When the weight of the world seems to rest on our shoulders, it’s the voices of experience and compassion that can guide us toward the light. In a heartfelt journey through the challenges of mental health in East Texas, Dr. Cheryl McCullumsmith from UT Tyler School of Medicine and Lynn Rutland, CEO of the Andrews Center, talk about the region’s distressing suicide rates. They open up about an upcoming summit that promises to forge a path to better support systems, and how breaking down the stigma attached to psychiatric illnesses is crucial for healing.
Plus, innovative tactics, from coping kits for college students wrestling with anxiety to integrating medical students into community mental health services, promise a brighter future.
Transcript
LANDESS:
The statistics are alarming. Texas Health and Human Services says that East Texas has some of the highest suicide mortality rates in the state. So what’s being done to address the mental health needs in East Texas? I’m Mike Landess. It’s hoped that an upcoming mental health summit here in Tyler may provide some answers and possible solutions. UT Tyler Connects with School of Medicine Department of Psychiatry and Behavioral Medicine Chair Dr. Cheryl McCullumsmith. You’ve described this upcoming event with the Andrews Center and UT Tyler School of Medicine as an opportunity to share insights and strategies to address critical mental health needs. What is the biggest missing component in dealing with this problem today?
MCCULLUMSMITH:
Well, I think in general, nationwide, we need to really come to grips with psychiatric illness as a true illness, and that includes substance use disorders, depression, schizophrenia — all of these things put you at risk for death by suicide, which is tragic. And I think that we need to pay just as much attention to preventing death by suicide as we do into preventing death by cancer, death by heart disease, any other medical illness, and right now we’re just not there, but we’re trying to get there here in East Texas.
LANDESS:
Well, that brings me to my next question. There’s education and public awareness campaigns, but there’s still the stigma for those who say out loud, “I’m not well. I need help.” How do you fight that?
MCCULLUMSMITH:
There is, and I think it’s got to come even from within the profession and from the top down. I can remember my grandmother and her friends would whisper about cancer as if that was something to be ashamed of. People with epilepsy used to be institutionalized, right? So we’ve seen that change can happen, right? I think that as we get more public awareness, and as we in the health profession treat psychiatric illness with true equity with other medical illnesses, and that’s what I was really excited about the opportunity here at UT Tyler Health is that they are very invested in treating the whole person and integrating treatment of psychiatric illness with other treatments for other medical illnesses, so we can really get an equitable treatment.
LANDESS:
You spoke about change that can take place and the time that it takes. Someone said to me the other day he said, “Do you remember 30 years ago, 30, 40 years ago, could you have imagined that an entire football or baseball stadium would be no smoking?”
MCCULLUMSMITH:
That’s right, that’s right. See, so things can change, right? Yeah, I can remember, yeah, exactly, not trying to sit in a restaurant where the smoke wouldn’t drift over to you, right? So things really can change.
MCCULLUMSMITH:
And I have five kids, 19 to 28, and I see huge differences in them, even the youngest one from the older one, in addressing mental health. My oldest son — I was very proud of him when he was at MIT. One of his friends died by suicide, and he started trying to get everybody to wear T-shirts that said, “I go to therapy, and it helps.” That was considered very controversial at that time, you know, 10 years ago. My youngest son — he’s on the phone with me, and his friends will pop into his room, and they’re like, “Your mom’s a psychiatrist, isn’t she? I need help, I want to talk to her about this.” I just see this difference even in the last decade, right? Yeah, “Or ask her about my meds.” Like they all seem to be, you know, much, much more open, and I think, you know–
LANDESS: Maybe much more medicated.
MCCULLUMSMITH: But much more familiar with the language and comfortable talking about it, and I think we need to maybe catch up to some of that.
LANDESS:
Catch up to some of that, yeah. Also with us in the studio is the CEO of Andrews Center Lynn Rutland. Andrews serves five counties in East Texas, and the per capita mortality rate has risen some 77% over the last 22 years because of suicide. How about in the last three, Lynn? Did the pandemic make a bad situation worse?
RUTLAND:
Well, we do know the numbers continue to increase. Our latest numbers are ’21 from the agency. So one of the great things that we’re doing in partnership now is trying to get more real-time data quicker, so that we can respond faster. So I know that we’ve got some initiatives in that way, but we continue to see that trend line going up. We best measure this, not just the suicides, but the people who are going into crisis who will call 988, or they call our crisis hotline. They get in touch.
RUTLAND:
We, last month, I do have these numbers real time, March of just 2024, we saw 300 individuals.
RUTLAND:
We had over 700 contacts with those, 50 of those required to be hospitalized. And so what we’re finding is that our crisis lines are more activated than they’ve ever been.
