By Gene Beresin, Executive Director and Khadijah Booth Watkins, Associate Director

Posted in: Multimedia, Podcast

Topics: Culture + Society, Stress

In the recent Advisory, Parents Under Pressure, the US Surgeon General noted that parents are currently more stressed, burned out, and lonely than ever before. The alarming statistics are not all that different than his Advisories on the Youth Mental Health and Loneliness Epidemics that have been escalating since the late 1970s.

In this episode of Shrinking it Down: Mental Health Made Simple, Gene and Khadijah discuss this new advisory and what parents can do to combat these increased feelings of stress and loneliness.

Media List

• Parents Under Pressure (U.S. Surgeon General Advisory)
• Protecting Youth Mental Health (U.S. Surgeon General Advisory)
• Our Epidemic of Loneliness and Isolation (U.S. Surgeon General Advisory)
• Self-Care for Parents (MGH Clay Center)
• NAMI | National Alliance on Mental Illness (NAMI)
• Myths About the 12-Step Program (MGH Clay Center)
• Parental Stress: Practical Tips in Response to the Surgeon General (Clay Center)

Episode Transcript

SPEAKERS: Gene Beresin, MD, MA; Khadijah Booth Watkins, MD, MPH.

[INTRO MUSIC PLAYS]

Gene 00:29

Welcome back to Shrinking it Down: Mental Health Made Simple. I’m Gene Beresin.

Khadijah 00:33

And I’m Khadijah Booth Watkins.

Gene 00:36

We’re two child and adolescent psychiatrists at the Clay Center for Young Healthy Minds at the Massachusetts General Hospital

Khadijah 00:41

In August of this year, the US Surgeon General released an Advisory. I mean, he’s been releasing several advisories that really speak to the needs that that kind of exist for children and families, which has been great. But most recently, he put out an advisory called Parents Under Pressure, highlighting the stressors that impact mental health and wellbeing for parents and caregivers. More specifically, he noted that parents are currently more stressed and lonelier than they’ve ever been before, which, which was definitely shocking to me, because I knew that parents were stressed, but I didn’t realize they were also more lonely.

Gene 01:18

And you know, Khadijah, it’s a fairly scary thing to me as a parent and a grandparent, but it’s also scary, I think, because, you know, we know that we’re in the midst of a youth mental health epidemic with escalating anxiety, depression, stress, loneliness, suicide, that’s been going on for a really long time, and now the folks who are like at the frontlines, parents and caregivers, if they’re so stressed out that they can’t help take care of them, you know, that’s a pretty serious situation, I’d add, because I’ve read the advisory that, you know, we talk about burnout a lot in terms of medical professionals, but it just occurred to me that that when you think about it, it’s, it’s very much, it’s very much like that they’re being they’re burnt out. And so how do we define burnout? So, burnout is defined as exhaustion, detachment and feelings of isolation and worthlessness, and it happens because we can’t accomplish what we believe that we need to do. So, burnout results in poor self-care, poor childcare, diminished empathy, impaired decision making. This case parental decision making, poor physical health and the report says that 41% of parents report that most days are so stressed that they can’t function, and 48% says they say that that most days they’re completely overwhelmed. And regarding loneliness, about two thirds of parents and guardians and 77% of single parents experienced loneliness and isolation. It’s pretty shocking, don’t you think?

Khadijah 03:17

Wow, for sure, and I often joke with my son, like, I don’t wear a cape, but it is really hard to prioritize, to set your priorities and pick the things that are necessary to do, as opposed to feeling guilty that you didn’t kind of meet your accomplishments. Because that is really a difficult challenge for it, for many parents’ kind of to be able to set their priorities. But, you know, these are, these are alarming statistics, and they’re not really all that different from the previous advisories that he put out around youth, the youth mental health crisis and the loneliness epidemic that have also been escalating since the late 1970s.

Gene 03:54

So, you know, where should we start? Maybe we should, I guess we should start with trying to understand what causes, what’s causing these increased level of stress. I mean, what do you? What do you? What do you think?

