- [Announcer] WVIA's Mind Over Matter, A Mental Health Initiative is underwritten by Geisinger.

- [Narrator] When you hear Geisinger, what comes to mind?

A hospital?

Doctors?

Health insurance?

We're all those things.

But here's something you might not think of.

We're also your local pharmacy.

Geisinger Pharmacy isn't just for people in the hospital, it's for you.

Wanna fill a prescription?

We've got you covered.

Just need over the counter stuff?

We've got that too.

And Geisinger Pharmacy is run by your friends and neighbors.

We're your local healthcare system and your local pharmacy.

- [Announcer] WVIA presents Mind Over Matter, A Mental Health Initiative.

And now moderator, Tracey Matisak.

- Hello, everyone.

Thank you so much for joining us tonight as we explore the connection between poverty and mental wellbeing.

The lack of essential resources like food, housing, transportation, and healthcare can significantly impact mental health, leading to chronic stress, anxiety, depression, and other disorders.

The numbers tell the story.

Nearly 20% of those living below the poverty line report regular anxiety compared with about 12% of Americans overall.

Kids living in poverty are two to three times more likely to develop mental health conditions than their peers in more financially stable households.

In Pennsylvania, mental health hospitalizations are about three times higher in areas high in poverty and low in education.

Locally, Lackawanna and Luzerne counties exceed the state average in mental health hospitalizations.

In a few minutes, we'll meet some individuals who have courageously shared their stories with us and how they're addressing the challenges they've been facing.

But first, a closer look at how some parts of Northeast and Central Pennsylvania came to have such relatively high rates of mental health challenges exacerbated by financial struggles and what's being done to help individuals and families who are dealing with it.

And for that, we turn to our expert panel.

Danielle O. Keith-Alexandre is the CEO and Executive Director of Keystone Mission, a faith-based nonprofit that serves people experiencing homelessness in Luzerne and Lackawanna counties.

The mission provides everything for meals to transitional housing and job readiness training with the goal of equipping people with tools for independent and sustainable living.

Danielle has more than 20 years experience working with people in marginalized communities, as well as with individuals experiencing HIV/AIDS, substance abuse, and homelessness.

Dr. Imad Melhem is the Chair of Psychiatry and Behavioral Health at Geisinger.

He specializes in mood and psychotic disorders, severe mental illness, autism spectrum disorders, substance use disorders, and inpatient care.

He completed his psychiatric residency training at the University of New Mexico, followed by a fellowship in Child and Adolescent Psychiatry at Harvard Medical Schools, Massachusetts General, and McLean Hospitals.

And he has a medical management degree from Carnegie Mellon University.

And Janice Mecca is the Director of Assertive Community Treatment at Scranton Counseling Center.

She holds her PhD in human development and has been working with individuals living with mental illness for nearly a decade in both residential and community outpatient settings.

So that said, thank you all for being with us.

We have a lot of ground to cover, but a couple of questions before we begin.

And I will direct this one to you, Dr. Melhem.

When it comes to homelessness in particular, government statistics say that 21% of homeless people report having a serious mental illness.

It's easy to see how being without housing could lead to mental illness.

But does it also work the other way where a mental illness itself could be a risk factor for homelessness?

- Absolutely.

In fact, their relationship between homelessness or poverty in general and mental health conditions is pretty well established, and it goes both ways.

There are many times where a mental health condition affects the functioning of the person to a period where they are unable to work in a sustained fashion.

And they start seeing the consequences of that where the inability to function will lead to what we call social drift sometime where that can affect not just the person but their families and even generations behind them leading to losing a lot, whether it's health insurance, home, and even the basic necessities such as food, et cetera.

- Yeah, there's quite a ripple effect for sure.

Janice, the government reports that 16% of homeless people report having a substance abuse disorder.

Can you talk a little bit about that?

About the role that substance use can play as it relates to homelessness and the link between substance use and mental illness.

- Individuals who are experiencing the trauma of homelessness, they look for ways to relieve those symptoms and sometimes substances are what they turn to if they're available because the stress of living on the street and trying to get your needs met can be really overwhelming.

- And it becomes sort of an escape, a coping mechanism that then builds on itself.

- Absolutely.

- Yeah.

- Danielle, there is a direct link between educational attainment and poverty.

Studies show that young people without a high school diploma or a GED have a 346% higher risk ending up homeless, 346%.

I wonder if you could address that connection.

I'm sure that you see this in the work that you do with the Keystone Mission.

The connection between that and the factors that can often keep a young person from attaining that minimum level of education required to be able to sustain themselves.

- Thank you.

I think it's so important to understand the link between education and homelessness.

