that he's being prescribed, about the side effects.

- She has been my brother's biggest advocate for sure.

He has a great doctor right now, but he only has a good doctor because my mom found someone in New York City, and we're in Missouri.

- Most of us, Dr. Hill, can't do that.

What do the rest of us do?

Just accept it?

- Absolutely not.

And Tim brings up a very good point.

Where do I send people that I know don't have insurance and I know need help?

I send them to the community mental health center, as does a lot of psychiatrists and a lot of therapists, which the community mental health centers are overwhelmed.

But they never turn anybody away based on whether they have insurance or not.

You should not have to go to New York to get your schizophrenia treated.

Absolutely not.

I guess it leaves me speechless that she had to go to New York to get this.

To get her son- - Yeah, but you ain't...

In the documentary, though, you say, "We're sending people by ambulance three to four hours away "to Joplin, to Columbia, "because there's nothing in Kansas City to help them."

What did those communities have that we don't?

- Well, it's a matter of getting a person placed, and when we call all of the hospitals in the Kansas City area, a lot of them are privately owned, privately run hospitals, so they can refuse patients.

And they really don't need to give much of a reason other than, "We don't have the capacity" or "It's too high level of acuity."

So sometimes when we look out in Joplin, Columbia, Maryville, we even go across state lines to Topeka.

They will often have beds and they are willing to accept the patients.

The problem is, now you're taking somebody, putting them in an ambulance, who's mentally ill, and transporting them three to four hours by ambulance.

And then you gotta get them back to Kansas City after they've had the treatment.

So logistically, it can be a problem, but it's just a matter of opening more beds in Kansas City and trying to get across the psychiatric hospitals that the medical hospitals and the streets are not the place for these individuals.

- [Nick] Tim.

- In many respects here in Johnson County, there's also a shortage of beds.

And when we're talking about being able to access acute hospital care, there are very few options.

When's the last time you saw a new hospital system building a new psychiatric facility?

It's not happening.

But you can find cardiac units, you can find cancer units being built.

And that goes to again, payment and insurance.

In Johnson County, if someone can't find a bed, they're boarded in an ER, or they're taken to jail, two places that are way more costly, and absolutely do nothing to provide service and treatment to the individual.

- The good news is, Tim, silently listening in to our conversation is the president of the United States.

We also have the governors of Kansas and Missouri and the head of the American Insurance Association with us.

And so what bigger change would you want them to do that would actually singularly improve or have the best chance of singularly improving the health of mental health of people in Kansas City?

- I'll chime in there.

Common sense is completely out the window in treating mental health here in the United States.

And it starts in DC, in my opinion.

Like Tim said, in 2012, they started as suicide awareness initiative.

We need that nationwide.

We need much more funding for mental health and a lot less funding on little pet projects.

- Okay.

If you've got all of this extra money, where would that money go?

- We should put that in mental health centers without a doubt.

I know they're state funded, but we need federal action to help the mental health centers as well.

And there are parody laws for mental health in terms of the insurance.

We just need to enforce them.

They've been in place for over 10 years and they were bi-partisan.

- [Nick] Linda.

- One of the things I tried to get a handle on is how to get people in private practice like myself, to volunteer at least a couple of hours periodically throughout the course of a month, to work with people who do not have insurance and do not have the amount of money to pay.

And I haven't had any luck doing it, but I, for example, would volunteer time for clients who can't pay.

- That's interesting.

Because dentists do that.

You see these big events that they do, and they will have people who are underserved and make sure that they get dental treatments, but that does not happen in the psychiatric arena?

- Not in any way that I see formally organized.

No.

- Let's get very practical here.

Many of us have felt anxious and depressed and traumatized in this pandemic year.

In the documentary, Michael, we hear from Holly, who is a nurse, who was getting relief for her anxiety from a meditation app on her phone.

- It's got different meditations on it.

It's got a check in that I can do that it'll track kind of my feelings about things.

This is one that I use, an anti-stress one.

- It sounds so easy.

Does it really work though?

- It works for her certainly.

One of the things that's happened of course during the COVID pandemic, is when people with a mental illness have gone out into stressful situations, situations where prior to the pandemic, they would have gone with someone else who would provide the support, they've had to go by themselves.

And one of the things they're able to take there of course with them everywhere is their phone.

So for her, certainly, those apps that she's got there really helped her.

- Many of those apps of course are free, but does anybody else say, "Hey, that's a great idea.

"And I've seen a measurable impact "in patients that I've seen?"

Linda.

- Yes.

