excellent well um I must say it's really
different starting a virtual meeting
versus being able to go up to a podium
and start tapping the microphone telling
everybody sit down
it's time to stop your breakfast because
we're all here now so I just want to
welcome everybody to the NASMHPD
Annual 2020 Commissioners Meeting um
this is a really new format for us but
just really really delighted that we can
all be together
as you know this will go for about a
week and a half and we understand that
there are
you as well as uh other members of your
staff will be joining on different days
um i just wanted to first acknowledge
the NASMHPD staff that have been
uh so core to having all this run well
um uh Jeremy McShan, Kathy Parker, Genna
Schofield, Kelle Masten,
uh Anthony Mcrae, and Nili
Ezekiel um just thank you so much
uh couldn't do it without you I am so
proud of this team
and I also want to thank Express Connect
for producing
uh the meeting um just some housekeeping
um
uh several many of us were just in a
commissioner coffee and there was open
dialogue
uh for the rest of the meeting except in
certain portions where it's noted
uh all of the question and answer and
dialogue will actually happen in the
chat
um so just a heads up on that um
and at the end of each day there will be
the opportunity to respond to an
evaluation poll
of of um just evaluating the sessions
it's a
just a quick piece at the end of today
it'll be two questions
um your feedback is really helpful to us
especially given this is new for us
um just remember throughout the meeting
to be muted
and um there was also the opportunity
the
the meeting is closed captioned if you
need closed captioning it's at the bottom
of your screen uh there should be a cc
uh button there um so
we are still getting
um again I'm sorry for the interruption
we're still getting the closed
captioning started so
okay up here if you just um go to
closed caption and show subtitles you
should start seeing it as soon as we get
her
situated okay thank you um
also I do know that the sessions are
going to be recorded
um at the end of the day I'm sorry at
the very
last day of the meeting the closed
sessions um
will not be recorded but all the public
sessions will be recorded
so uh with that uh I also want to thank
our sponsors
um there is the platinum sponsor
who is Netsmart uh thank you so very
much
Netsmart is the largest
technology provider for mental health
and substance use communities
they work with government organizations
in 44 states and the District of Columbia
including over 20 of NASMHPD state
inpatient mental health health hospitals
they are proud to be more than just a
provider of technology but also an
advocate on key federal legislative
and regulatory issues on behalf of their
clients and those they serve
Netsmart is thrilled to help NASMHPD
build a future of integrated whole
person care to optimize the health
outcomes for all
more information can be found by
clicking the link in the chat window
and be sure uh to join their breakout
session
leveraging technology to drive outcomes
and lower cost on Monday July 27th
at 1:15. um also i want to thank the
gold sponsor WellPath Recovery
solutions
silver sponsors Jansen Johnson & Johnson
and SMI Advisor and a supporter
is Mental Health Technology Transfer
Center Network
I'm now going to turn it over to Brian
Hepburn
thank you
thank you Megan thank you in the
NASMHPD team
welcome to the first NASMHPD virtual
conference this is a new adventure for
us
as Megan was mentioning we value our
in-person face-to-face meetings
however that was obviously not an option
here
therefore we're excited to do something
different with the virtual meeting
we started our beyond beds journey four
years ago
this year our focus is on crisis
services
as part of that Beyond Beds series
all of our papers this year are in
crisis services
however as we all know COVID-19 has
taken over our lives
so in addition we have become
increasingly aware
of the lack of equity as a result of
COVID-19.
so we are focusing on crisis services
but also COVID-19 and lack of equity
I have the pleasure of introducing
Valerie Mielke but prior to that I want
to welcome Dr.