Generally speaking, someone who have had a lot of degrees or have gone through a lot of educational years, and they may not be homeless.

You would see that they have the tools that they need.

They understand what is needed in order to cope or go through life.

And those who may just have a high school diploma or may just have a GED, that plays a factor in how they're able to cope and deal with the stresses.

- And we're living in a world where, in many cases, a high school diploma is not enough, right?

Minimally, you need to have mastered a skill or go on to a two-year or a four-year degree.

So yeah, it seems that it's becoming more and more that a high school diploma would be the bare minimum.

- That's correct.

A lot of the jobs out there require sometimes a bare minimum, a bachelor's degree and some a master's degree.

So we see that a high school diploma years gone by where it used to be acceptable, it's not really acceptable anymore.

And they're looking for individuals that have some form of higher level of education.

- Well, on any given day, over 10,000 Pennsylvanians are known to be homeless, living on the streets, in shelters, or occasionally staying with family or friends.

For Alexis and Kay, home is a peer beneath a bridge in Scranton.

The sisters have been living there for years.

Kay is a caregiver for her sister who faces physical health challenges.

But Kay has struggles of her own, including bipolar disorder.

It is a difficult life and one that forces them to be on alert at all times.

Alexis and Kay recently shared their story and their struggles.

(calm music) - [Interviewer] So can you tell me how long you've been- - [Alexis] Homeless?

- [Interviewer] What's the proper- - [Alexis] Yeah, we've been homeless for like, what?

Seven years already now.

- Seven years.

This year.

Seven years this year.

- [Alexis] Yeah, seven years this year.

we were in different places, but we kept getting kicked out until we finally got here.

And we were okay.

I mean, yeah, the cops have come down here and they've bothered us and threatened us and stuff.

They told us to leave.

We couldn't be here, but we never left because nobody else left.

A-L-E-X-I-S. - K-A-Y.

- [Interviewer] So you're- - Caregiver.

- Kind of a caregiver, yeah.

But there are things I can do for myself.

- [Interviewer] So were you scared when it first happened or?

- Oh yeah, we were terrified out of our minds because we didn't know what we were gonna do.

We've never done it together.

She's done it separately.

I've done it separately, but we never did it together.

And we were gonna have to get used to the way each other does things.

And we kind of worked that out pretty good.

- [Interviewer] Have you been mostly in Scranton the last seven years?

- [Kay] Yeah.

Well, no, no.

We've been bouncing around for this.

We've been here like four years here.

- Yeah, we've been here for like four years now because we kept getting kicked out everywhere else we were.

The cops harassed us and threatened us.

And they were gonna do this, that, and the other to us.

And rather than stick around, we just bounced around from different places until we got down here.

(calm music) - [Interviewer] For people that don't know, what's a normal day like?

Is it comparable to a normal day just outside?

- No, it's not.

- No, not really.

- [Alexis] It's still kind of harsh because you have to be on the lookout for different things happening.

You gotta watch out for thieves.

Thieves and stuff because all these people steal from each other.

They think it's okay because even though they had less, I had less than, then they steal from me.

Why?

Because I had less than they do.

And yet they're still stealing.

ESA dogs, emotional support animals because I was traumatized and she was traumatized through different things.

- I got bipolar.

- She has bipolar.

- And it's like I wanna commit suicide and I don't think so.

I got a dog.

I can't commit suicide because I got something to take care of.

And I gotta take care of her.

I gotta take care of her.

So my hands are tied here.

We can't have them in the housing because they're not neutered and spayed.

- Yeah, they're not- - He can't be neutered because he has seizures and she has medical problems.

- And she's old too.

- [Interviewer] If there was one message that you could give to people, what would you say?

- I think I would have to tell them, try to do the best he can without ending up out here like us.

- [Kay] What I did was he's got the sign- - [Alexis] He got an application.

- [Kay] Anything of help.

And I said, "Your sigh says anything will help.

Well, here's a job application."

- [Alexis] That'll help.

- [Kay] He done a one job.

He don't wanna work.

- [Alexis] He said he doesn't wanna work, - [Kay] He wants to stay out here.

He likes this.

- [Alexis] He'd rather panhandle.

Hey, you get a dollar, got $2?

- Yeah, okay.

- Yeah.

They do it every day like clockwork.

And I would tell people, "Don't do that.

Don't end up out here like that 'cause it's not a pretty life.

It looks glamorous from another point of view."

- It's not.

- "But let me tell you, it's harsh.

It's very, very harsh."

- Yep.

- It's like a nightmare.

- We wanna thank Alexis and Kay for sharing their story with us.

Danielle, before anything else, can we talk about the sheer resilience that it takes to live the way that Alexis and Kay have been living for all these years?

