Help, Hope & Action: Raising awareness around suicide prevention

A solo piano plays as a collage of pictures featuring people talking with therapists and in support groups is displayed on screen. Then, a purple and teal screen swipes over to a title page featuring a white background. Centering the screen, a teal and purple ribbon featuring two hands gripping at its center.  Text appears beside it.

ONSCREEN TEXT:      Help,

                                    Hope &

                                    Action

Beneath this, more text appears within two teal lines.

ONSCREE TEXT: SUICIDE PREVENTION

                        TOWN HALL

Four logos run along the bottom of the screen: Health Plan of Nevada, the u-shaped UnitedHealthcare logo, OPTUM, and American Foundation for Suicide Prevention.

ONSCREEN TEXT:      HEALTH PLAN OF NEVADA

                                    A UnitedHealthcare Company

ONSCREEN TEXT:      United

                                    Healthcare

ONSCREEN TEXT:       OPTUM™

ONSCREEN TEXT:      American

                                    Foundation

                                    for Suicide

                                    Prevention

                                    Nevada

The music fades. A man in a blazer sits onstage amongst a panel in a lecture hall. Text appears in the bottom left corner of the screen as he speaks.

ONSCREEN TEXT:           Kendall Tenney

                                    Moderator, 10E Media

KENDALL: Hello. Welcome to "Help, Hope and Action. A Suicide Prevention Town Hall." I'm Kendall Tenney. We appreciate you joining us today. We are here in the Chairman's Auditorium on the campus of Health Plan of Nevada, Las Vegas. And over the next couple of hours, I'm gonna have up on stage with me three expert panels. And we're gonna be talking about how depression, anxiety, hopelessness, and isolation can overwhelm a lot of people and what can be done. What tools are out there? How we can help such individuals, and how we can help ourselves should we find ourselves in that situation. We'll discuss a wide range of reasons why kids, young adults, seniors, veterans, and minorities experience mental health challenges with suicidal ideation. We'll also discuss the best communication and intervention techniques and what's being done in our local communities and our state to support those who are at risk.

The title page appears onscreen again as Kendall lists the co-sponsors.

KENDALL: Our co-sponsors for today's event include Health Plan of Nevada, UnitedHealthcare, Optum, and the American Foundation for Suicide Prevention. So let's get started.

The crowd in the auditorium is shown, followed by a wide shot showing Kendall sitting beside three guest panelists.

KENDALL: Our first panel is going to focus on suicide risk in children, teens, and young adults. So I'd like to introduce each of them. First, we have Emma White. In 2010, Emma was 15 years old and at that time experiencing suicidal depression after being bullied at school and online, she made a plan to end her life.

Text appears at the bottom left of the screen as Emma sits on the panel.

ONSCREEN TEXT:           Emma White

                                    Author & Advocate, Life is Worth it

KENDALL: Thankfully, she altered that plan and instead has become an author and an advocate for prevention through education with her organization, Life is Worth It. Please welcome Emma White.

A still image shows the cover of Emma’s book, “It’s not OK, but it will be.” Then, Emma waves as the audience applauds.

KENDALL: Also joining us today is Martha Thomas.

Text appears at the bottom left of the screen as Martha sits on the panel.

ONSCREEN TEXT:           Martha Thomas

                                    Teacher & Co-Founder, The Defensive Line

KENDALL: Martha has been a middle school teacher for more than three decades. She is also Chief Education Officer and co-founder of The Defensive Line. It's a nonprofit dedicated to providing suicide prevention resources to schools with a focus on supporting youth of color.

Martha smiles and the audience applauds.

KENDALL: Joining us remotely from New Jersey is Solomon Thomas, Martha's son.

A still image shows a man taking a selfie with three others, including Martha. Text runs along the bottom of the screen.

ONSCREEN TEXT:           Solomon Thomas

                                    NFL Player & Co-Founder, The Defensive Line

Another photo shows Solomon posing in front of the San Francisco 49ers logo with his mom and three others. Kendall continues to speak.

KENDALL: Now Solomon may be a familiar name to some in here, because he is an NFL defensive lineman. He's been with the San Francisco 49ers, with the Las Vegas Raiders, and this year, he will be playing for the New York J-E-T-S Jets. In 2018, Solomon lost his beloved sister, Ella, to suicide.

A photo shows Solomon grinning as his sister smiles and hugs him from behind.

KENDALL: He and his parents turned their grief into action through the founding of The Defensive Line. So please welcome remotely Solomon Thomas.

The audience applauds.

KENDALL: And finally, we welcome Dr. Debra Katz.

Text appears at the bottom left of the screen as Debra sits on the panel.

ONSCREEN TEXT:           Dr. Debra Katz

                                    National Medical Director, Optum Behavioral Health

KENDALL: She is the senior medical director of behavioral health at Optum. She brings 35 years of experience as a board-certified child and adolescent psychiatrist who specializes in behavioral health conditions with youth and individuals with serious mental illness with a special focus on marginalized and minority populations. Please give a welcome to Dr. Debra Katz.

She smiles and the audience applauds.

KENDALL: Thank you so much for being here. Really appreciate it. Let's begin by looking at the current statistics, and they are sobering. In Nevada alone, suicide is the second leading cause of death in 10- to 34-year-olds.

A purple bar headlines the top of the screen. White text appears within it.

ONSCREEN TEXT:           Latest Statistics on Youth and Teen Suicide

Text appears on a white background beneath the header.

ONSCREEN TEXT:           In Nevada, suicide is the second leading cause of death in 10 - to 34-year-olds.

ONSCREEN TEXT:           Death by suicide increased by more than 57% in 10 - to 24-year-olds in the

                                    decade between 2008 to 2018.

ONSCREEN TEXT:           More than 77,000 physicians and 200 children’s hospitals have declared a

                                    national state of emergency in child and adolescent mental health.

ONSCREEN TEXT:           33% high school students report persistent sadness or hopelessness

                                    and 17% report making a suicide plan.

KENDALL: Now this is before the pandemic that these stats that we're going to be discussing came out. And death by suicide had increased more than 57% in 10- to 24-year-olds. That was between 2007 and 2018. More than 77,000 physicians and 200 children's hospitals have declared a national state of emergency in child and adolescent mental health. 33% of high school students report persistent sadness or hopelessness, and 17% of youth report making a suicide plan. Dr. Katz, let's start by talking to you. Those stats really are sobering. What are the reasons behind them?

ONSCREEN TEXT:           Dr. Debra Katz

                                    National Medical Director, Optum Behavioral Health

DR. KATZ: I think you have to start by looking at normal development, okay? Adolescence is a tumultuous time whether you have a mental health problem or whether you're having a normative, you know, existence and not having any stressors. Youth are changing. They're going through puberty. Their body's changing. Their mind is changing. They're faced with things that they've never faced before. And as they try to develop into being their own individual versus being an extension of their parents, they wanna push the parents away. It's a time of separation in what we call "individuation." Meaning they're gonna develop their own person. So that superimposed on top of the stresses of school, the stresses of maybe family discord, trauma, violence--I could go on and on. The life of a teenager, the life of a young adolescent going all the way up to 24 is very stressful right now. I think one of the things that we like to talk about now that was actually very different than when I was a teenager is the contribution of social media. TikTok, YouTube. In two seconds, somebody sees a picture or a meme or a representation of what someone creates to represent themselves. So, when you do selfies or pictures anywhere, you're trying to--perhaps an adolescent is showing what they want to be. And that can be very upsetting to other teenagers that don't have the same self-esteem or aren't feeling very comfortable in their own skin. So that kind of situation, including as you'll hear from Emma, and it sounds like I would imagine other individuals have experienced bullying and isolation. Kids can be really mean when they're in middle school and during adolescence. And put all of that together, pre-pandemic, and now you have the pandemic. And what happens? All these youth who are trying to become their individuals, depend on their social circles are now forced to stay home, not be on athletic teams, not socialized in faith-based organizations, Girl Scouts. They have to be isolated. They have to do remote schooling. So, they're all alone. All they have is that social media connection, which even compounds the anxiety and the depression. So, I mean, there's a lot that puts them at risk. Never mind that many of the mental health challenges we face, mental health illness like depression and anxiety, start in your teenage years. So, you know, put that on top of it, including let's not forget the contributions of experimentation with marijuana, drugs, and alcohol. So, you put that all together with a pandemic, and we had a perfect storm.

KENDALL: Yeah.

DR. KATZ: And I think that's really what's contributed to where we're at right now.

KENDALL: It was already difficult for teenagers. You were a teenager pre-TikTok and all that stuff, Emma, But you had those very understandable and similar struggles. Tell us a little bit about your situation.

ONSCREEN TEXT:           Emma White

                                    Author & Advocate, Life is Worth it

EMMA: Yeah. So, I was 15 years old when I started getting bullied at school, stalked, harassed on social media. And like you said, that was pre-TikTok. So, it was more like Facebook and Snapchat had just become a thing. And there wasn't any understanding of how to have digital wellness, right? It was all just kind of happening so fast. So, when I started getting bullied online, I had no idea what to do about it, because I felt like I had no control. And that spiraled into getting bullied in person and didn't know what to do about that, and feeling like I'm the only person in the world that's struggling with this. So – which we know isn't true but felt like that. So, because of that, it spiraled into me feeling anxious and not knowing who to talk to, not feeling like I could talk to anybody, which then moved into depression, which I struggled with for four months. And then it moved into making a plan to take my life, because I had no idea. I just didn't know what to do. So thankfully, that didn't happen, 'cause I'm sitting here today. But looking at the warning signs that I was exhibiting, I lost a lot of weight, because the anxiety made me feel like I couldn't eat. So, I lost 20 pounds in a month. So that's a huge warning sign. Just not wanting to participate in things that I typically did. I was an athlete, played basketball and volleyball. Had no interest in going to practice. Didn't want to play. Didn't care. So those were some really big warning signs. And the warning signs are different for everybody, but in my situation, that's what it was. So, in looking at what parents can be looking for, we're really looking at that abnormal behavior and something that seems out of character is huge when looking at warning signs.

KENDALL: Yeah. And I think as a parent, that is the fear that we won't pick up on warning signs that may in retrospect be apparent. But at the time, may go over our head, because teenagers are teenagers, right? They're grumpy, and they're not easy sometimes. And it would be hard to understand that. What do you think, Martha, about that? The recognition of signs, that has to be so difficult.

ONSCREEN TEXT:           Martha Thomas

                                    Teacher & Co-Founder, The Defensive Line

MARTHA: It's extremely difficult. But the number one thing I would say in order to know the difference between the warning signs and normal teen behavior is to ask. Ask if they're at risk. Ask if they're thinking about suicide. Don't be afraid to say that.

KENDALL: Let's talk to your son. Solomon, welcome first of all. It's good to have you with us. And we're so sorry about your sister's loss. The loss of your sister I should say. Can you tell us a little bit about Ella and also, what advice you have for siblings who want to make sure their brother or sister isn't going through similar struggles?

Solomon appears at the panel projected onto a screen. His video feed encompasses the whole screen as he speaks, along with pictures of Ella.

ONSCREEN TEXT:           Solomon Thomas

                                    NFL Player & Co-Founder, The Defensive Line

SOLOMON: Yes, sir. Yeah. Thank you for having me today. It's honor to be on this panel and to be with you all today. Yeah, my sister Ella, you know, she was everything to me, which was my big sister, my protector. She taught me everything. You know, I was a weird little kid. You know, I didn't really know how to communicate with people. I didn't know how to make friends, know how to dance, talk to girls, any of that. And she taught me how to do everything. You know, she had this big, huge heart and just gave out so much love. She loved everyone around her. She loved people that she didn't know. She loved people she just met. You know, she loved people who didn't deserve her love. You know, that's just who Ella was. She just had this loving heart. You know, Ella's best friend, you know, Bennett from high school, describes her as a human narrator. Because Ella could bring in together any group of people, whether it was the jocks, the nerds, the dance crew, the band. She could bring 'em all together and make them feel like they all belong together. Ella had this special power to make people feel so important. Like, if you're in the room with Ella with as many people who are in the room today, you would be able to think you're the only person in the room with Ella. She just made you feel so validated and loved. When Ella struggled, you know, she was diagnosed with depression diagnosis with anxiety. You know, and she struggled. And she was open about her struggles. You know, she was vulnerable. If people asked how Ella was doing it, she would tell them, "Hey, you know, I'm struggling. I'm pretty anxious today. You know, I'm sad. You know, I don't feel well." And that would kind of push people away. And that would kind of make Ella kind of suppress her emotions, not talk about them as much, and make her feel more alone. You know, Ella was ahead of her time with her vulnerability and ahead of her time with the type of strength she had. And I feel like that hurt Ella a lot, 'cause the stigma that she lived in back then. You know, so unfortunately, you know, Ella died by suicide in 2018. And you know, as a brother, that's, you know, the hardest thing in the world to lose, you know, the person closest to you. Lost my sister, you know, a person who was my protector, but a person who I wanted to dedicate my life to, to protect, and dedicate my life to to make sure she got better. And to lose her was the hardest thing in my life. And, you know, the advice I would tell siblings is similar to what my mom said is, you know, ask the question. You know, ask how they're doing. Ask, you know--ask them. Let them--and ask about like, "Are you thinking about suicide? Are have you having these thoughts?" And as a sibling, I think it's important to know like, "Hey, like, listen. Like, I'm your brother, I'm your best friend, but I'm also a safe place for you. I can talk. I can talk to you. I can listen. I could be there for you in any way you need me to. And, you know, I'm here for you." And I think it's important and powerful to tell someone how bad you want them here and how bad you need them here. So, you know, I wish I could go back and tell Ella, like, how bad I need her here every day and, you know, how much, you know, I want her and how much she's loved and how much she should be here every day. You know, so that's just some advice, you know, and a little bit about my sister.