Georges Benjamin who I had the pleasure
of working with in Maryland
when he was the Deputy Secretary and
later the Secretary of Health
i'm a loyal supporter of Dr. Benjamin
especially because he hired me
into the position of being a
commissioner it shows he has great
judgment and I want to thank him for
that
so let me now introduce Valerie uh who
will more formally introduce Dr. Benjamin
Valerie is well known to all of you
she's Commissioner of New Jersey,
President of NASMHDP she's a terrific
leader and colleague
and she facilitated the New
Commissioners Meeting yesterday
and the coffee hour just prior to this
meeting
she did a great job when I first heard
we were going to have a virtual coffee
hour
I thought oh no
that will be a disaster because I
thought if I was leading a coffee hour
virtually it would have been a disaster
but I have to say
it was interesting it was engaging
it was a great idea of Megan's and uh
Valerie did a terrific job as
facilitator so
Valerie please go ahead thank you uh
very much Brian and
um first I just I really want to thank
uh NASMHPD
for you know stepping up so quickly and
um
and having the continuing to have this
annual conference
um I know as as not only a
mental health director but even prior to
being a mental health director I always
found these nashville conferences
to be packed full of a lot of helpful
useful information
as well as an opportunity for me to
interact with my colleagues across the
country
um you know who who have
experienced maybe some of the same
challenges that I was um
had come through on the other side and
that I could you know really benefit
from their expertise and from their work
and so um continuing this conference in
this format I just
I really appreciate your leadership in
doing that um
I also want to take the time to
um to read the joint statement
that uh NASMHPD along with the National
Council on Behavioral Health
issued uh June 15th um Brian, I just
really want to sincerely thank you for
your
your leadership and and in working with
the National Council to
put forth this really very powerful
thoughtful you know
statement that really I think as we go
through
our conference I would really encourage
individuals
to to think about the presentations and
the work that we do
uh within the context of
um of the uh
of this of the statement and so um
the the statement reads that as people
throughout the nation
address police brutality and other overt
acts of racism
that we must explicitly acknowledge that
many of the
institutions throughout our country were
founded upon
and continue to perpetuate systemic
racism
that our health care system including
behavioral health
is rife with less obvious but deeply
insidious
examples of these inequities a
differential
access to health care in america
physical health care
and behavioral health care represents a
glaring example of
racism which we have seen on full
display as
COVID-19 spread across our nation
the pandemic has devastated
African-American communities
social determinants of health one's race
and the multitude of factors
that make up where one lives works
plays and prays are deeply impacted by
systemic racism
and should not dictate the quality of
care a person receives
too often in America these factors
unfairly determine one's access to
quality care
we must repair health care in America by
addressing persistent disparities
rooted in systemic racism and we have an
obligation to do so
we have an obligation to break down
barriers to improve health care access
eliminating disparities will improve
individual and community health
this requires ensuring that everyone has
access to the best possible care
because one's physical health or
behavioral health
should not depend on the color of one's
skin
our organizations vow to raise awareness
about health care inequities
and urge our members to do the same by
creating safe spaces for individuals
receiving care
and individuals providing care to give
voice to the experiences
of trauma rooted in systemic racism
challenging our own implicit biases and
committing to developing practices
to approach care through the lens of
cross-cultural
humility and the intentional promotion
and practices of diversity
equity and inclusion by removing
structural inequity in hiring
disciplinary and promotion practices
within our own institutions by opposing
and working to eliminate
pre-existing social and health care
policies
laws and practices that sustain racial
inequity
in our society by implementing policy
and practice changes
that will systematically eradicate
health care disparities
by working with the African American
community and specifically
African American advocacy organizations
to improve
access to quality healthcare in
committed
transparent and quantifiable ways
so we ask that all of you please join us
as we work to improve access to quality
physical and behavioral health care
through ending historical and
contemporary racial inequities
faced by African Americans across our
across our nation this really is our
opportunity
and now is the time
and so with that it is my distinct
pleasure
to introduce to you on
Dr. Georges Benjamin to talk to us about
health equity
and COVID-19 and so Dr.