Most of us can't even imagine.

- Yeah.

It takes a certain amount of stamina and intuitiveness and also being able to push forward just to be able to survive out there.

As she said, it's not easy, it's a nightmare.

And to be able to survive more or less that long even is something that says how strong they are.

- Yeah.

Seven years.

- Seven years.

- Moving from place to place prior to that.

Incredible.

Dr. Melhem, Kay revealed that she has bipolar disorder.

Can you explain what that is and how it's treated, and what happens if it's left untreated.

- Absolutely.

Bipolar disorder is one of the mental health conditions that you see in our population under the mood disorders or effective disorders umbrella.

It's pretty prevalent.

The percentages can go anywhere between 0.8% and some people can rank it at like almost 5%.

It can come in many different forms and many different severities.

So you can go between the mild to the very severe type of illness that can actually affect the functioning pretty badly.

It can come with psychotic symptoms.

And it's characterized really by changes in mood, energy, ability to sleep.

Sometimes it's coupled with hallucinations or delusions in the most severe forms.

It's also a very treatable condition, however, that the person can also gain back functioning and lead a normal life if appropriately identified early and if treated appropriately.

The treatment typically consists of a combination of psychological therapies and psychotropic medications that can help the person gain back the empowerment they need to control the symptoms, become aware of the symptoms, and seek the treatment early enough.

It can be treated in the outpatient setting or in a hospital setting at times.

If left untreated, definitely the effects can be pretty significant on the person's life, on the life of their loved ones, in addition to their families, et cetera.

And can also be coupled, just like Kay mentioned, with significant effects on their ability to sustain their living and having the ability to have a home, access to food and the medications, and their basic needs in life.

- Janice, both Alexis and Kay have emotional support dogs and they talked about how part of the reason that they are not indoors is because of the dogs.

There are certain reasons that they're not allowed to be inside.

Were you surprised by that choice to live outside with the support dogs as opposed to being inside where more of their needs can be met?

- I wasn't surprised by that choice.

Having an animal, having a loved one to take care of and to just have that connection with somebody can be more important than having somewhere to go.

And they had mentioned that their suicidal thoughts were decreased because they can't commit suicide.

They have to take care of this animal, this person.

- Yeah, that was an important point because it seemed like that was part of the reason that she's been able to stay to care for her sister.

She has a reason to live because she has some people and animals to take care of, which I thought was really striking.

And, Danielle, I guess to that point, it's not unusual to hear about homeless people who choose to stay on the street.

Maybe not because of a support animal, but will make that choice as opposed to going to a shelter.

Why is that?

- Yes.

It's not uncommon at all.

We see that at our locations every single day where we have individuals, they are offered help.

And for various reasons, some of the reasons may be they like to be outside and when they weigh just being outside and having that freedom.

they think if they get these services or go through the different steps to get what is needed for them to get back on their feet, they may see it as a burden.

So for them, the best thing to do may be just to stay outside.

- Yeah.

They've become used to living there- - They've become used to living there.

- Feel a sense of control around that.

- A sense of control.

Correct.

- Yeah.

- Correct.

- Well, more than half of Americans live paycheck to paycheck.

And as a result, can be one crisis away from homelessness.

It can happen to anyone as the folks at Keystone Mission know all too well.

The staff there are dedicated to helping people who have fallen on hard times rebuild their lives.

They provide food, clothing, shelter, job readiness training, and a host of services to help their guests get back on their feet.

- Everybody has a story and it's not always what you think it is.

Just normal, everyday folk who had an issue with, say, a job loss, or an accident, or they retired and they realize they don't have enough to live on.

- I was a truck driver until I got hurt in a truck accident up in Albany, New York.

Broke my back and all my ribs.

My mom had to help take care of me 'cause I was still dealing with workman's comp and all that stuff.

I'd be still running the roads, coast to coast.

That was my biggest downfall was.

I couldn't pass my physical for the CDO.

- There's not enough shelter in any city.

Homelessness is a big problem right now.

- My mom passed away December 22 and man that she was living with told me I had till Labor Day to get out because it was his house.

So three to four months, I was sleeping in the car.

- The Keystone Mission has been in existence for almost 20 years.

We started in Lackawanna County out of the back of a truck.

We opened the Innovation Center on October the 30th, 2023.

We have an innovation center in Lackawanna County also.

This is the first time in Luzerne County's history that they've had a place that the homeless can go during the day.

- I was staying at the truck stop up there.

It was cheaper to sleep in a car than it was to rent pay for a hotel room.

And how I ended up down here was when it got cold in the wintertime, I ended up calling 911.