RUTLAND:
We also believe that people are more acute, they’re sicker than they’ve been in the past, and so then we just kind of follow that out. Those are the ones that we know, and I think our best estimate, this is with the data that we have, is that on about two per week are death by suicides in our catchment area, so about a hundred people or so. We think that number is low, Mike, and the reason we believe that is because of how that information gets captured, and there’s still that stigma. People don’t want to acknowledge that that’s what it was. It could have been a death by something else, and so we believe that number is low. We had a board meeting for the Andrews Center just last week, and we were talking about this very topic and, of course, the issue, not just in community, but whether it’s in the jail or wherever it happens to be, what’s the prevalence and what are the strategies that, as a community, we need to be embracing?
LANDESS:
Now, the partnership with the UT School of Medicine for the Mental Health Summit can certainly be applauded as a good first step. Will your organization be working with med students from UT Tyler?
RUTLAND:
We are, thanks to Dr. Cheryl and Dr. (Brig) Willis. The beautiful thing is, Dr. Mellon will be bringing residents over, and that starts in the summertime. We think there will be six of those residents who come. He will be there most all the time supervising them. It just allows us to see more people and especially in a more timely kind of way.
MCCULLUMSMITH:
And we’re hoping that we really get some interest among our residents and medical students for doing this type of really essential community mental health work. If they can get in and see it and do it and realize what a great impact they’re having, we’re very hopeful that they will stay in community mental health and stay in the area.
LANDESS:
Now Andrews deals with five counties. And rural mental health care, I imagine, is probably a real tough nut to crack.
MCCULLUMSMITH:
Yes, so I’ll be presenting some of this work. But we have looked at the rates of suicide in the 30-some counties count in northeast Texas, and it’s interesting and sad. But the rate of suicide in each county is directly related to how rural that county is and also not surprisingly, inversely related to the number of mental health providers in that county. And there are many counties without a single psychiatrist in them in this region. So that’s why we’re working on providing tele-health services. We have a general psychiatry residency, and we also have a rural psychiatry residency that’s based in Pittsburg, yes, and we are beginning projects to do tele-psychiatry and integrated psychiatry out throughout the region of the systems that UT Health serves with our residents and in addition to this work with the Andrews Center here, we’re hoping to begin to narrow that gap a bit.
LANDESS:
Now this event is taking place May 7. It starts at 2 in the afternoon, goes to 4, and then there’s from 4 to 5, I understand that there are actually vendors that are available there with information. Tell us a little bit about that, either of you.
RUTLAND:
Yeah, so the 4 to 5 — The events are going to be wonderful because Cheryl and Dr. Andy Keller, head of the Meadows Institute, Lee Johnson, with our CEO for all of our 39 community centers in Texas, those are three credible voices. All three of them could fill up the full 2 hours. That’s how informed they all are. So what we’re hoping for, though, because they all have a little bit different perspective is we get a little bit of each of them, and then each of them, into the future, will be having opportunities to fill in the blanks and let’s talk more about it. What are the real changes?
RUTLAND:
When we say we’re going to call for a change, it’s going to take people like them to help lead us forward in this, and so our great goal is to have more voices, and we believe that equals more change, the more voices that we can have in the room. So the Brookshire Center we aimed too big. We said it’ll hold 2,000. We’re going to try to put 2,000 in there, and so that’s our goal. It’s a stretch goal, but we already have almost 1,000 who have preregistered for the event. We believe there could be as much as one-to-one. So we say to everybody, even if you’ve registered, get there early. The door’s open at 1:15. The vendors will be there. There’ll be music playing, and those 40 vendors, those are critical partners for us.
RUTLAND:
We cannot do it all. The Andrews Center, even as a local mental health authority, we serve 12,000 people, but we can’t do it all. Because there are so many people on that spectrum. We have the sickest of those among us, those who have schizophrenia, bipolar, major depressive disorder. Most of those are uninsured, underinsured. So that’s our niche. But then, when you think about it today, the anxiety and the depression that people have for all kinds of reasons, those resources that address for them those needs that they have. See, they’re great partners for us because we will take as many as we can. But then we also have to have those warm handoffs and those referrals.
MCCULLUMSMITH:
Yeah, Lynn, I think that’s phenomenal, and I really appreciate you putting this all together. It’s tremendous. And I also think, having the hour for other organizations–so we’re using the word “vendors,” but I think it’s really people who are providing services in the area, and I think there are many services in the area, and that it’s very difficult as a patient or a family member to figure out which place you should call. Do they take my insurance? Do I have the right condition to go here? You know there’s criteria, and so that’s the other thing that we’re working on together is to assemble a kind of guide to this, so that you could know where you’re supposed to go for which services, because it’s overwhelming, right? So I think a lot of times there are some resources available. It’s just hard as an individual to figure out which ones you should be calling on right away. So I think this is a great chance for us to really begin to get together and put all of this together.