Khadijah 04:09

I mean, I think there’s no shortage of things that are causing this increased stress. But, you know, to highlight some of the highlight, a few, I think people are still recovering from the trauma that was COVID. They’re recovering financially. Some are still recovering from their physical health. There’s been tremendous amount of loss, you know, loss of jobs, housing. People are unhoused, and people have lost loved ones, and so that has been a major stress. Parents have a ton of demands on them. They’re working more hours than they’ve ever worked before, while also caring for their kids. And some of us are even caring for our aging parents. Parents are worried about their kids. I mean, we are in this, still in the midst of this youth mental health crisis, and so they’re worried about and taking care of their children’s emotional, mental health needs, their physical needs, and then we’re also worried about their children’s safety. You know, kids don’t feel safe. At school. Parents don’t feel safe sending their kids to school, in many cases, with the mass shootings and the cyber bullying and all that to say, you know, again, still back to worrying about their children. They’re worried about what future lies ahead for their children, like, what will the economy look like? Will they be able to get a job? You know, those kinds of things are huge burdens for parents, as they are for kids. Kids are worrying about these things well, but also similar to what kids struggle with. Parents are like you said, struggling with isolation and loneliness, and they’re also struggling with the negative impacts on technology of technology and social media. I mean this in no way is an, again, an exhaustive list, but given all of these stressors, how do these increased stress levels impact parents and parenting.

Gene 05:48

So well, just to start off, you know, when we think about stress, we have to think about, you know, biological, psychological and environmental factors that that are at play, and, and, and there’s an increased risk, I think, of mental health conditions. So, you know, the report notes that about 24% of parents had a mental illness, and about 6% had serious mental illness, and there are environmental issues. So, for example, when, when folks are stressed, there is the risk of exposure at where excessive use of alcohol and drugs and there’s also the impact of discrimination, discrimination and racism, that that contribute to this, and particularly victims of discrimination and racism. So for those parents who’ve been subject to that, we’re subject to adverse childhood experiences such as trauma, abuse, neglect, poverty, incarceration, you know, they may be at risk and biologically, you know, it’s kind of a dance between what we call genetics and epigenetics, or environmental influences that affect genetic genetics, hormonal fluctuations, pregnancy. So, all of these factors can actually summate together to be influenced by the stress. And what I’d like to think about with, with those of you listening, is its which groups are disproportionately affected by this, and the report says this pretty clearly. And you know, so who’s mostly affected? Those exposed to family and community violence, poverty, as I mentioned, racism and discrimination, low income, housing, job instability and unemployment, the racial and ethnic minorities are clearly more at risk, as are immigrants. Or I must say, in the current political climate, I bet you it’s off, completely off the charts in terms of the fears of immigrants. You know, with mass threats of mass deportation. Sexual and gender minorities. Women have a higher mental health conditions, have higher mental health conditions than men do. Maybe you can speak to this. I don’t really. I mean, women live longer lives than men do, but they have more risks of mental health problems, which is kind of interesting, and I think paradoxical. Clearly, postpartum depression is a risk factor, and what’s not been studied, and maybe this is kind of sexist, but, but paternal mental health. I mean, there’s a lot going on in terms of women’s mental health, but I don’t think we’ve looked closely enough at how men, you know fear under stress. We know that anxiety ranges from two to 18% of men, but I think it’s clearly under studied. So given all of this, what can parents and caregivers do to address the stressors with these increased levels so that we’re seeing,

Khadijah 09:46

I mean, so I think it starts with taking care of ourselves, as caregivers, as parents, we have to remember to take care of ourselves. We have to remember that we cannot do all things, and so we have to set our priorities and. We have to actively and deliberately engage in self-care. We it’s just like the whole airplane adage that puts your oxygen mask on first before you help others. It’s the same with parenting. We have to make sure that we’re healthy and in a good place, so that we can actually support and take care of our children. We have to also be careful to not isolate ourselves. You know, being again, deliberate about making connections and maintaining connections with other parents and caregivers and family members and friends. We have to remember to make sure that we have to be informed and use reputable sources. Knowledge is power, but we have to, you know, empower ourselves with the information about mental health care and what mental health conditions look like, so that we can recognize the signs and symptoms early, so that we can get help early. You know, we know that in all of medicine, early identification, early intervention, has the best outcomes. And I think maybe lastly, what I would say is that we need to remember that we don’t have to do this alone, like someone has done this before us. So, we don’t have to reinvent the wheel. But if we’re in a situation where maybe it’s unique, it’s all, it can always be helpful to think through a challenge with others. And so, you know, this can only happen if we are openly talking about the stressors, the struggles that the trials and tribulations that can sometimes come with parenting. And so, I would, I would encourage parents to not hold this all into themselves and kind of share and seek help so that we can kind of do this together and create a community. But speaking of community, what can communities, schools and community organizations do to support parents?