Georges Benjamin is currently the
Executive Director
of the American Public Health
Association and has led the association
since 2002. he came to APHA
from his position as Secretary of the
Maryland Department of Health and Mental
Hygiene
Dr. Benjamin became Secretary of Health
in Maryland
in April 1999 following four years as
its Deputy Secretary
for Public Health Services as secretary
Dr. Benjamin oversaw the expansion and
improvement
of the state's Medicaid program he is
board certified in internal medicine
and a fellow emeritus of the American
College of Emergency Physicians
and an honorary fellow of the Royal
Society of Public Health
Dr. Benjamin is the author of more than
100
scientific articles and book chapters
in 2008 2014
and 2016 he was named one of the top
25 minority executives in healthcare
by Modern Healthcare Magazine in
addition to being voted
among the 100 most influential people in
health care
from 2007 through 2017
so it's so again it's my distinct
pleasure
to welcome Dr. Benjamin to our conference
um as I kick off and so Dr. Benjamin I'm
going to turn over the microphone to you
so thank you for joining us this morning
hi well thank you very very much for
having me today and
there we go want to share my screen look
I'm really excited about being here
so let's let's talk a little bit about
um
um this this outbreak that we're we're
challenged with today
um let's see
there we go um
so we we know that this is indeed a
pandemic um it obviously that's all over
the world this is a
a current map from a day or so ago from
the Center for Disease, Control, &
Prevention
showing that the novel coronavirus has
been
reported in almost every nation and I
suspect the ones where it's not reported
those are the ones that are in yellow
um there are probably reporting problems
but it truly is a pandemic and those of
us who've been watching this map
actually watched it um
turn blue over the time period in which
it uh
the pandemic has developed um
as of the 19th we had 3.7 million cases
and over 140 000
deaths and as many of you know these
this this is old numbers
um now even though it's two years old we
have over
70 000 um new cases a day and
the amount of deaths continue to grow in
our country tragically
i'd like to say that we really have
three epidemics um we obviously have
this big uh
pandemic which is an infectious disease
but we also have
um what we call an "infodemic" which is a
an epidemic of misinformation and
disinformation which is causing it very
very difficult
to manage the outbreak in many ways we
also have this epidemic of fear
you know fear of the unknown um
then from this information I talked
about a really rapidly moving
communication environment um where what
you say in the morning may not
necessarily be true
in the afternoon and mismanaged by some
policy makers with a loss to trust
and that's a significant problem um
which I'm hoping
that our policymakers will begin to
address in a much more meaningful way
over time
this is um viruses from a family
coronaviruses we know it
because it uh two of its big strains
cause the common cold
um we also know that it can be very
deadly
so MERS uh is a virus that one gets
from camels
the good news is it's very lethal but it
doesn't transmit very well and of course
the first SARS outbreak that we had
several years ago
which was SARS-CoV-1 uh is a virus
that we
had and indeed caused an epidemic
around the world and it uh unfortunately
was not as easily spread
nor was it as lethal and so initially
many of us thought that our existing
containment efforts would contain this
virus that turns out of course not to be
true
um with what is now known as SARS-CoV-2
the disease that causes COVID-19
we notice an RNA virus with a membrane
coat membrane coat means that it
is not well protected uh and is easily
destroyed by a lot of medicines
and it's not a very hearty virus
despite its infectiousness um
and its ability to cause damage
we know that it can live on surfaces you
know we use the word
live but as you know a virus really
isn't alive it's an infectious particle
it's a parasite that
lives off of your cells and and right
now
studies have been done to show how long
it uh
um can exist and conceptually remain
infectious on various surfaces um
anywhere from hours to days the truth of
the matter is is that
while for example it says you can live
on on on plastic for three days
that is very unlikely to happen um
because it's easily
deactivated by a range of things which
is why we tell people
you don't have to worry about your mail
you don't really have to worry about
your groceries
you don't have to worry about your
packages because the virus
unless it's acutely infected and if it
goes to almost any environmental
condition it's rapidly rapidly
deactivating
we know that from an epidemiological
perspective that each person
can infect around two other people um
that's that's the the magical row number
which is the number of people
a disease can infect understand it's
an average
so that may mean um it's can be less
than one
uh in some communities and if you get
someone quote-unquote a super spreader
who can infect many many people 10 15
20 people um it can be more infectious
in some cases
and of course depending on where you are
the environment that you're in
can result in actually more people
getting infected but on