KENDALL: It's powerful too. And I have such admiration for you and Emma and Martha who have taken grave situations and turned them around, and you are now working with the nonprofit, The Defensive Line, brings suicide prevention resources to teachers and coaches and schools. Martha, you're a middle school teacher. So, you see kids all the time who may be exhibiting similar signs.

ONSCREEN TEXT:           Martha Thomas

                                    Teacher & Co-Founder, The Defensive Line

MARTHA: Yeah. So, I do, and I'm very forthright with my students. And I also am well aware of our school's protocol and who I need to refer them to. And to make sure I'm always telling someone else, I'm acknowledging that something's going on, that something's off with a student. You know, I'll say, "Hey, you don't seem like yourself today." You know, most kids will say, "Hey, I'm fine. I'm fine." And I'll be like, "But something's going on. It's different. Is it at home? Is it at school?" You know, and give them the chance to talk. But to make sure, you know, to check with other teachers, "Are you seeing the same thing?" And to make sure the counselors and the assistant principals know the concern as well.

KENDALL: And there is an increase apparently in suicides among different cultures and races. How does that play into this?

MARTHA: Well, it plays into our organization, because as the suicide rates for youth of color are rising, resources aren't there in communities of color. And so they're not as many resources. And so we're trying to help provide those to, you know, teachers and coaches in schools.

KENDALL: And you mentioned a big part of that is starting conversations.

MARTHA: Yes.

KENDALL: That's a big thing for you as well, Emma. How do you start those conversations though? I think a lot of people have a concern that bringing up the topic might exacerbate the problem.

ONSCREEN TEXT:           Emma White

                                    Author & Advocate, Life is Worth it

EMMA: Right. And that is a common misconception that people think about suicide. If they ask, "Are you thinking about suicide?" That it will give them the idea, or that it's contagious. And it's not. Talking about suicide does not give the idea to somebody. And we have to have those conversations to really understand where somebody is at. So, when we're looking at starting that conversation, I just always say to just be vulnerable and to really care and listen. Because a lot of times that's what kids are lacking. Is they're lacking somebody who genuinely cares or will listen without judgment. So, it can be difficult to start the conversation, but I just encourage people to jump in just as they do with their physical health. And I think a lot of parents feel like they can talk about their physical health, you know, more than mental health, but we really wanna talk about it on the same level. We're talking about, "Are you feeling sick? Do you have a sore throat? Are you feeling sad? Are you feeling happy? What are those?" So, I think that if we can look at it on that perspective, it becomes a little easier to have the conversation.

KENDALL: And, Dr. Katz, when the topic is broached, are people generally appreciative that it is even if they are not struggling?

ONSCREEN TEXT:           Dr. Debra Katz

                                    National Medical Director, Optum Behavioral Health

DR. KATZ: Absolutely. I think what Emma said is really true. People wanna be listened to, but the most important thing about being listened to is the thing that you said afterwards is without judgment. Adolescents always feel--teenagers and kids always feel like your parents are judging you. You're not good enough in your parents' eyes. You've let them down, because you didn't get the A versus the B, etc. A parent's role is really to listen and to guide and almost accept what your child is telling you and help them navigate the road. Not say, "That's wrong, and you shouldn't be doing that." That's some of the worst things you can say to a child or an adolescent. And I think the truth is that even as adolescents try to separate and become their own person, who do they first go to? Their parents. They don't lose some of that relationship where they go to their friends. And I think that the most important thing that you can do is create that safe space for conversation. And I often tell parents, "Talk about your own experiences." There's nothing like disarming a conversation when you tell your kid, "You know, when I was in high school, I tried marijuana." "Oh, my." And they look at you. "That couldn't be." "And when I did, this is my experience. And this is what happened." You can't imagine the good faith and the good communication that will come out of that with your child. So instead of seeing you as this, you know, perfect person, they can see you as vulnerable. They can see you having your flaws and your challenges. We all get sad. We all are anxious. We all get depressed.

KENDALL: Solomon, because of your nonprofit, the Defensive Line, because of everything you've been through, do you find it easier now to broach the topic with people?

ONSCREEN TEXT:           Solomon Thomas

                                    NFL Player & Co-Founder, The Defensive Line

SOLOMON: Yeah. You know, it's easier for me, you know, because I've been in this work for about, you know, three, four years now. And I've been talking, and I've been vulnerable. I've kind of put my whole life out there on the internet and on the line, and in front of big companies, big teams, you know, big people. And, you know, so it is easier for me to be vulnerable. But, you know, I think, you know, there's a big misconception about vulnerability. You know, people think that, you know, when they're vulnerable like that, that they're weak, that, you know, it's like a sign of weakness, or, you know, they're being sensitive, or soft. And it is so the opposite. You know, being vulnerable is such a sign of strength. You know, telling someone how you're really doing and how you're really feeling, you know, that takes a lot of courage and a lot of effort. It's not easy to look at someone and be like, "Hey, you know, I'm really struggling today. You know, I'm hurting, and I'm having a weird day. I just feel weird." Like, that's really hard. You know, when I was struggling, when I was at my worst and going through my dark days and not wanting to be on this earth, like, I would just tell people it’s like, "Hey, I'm good. Like, I'm fine." Like, 'cause it was easy to do. It was easy to lie to people. But being vulnerable, like, when I started opening up and going to therapy and talking about how I was feeling, that was hard. Like, it brought tears out. It brought emotions out. It brought trauma out. Like, it was a lot. And I think people need to understand how powerful and how strong vulnerability is. Those three- to five-minute conversations you can have, you know, on a train ride, on a bus ride, if you're vulnerable in those moments, like you can really change someone's life. You know, you can ask someone a question that can really alter their day and alter their life. You know, I've had many of those conversations just in passing people. You know, people know my story. People know, you know, what I've been through, and they say something vulnerable, and I'm vulnerable right back with them. And I can just see light come outta their face and light come outta my face. It lifts my heart. You know, so I think it's huge, you know, to understand, like, how important vulnerability is and how it can really change people.

KENDALL: Martha, did you find something similar that you became more vulnerable as a result of the tragedy?

ONSCREEN TEXT:           Martha Thomas

                                    Teacher & Co-Founder, The Defensive Line

MARTHA: Yes. Because, you know, we experienced a lot of people who didn't wanna talk about it after Ella died and would never mention the word suicide, didn't want to say Ella's name. And it became, you know, our mission to say her name and to talk about it. Simply because if we had known more, we could have helped her more. Might it have changed everything? It might have. We don't know. But we can sure do our best to make sure more people are educated about the signs and symptoms and what can be done, so it doesn't happen to anyone else.

KENDALL: I think you brought up something that's really important. Dr. Katz, I wanna touch on that before our next official question. And that is for those--you're not always able to catch the signs. And I speak from my experience. I lost a cousin when I was in high school, and I know on a much different level I'm sure, but on a level I was asking myself, "What did I not see? What could I have done?" How do you avoid the pitfalls that could potentially come with that? And I wanna ask you maybe first, Martha. How did you avoid the pitfalls that could come with that?

MARTHA: First of all, many of Ella's friends afterwards came and told us different things. And if we had known all those things together, it would've been easier to help her. And I mean, certainly it's hard to avoid the pitfalls, right? You know, and hard to get swirled into that. And so, you know, you really have to pull yourself out of it and catch yourself when you're getting into that mess.

KENDALL: Yeah, it is. I'm sure it's a quagmire that could just be a vortex. Dr Katz?

ONSCREEN TEXT:           Dr. Debra Katz

                                    National Medical Director, Optum Behavioral Health

DR. KATZ: Yeah. I mean, there are many, many warning signs. But you have to be sensitized to look for them. And I think sometimes parents, many of us are parents in this room, you don't wanna see the bad stuff. You just wanna see all the good stuff that your kid or their siblings are doing. So you have to pay attention, and you have to create that safe space for the conversation. Is to let, you know, your child and your partner, spouse, to be able to be able to talk about the hard things. You've gotta watch their sleep. You've gotta watch how their appetite--Emma, you said you lost 20 pounds in a month. You have to watch, "Are they still involved in activities that they like?" All of a sudden, if they're starting to even more socially isolate, not wanting to be on the volleyball, the basketball, or the football team, then not really wanting to socialize with other kids. They stay in their room more. They are more emotionally volatile. They get angry really quickly, get agitated. And if they start to--if you notice they're giving possessions away or if they're starting to talk about firearms, that is a big warning sign. Most kids who die by guns are not really by violent crimes, by accidents that happen and death by suicide. So, I think really we have to be very aware of that. And the same thing about medications and pills. Making sure that they don't have the lethal means and access to those things. And it's all about conversing without judgment. If I can't be more redundant about anything, everything I'm gonna talk about is without judgment. You may think it in your own head, but to give the person, to give them permission to talk freely is to be without judgment.

ONSCREEN TEXT:           Emma White

                                    Author & Advocate, Life is Worth it

EMMA: I think too also is when we're talking about having the conversation is I think a lot of people feel like if they ask that question, then they're required to have the answer and to fix it. And as a parent, it's probably really common where you ask that question, and you might not have the answer. And so I think it's really important just to stress that, sgain, that listening without judgment, you're not required to fix it all in one day, one hour, one moment. It's really just about being able to understand what's going on, so that you can connect to somebody who might be able to have further answers.

KENDALL: That's an excellent point. And an “aha” moment for me as a parent is I was thinking, how do you differentiate between a solemn teenager, which is every teenager quite often and a teenager who is really going through very, very difficult times. And to your points, it is talk, it is ask the questions, and listen.

MARTHA: And without judgment.

KENDALL: Right, which is apparent. Yeah.

ONSCREEN TEXT:           Martha Thomas

                                    Teacher & Co-Founder, The Defensive Line

MARTHA: And it's hard, but I also would like to say that, you know, if you're observing some behaviors, jot 'em down. Jot 'em, because with kids and especially kids that you're too close to, like your own kids, they sneak up on you. You know, and you you're like, "Wait. They're sleeping more. Oh, yeah. I noticed that two weeks ago too." You know that it just helps you with a little bit of a frame of reference.

KENDALL: That makes sense.

DR. KATZ: I'd like to add one thing.

KENDALL: Yeah.

ONSCREEN TEXT:           Dr. Debra Katz

                                    National Medical Director, Optum Behavioral Health

DR. KATZ: It's gonna sound counter intuitive, but I want parents to know your kids' friends. Because one of the things, Martha, you said is that Ella's friends came and talked to you afterwards. Know who your kids are friends with. Know what they're doing socially. Make relationships with those kids so that they're comfortable enough to even set the situation when they're over or they're socializing. Say, "Hey, if anything's ever going on, I'm a safe space to come and talk to. You know, if anything is worrisome." I mean, that takes practice. 'Cause, you know, the kids are, "We don't talk to the parent." They wanna go straight up to the room with their friends. But know who they are. Know what social media they're using. Know who they're conversing with. I mean, many times when a lot of adolescents get in trouble whether they're in chat rooms, whether looking at pornography, whether they're, you know, sharing on site about bullying, the parents don't know about it. So, I mean, it's not to be over their shoulders 24/7 but to get a general feeling, so you can establish that trusting relationship. To know if your kid's in trouble that you can be there to help them.

KENDALL: That's a really good point. Solomon, you were nodding your head when we were talking about knowing your child, or in this case, your siblings' friends. Why did that ring true for you?

ONSCREEN TEXT:           Solomon Thomas

                                    NFL Player & Co-Founder, The Defensive Line

SOLOMON: I've been nodding my head with everything. Everyone's been saying, you know, so much amazing things. And I really resonated, you know, when you guys were talking about, you know, just listening. And, you know, with everyone, like, kind of is afraid of talking and engage in these conversations, because they want to know the answers. They wanna--everyone wants to fix everyone. They wanna fix things. And, you know, that's one thing like why I didn't talk a lot in the beginning too. 'Cause, like, I know my parents had similar feelings. I know Ella's friends had similar feelings from losing her, and people just wanted to say something to make me feel better. I didn't really necessarily want to feel better. I just wanted to feel heard. I wanted to not feel alone in my pain, not to feel alone in my struggles. And that's why I tell people when people come to me and they'll ask, "Hey, what do I say? How do I help my friend out? She said, 'This.' My cousin, 'Said this.'" I, like, just listen to them. Like, hear them and make sure they feel heard. Because if they talk and they don't feel like you're in the conversation or you're just trying to fix them, they're not gonna feel that safe place. And so, I really just resonated with that. I thought that was huge.

KENDALL: Yeah, the theme I'm hearing is isolation is what a lot of people were feeling. That's what you were describing, Emma, as well. And there's a particular group that is at risk for suicide, teens and young adults who identify as LGBTQ+.