Gene 11:39

So this is kind of an interesting outline that we’re talking about, because it’s really something that Vivek Murthy has said and a number of the advisories, he wants to know what individuals afflicted, whether whatever it is, whether it’s young people, or whether it’s parents, can do and then looking at it at the community level, and then looking at it at the local, state and national level. So, I guess what I could do is speak to what he says and what maybe we think at the Clay Center about what community, schools and organizations can do. What I think first and foremost, super important is that that there can be we can foster more dialog about parental stress, mental health and wellbeing in culturally appropriate ways, and whether this exerts in whether this takes place in your places of worship or in your schools or in your community centers, you know, in Boys and Girls Clubs and 4H and you know in the YMCA or other organizations that are in your community, we should be able to equip parents and caregivers with resources to address parental stress and connect with supportive services. And so, one of the things that we try to do at the Clay Center is to foster what supports are out there? You know, the same is true. You know, for those listening, you know, go to NAMI online, that’s the National Alliance for Mental illness, or just Google, “where can I get some support services?” And then you can mention your community. You never know what you’re going to find. Hopefully it will be trustworthy. That’s another whole issue. I think, well, locally, we need to create opportunities to cult, cultivate supportive social connections among parents and caregivers. Now that’s a tough thing to do. I mean, where do we find the ability to do that, I think the two major places would be, you know, in in school based, school-based programs like PTAs or perhaps in places of worship, but there may be others, I think, elevating the voice of parents and caregivers to shape community programs. I mean, it’s really super important. I think, I mean, we’ve written about how teenagers need to be activists where it’s really good. Why is, why is activism good for teenagers? I think parents and caregivers, you know, can be advocates for themselves and for others around them, and how they can form coalitions to kind of help create forums, whether it’s in schools or places of worship or in community centers or in in forums that they establish and, you know, speaking of schools, I mean, schools are where our kids spend most of their time. So why not use the schools as places where the parents can gather and, you know, talk with each other and talk with other caregivers. So, Khadijah, what? What ideas would you suggest about the bigger picture? Care at local, state and national levels.

Khadijah 15:04

So to kind of take off from where you just landed, talking about schools, it would really be helpful if, if we could really figure out how to ensure parents and caregivers have access to, you know, affordable, comprehensive, high quality mental health care, and this would require addressing the mental health workforce shortage, but it could also look like, you know, how do we increase the number of training individuals who can offer support and guidance and education? This, like you said, could happen in schools where parents have to often be to drop off their kids and pick up their kids. They can offer, you know, things like peer support their, you know, groups of that nature. They could also offer educational kind of development and curricula to talk about, you know, social emotional learning and mental health kind of like how we kind of promote in the in our kind of at the play center through our kind of comprehensive mental health curricula. But other things that that government can do is really think about how we can expand funding that promotes supporting parents and caregivers and their families, like establishing the national paid family and medical leave programs, addressing the economic and social barriers that contribute to the disproportion, disproportionate impact mental health conditions on certain groups, and thinking about how we can promote visitation initiatives that that help parents or caregivers who’ve been incarcerated to reenter and reconnect and were engage with their families would also be, you know, another way to really help with this whole parent in parental stress.

Gene 16:45

Y0u know, I think one of the issues here that is most vexing is that we do have a national workforce shortage for both kids and adults. I mean, there are only 35,000 child and adolescent Well, the 35,000 psychiatrists in the nation for over three, 50 million people, and with a with one in four having a psychiatric disorder. I mean, it’s shocking how, and if you look at just, you know, child and adolescent psychiatrists who might be in a better position to help parents under stress, because they we understand kids and families, there are only 8,000 Child Mental psychiatrists, maybe 4,000 child psychologists, and probably about 120,000 clinical social workers, but many of these are guidance counselors, and they can’t provide mental health services, so we really have to think outside of the box, right? I mean, what? What do you think we can do about this workforce shortage, to help parents and help kids and families? Well,

Khadijah 17:47

I mean, I think one, one thing that comes to mind when I, I know this is a while ago, but when I was in school and we had our career days like we never had a mental health provider come in and talking about, you know, this is my job. We’d always have, like the internist or the cardiologist or the surgeon. And so, I think it goes back to early recruitment, early kind of education, and making people aware of the role of mental health and the opportunities that exist in terms of in the job, job force or the workforce as it relates to mental health. So recruiting kids early, you know, giving them an exposure and experience to what, what it would look like to be a therapist, to be a psychiatrist, to be a psychologist, could really be one way to be helpful, and another way, you know, often falls back to money. You know, we tend to get really poorly reimbursed for our services. And so how do we, kind of, you know, make the reimbursement match the work that we’re all doing and the work that’s so necessary, so that it feels valued. I think that’s another reason why there’s so few in the workforce now and then. I think lastly, you know, because, again, we’re not compensated in the way other medical professions are thinking about how we can do more loan repayment because, you know, school is expensive. And so, I think if we can kind of think about some of these things. I’m sure there are many more. Those are some ways that I think we could really think about and be effective in expanding the workforce.