And they gave me Keystone Mission as the cold blue to go when it was cold.

I walked down from by the airport down to here.

- [Kathy] We want everybody to be treated with respect.

We don't turn anyone away, regardless of religion, or gender, or nationality.

Everyone is welcome here.

- It's seeing a person and not homeless or not seeing poverty or not seeing mental illness or not seeing a drug addict.

There's a person behind all those things, - Still adjusting to it.

So used to being by myself doing stuff myself.

And if it wasn't for Melanie and Kathy helping me out here after I became homeless, I probably wouldn't be here today.

- We refer to the people who come into this mission and all of our mission as a guest.

And so some of the agencies are a little bit thrown off by that because they call them clients, but they're not our clients.

They're our guest here.

- The guests come in in the morning around nine o'clock.

Usually, you'll hear my name oftentimes.

Melanie, I need to talk to you for a second.

And it's usually anything from getting housing applications in, checking on status of housing applications.

- We wanna make sure that everybody has identification so we can start helping them receive the benefits that they need.

- When my ID that I did have ran out, Mel gave me paperwork to go down and get my ID renewed.

- So we wanna make sure that we're hitting the basics before we take a look and try to get them into housing because right now there is a wait list on some of the housing units that are in the city.

- We have a great partner, the Sherman Hills on Cole Street.

They have been wonderful working with us, but it's tough.

We look into different landlords that rent rooms.

There's some hotels that will offer monthly rates for some of our guests, but they fill up quickly.

- You cannot pay $1,500 a month rent for a single bedroom apartment and when you're getting $890 a month social security.

- We did just receive ARPA funding.

That is what helped us by the American Rescue Plan Act, helped us open this building.

So I think we do have a lot of like the counties on our side that are interested in helping us find funding too, which is really awesome.

- We are almost 100% donor-funded.

- So it can be disheartening or it could also be like the best thing ever when you get that check in the mail and someone's like, "Yeah, I believe in what you're doing.

I want to partner with you through this."

- [Kathy] It is grandma sending in the $2 a month.

It's people, our monthly donors that like what we do and supply for that.

- You just see a lot of hearts being restored and it makes me get a new perspective on life.

- Some of the homeless might be people you know.

- And guests I met in January that wouldn't say two words to me now come in and tell me they love me and they give me a hug at the end of the day.

And they have that, "Hey, can I get a dress shirt?

I'm gonna go and apply for that job."

They're more confident to do so because we see them and we see who they really are behind that mask that society gives them.

- I got approved for housing on Saturday through Melanie.

It's a lot of work that they do and a lot of people don't see that.

- Just take time to hear the stories and you'll have a better understanding of what we do here.

- I don't mean to sound rude, but lazy.

Get up off your butt and do stuff.

- Well, thanks to the folks at Keystone Mission for that.

Danielle, Kathy Regan, the Operations Manager, made a really important point at the very beginning when she said homelessness can happen to anyone.

As with mental illness though, there has always been a stigma around homelessness.

Can you address that stigma?

And what Keystone Mission is doing to try to address it, to try to reduce the stigma, just as we see in mental health?

- Yes.

As you said, there is definitely a stigma around homelessness and also around mental health.

And we are seeing individuals who are living in cars, individuals who have jobs, and they are homeless, they're unsheltered.

And it's not like it was years ago where you would look at the person on the side of the street asking for a dollar and would think that that's the only category of people who's homeless.

We're seeing that those needs are very different now in the faces.

The situations are very different.

With Keystone Mission, what we are doing, we are helping these individuals and giving them hope through the different various ways that we give them hope.

Some may be needing an an ID identification, getting back vital documents, just speaking with them, just seeing what their situation is and working with each one on a case by case basis.

And more than ever, making sure that they are aware and they know that we see them as a guest, as a human being.

- I wanna come back to, in a minute or two, to the ID piece of it and just kind of getting some of those things that we take for granted done.

But first, Dr. Melhem, there can also be clinician bias in addition to the stigma that exists around homelessness and mental health.

There are studies that reveal that homeless people feel that sometimes their care is compromised because they're not taken seriously by a healthcare professional.

People of color report that all the time regardless of their housing status.

So what is being done or what do you think needs to be done to address clinician bias and to promote more culturally competent care?

- Absolutely.

And that's a huge point actually that you make because patients with mental health conditions are at a higher risk of marginalization and stigma is one of them.

But as you get into poverty and start having all the other risk factors, now you're in a category that is at the lowest ability and opportunity to actually not only treat the mental health problem, but also get out of poverty hopefully and get back to enjoying and functioning in life.

Having a culturally sensitive clinician is a key component of any treatment, not just in mental health really, in all health-related components.