ONSCREEN TEXT:           40% of LGBTQ+ youth have seriously considered attempting suicide in the past year.

KENDALL: Current statistics show they are 40%--or that 40% of them have seriously considered attempting suicide in the last year. That's amazing. What do we need to know, Dr. Katz, about their particular challenges?

ONSCREEN TEXT:           Dr. Debra Katz

                                    National Medical Director, Optum Behavioral Health

DR. KATZ: I do a lot of work with this community and really trying to remove the barriers. The number one thing is stigma. Listen to the news. Listen to what's going on in your states, the country, the kind of discrimination that people who identify in the LGBTQ+ population. They feel it every day. Even when, like, a trans person wants someone to refer to them and they wanna be referred to the pronouns of say he, him, and they. And oh, people balk at that. So, it's disrespectful to that individual. You do not have to agree with someone else's perspective on their choices. But the number one thing is you have to respect the skin that they exist in. And there is so much stigma and so much discrimination, and bullying, you know, is horrible in this community. And just the simple things of I could tell story after story about the teenagers at school and the teenagers--how about a trans kid wanting to use a bathroom and everybody arguing about what bathroom to use? Or wanting to go to a doctor and talk about hormones, because they wanna suppress puberty, or they wanna, you know, start to transition and the doctor's judgmental. And, "Oh, I don't believe in that." They have no access to healthcare. If you talk to--they have access to healthcare, but there are a lot of barriers. So, it's the stigma, discrimination, bullying, and it's really people aren't educated. And people aren't accepting of the differences. And I think we need to do a much better job at educating ourselves, educating our families, educating our legislators, educating our teachers and our schools, to be able to create again, what we've been talking about, those safe environments. Also, please note that when you talk about trauma, it's a big issue in not just the LGBTQ+ but of people of color, okay? And the adverse childhood experiences that occurred because of the trauma that they can--you know, a lot of these kids and adults have been bullied, have had physical violence, sexual violence. I mean, these are serious things that really impact their trajectory. High rates of suicide. High rates of depression, anxiety. High rates of substance use disorder. Also, high rates of them not accessing healthcare, because they've felt that they've never been able to go to a doctor or anybody who they could be themselves with them.

KENDALL: How do we counter? And I don't want at all this to delve into a political conversation. But obviously there's some polarization when it comes to this issue. How do we make sure that the young people or individuals who are impacted by this do not feel targeted? Because that stuff is gonna continue. That debate will continue one way or the other.

ONSCREEN TEXT:           Martha Thomas

                                    Teacher & Co-Founder, The Defensive Line

MARTHA: One of the things we can do for youth of color, for LGBTQ+ is when we hear a microaggression against them, we can also provide a micro-affirmation. We're not gonna stop all the aggression, but we can be part of the solution to make them feel heard, to make them feel recognized, to acknowledge that we've heard something going on. Whether it's something simple like recognizing someone's name or making fun of someone's hair. Ella used to be told, "Oh, yeah, you're cute for a black girl." Like, that's a microaggression.

KENDALL: Yeah.

MARTHA: Or an aggression.

ONSCREEN TEXT:           Dr. Debra Katz

                                    National Medical Director, Optum Behavioral Health

DR. KATZ: It’s an aggression. It's again being respectful. And education, education, education. I can't--you know, that's a lot of the work that The Defensive Line I really applaud you and the work that your whole family's doing. Because, you know, ignorance is often the root cause of stigma and discrimination. People don't know. People don't understand cultural differences. People don't appreciate people's choices. And I think if we--and if you--just like you said, Martha, if you can stand up for someone who's maybe bullying, don't be silent. Stand up and show your respect and model for them, so that they can be empowered to stand up for themselves.

KENDALL: We could do a –

DR. KATZ: And I think we can really change things.

KENDALL: Yeah. We could do a whole discussion, and I would love to at some point on empathy, and why that's so critical to this conversation. But this is about hope as well. And you guys have brought that up many times. And resiliency is so important. It's a way we can empower youth or anyone who is struggling with these thoughts. Let's start with you, Solomon. How do we empower youth to be resilient?

ONSCREEN TEXT:           Solomon Thomas

                                    NFL Player & Co-Founder, The Defensive Line

SOLOMON: You know, to empower youth to be resilient, I think it's to honor their feelings, honor their emotions. You know, we're in--you know, we kind of grew up--my generation and above grew up in this mentality of mental health where, you know, "Hey, rub some dirt in it. Hey, get over it. Hey, mental health is just a feeling. Some emotion. You know, it will move on." And which is so not the truth. You know, mental health, you know, depression, anxiety, you know, they are mental illnesses where you're not getting the right chemistry to your brain. It is a scientific disease just like cancer. It's like diabetes. And to make sure people understand that and to people--so they feel that empathy. They feel like, "Hey, like, people are understanding what I'm going through. People are understanding the struggles I'm going through." So they don't have to go through the stigma. You know, the stigma is what kept me from talking for a long time before Ella died. You know, it kept me from talking about me being suicidal for the longest time especially as a man in the NFL. You know, to find ways to erase that stigma and let people know, "Hey, it's okay not to be okay. You know, the human life is really hard. We go through so many emotions." You know, we're in the social media age of the world where it's, like, all good, good, good, good, good. And that's not life is. Life is about ups and downs, about the adversity. And so, if we can teach people to really know that it's okay to feel sad, it's okay to feel awkward, angry, weird, depressed, anxious. Like, these are feelings we're gonna feel throughout the experience. So, to let people honor them and validate them, that will really empower our youth. And just to make them feel like, you know, they're understood that they're not alone in this battle against depression. That they're not alone in this battle against bipolar disorder. That they're not alone this battle against schizophrenia. Like, to make sure that they understand that, "Hey, like, I'm not alone in this battle and that there's help. And that there's a light in this dark town that I'm going through." I feel like these are ways that we can empower our youth by just having them feel heard, loved, understood, know that there's help, know that, you know, vulnerability is a strength, knowing that getting help is a strength, knowing that being empathetic and checking on your people and loving your people and respecting your people is a strength. I think that is a huge way we can empower our youth.

KENDALL: I absolutely love that. And as we near the completion of this initial discussion, let's continue to talk about resiliency and how to empower the youth. Emma.

ONSCREEN TEXT:           Emma White

                                    Author & Advocate, Life is Worth it

EMMA: Yeah. I would say a really important factor is that we show kids how to be resilient by how we react. So, with parents or caregivers or other people that are in kids' lives, they model that for them. And an example is I worked with a youth who was acting out on social media and bullying other people. And when we got into a conversation, she said that she had seen her mom on Facebook arguing with people about something, and she took that. So, I think that we--and I'm not a parent, but I do know that as an adult, I can model those behaviors for myself. And it shows other young people how to interact with people in their community. And back to that respect piece is showing people respect, regardless, I think is huge. But resilience for sure is a learned skill.

KENDALL: Yeah.

EMMA: We are not born being resilient. It comes through trials, and we can model that.

KENDALL: Modeling resiliency is beautiful. Martha.

MARTHA: I'd say, let your kids fail and don't pick 'em back up, but show them how to get up.

KENDALL: Not always easy though, as a parent.

MARTHA: No.

KENDALL: Right? I mean our tendency is –

MARTHA: Not at all.

KENDALL: I know we just wanna go and help 'em, right?

MARTHA: It's hard, but we have to do it. Otherwise, they can't learn on their own.

KENDALL: Yeah.

DR. KATZ: But I also wanna add one thing. That to be able to model that resiliency, parents and caregivers need to take care of themselves. That we all struggle with mental health wellness and maybe with mental health illness. We have got to spend the time to be, "You don't do as I say. Do as I do." Model for them. Show them what it means to exercise, to breathe, to ask, to talk about your feelings. Life has been really hard the last few years, and parents have struggled, whether it be unemployment, homelessness, food insecurity. I could go on and on with all the social determinants. Well, that affects how they parent. And they haven't been always the best role models for their kids, because they didn't have the resources themselves. So we really have to work on helping our parents and caregivers look in the mirror and try to be vulnerable and take care of themselves, so they can better parent or model for their kids.

 KENDALL: I absolutely have loved this discussion. And I so appreciate the input each one of you has given here that I think will help a lot of people. Either parents, people who are friends with someone, or someone who is going through this themselves. So, thank you for being vulnerable and for talking about resiliency and for being here today. Let's thank our guest.

The audience applauds. Dr. Katz waves.

DR. KATZ: Bye Solomon. Nice to meet you, Solomon.

KENDALL: Yeah, Solomon, that was fantastic.

SOLOMON: Nice to meet you, everyone.

KENDALL: You're gonna turn this Cowboys fan into a Jets fan.

SOLOMON: I hope so. I hope so.

KENDALL: Wanna remind you if you are in a crisis, there are ways to get help. You can call 1-800-273-TALK or text 741741. Or there's a brand-new number that's easier to remember. And that is the new national crisis number. It is 988. So rather than calling 911, it's simply 988. Those are three ways that you can get the help you need. And those numbers will put you in touch directly with a crisis counselor 24 hours a day, seven days a week. And we will be sharing that information again later as we continue our discussions. In a moment, we are gonna share some other important resources, some phone numbers, some websites that hopefully will continue to give us the tools needed to help kids and others who are in need. But first, a personal message about the importance of mental health awareness from magicians Penn and Teller.

Wearing suits, Penn and Teller stand before a red velvet curtain.

PENN: My name is Penn Jillette. With my partner Teller, we're Penn and Teller. We're magicians. I'm a father. I'm a husband. You know, if someone that we loved in our family had cancer or heart disease or anything like that, we would not wait to get treatment. And we have to do the same thing with mental health. We must make mental health a priority. And that's why things like the "Suicide Prevention Town Hall" are so, so important. Please let's make mental health a priority.

Teller nods. A slide appears onscreen as instrumental acoustic guitar music plays.

ONSCREEN TEXT:           Crisis Resources

ONSCREEN TEXT:           National Suicide Prevention Lifeline.

ONSCREEN TEXT:           24/7 Crisis Support ∙ 1-800-273-TALK (8255) or 988

                                    3-digit phone number Introduced in July 2022

ONSCREEN TEXT:           Spanish Language

                                    Suicide Prevention Hotline

                                    1-888-628-9454

ONSCREEN TEXT:           crisistextline.org

ONSCREEN TEXT:           Crisis Text Line ∙ Text to 741741

                                    Online Chat ∙ suicidepreventionlifeline.org

A QR code appears at the bottom left of the screen. A new slide appears.

ONSCREEN TEXT:           Resources for LGBTQ+ Community

ONSCREEN TEXT:           LGBTQ Center of Southern Nevada

                                    1-702-733-9800

                                    www.thecenterlv.org

ONSCREEN TEXT:           The LGBT National Hotline

                                    1-888-843-4564

                                    www.glbthotline.org/hotline.html

                                    E-mail ∙ help@lgbthotline.org

ONSCREEN TEXT:           Trevor Project

                                    1-866-488-7386

ONSCREEN TEXT:           thetrevorproject.org

ONSCREEN TEXT:           Crisis Text Line ∙ Text to 678678

                                    Online Chat ∙ www.thetrevorproject.org

A QR code appears at the bottom left of the screen. A new slide appears.

ONSCREEN TEXT:           Youth & Teen Resources

ONSCREEN TEXT:           Teen Line

                                    1-800-852-8336 (evenings only)

                                    Text to 839863

                                    Contact by Email at www.teenline.org

ONSCREEN TEXT:           National Runaway Safe Line

                                    (24/7 Crisis Connection)

                                    1-800-RUNAWAY (786-2929)

ONSCREEN TEXT:           www.1800runaway.org

ONSCREEN TEXT:           Chat or connect via email at www.1800runaway.org

                                    Resources available for youth and concerned adults

A QR code appears onscreen. A new slide appears.

ONSCREEN TEXT:           Other Mental Health Resources

ONSCREEN TEXT:           NAMI

ONSCREEN TEXT:           National Alliance on Mental Illness (NAMI) Help Line

                                    Monday thru Friday/10a.m. -10 p.m. Eastern

                                    1-800-950-NAMI (6264)

ONSCREEN TEXT:           www.nami.org

ONSCREEN TEXT:           Email ∙ helpline@nami.org www.nami.org

                                    Text “NAMI” to 741741 (24/7 confidential crisis counseling)

A QR code appears at the bottom left of the screen. A new slide appears.

ONSCREEN TEXT:           Other Mental Health Resources

ONSCREEN TEXT:           National Sexual Assault Hotline Rape Abuse

                                    and Incest National Network

                                    1-800-656-HOPE (4673)

                                    24/7 Live Chat at: www.rainn.org

ONSCREEN TEXT:           National Domestic Violence Hotline      

                                    1-800-799-SAFE (7233) TTY 1-800-787-3224

                                    Crisis Text Line ∙ Text to 88788

ONSCREEN TEXT:           Online Chat ∙ www.thehotline.org

A new slide appears.