Gene 19:08

I totally agree. But you know, those are long term those are long term projects.

Khadijah 19:16

You want to short? You want a short-term project?

Gene 19:18

Yeah, I want not a quick fix, because I don’t think there are any quick fixes, but I think the low hanging fruit here, for example. I mean, if you look at the success of the 12-step program, I mean, most people think that you, if you have an addiction, you know you’re dead in the water, but 75% of folks with addictions actually recover, and largely with the help of this 12-step program. Now the 12-step program is based on peer support, and you know, why not, since there’s so few of us, why don’t we supervise kids in school that can actually. To provide peer support, like students against disruptive decisions, like Active Minds in colleges and other kind of peer support groups for parents, because that way we as trained professionals can actually be present to help train, you know, folks who have a have a really sincere interest in this and kind of, and, look, you know, the 12 step program is incredibly helpful, but their sponsors don’t get, don’t get trained supervisors. I mean, they do read the 12-step book, and they do have a culture in ethos and, and they learn from each other. But I wonder why we as a field haven’t really done more of training, just, you know, everyday folks to actually be support and know what kinds of questions to ask, know what when, when things are getting risky, know what numbers to call, have access to resources. I mean that that could be done, I think, much quicker than waiting for when waiting right, waiting for the government to help us with loan repayments, which, you know, I’m pretty skeptical about.

Khadijah 21:28

Well, I mean, I do think we do underutilize peer support, which, which could be a really valuable resource from the standpoint of just mitigating the challenges with the workforce shortage, but also, people tend to feel more comfortable with people who they think they have something in common with that they can relate to. So, a parent would feel comfortable in a group of parents led by parents similarly, you know, kids feel comfortable when they’re in team groups that are often led by their peers. So, I think that is something that we should really be thinking about, how we can utilize those, those more in a way that we can, you know, validate it and make it effective and consistent. But definitely, I think there, there’s something there for sure, yeah, but, well, I think we have come to the end of our, of our, of our shrinking it down, but, but before we wrap up, since, you know, we’re both parents and, in your case, your grandparent. What is your favorite way to de stress?

Gene 22:25

Oh, that’s, well, two, two things right now. I mean, one is cuddling with my dog. There’s nothing better. I mean, she’s lying there in the chair right now, right next to me. But that’s that, that’s my quick fix. And then one which helps me de stress, but is also stressful, is playing music as a musician. It’s, it’s, well, it can be a source of stress. It depends on my mindset, you know, if I’m thinking, okay, I’ve got to learn this, this, this and this, then it’s really stressful. But if I just sit down at the piano and just say, look, forget about learning new stuff, which I always want to do, but just play, it’s kind of like what my piano teacher, you know, said to me at one point, and he was trying to teach me all this kind of new, new stuff that I did never knew before, and it’s kind of like learning a new language. And he said, you know, sometimes you really just sit down at the piano and don’t worry about anything, but just play. And I need to do more of that, because that would, that would, that would help a lot. So, what about you? You know, you have one college grad and one kid at home in high school, plus your full-time working doctor.

Khadijah 23:55

I have two go tos that I also, they also helped me. I’ve recently gotten into listening to on my Audible account, these romance novels, they’re kind of almost like Hallmark stories, because it’s the first two people that meet at the beginning and they end up happily ever after in the end. And it’s kind of just mindless listening, but it’s happy and pleasant. So, I have gotten into that recently, and then I also enjoy just walking around the city, like I just love to walk around the city, and even if I have no destination, I have no purpose, but just to get outside and walk around the city usually always brings me lots of joy and helps me distress.

[OUTRO MUSIC BEGINS]

Gene 24:30

Wow, well, and for those of you at home, if you like what you’ve heard today, consider leaving us a review, and consider kind of letting us know you know what. What causes stress for you. If we missed something, please let us know what we may have missed. And if you have other ways of helping other parents or caregivers reduce their stress or burnout. Please let us know, as always, we hope that our conversation will help you have yours. I’m Gene Beresin.

Khadijah 25:08

And I’m Khadijah Booth Watkins until next time you.

[OUTRO MUSIC ENDS]

Episode music by Gene Beresin

Episode produced by Spenser Egnatz