average we like to think of this one as
what each person can infect two other
people
regardless there's much more infections
in influenza
um and frankly less infections than
something like
measles which is extraordinarily
infectious
uh 80 of the cases have generally have
mild symptoms but that 15 to 20 percent
are very very severe and let me point
also
that while the the case fatality rate is
somewhere between one and a half and
three and a half
we really don't have a good sense of the
denominator yet
and you continue to hear about the fact
that we have very young people
that get disease don't get very sick but
we know there's a lot of complications
from this disease it causes
um a range of immunological dysfunction
that's a real problem um strokes and
clots
and immune dysfunction and in young
children a really strange immunologic
function dysfunction that causes
problems in a small number of kids
we don't know quite sure why those kids
get that disease
and others don't and of course though
the community transmission actually
occurs
um both symptomatically
pre-symptomatically and asymptomatically
and the asymptomatic transmission is
somewhere around a quarter to forty
percent
you get this it's close contact to
airborne particles
um aerosolization through airborne and
fomite infection is of
course
you can contaminate your hand
you touch the doorknob you contaminate
the doorknob
and then somebody comes behind you and
touches the doorknob or the desk or some
other contamination
again um simple cleaning with the wipe
um cleans that off
and the fact that that's a not a major
form of transmission
is simply a factor of the fact that
we're not all out and about
as we were before the epidemic started
there's a big debate about what is the
relationship between
particle infection
versus aerosolization aerosolization
right now
is when you get fine particles and you
know anytime you cough, sneeze, talk, sing,
you put out a whole range of particles
different particle sizes
some of them are small enough to suspend
themselves in the air and stay there for
a while
and then if somebody comes along they
can breathe that in
and they can get infected if they get a
big enough infectious dose
the challenge is we don't know what the
representation
of this is a relative amount of each and
of course the studies
that they have done in animals show that
you can get infected by both methods but
of course
that's not as good enough in
understanding that in humans
which argues for the mask no matter what
you do
and we don't have a lot of therapeutic
interventions but i'm going to come back
to that in a moment
but heretofore our largest
way to control this was through
non-pharmacological interventions hand
washing covering up your nose and mouth
when you cough and sneeze
social distancing which we now of course
like to call physical distancing because
we want people to be
physically distant but socially cohesive
uh travel
restrictions and closures of large
events to reduce the number of people
that get exposed
and of course facial coverage um which I
you know work with your mask and it's
important that both
people all of us wear a mask even if
you're infected you're having the mask
on reduces your ability to expose others
and if someone else has a mask on it
reduces their ability to get infected by
you
the goal of course we all I think
everybody in America uh regardless of
their occupation
is now understanding this concept of flattening
the curve
you know the health community made a big
deal about the fact that it was
important to flatten the curve so our
health system
could handle this uh and that's true but
the other part of that equation was to
make sure that our public health system
was geared up to do contact tracing and
testing
while we geared up the health piece of
this we did not do a good job
of gearing up the public health part of
this that really didn't get the
attention that it deserved or the
funding or resources
that they're now pouring into the system
now I often get asked the social
distancing work
we have lots of examples from this
outbreak but if you go back to the 1918
influenza um we're trying to get the
nation to be more like
St. Louis and less like Philadelphia
Philadelphia
had a lot of events closed late opened
early
and had this enormous spike in cases
St. Louis um responded differently they
had a much more
cohesive public health response closed
early
a lot of social distancing wearing a
mask
encouraging people to to um stay away
from one another and then you can see
they had a much different response
um during the 1918 influenza
you know lots of mass obviously the n95
mask is best
but we're now finding out that any kind
of facial covering
um offers some protection
um even the cotton mask that many of us
are now wearing out and about
as you know the early reasons for
telling people not to have a mask for
really two for one
there was a shortage of masks but even
more importantly there was a you know
this lore in the public health community
that you could breathe around the mask
it wasn't as protective as an n95
and in some ways the science got ahead
of the message
um that is the importance of wearing a
mask
and so we didn't encourage people to
wear a mask initially but now that we
know
that asymptomatic spread is so prevalent
wearing the mask
outweighs any concerns that we have
about people