ONSCREEN TEXT:           Other Mental Health Resources

ONSCREEN TEXT:           Substance Abuse and Mental Health

                                    Services Administration (SAMHSA)

                                    U.S. Department of Health & Human Services

                                    www.samsha.gov

ONSCREEN TEXT:           Disaster Distress Helpline

                                    Call or Text 1-800-985-5990, Press 2 for Spanish

                                    www.DisasterDistress.samhsa.gov

ONSCREEN TEXT:           American Foundation for Suicide Prevention

                                    afsp.org

                                    www.afsp.org

A QR code appears onscreen. A new slide appears.

ONSCREEN TEXT:           Educational Resources

ONSCREEN TEXT:           Health Plan of Nevada

                                    www.healthplanofnevada.com

ONSCREE TEXT:             UnitedHealthcare

                                    www.uhc.com

ONSCREEN TEXT:           Optum – Free Conversation Starter

                                    Cards for Parents/Caregivers

                                    www.Optumconversation.com

ONSCREEN TEXT:           optumconversation.com

A QR code appears onscreen. A new slide appears.

ONSCREEN TEXT:           Mental Health Mobile Self-Help App

ONSCREEN TEXT:           Sanvello

                                    FREE to Download

                                    (Premium Version requires a fee for non-UnitedHealthcare users)

ONSCREEN TEXT:           Helps navigate difficult emotions with

                                    daily mood tracking, personalized progress trackers,

                                    personalized coaching, and community support.

ONSCREEN TEXT:           www.sanvello.com

                                    Download at the Apple App Store or through Google Play

The music fades.

Gentle piano music plays as photos glide past: people comforting one another, clasping hands, taking notes while listening, and talking with engaged expressions. A purple background with teal lines moves past, followed by a teal background with white lines. Now, against a white background, a purple and teal logo in the shape of a ribbon resembling two clasped hands appears. Black text to the right of the ribbon reads:

ONSCREEN TEXT:      Help,
                                    Hope &
                                    Action

Beneath the black text, a purple title appears offset by teal lines:

ONSCREEN TEXT:        SUICIDE PREVENTION
                                    TOWN HALL

Logos beneath the text appear for Health Plan of Nevada, UnitedHealthcare, OPTUM, and the American Foundation for Suicide Prevention.

A man with dark hair in a navy suit speaks in front of a potted plant. White text in the bottom left corner and a purple banner show his name and attribution:

ONSCREEN TEXT:        Kendall Tenney
                                    Moderator, 10E Media

                                   

KENDALL TENNEY: Welcome back to Help, Hope, & Action, a suicide prevention town hall. I'm Kendall Tenney, along with our second panel of guests that I'll introduce shortly and our audience on hand today, and we're glad you're with us.

On a stage, he gestures to a panel of four guests seated in armchairs in front of a screen featuring the title slide. A small coffee table sits in front of the guests.

KENDALL TENNEY: In our last segment, we heard from those with experience and professional expertise about the challenges that place children and teens and young adults at risk for suicide and how we might be able to help those individuals or help ourselves. In this half hour, we're gonna be talking about the risk of suicide among adult populations and particularly seniors, Veterans, as well as the underserved and marginalized in society. We'll be discussing how to identify those who are struggling and what can be done to support them. And now, it is my pleasure to introduce our second panel.



A woman with black hair and dark eyeliner smiles. White text in the bottom left corner and a purple banner show her name and attribution:  

ONSCREEN TEXT:        Rachel Rosensteel
                                    Assoc Dir., Health Equity, Health Plan of Nevada Medicaid Program

KENDALL TENNEY: Rachel Rosensteel is Health Plan of Nevada's Associate Director of Health Equity. Rachel works to ensure the plan's Medicaid members have access to the important services and resources. She has extensive experience supporting those challenged by social determinants of health, the homeless, and the recently incarcerated. Please welcome Rachel.

The audience applauds. A woman with wavy blonde hair smiles, and white text appears in the bottom left with a purple banner:

ONSCREEN TEXT:        Michele Freeman
                                    Healing Conversations Coordinator, American Foundation for Suicide Prevention

KENDALL TENNEY: Michele Freeman is a former chief for the City of Las Vegas Department of Public Safety. Michele has her Doctorate of Public Policy, focusing on suicide awareness and prevention for law enforcement officers.  She also holds a master's degree in public administration and a bachelor's degree in criminal justice with a strong emphasis in sociology and psychology. Michele is a board member of the American Foundation for Suicide Prevention, one of the sponsors of today's town hall. Please welcome Michele.

The audience applauds, and Michele nods to Kendall and mouths “Thank you.” Now a woman with glasses and short, black hair smiles. White text appears in the bottom left with a purple banner:

ONSCREEN TEXT:        Dr. Nichole Bauknight-Boles

Psychiatrist & Senior Medical Director, Health Plan of Nevada

KENDALL TENNEY: Next, we have Dr. Nichole Bauknight-Boles, Senior Medical Director of Behavioral Health at Health Plan of Nevada. An Army National Guard veteran, Dr. Bauknight has 22 years of experience and is a double board-certified child and adolescent and adult psychiatrist. She has worked in all levels of mental health care with a wide variety of age groups and populations in both the public and private sector. Please welcome Dr. Bauknight.

Dr. Bauknight nods and smiles to the audience as they clap. Now Kendall introduces a man with grey hair and a moustache and goatee. He wears a purple badge that reads “OSP” in white letters. In the bottom left of the view, white text appears with a purple banner:

ONSCREEN TEXT:        Richard Egan

Training & Outreach Facilitator, Nevada Office of Suicide Prevention

KENDALL TENNEY: And finally, we have Richard Egan, is the Southern Nevada Suicide Prevention Training and Outreach Facilitator for the Department of Health and Human Services. A 26-year veteran of the U.S. Air Force, Richard brings 24 years of experience of preventing suicides in Nevada by utilizing awareness, prevention, and intervention certifications. Please welcome Richard and all of our guests.
Richard nods with a smile and mouths “Thank you” to Kendall.
KENDALL TENNEY: All right, before we launch into this segment, let's go over some numbers that are sobering.
A slide with black text on a white background appears, beneath a title in a purple and teal banner:
ONSCREEN TEXT:        Latest Statistics on Adult & Senior Suicide

                                    - According to United Health Foundations most recent America’s Health Rankings report, suicide rates increased 13% among seniors between 2009 and 2020.

                                    - Nevada has some of the highest suicide rates among seniors of any state in the country; currently ranking 4th in suicide among  those 65+

                                    - In 2019, the rate of suicide among Veterans was 52% higher than of non-Veterans

                                    - In 2021, adults with disabilities were three times more likely to report suicidal ideation in the past month compared to persons without disabilities.

KENDALL TENNEY:  According to the United Health Foundation's most recent America's Health Rankings report, suicide rates increased 13% among seniors between 2009 and 2020. So that doesn't even take the pandemic into account. Nevada has some of the highest suicide rates among seniors in the country, currently ranking 4th in suicide among those who are 65 and older. In 2019, the rate of suicide among Veterans was 52% higher than non-Veterans. And in 2021, adults with disabilities were three times more likely to report suicidal ideation in the past month compared to persons without disabilities. So, Dr. Bauknight, why? Why are those numbers the way they are?

As Kendall turns to each guest, the view focuses on the speaker and displays their name and attribution in the bottom left corner once more.
DR. BAUKNIGHT: Well, I believe among seniors, one of the major contributors to death by suicide is the fact that there's been changes in life in phases, and there's been a significant amount of loss and grief. There have been changes in physical abilities and capabilities, and a loss of independence. At that particular point, when someone is 65 and older, they're really looking back on their life and assessing their accomplishments. So when there's a lack of accomplishments and feelings of loss, that can lead to depression, anxiety—which contributes, of course, to suicide.

KENDALL TENNEY: Yeah, it is a time in life when you start to look back and maybe have regrets and maybe think there's no reason to really move forward. Is this a lot of what's going on?

DR. BAUKNIGHT: Yes. Lack of accomplishments in evaluating and reflecting on your life at that point can really lead to depression and anxiety in people. And that could be the housewife that has grown children that are out in the workforce now. They're gonna look back on their life and say, you know, ‘Do I have successful children? Are they contributing to society? Have I—have my children—and my primary goal was to raise them to be contributors of society and meaning.’ They're going to be looking at it that way, whereas the CEO of a major corporation will be looking at their career aspects and what did they leave as far as legacy is concerned? So a lack of accomplishment can really put a person into a depression or anxiety, and that can lead to thoughts of suicide.

KENDALL TENNEY: A perceived lack of accomplishments, right? All right, social determinants, you mentioned those a little bit. Things like being limited when it comes to transportation or housing, or a job, food. All those sort of things come into play. Rachel, let's talk about that. Let's talk about the impact of social determinants of health and what impact they have on mental health for the Medicaid population, and what's being done to support such individuals?
RACHEL ROSENSTEEL: Right. So as you mentioned, social determinants of health are things like transportation, housing, employment, food insecurity, education. They are the conditions in which we are born, in which we work, we play, we grow, we age. They are also things like the neighborhoods that we live in, our social support systems, our personal safety, domestic violence, involvement in the criminal justice system, and also access to healthcare. So our underserved communities, they have difficulty prioritizing mental health, because they're thinking about, you know, where they're gonna sleep at night, or how they're gonna feed their children, how they're gonna get to work tomorrow, you know, how they're gonna get a ride to their mandated court appearance. So, you know, those things are oftentimes more important than going to a therapy appointment. You know, mental health is one of those things that cannot be seen, so oftentimes, people suffer in silence. And mental health can exacerbate other things, like physical health conditions and social situations. So, you know, our underserved populations, they sometimes have hesitancy around accessing mental health services because the traditional services will address the mental health symptoms but don't necessarily address the social determinants of health issues that contribute to the symptoms. So, you know, the stress around how they're gonna pay their rent, or how they're gonna feed their families, can, you know, can lead to anxiety and depression. And some of the services out there don't, you know, don't pay their bills.

KENDALL TENNEY: Right.

RACHEL ROSENSTEEL: So why would they go, you know, access therapy when they need to go to work? So it's very challenging. And then it—you know, when these individuals live in a toxic or stressful environment, it can be very challenging for them to engage in any form of treatment if they are going to be returning to that same home environment, and there's no change in their social situation. So, you know, if they're going to expect a change in their, you know, if they're gonna expect a change in the outcome, you know, that could be difficult if there's no change in the social situation.

KENDALL TENNEY: The root of the problem is not being addressed in their estimation.

RACHEL ROSENSTEEL: Right, exactly. Exactly. So, you know, I think there has been a big shift in our communities around how this is being addressed. We are seeing more collaboration between all of the organizations, such as our government entities, managed care organizations, our hospital systems, our behavioral health providers, our medical providers, non-profits, our community-based organizations, our faith-based community, our faith-based organizations, you know, our community health workers, peer support specialists. You know, we're seeing more people come together to address social determinants of health in order to improve mental health outcomes among our vulnerable populations. And we are seeing--or I have seen, over the past few years, all of these groups come together to take more of a trauma-informed approach towards addressing mental health in our underserved community members. And there's also been an increased awareness around how important social determinants of health are. You know, social determinants of health can impact health outcomes up to 80%. So, you know, it's significant.
A statistic in white text appears in a purple banner at the bottom of the view:
ONSCREEN TEXT:        According to the AMA, 80% of what influences a person’s health happens outside of a doctor’s office.

KENDALL TENNEY: You know, you talked about vulnerable populations, and another vulnerable population is Veterans, and Richard, you work primarily with Veterans. What can be done, and what needs to be done, to intervene with those who are going through suicide ideation or experiencing some of these mental health challenges?

RICHARD EGAN: Kendall, that's a really good question because our Veterans go through the exact same things that we've talked about here, and the best the thing to do is come along the Veteran, ask him or her, "What got you to this point today?" And listen to those aspects of their lives that is affecting them. Always do remember, though, that it can be something from their military career. Some of the examples might be that they have PTSD from a deployment or a mental health concern from a deployment, but it could also be trauma from a car accident two months ago. It could be trauma from a childhood event. All the normal things that a community member goes through can be there also. But be aware that something else can be there, such as PTSD. Michele and I were talking before we came up about different populations that have aspects of their life that could come forth because of their profession, or because of their culture, or because of their upbringing that we need to be aware of. So we need to be open to all of those different things that a person can go through.

KENDALL TENNEY: Yeah. Michele, you were talking about the law enforcement population, which suffers some of the same trauma that Veterans would go through as well.

MICHELE FREEMAN: Absolutely, Kendall, and what it is is that law enforcement, a lot of law enforcement, and even other first responder fields, were Veterans or are Veterans, and/or potentially still in the military. So now they have this, they have being a human, right? And then they have being a Veteran, and then they have now being in the first responder field. So now they have more, potentially, trauma or tragedy or devastation that they've been exposed to, which can absolutely add another layer onto the seat that they're sitting in.

KENDALL TENNEY:  Well, in the first segment, we talked about intervention when it came to--when it comes to children. It's different with adults, I would assume, and maybe it's not. What do people need to know about how to intervene with someone in their family, be it an adult or a senior who is going through struggles or they think might be going through struggles?