There's a lot of awareness that needs to happen in training as well, and gaining more and more ability to interact, and learn about the areas we live in.

At Geisinger, for instance, we cover areas that span Pennsylvania, rural and urban areas.

And you will see very different cultural components that can affect the ability of the patient to really seek treatment.

It can be transportation sometimes, or it can be awareness about the mental health problem itself.

So the culturally sensitive and competent clinician is a key component in breaking that cycle of poverty, of mental health, and the continuous revolving door.

That would be with clear attunement to the patient, but also gaining the training necessary to identify which population the patient could be belonging to or whether what are the elements of potential marginalization, whether it's race or other elements.

- And, Daniel, back to you.

for Joe, the truck driver who was featured in the piece, one work-related accident was all it took for him to ultimately end up homeless.

And he talked about how the people at Keystone Mission have helped him to get his ID renewed to get paperwork done that so many of us take for granted.

And I wonder if you would talk about just the challenge that people who do not have a home, who don't have an address have in doing something as simple as getting an ID renewed.

- Yeah, there's so many challenges.

When you have individuals who are homeless, a lot of times they come into our shelter, our innovation center, and they don't have these documents.

Some may have been lost, some may have been stolen, some may have been expired.

And we work with them to make sure that they get those documents back.

It's very important also to realize that education also plays a factor.

And we have individuals coming in and some may just have a third grade, or fourth grade, or fifth grade education.

So the staff really works with individuals in assisting them to complete these necessary documents because they need the documents, they need the ID, they need the birth certificate, they need the other things that are necessary for them to be able to move forward.

- And something as simple as internet access that most of us take for granted.

If you don't have that, you can't do very much.

- Yes.

We have a kiosk center so that they are able to use the computers when they come in.

We assist them, those who need help in completing the documents.

We help them assist it, but we also have those who can just use a computer and they're able to find jobs and go and apply for different things as well.

So they have a place where they can come to and get the help that is needed.

- Yeah.

Janice, Joe's accident left him with a broken back ultimately without a home, as he said.

as a mental health professional, how do you help someone in such difficult circumstances, the kind that we're talking about with Joe, to address the collateral damage to their mental health?

- I think it could be really difficult to treat individuals in this position because the basic needs are not met.

So they don't have a home.

They don't have transportation, food sometimes.

And to work on deep therapeutic interventions can be difficult.

So a lot of times, we work on kind of getting them housing, getting all of those basic needs met so that they could work on their higher level needs.

- Yeah.

And it's gotta be difficult when you think about the chronic stress that we talked about that comes with all of that.

You can see how easily that can lead to anxiety, how anxiety can then become depression, and how you can just continue to sink.

And it seems like there would be a great deal of help that is needed to try to help someone kind of pull them out of that hole, quite frankly.

- Definitely, it requires a lot of support.

Our team at Scranton Counseling Center are able to work with individuals so we could see them through every step of the way, provide them intensive services, and really make sure that they get all of their needs met.

- Yeah.

Danielle, one of the services that Keystone offers, of course, is job readiness training.

And I was thinking back to what Kay and Alexis said, the women who are living under the bridge.

And they said that there was a man in their community who kind of was content to just stay where he was and they said he should get a job application, get a job, that would help.

It's not uncommon, I think, for people, housed or unhoused, to think, well, hey get a job, start somewhere, get a job.

But if you don't even have an address, how do you then find interview -appropriate clothing, access to a shower?

It's so much harder than it sounds.

- That is so true.

It is very difficult for individuals who are unsheltered to be able to access these things.

And there are some of our guests who will want the help, they receive the help.

And then there are others who are comfortable outside.

However, as mentioned before, we have those individuals who want the help and we have the things that they need.

So the shower, the clothing, how to be able to speak at it for an interview, resume building.

These are all things that we know is important for the guests to grow and to get out out of the situation that they're in.

Those are the things that we work on with them.

- Yeah, if you don't have that, you can't really go very far.

- Exactly.

- Well, it's no secret that nutritious food is key to living a longer, healthier life, but gaining access to healthy food can be a challenge for people who are struggling to make ends meet.

Sugary, salty processed foods tend to be cheaper and easier to come by, but the health impact over time can be devastating.

And for those battling chronic conditions like diabetes, access to nutritious food can make the difference between life and death.

And that's where Geisinger's Fresh Food Pharmacy comes in.

It serves individuals and families struggling with food insecurity and medical conditions that are dependent on a healthy diet.

It's food as medicine and it's making a huge difference for people whose finances make it harder to make healthy choices.

- With a family of five, I struggle.