touching the mask pulling the mask down
contaminating their face
I know that when I put my mask on I'm
always picking at it all the time
and I do run the risk of infecting
myself um
through quote unquote fomite
transmission um but
we know that wearing a mask even the
cotton mask does make a big difference
almost a 24 reduction in your risk
and we know that the 19 testing this is
a pcr testing for the virus
um it's we're still having shortages of
testing we're now having
uh real long turnaround times even
though
um you know we do have some rapid tests
that are coming out
and being used we also know that these
have these antibody tests now
which tell you whether you had the virus
in the past so just remind you there are
two types of tests
we test that test for the virus which
most people do to see if you're actually
infected
right now and at risk of spreading the
disease
or in need of medical care or the
antibody test
which tells you that you had the disease
in the past
tragically the antibody test a lot of
them are not as accurate as that we
would like
so one has to be very careful when we
take the antibody test
we know that test has been unequal that
some of these inequities have been
accessed to testing
differences in the quality of tests
really behavioral distance on how one
reviews testing
and a whole range of social determinants
that impact um impact testing
um and and we know that this issue
around contact tracing
um also has been an issue um the ability
to find tests
you know there's a lot of mistrust uh in
people doing contact tracing
um there have been efforts uh to give
people misinformation
they're actually flyers out there that
say you know they were targeting
communities of color that said look you
shouldn't get the test if you get the
test they're going to profile you
they're going to put you on a list
um obviously there's been
confidentiality concerns there always
are
particularly with all these new
technologies uh and you know
if I called you up on the phone and said
hey yesterday you were
exposed to so and so um or if I said you
were exposed to someone
tell me where you are yesterday and I
don't know you
the likelihood of me giving you that
answer is close to zero
um and so that's one of the challenges
is that we do have people
who are very good at getting that
information out of people building trust
on the phone is
very very important as part of our
contract tracing efforts
particularly since a lot of this is
happening on the phone and we're not
going out and banging on doors for a
range of infection
infectious control reasons um we do have
traces and not linked to the existing
public health programs and that's a
problem
um we've had some issues with the
inability to isolate a quarantine you
tell somebody
yep you've got you know you're infected
you need to go home you need to
quarantine yourself from others
or you need to isolate yourself if
you're infected
but you live in a home where you really
can't effectively do that that remains a
problem
in some other nations they've actually
built facilities or sent people the
empty hotel rooms
when they couldn't go home in order to
provide them the opportunity both
effectively isolated quarantine
we know that we still have a problem
with access to health care in our
country we don't have a system
with everyone in and everybody out and
there's a whole range of associate
determinants that
limit our ability to find individuals
you know if you're homeless
it's tough to track you
we do have a growing amount of
therapeutic interventions and i'm proud
to say that
um our clinicians that do this have
gotten much better at providing care for
folks
we've got vaccines in development which
sow some promise
we have a few antiviral agents on the
way some of them are in use from
Remdesivir is one of those
um antibody rich plasma is showing um
good promise
and we're learning a lot about how to
manage the airway
in the days when anybody who was at a
low oxygen level was short of breath got
intubated
we've learned that all kinds of other
techniques around putting them on their
side putting
on their tummy not intubating them right
away
simply giving them supplemental oxygen
has an enormous
improvement in their clinical outcomes
and in fact we avoid
intubating people unless we actually
have to today because
once you intubate people for a variety
of reasons their mortality is higher
and we know we have a bunch of
disparities um clearly
African Americans and Hispanics have
been disproportionately impacted both in
the prevalence of disease and the
clinical outcomes of disease in terms of
hospitalizations and death which remain
the big issue
where you have over 30 percent in some
some places
of people having the disease and yet
they represent for African Americans
only
12 to 13 percent of the population in a
place like
Maine which has less than two percent
of the population where over 30 percent
of their cases are in the communities of
color
that remains a real challenge
and so one of the reasons we know this
we know this because of higher exposure
because of public-facing jobs
higher susceptibility because of chronic
disease disparities
and all the social determinants of
health that ultimately lead both to
higher exposure and the chronic diseases
the inability to have paid sick leave
the fact that you live in a home where