MICHELE FREEMAN: I think it's very important--we say in AFSP, the American Foundation for Suicide Prevention, to trust your gut. So trust if you feel like somebody is not okay, and ask them. Ask them if they are thinking about killing themselves. And you can say those words. You can say, "Are you thinking about killing yourself?" You can say, "Are you thinking about suicide?" And that's not going to plant a seed in their head. That's going to show compassion, care, and that you're there, potentially to help them and support them. So we want to be able to have these communications. We want to be able to have open communication, be authentic, and make sure that they know that we care about them, whomever the “we” is. And one day, we're all going to be seniors, right? So if we start laying this foundation down now, we'll just keep on building and building and building, so the culture is already changed.

KENDALL TENNEY:  Yeah. That's important to remember. Dr. Bauknight, let's discuss medical interventions and treatments and use of medications for severe depression when it comes to the senior population.

DR. BAUKNIGHT: Well, I think when you're dealing with seniors, because there's going to be changes in their physicality over time, as they continue to mature in season, it's always important to have a medical professional kind of at the helm. Having a primary care physician or an APN is really going to be critical in managing those physical needs. But also making sure that the psychotropic medications, if the senior is placed on them, are not interacting with those physical health medicines in a negative way.
White text appears in a purple banner at the bottom of the view:
ONSCREEN TEXT:        Supporting Seniors: Ensure psychotropic and physical medications don’t conflict.
DR. BAUKNIGHT: Seniors are more sensitive to medication, so lower doses are always recommended. Once-a-day dosing for simplifying how to take their medications is important, but it's not always necessary to start with medications. I think starting with a good physical exam by a primary care physician, ruling out any medical conditions that can cause psychiatric problems, or have psychiatric manifestations, is important to rule out before you're looking at putting someone on psychotropic medicines. And with seniors, we can also look at what other treatment modalities would be—could be more successful in treating their depression or anxiety. We can't rule out psychotherapy as being the primary or only source of treatment for depression or anxiety in a senior, especially a more seasoned senior that is on a complicated medical regimen for their physical health. So psychotherapy can be very important. Individual psychotherapy and family psychotherapy.
White text appears in a purple banner at the bottom of the view:
ONSCREEN TEXT:        Supporting Seniors: Consider individual and family psychotherapy
DR. BAUKNIGHT: I like to always think about, when you're dealing with a senior, you have to think about what is their village? What is their village looking like? What is their family looking like? What are their friends looking like? Who are their peer support?
White text appears in a purple banner at the bottom of the view:
ONSCREEN TEXT:        Supporting Seniors: Who’s in their “village”?
DR. BAUKNIGHT: Let's not rule out having mental health peer support specialists working as well. That can be a very powerful tool that helps seniors. I also like to always question seniors about volunteering.
White text appears in a purple banner at the bottom of the view:
ONSCREEN TEXT:        Supporting Seniors: Are they volunteering?
DR. BAUKNIGHT: Get yourself out of your own environment, your isolation, your rut, and giving back to the community can be very, very empowering. So we can't negate the importance of volunteerism. Every senior has had numerous experiences. They have something that they've learned through those experiences, and they have something to contribute to society and help us all learn. So whether it's through church, sororities, fraternities, volunteer organizations like food banks and clothing banks, those can all be very powerful ways to help a senior get out of depression and put themselves back into the community, to connect with the community in order to get out of that depression and anxiety.
White text appears in a purple banner at the bottom of the view:
ONSCREEN TEXT:        Supporting Seniors: Is there an opportunity for a senior to work with youth?
DR. BAUKNIGHT: Working with youth can be very powerful for seniors because they can always feel like they're contributing to impart wisdom. So those are non-medication ways that can be very successful in helping seniors. But if they have to be on medication, a mental health professional is going to be the key in actually doing a proper evaluation and coming up with a treatment plan that's best for that senior. So I would recommend going to an APN—an advanced nurse practitioner—or a psychiatrist that specializes in behavioral health to actually get medications prescribed.

DR. BAUKNIGHT: I love that you touched on keys to resiliency as we did with the youth. And let's continue along that thread. Richard, what are some other ways to inject resiliency into the adult population, those who are struggling, be it Veterans or seniors or others?

RICHARD EGAN: So resiliency is, as it was said earlier, is a learned experience basically. But what we can do is we can increase connectivity amongst our adults, help them and support them through any life issues that they may be going through. Those life issues could be medical situations. Those life issues can be financial. Or something we talked about a little while ago: the difference between an elderly individual who has had self-esteem throughout their life, like a Veteran who has served his country for many years. His self-esteem or her self-esteem may be very high, and going into the elderly age, that self-esteem may not be there anymore. They may feel that they're not giving back to the community or supporting their family like they used to, and that can be very detrimental to them. And getting involved in these community organizations along with connectivity with their doctor, with the supports, being able to have people around them can help them build that resiliency to those life issues.

KENDALL TENNEY: What are some other ways, Rachel, to build resiliency?

RACHEL ROSENSTEEL: Yeah, so I think it's really important that we listen to people, we ask them questions to understand their experiences. And I also think it's important that we empower them through their journeys. You know, we don't dictate their journeys for them. We just help them through the journeys that they decide to take on their own.
KENDALL TENNEY: Yeah. Going back to the listening part of this is critical.

RACHEL ROSENSTEEL: Yeah.

KENDALL TENNEY:  Michele? Oh, sorry.

DR. BAUKNIGHT: I'm sorry...

MICHELE FREEMAN: No, please.

DR. BAUKNIGHT: I was just gonna piggyback on what Rachel was saying. The greatest gift that we can give any individual is validation, right? So if we can listen and be empathic and validate a person's experience—their past experience, their present condition, and any hopes that they have for the future—it's gonna be very important.

MICHELE FREEMAN: Yeah and I think what we heard too—Dr. B said it beautifully: we don't have a cookie-cutter approach, so kinda the same thing with resiliency, right? We wanna go ahead and have these people feel like they have the “why,” they have the purpose, like Richard said: ‘What's my purpose? What can I do?’ So build into your resiliency toolbox, and then take out what's gonna work best for whomever that person is you're working with. So if the senior can just do things like have a schedule—things that we would say for anyone: exercise, eat healthy, get enough sleep, have connectivity. So important to maintain your social connection, even in the time where we had the pandemic. We wanna stay socially connected, even if we have to be physically distanced, right? There's a difference. We don't want to be socially distanced. We wanna be physically connected at the same time. Or, excuse me, socially connected at the same time. So you can do this in so many platforms, right? We can do things together that we never knew we could do together before. We could literally do reading a book with somebody cross-country. So you can have an elderly person in another country and literally read the same book. Get on a social media—or, excuse me, a virtual platform and be able to have a discussion about the book. You can have a beautiful walk outside. You can be with them, and you talk about that afterwards as well. So you can build all these wonderful things into their daily pattern, and even if they can't necessarily walk, they can go sit outside and still have a sense of being and a sense of purpose and see the beauty and the outside environment is so important for our health. All of us. Particularly our seniors as well, because a lot of times, like we've already heard, isolation may set in, because a lot of the people that they grew up with are no longer here. And even their friends and family members, animals, play a big part in that too. So when they have a lot of that death surrounding them, that even compiles more, so it's so important to build that resiliency muscle, and you have to continue to practice it.

KENDALL TENNEY: You touched on something I think is so important, and I just wanna see if anybody wants to jump on that topic. Earlier, we discussed the importance of breathing and what a difference that can make for our mental and physical health. You just talked about nutrition, and it does have a direct link to our mental health. Anyone else? Or would you like to add to that?

MICHELE FREEMAN: I'm more than happy to add. I mean, even just, you know, things that are things that are resilience--resiliency tools can be breathing. Have nice, good belly breathing. Not just from up here, right?
Michele gestures to her chest and throat.

MICHELE FREEMAN:  'Cause that enters our fight or flight or freeze. But down here, so we get these good breathing, and that can help self-regulate and be part of resiliency when you're not feeling well, when you're alone, or if you're with someone else.
Michele gestures to her belly.

MICHELE FREEMAN: Meditation is a beautiful way to build into your resiliency. And meditation's something that seniors can do, as well as all of us. And so there's so many different things that can be—and they'll be different for different seniors, as well as different humans, for all of us.

KENDALL TENNEY: What I love about my discussions with you and the previous panel is feeling your passion for this. Why is it so important for you to make a difference? Richard, why is it important in your world?

RICHARD EGAN: I am a firm believer that one person can make a difference in this world if they put their mind to it. And with suicide prevention efforts across this state, over the past decade, this state has moved forward. We're the only state to reduce our suicide rate between 1999 and 2016. We're only 1 of 17 states that reduced their suicide numbers in 2019 and 2020. We are making a difference. It's not just me. I'm just part of it. It's not just you. You're part of it. We are all part of going down this highway to prevent suicides. The Office of Suicide Prevention is just helping to maintain that highway, or giving you gas for your car so you can drive what you do down that highway. And we can all do this in our own world, in our own area, with the help of each and every one of us, doing our part of it. Whether it's in the elderly community or in our youth community, or in our adults—where we lose so many of our adults because they get into that area that they think that there's no other option but suicide. And we can reach out to them and make a difference.

KENDALL TENNEY: Dr. Bauknight, same question for you. Where does the passion come from, and why is it so important for you to fulfill this mission?

DR. BAUKNIGHT: Well, part of the reason I chose to go out of clinical practice and go into managed care and be part of a managed care organization and a health care plan was to be able to reach large volumes of people quickly, instead of actually having to reach a person individually, one at a time. That was my passion. But individually reaching out is equally as important. I love the work that we do at the health care plan and being able to come up with policies and also coming up with programs that can help large groups of people at once time and offer services and coordinate those services for mental health reasons. I did want to add that part of the resiliency and part of the planning for seniors is making sure that we incorporate them into the plan. It should not be me, as the mental health provider, dictating to a person what they need to do only. Seniors have opinions. They have lived a very long life, and they can contribute to the plan that is going to affect them. So they have a voice. Allow them to tell you how and what they feel like they can do and accomplish. You have to listen, you have to be empathic, but make sure that they have a voice in planning that. Whether you're a family member or friend or a medical professional giving, you know, assistance to a senior. Make sure they're part of the plan.

KENDALL TENNEY: Because they're likely already feeling stripped of some independence that they have experienced their entire lives.

DR. BAUKNIGHT: Correct. Correct. Correct.

KENDALL TENNEY: And so they have that--

DR. BAUKNIGHT: There's change in independence throughout a senior's life, right? As the mental health issues become more, as the physical health issues grow for them, they're gonna feel more losses. And they can be quickly, like someone having a stroke and their life changes immediately, or it can be insidious, like someone developing dementia over time. But having them have a voice and be part of that plan is so important.

KENDALL TENNEY: 100%. Michele, why is it so important for you to make a difference?

MICHELE FREEMAN: Well, Dr. B just reminded of a story, and I think that not all seniors, of course, are the same, and so it's really important to listen and to authentically give them your time and pay attention. So, I ran into Whole Foods not too long ago. Well, it was long ago now that I think about it, because we had the pandemic, so it was pre-pandemic.
Michele smiles and makes a backpedaling motion with her hands as the audience and panelists chuckle.

MICHELE FREEMAN: And this gentleman—I went up to the juice bar, and all I was gonna do—it was a day off. And I needed to just go quickly in there, get my juice, and then go run my errands. As I was standing up at the juice bar, figuring out what I was gonna order, I placed my order, and I could feel somebody over my shoulder. And all the sudden, I hear a gentleman say, "Is this your favorite drink?" And I said, "I don't know, I've never had it before, but it could be my new favorite drink." So he—I get my drink, he gets his drink, and he says, "Will you come and sit with me?" So I knew that I had a lot of things that I needed to do, “needed to do,” right?

Michele makes air quotation marks with her hands.

MICHELE FREEMAN: My errands before I went back to work. However, I'm gonna sit with this gentleman. We shared about an hour and a half together of—I listened to these beautiful stories, and the biggest thing that my takeaway was, is that he said, ‘My daughter is very concerned about me. She doesn't live here, I live by myself’ –and by the way, he was over 80, so he had told me his age. He says, ‘I live by myself, and she thinks that I don't get out and do things enough, and I don't invite people over to my house. My house is my sanctuary, and so what I do, is today’—the day of the week that we were there, he goes to Whole Foods, and that's his socialization. And so I was able to learn that his socialization may not look the same as others. And what a beautiful time I had to listen and learn from somebody that had years on me and a lot of wisdom to be shared. So I'm grateful that I was able to have that interaction and that connection, which is so important.

KENDALL TENNEY: Isn't it interesting that you think about—it's been two plus years probably since that took place. If you'd just gone about your daily task, you would have no recollection of that day, in all likelihood. And instead, it's one of those life-changing events.

MICHELE FREEMAN:  Absolutely. Which allows me to have gratitude, and I'm sure, him, some company.

KENDALL TENNEY: Yeah. It's beautiful too. I think a lot of us, just seeing each other, so many of the problems we have right now. Rachel, why is it so important for you to make a difference?

RACHEL ROSENSTEEL: So…so I'm a single mom. My daughter is seven, and her father fell victim to the opioid epidemic. And when she was a year old, we spent every weekend for a year driving six hours away to visit him in prison. And what I learned from that experience is that the prison system is not supportive of people with substance use disorders and mental health issues. So when he got out, he struggled. And I searched far and wide throughout the community to get him help and services, and…and there was nothing. And through my time here at Health Plan of Nevada, I have had the absolute honor of working with—I'm sorry, I get all emotional whenever I talk about it.
Rachel blinks away tears and tosses her hair out of her face as she speaks with emotion in her voice.