I've been a meditator myself for over 30 years and anytime I can get a client to agree to let me teach them, I do it.

If I said, this is one thing everybody can do easily, yes.

- I recommend the apps to patients all of the time, especially the ones that I know really all they need is some meditation and some time to retrain their thoughts and with guided imagery and self-hypnosis.

I'm a huge believer in that, and I'm a psychiatrist, I do prescribe medicines, but I think if we had a lot more skills, we'd have a lot less pills.

- I like to recommend gratitude activities, things that they're thankful for, things that they've done to help other people, or things that they can do to volunteer or show kindness to somebody else, because that can, in a time when you're feeling stressed out, can help take the focus away from you and put it on someone else and can relieve some of that anxiety.

So that's one of the activities that I use for people sometimes, especially if they say they have trouble with doing things like meditation, 'cause some people have trouble with turning off their thoughts, especially kids.

- Let's go back to the film.

And the very first scenes that we see is of a farmer in Kansas.

- One of my biggest regrets was not asking for help sooner.

And luckily I had some strong people in my life to kind of nudge me in the right direction.

And looking at where I'm at in my journey now to where I was before, didn't realize what kind of toll I was taking on my family, my coworkers, my kids, myself.

- "My biggest regret is not seeking help sooner."

Now, that's of course true for many of us.

What's the first step I can take right now to turn that regret into action, Dr. Moore?

- Hi, I think that's the hardest question that I could even try to answer.

You have to make the call.

You have to make the connection.

And if you're struggling with that, then... - But what held my feeling is though I think one of the reasons perhaps is that a lot of folks don't feel like coming to see somebody who looks exactly like you, is gonna make a difference in my life.

What could you possibly tell me or give me that is gonna transform my life?

- I know you meant that as a compliment.

(laughing) We go see our doctor for our annual checkups, we go see our doctor if we have a cold or a headache or stomach problems.

And I think the really, the best place to start is with your primary care doctor.

You start there, the person that you're comfortable with, and then they can refer you to a therapist or a psychiatrist, but starting with them because they're easier to get into, they're kind of the gatekeepers for the rest of the care, I think that is one of my suggestion.

It's human nature not to want to go to the doctor.

I mean, it is.

We're afraid of getting poked and prodded and we're gonna be told some bad news, but I think if you have a good relationship with your primary care provider, that's the best place to start.

And with the farmer, again, that's even more kind of an environment where you work by yourself, you take care of your own problems, you don't need anybody to help you.

But it's definitely not the case.

And he's very good at describing why he wishes he would have got help sooner.

And that, we hear that every day.

- And Michael Price, it's interesting that you started with the farmer.

We have assumptions about the people who have mental illness, mental health problems in our community.

What does that person look like?

For many of us, it wasn't seeing a white farmer out in Douglas County.

- The farming community really is a forgotten community.

On one side, they're very central to American life, maybe in kind of sidelined.

And as we see more and more extreme climate events, as we've seen in recent years as well, of course, there's been some brewing tribe wars.

They are not the same by themselves and they don't have that sort of firm network around them.

- By the way, you either have ghosts or somebody was trying to get into the room to silence you.

I did see the door opening down, Michael.

Okay.

- That's the house help who's on with my daughter, Lucie.

- Okay.

Alrighty.

Alrighty.

Tim, did you wanna comment on the whole reluctance and hesitancy to come and see somebody like you?

- One of the interesting statistics that exist is, is that when you see initial onset of mental illness to the time someone gets treatment, the average length of time is eight to 10 years.

From onset to first treatment.

That has to change.

And one of the ways that has to change is that we have to move upstream.

So if we remove stigma, if we move upstream and get early intervention and engage people early on, as youngsters, then we begin to see the output of people not needing the intensive services that we provide on a regular basis.

- Yeah.

Once they get treatment, they do get better.

But, yeah, as Tim is saying, the average length of time between onset of symptoms, for example, in bipolar disorder, and treatment is 10 years.

- One of the most disturbing components of the documentary is when we go into the home of a woman by the name of Gillespie, where she has rats in the home.

- And I'm telling you, this is a good reason for a mental breakdown.

- [Michael] To find out how bad the rat infestation was, we installed a trail camera in her basement.

Any movement in front of it would trigger it.

On the first night, nothing.

But on the second night, we put it in Gillespie's bathroom, then her kitchen, and finally her walk-in cupboard.

On one night in July, 2020, the camera was triggered 90 times.

- And I have to say, Michael, you shot at her home six months ago.