you can't physically distance from one
another
the fact that you have a public-facing
job where you're you're
um you're seeing lots of people in your
community and high you know communities
in which
there are just high percentages of
people that have the disease
um because once disease gets into a
community or gets into a particular
household
um you're most likely to spread this
disease to others
i mentioned this issue about the
infodemic this is a a
flyer from new jersey and it is an
example of a
false flyer and what this flyer tells
people to do
that if you have the disease you should
get on public transportation
you should go to a synagogue you should
go to a low-income community and hang
out
tells you all the things that you should
not do and
let me just point out the fact that it
falsely has
the logo of the CDC and the logo from
the World Health Organization
on this flyer so clearly someone was
doing this
to give misinformation and to affect
hurt people and we're seeing a lot of
that activity coming
um each and every day and we're seeing a
lot more of it on social media
and one of the challenges we have to do
is we have to figure out how we rebuild
trust
uh in our community with all this false
information
um one of us one of the things I've seen
from some of the anti-vaxxers or the
people that are against vaccines
is already reaching out to
African American communities who have a
fundamental distrust
of research and telling them you don't
want to get this vaccine even when
even when it becomes available you don't
want to participate in the vaccine
studies
because they're quote unquote
experimenting on you
remember Tuskegee and so that kind of of
rhetoric
um it is a concern you know I am
concerned about
um um missed you know about problems in
research
and research credibility uh but unless
we have
everyone in this research model we don't
really know what happens
we only do the research on old on older
white males
then we won't know how it impacts
women we won't know how it impacts
younger people at all and we still won't
understand how it impacts
people of color and while we're all 99.9
genetically the same which i'll come
back to
um that point one percent makes a big
difference for
a lot of medical teams
so we don't know a lot we don't know the
true mortality rate we don't know
whether it's seasonal represent
or episodic although it's it's it's
we'll see
we're getting to know a lot more about
it all the ways that it's spread
um its true effects on women and fetus
uh women and fetuses
tend to do okay although we're seeing
more children with the virus that are
at birth and we're not sure whether or
not that is um um
transmission during the birth process um
we the pregnant women we are seeing some
premature births but
um concerns about um um
damage that we've seen on the placenta
post-birth
gives us concern about what the impact
will be on pregnant women
um and we as I've said we know children
have an overall lower mortality
but we don't know whether or not their
role as carriers although we know that
they can transmit it to others
we don't fully know that and we've had
multiple system failures today
you know I mentioned the poor and
confused federal leadership
um the fact that our public health
system has been under-resourced at the
state
federal and local level um some
technical failures early on with testing
which we're quick
were fixed but we didn't fix it fast
enough
and a whole range of things like we've
been working we've been waiting for this
pandemic for many years
uh and yet um we didn't respond when we
should have
um I like to I believe in Tony
Fauci's um statement that the virus
drives a decision when to reopen
our original plan was to close our
society
and then have a measure and phase
data-driven reopening process
um that hasn't happened yet we're
obviously hoping that somewhere this
time next year we'll have a vaccine
um so that we can once and for all stamp
out this disease but we don't know that
for sure
um and again we don't know the real
pattern of this disease but that was the
original plan was to close up
and slowly reopen um safely reopening
requires
reduction of clinical parameters health
system capacity
a robust testing infrastructure with
less than five percent of returns
on positivity um reason we picked that
number is so it used to be 10 percent
it's not down to 5 percent reason we picked that
number is that that
ensures you're not getting clusters of
people that haven't been exposed yet
um and then obviously adequate contact
tracing
and the ability to isolate and
quarantine is essential
but now the US is reopening um we're
opening in a challenging operating
environment where we have quarantined
foresees
politization of our response we're not
managing the trade-offs as we need to
growing public anger and growing
distrust
um and our current outcomes in events by
race expose racism
and systemic roots
we know that race is I said a social
construct uh based on physical
characteristics
the racism is a false belief in the
superiority of one group of people over
another based on race
um my good friend Kamar Jones reminds me
that unfairly disadvantage of some
individuals
it unfairly advantages other individuals
the concept of white privilege
is here um it also saps the strength of
the whole society about wasting human
resources imagine
not having a Charles Drew uh imagine