RACHEL ROSENSTEEL: You know, I've had…the honor of working out in the field with our Medicaid members, and—you know, who are homeless, who are being released from jail and prison, and, you know, it's so hard. It's so hard for them to get their lives back on track because the system is just not conducive to their situation. And I've seen how impactful it is to just hold your hand out to someone who has lost all hope and, you know, and just has no direction, and, you know, I think that it is so powerful to just be there for someone and, you know, the power of human connection can really change the course of a life. And…everyone deserves that.

KENDALL TENNEY: Thanks—that is so powerful and so true. Thank you, Rachel, for sharing that and for being vulnerable as well. And like Emma and Solomon and Martha on the previous panel, you've taken something that was horrific and changed it and turned it into good. And I think that inspires so many people, so thank you very much for doing that. And thank you to all four of you for being tremendous panelists and for sharing with us today. It's much, much appreciated. Let's thank our panel.

Kendall smiles and turns to the audience, who begin to clap.
KENDALL TENNEY: We wanna, again, invite anyone who is experiencing this kind of mental challenge to take advantage of some of the tools that are available. If you are in a crisis right now, there are some numbers you can call to get help right away.

White text appears in a purple banner at the bottom of the view as Kendall reads out the numbers:
ONSCREEN TEXT:        Call 1-800-273-T-A-L-K, text 7-4-1-7-4-1, or dial 9-8-8.

KENDALL TENNEY: You can call 1-800-273-TALK. That's one way. You can text 7-4-1-7-4-1, or there's a new national crisis number, it is 988. Any of these numbers will put you in touch with a crisis counselor, 24 hours a day, 7 days a week. Now in just a moment, we're going to share some other important resources onscreen: phone numbers, websites, organizations, places where you can get help or get help for a loved one. But first, a personal message about the importance of mental health awareness from UnitedHealthcare's Chief Executive Officer in Nevada, Don Giancursio.

A video plays, beginning with a view of a pale sunrise over Las Vegas. Inspiring piano music plays as a grey-haired man in a black suit and bright blue tie speaks in an office:

DON GIANCURSIO: Hi, I'm Don Giancursio, President and CEO for Health Plan of Nevada and Sierra Health and Life Insurance Company. I think we'd all agree that we live in extraordinary times.

Views of the empty Vegas strip and landmarks glide past, including a mask hanging from the rearview mirror of a vehicle.

DON GIANCURSIO: Our great state of Nevada: it's weathered one of its greatest challenges during this pandemic, yet here we are, strong and determined, resilient, to thrive once again. I wish I could say that that was the case for everyone facing challenges in their lives.

A woman sits on the floor of a dark living room with her kneels curled up to her chest and her head lowered. A man clutches his head at a dim kitchen table with a glass of liquor nearby.

DON GIANCURSIO: Unfortunately, too many people feel anxious. They feel depressed, isolated, lonely, even when they're in a room filled with people.

A woman shakes out her hands as she paces into a bedroom, and a man braces himself over the kitchen sink with a glass of liquor in his hand. A woman drinks on the couch. arms against the kitchen sink, and a man sits in a gym with his chin in his hand.  

DON GIANCURSIO: And unfortunately that severe depression and hopelessness can lead to thoughts of suicide. As a health care company, we know the danger is all too real, and I believe we have a responsibility.
A person takes notes on a clipboard while another person tensely crosses their arms. A young person’s hands caress an elderly person’s hands, and a sign on a grassy lawn reads: “Depressed? Let’s Talk.” A young woman in a backpack walks along a desert highway and throws her arms out wide.

DON GIANCURSIO: A responsibility to bring the discussion out from the shadows so that we can all learn how to better deal with it.

A family holds hands as they watch the sunset near a child’s bicycle. An enormous cross rises into a blue sky over mountaintops. A person carries a briefcase down a hallway.

DON GIANCURSIO: Help those families among our friends, individuals at our churches, workplaces, schools, and businesses who need intervention. They need communication, and most importantly, they need help.

A young person holds a senior’s hand as the sun sets over Las Vegas in the distance. A person types at a desk with a coffee mug, and a hand scrolls through an email platform on a phone. A person clicks a “share” button on their smartphone. Hands types on a wireless keyboard, and person texts on a phone. A person’s smartphone lights up while they work on a laptop, and an adult takes a child’s hand against a sunlit sky.

DON GIANCURSIO: So thank you for watching this town hall video. Thank you for socializing it with your employees, with your clients, with your students, neighbors, anyone you think might benefit. Share the website, the links, the resources with others. This is a problem that none of us can tackle alone. One life lost is one life too many. Thank you.

Don nods and the view fades to black. A slide appears as soft classical guitar music plays:

ONSCREEN TEXT:      Crisis Resources
                                    National Suicide Prevention Lifeline

                                    24/7 Crisis Support: 1-800-273-TALK (8255) or 988
                                    3-digit phone number Introduced in July 2022

                                    Spanish Language
                                    Suicide Prevention Hotline
                                    1-888-628-9454

A QR code appears to the left of a URL at the bottom of the view:

ONSCREEN TEXT:        crisistextline.org

To the right of the URL, more text reads:

ONSCREEN TEXT:      Crisis Text Line: Text to 741741
                                    Online Chat: suicide preventionlifeline.org 

A new slide arrives onscreen:

ONSCREEN TEXT:      Senior Resources

                                    Institute on Aging Friendship Line
                                    24-hr. toll-free crisis line for adults 60+ and adults living with disabilities

                                    1-800-971-0016
                                    www.ioaging.org/services

Two columns appear at the bottom of the slide. The left column reads:

ONSCREEN TEXT:      The LGBT National Hotline
                                    1-888-843-4564
                                    https://www.lbthotline.org/
                                    Email: help@lgbthotline.org

The right column reads:

ONSCREEN TEXT:      Sage LGBT Elder Hotline
                                    1-877-360-LGBT (5428)
                                    Trans Lifeline
                                    1-877-565-8860, Option 2 for Spanish

A new slide appears:

ONSCREEN TEXT:      Senior Resources

                                    National Council on Problem Gambling Helpline
                                    Call or text to 1-800-522-4700
                                    Chat on Website: www.ncpgambling.org

Text appears to the right of another QR code:

ONSCREEN TEXT:      National Alliance on Mental Illness (NAMI) Help Line
                                    Monday thru Friday/10 a.m. – 10 p.m. Eastern
                                    1-800-950-NAMI (6265)
                                    www.nami.org

                                    Email: helpline@nami.org Text “NAMI” to 741741 (24/7 confidential crisis counseling)

The view changes to a new slide:

ONSCREEN TEXT:      Veterans Resources

                                    Veterans Crisis Line
                                    Available to Veterans and Families
                                    1-800-273-TALK (8255) option 1

Next to a QR code in the bottom left corner, a URL reads:

ONSCREEN TEXT:        veteranscrisisline.com

To the right of the URL, more text reads:

ONSCREEN TEXT:      Crisis Text Line: Text to 838255
                                    Online Chat: www.veteranscrisisline.net

The view changes to another slide:

ONSCREEN TEXT:      Other Mental Health Resources

                                    National Sexual Assault Hotline Rape Abuse and Incest National Network
                                    1-800-656-HOPE (4673)
                                    24/7 Live Chat at: www.rainn.org

                                    National Domestic Violence Hotline
                                    1-800-799-SAFE (7233) TTY 1-800-787-3224
                                    Crisis Text Line: Text to 88788            Online Chat: www.thehotline.org

A new slide appears:
ONSCREEN TEXT:        Other Mental Health Resources

Substance Abuse and Mental Health Services Administration (SAMHSA)
                                    U.S. Department of Health & Human Services
                                    www.samsha.gov

                                    Disaster Distress Helpline
                                    Call or Text 1-800-985-5990, Press 2 for Spanish
                                    www.DisasterDistress.samhsa.gov

Beneath a QR code on the left-hand side, text reads:

ONSCREEN TEXT:      American Foundation for Suicide Prevention
                                    afsp.org
                                    www.afsp.org

A new slide appears:

ONSCREEN TEXT:      Educational Resources
                                    Health Plan of Nevada
                                    www.healthplanofnevada.com
                                    UnitedHealthcare
                                    www.uhc.com

Below a QR code on the left, text reads: ONSCREEN TEXT:      optumconversation.com

                                    Optum – Free Conversation Starter
                                    Cards for Parents/Caregivers
                                    www.OptumConversation.com

A new slide appears:

ONSCREEN TEXT:        Mental Health Mobile Self-Help App

                                      Sanvello

FREE to Download (Premium version requires a feee for non-UnitedHealthcare users)

Helps navigate difficult emotions with daily mood tracking, personalized progress tracks, personalized coaching, and community support. www.sanvello.com

Download at the Apple App Store or through Google Play

The slide fades to black.

As soft piano music plays, a collage of photographs appear of patients speaking with a therapist, some with tears in their eyes. Therapists take notes and press a reassuring grip on their client’s hands.

A purple background with two blue lines slides across, giving way to a light blue background with white lines, then a white background. A purple and blue hand hold onto each other in the shape of a ribbon, and text appears.

ON SCREEN TEXT:    Help,
                                    Hope &
                                    Action

                                    SUICIDE PREVENTION
                                    TOWN HALL

Below the text, logos for Health Plan of Nevada, United Healthcare, Optum, and American Foundation for Suicide Prevention appear.

On a town hall stage, a man in a dark blazer and blue shirt sits down. Text appears.

ON SCREEN TEXT:    Kendall Tenney
                                    Moderator, 10E Media

KENDALL: Welcome back to Help, Hope & Action, a Suicide Prevention Town Hall, I'm Kendall Tenney here with our third panel of the day. We have had a tremendous time already and we have learned so much over the last hour. We've discussed the risks and warning signs, the methods of communication and intervention, and resources available to people exhibiting severe depression and suicide ideation. So, we've heard some incredible stories as well of survival, we've met inspiring people who are making a real difference in the lives of those who are at risk. And we've listened as behavioral health professionals have explained why and how families and friends can intervene and make a difference. And the importance of helping people of all ages and background build resiliency. So, now we turn to what's being done in our communities in healthcare and in government to help those in need. Joining us for this discussion, we have Dr. Laurine Tibaldi. She's the chief medical officer of Health Plan of Nevada and Sierra Health and Life. Her roles include oversight of inpatient and outpatient case management, utilization management, quality and population help teams. Dr. Tibaldi is a member of the Clark County Medical Society and the Nevada State Medical Association. She is a board-certified internal medicine physician and hospitalist. Please welcome Dr. Tibaldi.

The audience claps, and text appears over a blonde woman in a red dress, sitting next to Kendall.

ON SCREEN TEXT:    Dr. Laurine Tibaldi
                                    Chief Medical Officer, Health Plan of Nevada

KENDALL: Michele Freeman is a former chief with the Las Vegas Department of Public Safety and a board member of the American Foundation of Suicide Prevention, a co-sponsor of today's program, Michele with us in our last panel and the crowd voted and said "You got to come back." So, please welcome Michele.

A blonde woman in a light green blazer smiles. Text appears.

ON SCREEN TEXT:    Michele Freeman
                                    Healing Conversations Coordinator, American Foundation for Suicide Prevention

MICHELE: Thank you.

KENDALL: Misty Vaughan Allen, who has served as Suicide Prevention Coordinator at the Nevada Department of Health & Human Services for the past 17 years is our third panelist. Please welcome Misty.

Text appears over a brunette woman on the far end of the stage.

ON SCREEN TEXT:    Misty Vaughan Allen
                                    Suicide Prevention Coordinator, Nevada Dept. of Health & Human Services

MISTY: Thank you.

KENDALL: And Rick Elorreaga. Did I get it right?

Text appears over a grey-haired man in a suit.

ON SCREEN TEXT:    Richard Elorreaga
                                    President, Behavioral Health, Health Plan of Nevada

KENDALL: President of Health Plan of Nevada Behavioral Health where he's responsible for the direction and oversight of the Behavioral Health Team. Rick was previously a vice-president at Optum, responsible for overseeing behavioral health programs, including state Medicaid programs, county-funded programs, and federal behavioral health programs. Please welcome Rick. All right, so we've started each segment by looking at some statistics. Not always everyone's favorite part because the numbers are sobering. But let's start by talking about this.

A slide with different bullet points of statistics appears while he speaks.

KENDALL: In 2020, suicide was the 12th leading cause of death in the United States. In that year, nearly 46,000 Americans died as a result of suicide. There were an estimated 1.2 million suicide attempts. On average, there are 125 suicides each day.

The slide disappears, giving way to Kendall.

KENDALL: So, each one of you represent a component of the healthcare continuum. And whether you work with Health Plan members, patients, in a medical office setting or people in need, you have organizations that are key when it comes to suicide prevention. So, Dr. Tibaldi if we could, let's begin with you. Integrated care, it's also known as whole person care. We're hearing a lot more about that. Tell us what that is and how that plays into suicide prevention.

A chyron identifying Dr. Tibaldi appears once again below her.