There's times where before this program, I couldn't afford a meal for myself, which was fine for me or so I thought, but my sugar would skyrocket.

And without eating, people don't realize, they think, "Oh, I'm overweight, I can spare a meal," which you think that, but as a diabetic you cannot.

Your liver enzymes shoot up, and your body releases glucose, and your sugar will go up.

(bright music) - The Fresh Food Pharmacy is really designed for individuals who have uncontrolled type 2 diabetes.

They also have identified that they are food insecure, which means they struggle to provide food for themselves and for their family.

And so once an individual identifies that they meet those two criteria, they can be referred to the program, and they engage with our clinical staff.

We have a registered dietician.

- The list is pre-made.

We're gonna start over here.

So this is our milk and our eggs.

So I have a family of five, so we shop for two weeks.

So we get one per person.

And since I'm a family of five, I get two cartons of eggs.

So strawberries, I'm gonna get two.

- I am a diabetes educator.

I'm actually a registered dietician, as well as a registered nurse.

And I'm a certified diabetes education specialist.

So I work with all our patients here along with our end health manager to just help our patients get the best control they can over their diabetes.

I focus on lifestyle changes such as diet and physical activity.

Diabetes has a lot of comorbidities, so it increases risk of heart disease, a kidney disease, just to name a few.

By us offering healthy food items, it helps to prevent complications from those other comorbidities.

- When I came here, my A1C was nine.

Diabetics, we like to keep our blood sugar six and lower.

So for this program, your A1C has to be seven and above.

So I signed up for this program through my doctor and I got my A1C down to a six.

I also lost a hundred pounds being on this program.

I was almost 400 pounds and now I'm down to 200.

- Often it's not just food insecurity for the individuals who come into the program.

They have transportation challenges.

They have challenges with utilities.

They have challenges with isolation and other social needs that are identified as part of working with the individual.

So we wanna ensure that they're taking advantage of the SNAP benefits that they have available and utilizing some of those other resources.

- One common theme I hear from a lot of my patients is, some of the federally funded programs like SNAP, a lot of my patients are noticing decrease in that funding so it's making it harder for them to source healthy foods.

We provide them with enough food to feed themselves and as many people in their household.

We give them fresh fruit and vegetables, lean proteins such as ground turkey, ground chicken, pork, loin, fish, as well as whole grains.

- The nice thing about this program is not only does it look at treating diabetes and the importance of treating diabetes, but also it looks at the role that food has in that, particularly for our patients who are food insecure and not able to secure healthy, nutritious options.

- You give kids a couple bucks, go get a snack, what are they gonna choose?

Are they gonna choose the apples and the green peppers and the bananas?

Are they gonna choose the chips?

Of course, they're gonna choose the potato chips because the potato chips are cheaper, they're tastier, and they're more affordable.

Anybody can do it.

If you just focus on eating the right foods and watching your blood sugar, good things can happen.

Hey, listen, I can get over my diabetes.

I can be strong.

I can fight this.

(calm music) - And thanks to the folks at Fresh Food Pharmacy for sharing that with us.

Dr. Melhem, of course, healthy food is essential for our bodies, but also for our minds.

Can you talk about how the food choices that we make or are forced to make in some cases impact our mental health?

In other words, if you would talk about the linkage between food insecurity and our mental wellbeing.

- Absolutely.

The interplay between physical and mental health is very well documented.

In fact, the biological aspects, but also the psychological and the even cognitive and social aspects of poverty itself can lead the person to be under a lot of stress, that even metabolism can be different in the way we ingest or we metabolize the foods we take that can be affected by these stressors.

The ability to have access to food is one of the main basics that we assume it's available for us.

But when you have multiple risk factors such as mental health conditions, physical conditions, and the inability to access, whether it's a safe environment, but also the appropriate food to have, really that adds a lot to our patients or our community members that tend to be the more significant the mental health problem, typically, these are the same patients who have the highest barriers to access to care, but also to the basics.

And so really focusing on those aspects and asking the patient whenever they present to treatment about food insecurity, about the basics needs, safety among other things, to make sure that we are not missing any of the social components that can really add on and augment the treatment we are doing in our offices in our clinic.

So really again, it's too many risk factors that our patients with mental health conditions are facing every single day.

And they're not to be undermined actually.

- Yeah.

And, Danielle, it's no secret that if you go into a marginalized community, it's gonna be easier to find a Big Mac and a cigarette than it would be to find fresh fruits, fresh vegetables, to Dr. Melhem's point.

The access can be so difficult for healthy foods.

The junk food isn't hard to come by and it's easier to afford.

And I'm sure that you see that at Keystone Mission with some of the guests that you have there.