And for all of the efforts to try and put her in a better position, is she still in that house?

- Yeah, she's still there.

She's still there.

She's, my understanding is I have stayed in touch with her and I have been in regular contact with Gillespie.

My understanding is that now she's found about poison and she's killed off a lots of the rats.

But in all my years of filmmaking, I've filmed in some pretty hairy places in the States and the UK.

I've never seen anything like that.

I've never seen anything like it.

- What did you think of that, Linda?

- I think it's an exposure of the underbelly of our healthcare system in general.

I thought it was frightening and disgusting and that the inequity in the system is demonstrated in Michael's film.

That's what depresses me.

I mean, people who can pay out of pocket for therapy are not struggling with going to a therapist.

- We hear in the documentary from Diane, who's been checking on Gillespie.

- She's a brilliant woman.

She doesn't mince words.

And those are the things I love about her, is that whatever she says, if it comes up, it comes out.

So... (laughs) - I can't get a case.

I'd bring cases (indistinct) - And with any person that's having mental health challenges, that's the one key thing to do just to listen and be there for them.

I bring her food, I take her on rides, and just sometimes, like when we came in and cleaned up and threw things in the dumpster, my son and my grandson and myself.

And now my encouragement to her, and I'm gonna talk to her about it, is the stuff that she has in her house.

It needs to go.

- "One thing you can do is to listen to them, "to be there for them."

So how do you do that then, Tim, without being accused of being a busy body or sticking your nose in where it's not wanted?

- Assertive outreach is the preferred mode of outreach.

And what I mean by that is that we assertively engage with folks.

So we want to demonstrate, and it's really about developing a relationship.

Again, the healing power of human connection.

It's about developing a relationship with someone, listening to them, listening to what their experience is, listening to what their story is.

And then building upon the trust that you're able to gain with them from that opportunity to then hopefully help make progress in whatever they want to achieve.

- Trista, what is your response to that?

I mean, people don't wanna be accused of sticking their nose in where it's not wanted.

So if you know someone who you think may be in crisis, who needs help, what is the best way of responding?

- Well, I completely agree with what Tim said.

Like we have what we call is evidence-based procedures or treatments, but it's also about listening to what the family is coming to you and asking for.

And it's about finding a middle ground between what they're asking for and what we know to be helpful, and finding what's gonna work for them, because if it's not gonna fit with their lifestyle and what they need, then it's not appropriate for that family.

And that's where our expertise comes in.

It doesn't matter what the textbooks say or what the research says if it's not appropriate for that particular family.

- I may just add to that.

- [Nick] Yeah.

- It's not rocket science.

If you come from a position of genuinely caring, when you approach someone who's in a crisis and you're from a non-judgemental caring standpoint, they are gonna appreciate the help, they really are.

And sometimes you have to be persistent.

- Before we leave, I wanna look into the future.

And we don't know, of course, the full implications of what this pandemic will have, its implications on our children or grandchildren.

What are you watching for?

Will many of the problems, Dr. Moore, that we're experiencing today, melt away once everything opens up again, perhaps in the fall?

- I don't think we have an answer to that.

And the lack of predictability is huge.

I don't think it's going to magically get better.

I think we have a huge gap between what we're accustomed to, what we're doing now, and what's gonna happen in the future, and then I don't think we have a handle on it yet.

- What are you watching for, Tim?

- We've been helping people survive a global pandemic, and now we are going to be moving into a phase of recovery.

And phases of recovery are way, way more intensive.

They take way more work.

They take way more time and energy.

And so I think the mental health system is actually going to be more pressured moving forward, as we move out of the pandemic than it has been currently.

And we know that there's been increases- - But do you have more money and resources today than you did when the pandemic started?

Absolutely not.

- No?

- Absolutely not.

But I think that the conversations that we have begun, is better and allows the opportunity for us to have the discussions about how important mental health is and how it needs to be funded.

- Trista, what are you watching for?

- Now that people are emerging from the pandemic and we're coming out kind of the intersection of the issues we're having with discrimination and race relations along with the pandemic are really gonna come to a head now that kids are going back to school, and that has been kind of the big crises we're having right now with kids.

So, yeah, it's been a challenge.

- But did we have less bullying though, because kids were not in school over the last year?

- I will say a little bit less, but some of that was still happening virtually.

But I am really concerned about all of the things that are gonna happen now with what's been happening with social justice.

- Dr. Todd Hill, what are you watching for?

- People are coming out of the shadows now.