DR. TIBALDI: Yeah, so whole person care is really looking at an individual holistically. We cannot, at United Healthcare, help people live healthier lives or make the health system work better for everyone if we're working in silos. We can't have a physical health team and a behavioral team that don't talk to each other. So, I have the privilege of managing teams and working with teams that provide care management and care coordination for our members. And it really came from the team in wanting to do better, in coordinating those resources. So, I'm inspired by folks I work with, like Rachel, that we heard from in the second panel and Dr. Bachight, and Rick, we've been able to do some really cool things together to bring people together that historically never learned together, never trained together, have always worked in silos. You had mentioned earlier that I worked as a hospitalist and one of the things that I noticed is that in Las Vegas, where I worked, and in a variety of hospitals, I might have to take care of someone that tried to take their life. Or someone that had an overdose. And as a hospitalist, I'd get you admitted from the ER, I take care of you in the ICU, I make sure all your electrolytes are corrected, everything is doing well physically, and then it was kind of like a hand-off and what happened to that person? Could I have done something better to pave the way for that person to be more successful holistically? So, our teams strive to bring it together. And one of the most exciting things that we've done recently is actually even within our call center, we have a great team of RNs and they've taken on some of the behavioral phone calls. If you look at our insurance cards, or now some of us have it on our phone even, there are phone numbers on the card where to call to get help. And we've integrated some of those functions where nurses that generally dealt with questions about physical health are now fielding questions about behavioral health. And we recently just had a call from a mother and her daughter on the phone at the same time, both in tears, not knowing what to do. Teenage daughter telling her mother she's going to kill herself. And they just had no idea what to do, where to turn, the mother thought about immediately taking her to the ER, but learned that she could call the number and get some advice, some help, some direction. So, our team using their triage and protocols and having access to a behavioral specialist provider were successfully able to navigate that member to an out patient service the next day. They successfully avoided what may have been a negative experience in the emergency department. I mean, I spend a lot of time in the emergency department in my work and, you know, it's not a great place to get mental healthcare necessarily. So, we followed up with the patient and her mother and they were able to successfully get plugged into the system and the help she needed, so it was definitely a success.

KENDALL: That is beautiful. And so needed, as we talked about the numbers in 2020, which some might point to as a result of the pandemic. Rick, let's talk about that. The numbers being what they are, can you provide some observations on how the pandemic impacted mental health across the world?

A chyron appears identifying Richard Elorreaga once again.

RICK: Sure, Kendall. Well, as mentioned pre-pandemic, behavioral health prevalence was increasing. You know, prior to the pandemic hitting. When the pandemic hit, it was a game-changer across the world. We saw increases in drug and alcohol abuse, social isolation, mental health issues, and the healthcare industry really had to pivot pretty rapidly on what and how we're going to care for our members, holistically. And so, you know, what the healthcare system had to do is become innovative and develop some engagement strategies and what came about, you know, the pandemic, which is a positive, is some of those innovations such a virtual visits, Telehealth, you know, telephone therapy. Also, there's, you know, it brought to light the awareness of individuals who thought behavioral health issues were really contained and, you know, negative, and not in a positive light. So, the stigma of behavioral health became more and more decreased as a negative connotation. And more and more people, as we all know, it's impacted probably everyone in this room and everyone that's going to be hearing, you know, this presentation. And so, going forward, what it gives us, the opportunity as a health plan, is to continue to be innovative and actually to close some of these gaps with additional resources that we have. So, it's actually, you know, from a solution and a problem-solving standpoint, it's really kind of exciting. From a healthcare delivery perspective because you can actually start to engage collaboratively with key stakeholders, not only in your community, but in the world and develop programs that close the traditional gaps of care, acute inpatient, sub-acute, outpatient. There's opportunities to develop programs and actually outreach and develop access points that makes availability more accessible.

KENDALL: You bring up a really good point and one that is exhibited by our presence here today and that is that people are now, it seems to me, talking more about mental health. The stigma that you talked about seems to be diminishing somewhat. Do you all agree with that?

DR. TIBALDI: I definitely agree with that. I think that the more we raise awareness, and we create a comfort zone to have these discussions and then empower our people to further direct those that come to them with those issues, the more we can do.

KENDALL: Yeah.

MICHELE: Yeah, and I love what you said earlier too, breaking down the silos and having that connection because that's really giving us an opportunity to increase education, increase awareness, lower stigmatization, and have a culture where health is health. Why does it have to be physical health versus emotional or mental or behavioral health?

KENDALL: Misty, I want to talk to you about government and how it is playing a role in this topic. Before we do that though, we want to take a moment to share a message from Nevada governor Steve Sisolak about today's Town Hall.

A grey-haired man appears, sitting at a desk with an American flag behind him. Text appears.

ON SCREEN TEXT:    Steve Sisolak
                                    Governor, State of Nevada

STEVE SISOLAK: Hello, everyone. This is Nevada governor Steve Sisolak. I'm honored to be able to be a part of this conversation today. This is a subject that's very important to me. I'm thankful to the organizers from Health Plan of Nevada, United Healthcare, and the American Foundation for Suicide Prevention for hosting this virtual Town Hall. The pandemic has brought a light to just how important it is to invest in mental health and suicide prevention. Overall, suicide deaths have gone down from 2018 to 2020, but it's important to acknowledge Nevada is projected to have an 11% increase in suicide deaths amongst our children, 17 and younger, in 2021. There's also projected 17% increase for young adults, age 18 to 24. These kids and young adults were among the most impacted when the pandemic uprooted our lives. And we owe it to them to pay attention to their mental health as they navigate this post-pandemic world and their lives as young adults. Comprehensive and sustained suicide prevention efforts, but they require a dedicated effort from our community working together. I'm proud of the steps Nevada and the Department of Education has taken to address this issue, including dedicating additional funding for projects like the Nevada Resilience Project, Zero Suicide, and Project Aware. Last month, I announced plans to make a $20 million investment for Nevada's crisis stabilization centers. When someone is in a crisis, they don't need help from a counselor or therapist in six months, they need it now. This is a critical time to make this investment as we prepare to launch the new Behavioral Health and Crisis phone number in July: 988. This funding will be transformational for our state and those who have felt there was nowhere to turn. They will handle the support they need 24 hours a day, seven days a week. While we celebrate the great work that's been accomplished, we must not stop here. We have a duty to our state, our communities, and families to work towards preventing all suicide deaths in Nevada. Thank you again for participating in this event tonight and sharing ideas and resources that will save Nevada's lives.

Kendall sits on the stage.

KENDALL: Thank you, governor. All right, let's talk about the $20 million investment, Misty. What is that going to look like to Nevadans?

MISTY: You know, it's unheard of, it's such a blessing to have this opportunity to have real resources, but the funding for stabilization centers is one piece of an overall crisis response system that is absolutely going to be transformational, as the governor mentioned. This $20 million from the governor, we have the legislature who for several years have been preparing for this moment. So, Nevada is poised, one of four states in the nation, poised well ahead with funding support to really develop a crisis response system that's going to be effective. Because as you hear from everyone, 988 is happening and it will give someone a place to call. But that's one piece. That care traffic control center and they can reach out, so it pulls behavioral health crisis out of 911, where it should be, and it has people responding to 988 that are well-trained, peer support responders, peer responders, to really be there in that crisis and deescalate. Because most of the time, people don't need that emergency department response. So, this is going to be that continuum of care that this whole segment is about. Someone to call, someone to respond, which would be the 24/7 mobile crisis response teams, for adults and kids. Then the crisis stabilization centers, which give a warm and nurturing environment for deescalating a crisis. It's got peer support responders in that center and it's much more healing and less traumatic, like an emergency department just isn't equipped for it, to have that deescalation and healing. So, this is so exciting. Much safer for first responders, providers, as well as those in crisis, and their families. The third pillar of this system is someone to offer support in the ongoing care. So, they might deescalate, get the help they need, or maybe need inpatient treatment, but once they get out, there is follow-up, maybe it's mobile crisis, maybe it is, we have a wonderful NAMI Nevada, NAMI Western Nevada warm line that's called Caring Contacts and they will have this agreement with the person to check in, until they feel ready, the resiliency skills kick in, and they're able to keep themselves stable again. So, it's such a wonderful opportunity. Nevada is really leading the way I think right now when we have been typically maybe challenged with mental health and suicide, I think we are now forging ahead.

KENDALL: I love hearing that and it goes along with what you were saying, Dr. Tibaldi, about no longer a Band-Aid approach. It is moving forward what is going to be done for these individuals. And a follow-up question to that, if someone, 988 is brilliant because it's so easy to remember, but if someone doesn't know about that yet and calls 911 in a crisis, will they then be patched in to 988 operators?

MISTY: So, the state has been working with community partners across to work on the interoperability and the communication, so they have had years of work groups to make sure we're doing that interoperability properly, geo-location, like 911 has, so they might be able to get that mobile crisis team readily. They call it care traffic control because typically right now the access is challenge and people can be there for nine days, sometimes. Three days. It can be a painfully long wait, which is really difficult in that crisis. You're deteriorating even more. But absolutely if they have accidentally call 911, it's going to be set up to get to the place it needs to be. Or, likewise, the wrong line, if they aren't meeting that immediate suicide crisis.

RICHARD: Yeah, Misty, there will be no wrong door approach. Literally.

KENDALL: Yeah. Good to know. And it's great that there's such coordination and it's great to know that Nevada is ahead of the curve on this one. Michelle, you are a board member of the American Foundation for Suicide Prevention and there is something going on with that organization called Project 25. What is that about?

MICHELE: Yes, so Project 2025 is a beautiful project. So, the goal of the project was to incorporate various agencies or organizations so that we can reduce suicide 20% by the year 2025. And we know we can't do it alone. American Foundation for Suicide Prevention, right? We need to not be siloed and we need to do it together. So, basically what it is we wanted to look at a way, the best way, to reach the most people in the shortest amount of time. Doing that, there were four different areas that were identified. The first area is firearms. We know in the United States overall that more than 50% of death by suicide are by firearms. We also know here in the state of Nevada that 68% of firearms are suicides. Those are startling numbers, right? So, if we can get out there and educate our firearm owners on to how to safely store and understand about suicide prevention and mental health, then we'll be able to reduce suicide. So, that's the first area. The second area is healthcare systems. We know that 45% of the people who die by suicide were in their regular practitioner within that month, so that's a lot of people that are going through their regular practitioner, right? And I'm going to put that on hold for a second because I'm going to tell you the next one and how they collaborate. The next one is emergency departments. And we know-- And it's estimated, again, the percentages that I'm revealing, and so we know that estimated that 39% of people who die by suicide were in the healthcare, or, excuse me, the emergency departments within the last year of – prior to their death. So, when we look at an opportunity through the healthcare system and for the emergency department to be able to, and some of us have already seen this, right? We go to our regular practitioner and they're already asking questions. Because they can do a risk assessment where they have these people, they have humans, they have all of us in their office, so why not do a risk assessment at that time so that we can go ahead and get people the need that they, get people the help that they need while they're there? And we can see that. And then the last one is in our correction settings. And we heard in the last segment that prisons and jails, it's a unique setting, and people that are incarcerated have a higher vulnerability in so many ways. We know that the leading cause of death in jails is suicide. We also in the last recent years suicides have gone up 30% in prisons. So, if we can educate the people that are working there and if we can have people intervene and ask questions and do the risk assessments and the connection while people are still incarcerated during specific times of their incarceration, we know that will save lives as well in that manner.

KENDALL: I love it. Well, all right, let's talk about a similar question to what I asked the last panel, why is this so important to you, personally, and to your organization? Rick, let's start with you.

RICHARD: You know, United Health Group, particularly Health Plan of Nevada, is heavily invested in the transformation of the system of care. And, you know, thinking about what Misty has described, what the governor is contributing, and how we coordinate the resources in a community is critical. We have the opportunity in our, you know, in managing a health plan, to see where these gaps and how it impacts individuals. So, starting with an individual person on what those needs are and what those access points are an incredible opportunity to decrease those numbers that you described.

KENDALL: Misty, what about your organization?

MISTY: I just have to say I love what Rick just said because I think we go out there and work with the individual in crisis and it's often about the un-met needs. What are, as providers, missing? And I love that you're looking at that un-met need. I'd started this work many years ago, on the hotline, and at that point in time, Nevada had the highest rate in the nation, for decades. So, I ran that hotline for five years and every time I had the gift of picking up the phone knowing that person had a part of wanting to live within them, they had some hope, we just had to listen and help them find it. That's carried me through the government work because definitely we're looking at the 30,000 foot view and the bigger pictures, but that individual in front of me is what grounds me to do this work and I'm so excited where that is heading and the collaborations. No longer, it's no longer one fight, it's now so many in the community fighting for this.

KENDALL: Could you share an example of how a suicide hotline worked, that you experienced personally? Because I think that is great and beautiful to hear that these are solutions, these are working, these are saving lives.

MISTY: Oh, absolutely. Our Crisis Support Services of Nevada is one of the oldest in the country and they currently get about 85,000 calls a year. They're part of a national network. With the new crisis response system in 988, if we just look at Nevada calls only, we're going to be approaching 99,000 in three years. Just Nevada. Right now, it's everywhere. And that's, we're helping our own people now. We have the system with caring people to help and I think what's so important is the hotline is one piece, but as you also eloquently mentioned, the physicians are such a crucial piece of this with your suicide initiative. Everyone can do something to help. We have to listen and we have to be present. And I think the first panel said it, no judgment. We can't fix it for people, but we can-- Oh, Ms. Thomas, I loved it. "We can teach them how to get up." I'm going to steal that line. We can teach them to get up and walk by their side because the next time they have thoughts of suicide or make an attempt, they know they can get through it with the right supports.