LANDESS:
I’ve read one study that says that one in three college students have been diagnosed with anxiety or depression, or both. How do you even begin to address, in this day and age of social media, isolation and all of the pressures that Generation Z is facing right now?
MCCULLUMSMITH:
It’s tough. I think that we have to be available, and we have to provide some basic services. So, I have this project I’m working on that I did with some of my kids in college and their friends, and we’re looking to test in more of our communities here. It’s called, “Coping Kits.” So they are a little kit that zips up, looks like a binder for school, and it has things in there to help you de-stress: either a lavender scent or a quote or a squishy ball or coloring. And you know I was surprised.
MCCULLUMSMITH:
My daughter was at NYU in New York City with all these fancy people in their senior year, and they were all calling me happy about their Coping Kits, right?
MCCULLUMSMITH:
I think that you know, especially during the lockdown with the pandemic, you know you’re supposed to have tests and stressors and learn how to cope, right, in little ways as you’re going to school and doing that. And I think some of these kids have missed that learning process and then they’re kind of thrown into college on their own, and I think that’s really tough. So you know, starting with not assuming too much and making sure we’re teaching them some of the basics about how to cope with stress and that everybody has stress, right, and everybody can use these tools and then really having services available. So we do have resident physicians also coming here to the student health services, and I think if you can get more kids walking around, young adults walking around, like my son saying, “I went to therapy, and it helps,” I think that will help a lot. So just opening up the dialogue that it’s pretty normal to be anxious in college, right, but we can help you cope.
RUTLAND:
It’s kind of, you know, let’s say not quite so manly to ask for help. I don’t even ask my wife how to get to places, you know, but she tells me anyway. So you know one of the great things is that we need to destigmatize this whole issue.
RUTLAND:
We really need for people to know it’s OK to ask for help. There is a 988 number. That’s so simple. You just call it, and if you need a little bit of guidance or you need a lot of guidance, they’re going to direct you in the path that you need to go, and they’ll connect you with local resources. But just make that phone call, and you know to take all of that away from “Oh my goodness, this is what really crazy people do.” Well, this is what all of us do from time to time; we have those situations. Who of us hasn’t been situationally depressed at some point in time in our life? So those are the kinds of just practical things that you know are so important for our folks to learn, especially our men, and that it’s OK to ask for help.
MCCULLUMSMITH:
I was just going to say going back to like the smoking or something. Think about all the education that’s going on about signs of a heart attack and what to do. You know people tough it out with a heart attack. Well, hardly anybody would do that now. Some might still, but maybe my grandpa. But you know what I’m saying, that that’s an education thing. Like there are times when you do need some help.
LANDESS:
I’d like each of you to tell us what your hope is for this mental health summit and what comes afterward. We’ll start with Dr. McCullumsmith.
MCCULLUMSMITH:
I’m excited about bringing together all these different voices and perspectives, and I’m excited about getting feedback from the people who are there about what their needs are, because, really, you know, people talk a lot about patient-centered care, and it irks me a little bit and I realized why. It’s because the patient is the center of care, right, always. They make all the decisions, and if they’re deciding to come to us or not, we have to listen to them about why they’re not, right, because we can’t just say, “This is good for you. Come on.” If they don’t come, we need to understand that better. So I’m hoping to really start some dialogue, so we can understand better what people’s needs are and how we can help them in a way that’s good for them. I feel my mantra is to provide care where the patient needs it, when they need it, how they need it, and we have to talk to the patient and their family members to understand what that is.
LANDESS: Lynn?
RUTLAND:
When I got here in the summer of ’22, the first 90 days, I asked everybody the same question: “Are we ahead or are we behind in mental health care?” And I finally got all Republicans and Democrats, young and old, everybody, every way you want to slice and dice it, they all had the same answer: “We’re behind.” And sometimes they say we’re way behind, and their heads kind of dropped when they said that. What’s my goal? I think it’s the same for all of us. I want a day when I can ask for 90 days that question. They go, “You know, maybe we’re not as far down the road as we want to be, but we’re better than we used to be. We’re making progress, we’re making changes.”
LANDESS:
Thanks for listening as UT Tyler Radio Connects with Dr. Cheryl McCullumsmith and Andrews Center CEO Lynn Rutland.For UT Tyler Radio News, I’m Mike Landess.
(Transcripts are automatically generated and may contain phonetic spellings and other spelling and punctuation errors. Grammar errors contained in the original recording are not typically corrected.)