So you're going to have a lot of people who have been neglecting their mental health, and now they're going to be coming out in droves, just like we're seeing an increased risk, or increased numbers of cancer diagnosis because people were not getting preventative treatment because they were afraid to go to the hospital, same with mental health.

And Tim is exactly right.

I have a feeling we're going to get an influx of a lot of people who've been sitting and suffering in silence, coming to the hospitals now.

- Michael Price, you were the one who brought us all together.

Based on what Dr. Todd Hill just mentioned there with all of these people coming out of the woodwork, are you up for spending another year of your life on part two of "The Hidden Pandemic?"

- Well, it's an issue that's not going anywhere and I'm not going anywhere, so... - See what you started, Michael?

(laughing) - I mean, wouldn't it be wonderful if we could all sit down in five years and say, "What a great job the national government, "the state governments have done," and really putting the money where it needs to be, and really raising standards and seeing normal people saved.

And that's what we're talking of here, saving the lives of Americans.

And it's a conversation that we're having here, it's one that people need to be having in their own home as well.

- Well, Michael, Tim, and Linda and Todd and Trista, thank you so much for spending the time with us.

If you've heard phone numbers and web addresses and organizations mentioned over the last 1/2 hour, do not worry.

We have put them all in one place for you.

You can find it on our website at kansascitypbs/hiddenpandemic.

While you're there, you can also see more mental health reporting from our digital news team at Flatland KC.

Now, many of us have a first aid kit like this one to fix up our bumps and scrapes around the house.

But what about a first aid kit for our mental health?

Have you seen one of those?

And what would you actually put in it?

Well, stick around immediately following this program, psychiatric nurse, Holly Miles is on her way back to us.

She's the psychiatric nurse we just saw in the film, coming clean about our own mental health woes.

She's come up with some handy-dandy tips for a mental health first aid kit for me, you, and those we care about.

That's straight ahead.

I'm Nick Haines, from all of us here at Kansas City PBS, be well, keep calm, and carry on.

(gentle music) - [Narrator] Support for "The Hidden Pandemic" is made possible in part by CommunityAmerica Credit Union, the William T. Kemper Foundation Commerce Bank Trustee, Husch Blackwell, the Hall Family Foundation, Marlese and Robert Gourley, and from the generous financial support of viewers like you.

Thank you.

(gentle music) - Hello.

My name is Holly Miles.

I've been a nurse working in healthcare for nearly 20 years and currently work as an Assistant Professor at Research College of Nursing.

I have a great passion for mental health care due to my own lived experience with mental illness.

Diagnosed at the age of 17, I was told that I couldn't talk about my mental illness to anybody, but this never felt right.

What was so wrong with telling people what was going on?

I remember what it was like to be the patient and have people look at me differently, even some of my family members.

One of the most important things to remember when experiencing symptoms of a mental illness is that you are not alone.

Today, I wanna outline a five-step action plan developed by the international program, Mental Health First Aid.

This is designed to help provide assistance to loved ones who may be developing mental health problems or experiencing a crisis.

The first step is to assess the risk of suicide or harm.

When helping someone through a mental health crisis, it is important to look for these signs.

These can include talking or writing about threatening to hurt or kill oneself.

Having feelings of hopelessness.

Withdrawing from family and friends.

Engaging in risky activities and, or having a dramatic change in their mood.

If you recognize any of these behaviors, the second step is to listen non-judgmentally.

Listening is critical in helping an individual feel respected, accepted, and understood.

The third step is to give reassurance.

It's important to recognize that mental illnesses are real.

They're treatable conditions from which people can and do recover.

It's important to approach the conversation with respect and dignity and don't blame the individual for his or her symptoms.

The fourth step is to encourage appropriate professional help.

While offering yourself as a source of support is incredibly important, it's also crucial to recognize that sometimes we need trained professionals to intervene.

Luckily, the list of local resources is a little wider than we may realize.

This can include doctors, counselors, therapists, and support groups.

These groups may specialize in specific struggles, like dealing with loss, eating disorders, bipolar disorders, or support for families who have lost someone to suicide.

The fifth step is to encourage self-help and support services.

Individuals with mental illness can contribute to their own recovery through practices like exercise, meditation, participating in peer support groups and engaging socially with their family and friends.

All of these steps are just part of the Mental Health First Aid course that is available online and it's free through the Mental Health First Aid Missouri website listed below.

Personally, I recommend NAMI, the National Alliance on Mental Illness, which offers a broad selection of free services.

You are not alone.

You have people in your life who love you, and you have purpose here.

Remember that and take care.

(gentle music)