- Yes, it's very easy for them to, with the finances that they have, go and get a meal that is what we'd like to claim as unhealthy.

However, it's because at times the food is expensive and we have to look at the prices.

And having that access to fresh fruits and vegetables, it helps them, not only helps them physically, but it can also help them mentally as well.

Again, that access plays a key part in them being able to get ahold of those foods.

- Yeah.

And, Janice, living with a chronic condition like diabetes is difficult physically, but certainly can take a toll mentally, to Dr. Melhem's point.

You're a mental health professional.

How do you help people who are living with chronic conditions, with chronic pain, just all kinds of physical issues that ultimately do impact their mental health?

How do you help them to cope with that without sliding into depression or anxiety?

- Sure.

So we provide education about both their physical and mental health and the way they work with each other.

We support individuals with making better choices, identifying foods that are healthy for them, and then teach them coping skills to manage their stress and depression.

- Yeah.

And I was thinking too, Janice, that in the case of chronic illness, as with everything else, poverty only serves to exacerbate it.

And so you have people who have a lack of access, but who also may not have health insurance in all likelihood.

And so if you've got a serious health condition, you don't have health insurance, that only complicates things.

So are people then going to the emergency room?

What happens in a case like that?

- So we see a lot of individuals overutilizing the ERs due to transportation issues.

Maybe they can't make it to a primary doctor or an urgent care, so they go to the emergency room and take up time that might be more better used for people in crises and emergencies for minor medical conditions due to all the barriers that they face.

- Yeah.

And it strains the resources of the emergency room and creates other issues.

Dr. Melhem, we talked about diabetes being diet-dependent.

That really food makes a world of difference and we saw it in the example of the woman in the piece who has done so well in being able to have access to nutritious food.

I'm sure that there are, you can name almost any health condition, that would be improved by food, but are there other health conditions similar to diabetes that really are dependent on the kind of food you eat that that can really make or break how successful you are in managing them?

- I think in general, especially when we think about mental health or health in general, having the opportunity and the choice to be able to choose the right foods is in and by itself one of the main components that we should draw attention to.

Meaning, can the person actually choose the type of food that they need?

educating people about the appropriate kinds of foods, whether some conditions other than diabetes, hypertension, or the amount of sodium that could be in some ingredients, processed foods, et cetera.

All of those can add to the stress that the body is perceiving.

And of course, that starts a kind of a vicious cycle of worsening in general.

But really food in mental health, for example, it's not a causative agent necessarily.

It doesn't cause the problem, but it can be a symptom or bad eating habits can be a symptom.

In depression, for example, appetite is significantly decreased in most types, although it can be increased.

And as such, the person suffering with a depressive disorder or a mood disorder may end up having to eat because they can feel the need for it, when in reality it's not necessarily a choice they would make had they not had depression.

So it goes back to really focusing on diet in general as part of a comprehensive plan that cannot only affect the physical, the mental, but also the access to the components that Janice mentioned.

The Fresh Food Pharmacy is a great example that Geisinger is super proud of because without it, really the patients would not have even access to that choice that we talked about.

- Well, and even if you don't have a chronic health condition, food affects mood.

- [Dr. Melhem] Yep.

- Right?

We all have had those experiences where you eat something that tastes pretty fabulous going down, but may not make you feel so good after physically or mentally for that matter.

- The studies on Mediterranean diets have been clear about reducing multiple risk factors, whether it's in cardiovascular disease, even including also dementia.

But again, Mediterranean diets has a lot of vegetables and those tend to be super expensive for patients who suffer through access issues or financial stressors.

So we can recommend it, but really working with the patient, as Janice was mentioning, to gain that access and being able to connect to a service like the Fresh Food Pharmacy at Geisinger would be an amazing add-on for our patients.

- Yeah.

Danielle, just letting people know about the resources that are available, I imagine, can be a challenge.

Every neighborhood doesn't have a Fresh Food Pharmacy.

Every neighborhood doesn't necessarily have a Keystone Mission, but there are resources out there.

Oftentimes people just don't know about them.

And so what needs to be done to just help make people aware that there are people out here, there are services that are available?

But oftentimes people just don't even know that they're there.

- Yeah, that's so true.

Outreach is really needed and organizations can do outreach.

They can make their services known also at the doctor's office where those individuals may go to the doctor or supermarket.

And there's a plethora of ways that outreach can be done or outreach services, but it's all about educating as well.

So if we inform people and we give people the information that is need, then they're able to make better decisions.

- Yeah.

By the way, if you have had these kinds of struggles, please know that you are not alone.

If you need someone to talk to or maybe you'd like to explore treatment options, dial 211 to speak with a caring person who can help.