KENDALL: I love that. And the hotline, those who are on the other end, or on the receiving end of the hotline, they are the first responders in this case and obviously there's so much more that comes after that. And I love that that's being seen through as well. Michelle, what about you? Your organization, why is this so critical to you?

MICHELE: So, the mission for the American Foundation for Suicide Prevention is to save lives and bring hope to those who have been affected by suicide. And there's really four components with that, so basically advocacy, whether it's at the state or the national level, education, support, and research. And what I love about the organization as well is the majority of things we do, we're doing them-- I'm a volunteer, I'm not a paid person. So, I volunteer for the organization. I get out there because I'm passionate, because I love it, because I want to make a difference, and I want to reach our own community here. We have this beautiful support for suicide survivors. Meaning, it's called Healing Conversations, and each state, here's the other thing that's really beautiful about the American Foundation for Suicide Prevention, there is a chapter, at least one chapter, in every state in the United States. And we work nationally together. And we're the largest foundation or non-profit that is able to do research-based information and has these, the statistics and research and, like I said, it's just beautiful. And so we have Healing Conversations, and what Healing Conversations is, is it's a time for this no judgment. It's one compassionate phone call, they're trained volunteers, they're not taking away from trained professionals, they're not taking place in the grief journey, but they're able to have this one connection, this one phone call, so that they can have an empathetic ear, non-judgmental, and have a place where they feel safe, that they can say what they are feeling because many times during the grieving process, even families, and/or cultural barriers exist because families may not be grieving at the same time, the same way. So, this is really truly one of the things that I just love about AFSP, the American Foundation for Suicide Prevention. Thank you.

KENDALL: Awesome. Dr. Tibaldi.

DR. TIBALDI: We can do better. It's just so important. We have to do better. We're uniquely positioned here. We have the tools. We have the people. Our people are restless. They want to do better. So, I want to-- I don't want to copy Dr. Bachnight, but I'll borrow from what she said earlier. I went into this role because when I was working as an individual provider, an individual contributor, I could only impact one patient at a time. In this role, I work with teams that can make system change and that is so inspiring to me. And just the passion, like you heard from Rachel in the last panel, I mean these are our people. This is who works for your insurance company. You know, we are here and we're uniquely positioned to provide these care coordinated services. I know we can do better. We just had a case of a guy that discharged from a psychiatric hospital and unfortunately he's schizophrenic and has diabetes. Well, he left without the right diabetes prescriptions. So, he ends up right back in the ER to no fault of his own. And we have a community health worker team and one of the things they work on in addition to social determinants is health literacy. And that's something this gentleman just didn't have a grasp of. He, he couldn't really manage his diabetes or even know what to ask for. So, when I heard about this, you know, Dr. Bachnight and I talked about the case, and, you know, in my mind, I'm thinking one thing should happen and, you know, in her mind historically another thing should happen, and we're like "Wow, we have a gap here." And it shouldn't be that way because we can help those providers. I mean, I get it, the psychiatrists, they don't know diabetes and, you know, as an internist, I didn't know much about schizophrenia, but we need to help our providers and make these connections for them for people to be more successful in their overall health. And that's just what's so important to me.

KENDALL: I want to continue with that topic. As wrap things up, I want to talk about what more can we be doing? I love everything that's been discussed today and especially when it comes to building resiliency because at the end of the day, it is about giving hope and giving people the ability to cultivate their own hope. What more can we be doing, Rick?

RICHARD: I would say we need to break down some barriers of the knowledge of the system of care. There are programs that are incredibly valued that are actually providing care that individuals don't know of, that we don't know of. So, being able to coordinate care, and I think about the non-profit organizations, I think about the facilities or the provider agencies that can expand, you know, their programs and actually, you know, capitalize on some of the crisis programs, these are the puzzles of, pieces of a puzzle in a community that we need to put together and all the touch points, so that that member truly there's no wrong door, as I said. Right now, there's the individual, there may be individuals who, you know, may not know, you know, to Dr. Tibaldi's point, where to go for diabetes or schizophrenia or they're having a psychotic break, just to the ER. But there are diversion programs that are developed and they're programs that are intermediary to the traditional levels of care that we can develop and I believe it's a great opportunity and it's going to be exciting.

KENDALL: Misty, what can we do more?

MISTY: Can only build off of Rick. I think what we also want to do, complementary to that, is build caring communities. We can't put everything on the school, we can't put everything on the hospital or the private care, the physician who's out there. They have to go back to their environments and their homes and their schools, so we need to wrap our arms around these very important entities who do see our kids, who do see our elders, but everyone can have this conversation. Those with thoughts of suicide, or who have survived attempts, what we learn from lived experiences is that they didn't want to die. They didn't want to be a burden on their family, but we have to recognize and teach everyone to recognize because I'm going to see something different than you. And you're going to see something different. And all of our eyes and ears will help keep that person safe and then suicide-safe in our community.

KENDALL: Fantastic. Michele?

MICHELE: I think continuing to educate, lower the stigmatization, and there's ways to do so safely, so there's safe language that we like to talk about as well, so I'll just mention that for a moment. We try to refrain from saying "committed suicide" for example because that has a negative connotation to it. So, instead of saying that, we would say "died by suicide," "took their life," or "killed themselves." We don't want to say "committed" because a lot of times that's connected as well with a crime. We wouldn't commit diabetes, we wouldn't commit cancer, we would "die from." So, we liked to try and remember to say, "died by suicide" or not say the word "committed." And I've said it so many times just right now, I'm getting like, “ugh” because I'm trained now not to say it, right? And then the other thing is also not to use the words "successful" or "unsuccessful," right, with an attempt. So, because suicide should never be the choice, it is not an option, and it's never a success. Success, we think of as a good thing. And suicide is never a good thing and it's never successful. And, conversely, "unsuccessful" would mean that there's success. And so, and it's not an unsuccessful attempt either. So, it's an attempt, it's somebody could have tried to kill themselves and they survived, so we try and not to say "successful" or "unsuccessful," we would say "a survived attempt" or "they completed suicide," or they, or we just refrain from those, that language. Because it's really imperative and the negative connotations that's along with it.

KENDALL: I love that these discussions help take away the stigma that is often attached with mental health challenges and put it in the mainstream. Dr. Tibaldi, let's wrap up with you, what more can we be doing?

DR. TIBALDI: To build on all those amazing things, I would say we need to do more of this. We need to-- We need to talk more, we need to-- We heard earlier, we need to be vulnerable to where we have weaknesses in our systems, in our processes. We just need to open it up and come together for where we can have the best synergy with the resources that we have.

KENDALL: Thank you to all four of you, you were fantastic and I appreciate so much your input. Let's give them a round of applause and thank them for being here today. So, our goal today was to broaden people's understanding of the significant challenges that age groups and different individuals and cultures face when it comes to mental health and the importance of supporting and communicating and intervening in the lives of those who are going through incredibly tough times. And the message of resiliency and hope is strong. So, if you know someone who is struggling, man, you guys have said it so well tonight, just lend an ear, listen, be there with no judgment, help them reach out to a professional that can help them and remind them of who they are and why this life is worth living. So, we leave you as we have at the end of each our segments with a list of resources that can help you or your loved ones in a time of need. So, if you are in a crisis right now, or if you are in a crisis down the road, these are good numbers to jot down.

Text with the phone numbers appears over a purple banner as he speaks.

KENDALL:1-800-273-TALK is a phone number you can call, or you can text 741-741, or we've talked about the new national crisis number, 988. Simple to remember. You can give that a call. These numbers will put you in touch with a crisis counselor, someone who can help, 24 hours a day, seven days a week. So, thank you to Health Plan of Nevada, the United Healthcare Optum, and the American Foundation for Suicide Prevention for sponsoring today's Town Hall discussion. It has been outstanding, thanks to these panelists who bring so much passion and purpose to this stage. And thank all of you who are in the audience today and thank you for watching.

As soft music plays, slides with text appear one after another.

ON SCREEN TEXT:    Crisis Resources

                                    National Suicide Prevention Lifeline

                                    24/7 Crisis Support – 1-800-273-TALK (8255) or 988
                                    3-digit phone number Introduced July 2022

                                    Spanish Language
                                    Suicide Prevention Hotline

                                    1-888-628-9454

At the bottom of the slide, text sits next to a QR code.

ON SCREEN TEXT:          crisistextline.org                Crisis Text Line – Text to 741741

                                                                                    Online Chat – suicidepreventionlifeline.org

A new slide appears.

ON SCREEN TEXT:    Resources for LGBTQ+ Community

                                    LGBTQ Center of Southern Nevada        The LGBT National Hotline
                                    1-702-733-9800                                    1-888-843-4564
                                    www.thecenterlv.org                            www.glbthotline.org/hotline.html

                                    Trevor Project
                                    1-866-488-7386

Text sits next to a QR code.

ON SCREEN TEXT:          thetrevorproject.org                 Crisis Text Line – Text to 678678

                                                                                    Online Chat – www.thetrevorproject.org

A new slide appears.

ON SCREEN TEXT:    Youth & Teen Resources

                                    Teen Line
                                    1-800-852-8336 (evenings only)
                                    Text to 839863
                                    Connect by Email at www.teenline.org

                                    National Runaway Safe Line
                                    (24/7 Crisis Connection)
                                    1-800-RUNAWAY (786-2929)

                                    www.1800runaway.org             Chat or connect via email at www.1800runaway.org
                                                                                    Resources available for youth and concerned adults

A new slide appears.

ON SCREEN TEXT:          Other Mental Health Resources

—NAMI—

National Alliance on Mental Illness (NAMI) Help Line

Monday thru Friday/10 a.m.-10p.m. Eastern

1-800-950-NAMI (6264)

Text appears beside a QR code.

ON SCREEN TEXT:          www.nami.org                          Email – helpline@nami.org www.nami.org
                                                                                    Text “NAMI” to 741741 (24/7 confidential crisis counseling)

Another slide appears, keeping the “Other Mental Health Resources” header.

ON SCREEN TEXT:    National Sexual Assault Hotline Rape Abuse
                                    and Incest National Network

                                    1-800-656-HOPE (4673)
                                    24/7 Live Chat at: www.rainn.org

                                    National Domestic Violence Hotline
                                    1-800-799-SAFE (7233) TTY 1-800-787-3224
                                    Crisis Text Line – Text to 88788              Online Chat – www.thehotline.org

A continuation of the slide appears.

ON SCREEN TEXT:    Substance Abuse and Mental Health
                                    Services Administration (SAMHSA)
                                    U.S. Department of Health & Human Services
                                    www.samsha.gov

                                    Disaster Distress Helpline
                                    Call or Text 1-800-985-5990, Press 2 for Spanish
                                    www.DisasterDistress.samsha.gov

                                    Afsp.org            American Foundation for Suicide Prevention
                                                            www. Afsp.org

A new slide appears.

ON SCREEN TEXT:    Educational Resources
                                    Health Plan of Nevada
                                    www.healthplanofnevada.com

                                    UnitedHealthcare
                                    www.uhc.com

                                    Optum – Free Conversation Starter
                                    cards for Parents/Caregivers

                                    Optumconversation.com           www.OptumConversation.com

A new slide appears.

ON SCREEN TEXT:    Mental Health Mobile Self-Help App

                                    Sanvello
                                    FREE to Download
                                    (Premium Version requires a fee for non-UnitedHealthcare users)

                                    Helps navigate difficult emotions with
                                    daily mood tracking, personalized progress trackers,
                                    personalized coaching, and community support.

                                    www.sanvello.com
                                    Download at the Apple App Store or through Google Play

Credits appear over a white background.

ON SCREEN TEXT:    Executive Sponsors
                                    Richard Elorreage
                                    Donald Giancursio

                                    Supervising Producer
                                    Lisa Contreras

                                    Producers
                                    Stacy Hakes
                                    Wendy Whitsett
                                    Terry Bahr

                                    Production Team
                                    Levi Glenhue – Director
                                    Miguel Campbell – Video Director
                                    Nathan Craig – Editor

More text appears.

ON SCREEN TEXT:    Our thanks to:
                                    Health Plan of Nevada
                                    American Foundation for Suicide Prevention
                                    Nevada Office of Suicide Prevention
                                    The Nevada Governor’s Office
                                    The Defensive Line
                                    Life is Worth It
                                    Penn & Teller
                                    UnitedHealth Group
                                    UnitedHealthcare Office of Responsibility
                                    UnitedHealthcare
                                    Optum
                                    10E Media
                                    Kirvin Doak Public Relations

White text appears over black.

ON SCREEN TEXT:          “FORGOTTEN DREAMS” by Leroy Anderson (performed by Markus Staab) is licensed under a Creative Commons 3.0 License and accessed via MusOpen

                                    “ONE FINE DAY” by Jason Shaw is licensed under a Attribution 3.0 United States license and accessed via Free Music Archive