Speaking of caring people, Janice, this is your life's work.

I'm curious in the course of the pandemic because on this program, we've talked a great deal about the effects of the COVID-19 pandemic on our mental health.

And I wonder what you have seen, particularly as it relates to poverty.

You had people who lost jobs during the pandemic who had to make all manner of changes to their lives, not necessarily for the better.

Tell us as a mental health professional kind of what you have seen in terms of poverty and mental health in the years since the pandemic started.

- So individuals have lost their jobs due to the pandemic.

They've lost housing, the resources really weren't available.

Everything was closed, so access to food, access to the doctors.

Individuals who are homeless or unsheltered, they sometimes don't have access to telehealth services.

And we went to a society where your doctor's appointments were over the phone, over a video.

So they kind of fell through the cracks with some of their just basic medical care and getting their needs met in that way.

- Yeah.

What are you seeing in the time since then?

I mean, we've gotten to a place now where we're mostly past it.

We're still experiencing COVID and it's going to be with us for a long time, but we're certainly past the darkest days of the pandemic.

Have you seen changes as things have started to normalize to some degree?

- Mm-hmm.

I believe the financial situation has worsened since the pandemic and the benefits, what used to cover a full grocery order, now the prices of foods are so high that individuals are using the pantries more, they're using the community resources.

And it's putting a strain on the food pantries, and it's just systemic.

One thing leads to another.

There's lack of accessible housing.

So everything kind of piles up and has an effect on each other.

- Yeah.

It seems that we'll be feeling those effects for much longer, I think, than anyone anticipated.

Dr. Melhem, we have talked during this conversation about bipolar disorder.

We've talked about anxiety.

We've talked about depression.

And I'm just thinking about the people who are struggling with these issues.

Again, access being a problem.

There were so many people during the pandemic who were seeking mental health help, and it was difficult because there therapists and other mental health professionals were overwhelmed by the need.

I wonder what you have seen in the kind of work that you do as a psychiatrist.

Is that still the case, that the need is as overwhelming as it was during the toughest days and years of the pandemic?

- Yeah, in fact, we refer to it as a crisis in mental health and also in substance use disorders, which has been really getting worse over the last decade.

The pandemic revealed and worsened that even more.

So we have seen an ever-growing need and referrals or requests for mental health appointments, even though the number of telehealth organizations that started delivering mental health treatments through video conferencing or modalities that were not necessarily that available before.

In fact, up to 41% of mental health visits continue to be in the video or through telehealth.

But even with that, the request, and that could be also due to in the last few years, a lot of the stigma about mental health has gotten a little bit better where patients or people suffering with mental health conditions started feeling more and more empowered to ask for help.

And while this is a great thing for us, but it definitely added a large volume of new patients asking for treatment and an already stressed workforce in mental health.

In fact, the number of psychiatrists and counselors and the people we need just to meet the unmet needs in mental health is a huge number.

It's almost half a million people just to meet the patients that are requesting treatment right now.

At Geisinger, we have seen definitely the waxing and waning.

And we continue to try to meet that ever-growing, unmet, and shortage in mental health visits and mental health patients, new patient evaluations, for example.

And that is about to continue.

Especially when we think from mental health and poverty together, a lot needs to be done not just by healthcare systems because definitely we can do the treatment component.

But as evidenced by the videos we have and the conversation today, really there's a social component that has to come in and a health policy component that can help us, whether through grants and ability to grow our programs to start meeting the need in the community.

And definitely collaboration with all stakeholders in any community is a necessity, not just an option.

- Yeah.

It's great news that the stigma has been reduced, but the need has increased and the need for the resources along with it.

Very quickly, Danielle, what have you seen, and I don't know how long that you've been at Keystone, but over the course of the pandemic in terms of homelessness and the guests that you work with every day?

Have you seen an increase?

Where are things now relative to the pandemic?

- We have definitely seen an increase at any one of our innovation centers, be it in Scranton or Wilkes-Barre on any given day.

You sometimes have about 50 people coming in and that's, I would say, by nine or 10:00 a.m. You have 50 people.

And we've seen the numbers increasing for people that come in asking for help for the different services that we offer.

- So the need is great and the need continues.

We'll have to leave it there.

But Dr. Melhem, Janice Mecca, Danielle O. Keith-Alexandre, I wanna thank all of you for being part of tonight's program and for your ongoing work in the area of mental health in Pennsylvania.

For more information, visit wvia.org/mindovermatter.

And remember, you are not alone.

On behalf of WVIA, I'm Tracey Matisak.

Thanks so much for watching - [Announcer] WVIA's Mind Over Matter, A Mental Health Initiative is underwritten by Geisinger.

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