not having a Karen Johnson
imagine not having a W.E.B. Du Bois
um or a Carter you know um
the fact is that that we need to address
this very very effectively
we have three types of racism structural
racism which is different to actions of
good service and opportunities by race
personally mediated risk racism which is
the kind of racism we all kind of think
about which is prejudiced discrimination based
on assumptions about
one's capabilities motives and intent
and then internalized racism the
acceptance of stigmatization by negative
messages about one's own abilities
and worth um it plays out in this
outbreak in interesting ways
um when we place the original testing
sites
were not necessarily accessible to
everybody um
the need to the fact that we had to have
a gateway provider initially to get
tested in many cases
if you didn't have a doctor you it was very
difficult to get tested
the cost of testing and the cost of care
both are challenging even though the
Feds
theoretically cover the cost of testing
if you go to your doctor
you still may have to pay for the
medical exam um so
it isn't it isn't necessarily free and
we saw we've seen this a lot
when the Feds pick up a cost for a test
but don't cover the comprehensive
intervention that occurs
um you know masking while black which is
a term
because many African American men won't
wear masks because they're concerned
about being profiled we have at least
several examples but the one that caught
my attention because I'm from Illinois
was when two African American men were
escorted out of a
a store in um Illinois
by guard because they were wearing masks
they didn't escort the whites out but
they escorted these African American men
out
and they're just fears of getting the
tests I mentioned the disinformation
um but folks don't want to be profiled
in any way it's concept that this may be
a black disease is a concern
of many people and and just the fact
that we've not really done effective
risk communication or communication to
all communities we're not talking to all
communities in languages
um where the language is not their first
language for example
and then obviously police violence um um
has
hit the national stage um the national
protest in response to that
um um created a big exposure risk you
see this picture we have people wearing
masks and people not wearing masks
well clearly this is not an example of
physical distancing
wearing a mask or um being able to wash
your hands
um and so we have this health risk
paradox we have people making a
risk-based decision
and an ethical decision to protest um
there are many ways balancing the risk
of racism
and the health impact that they're going
to have from the protest to the physical
and health impact of COVID each and
every day when you see police violence
profiling
profiling verbal harassment and you're
afraid to go outside
um that's a disease that you can see if
you're African American
or Hispanic each and every day you can't
see the COVID virus
and so people are really making a
rational to some degree decision
I don't necessarily support that
decision completely because I think
they're putting their life at risk
but that's why people are concerned
they're going out because they believe
that if they can stop this police
violence
then they can also um have a safer
society
so we have concerns about that obviously
tear-gassing, pepper spray
um causing you to pull your mask out
even if you're wearing one you cough you
choke you sneeze
um if you're infected you're likely to
spread the disease
um when police is one of their
containment efforts is to control,
corral and detain people in large in
jails
in large groups that can help spread the
disease
um I wouldn't be a good er doctor if I
didn't point out that rubber bullets and
bean bag round injuries
hurt and kill people they're not
non-lethal as they're as they're
professed to be um and we're now seeing
some disease fights
um uh in the community and of course
that results in the disparate
health outcomes we talk about also note
this picture here
that many of the police are also not
wearing masks and those police officers
are at risk of getting sick from this as
well
that's why we recommend obviously
politicizing this COVID-19 response
demilitarizing the response promoting
non-pharmacology interventions
um at mass physical distance and hand
hygiene I get asked this all the time
what's the solution to maintaining this
disease and handling it
it's wearing a mask, physical distancing,
hand hygiene
ethical access to contact tracing um and
testing
and having culturally competent health
education
each and every day and doing a phase
reopening
based on data that drives these
decisions
for us to resolve this issue each and
every day that's the only way we're
going to solve this problem
until we get a vaccine and then we're
going to have to do all of these things
and add the vaccine to that
so there's some you know obviously
getting testing done we got to do this
with equity in mind that's going to be
very important
using trusted messengers um
it's going to be something very
important to do recognizing that
everybody can't get to the test
making sure that the contact tracing
includes
a mechanism to maintain trust again
using trusted messengers
ensuring the confidentiality of this
information
and ensuring the capacity to isolate and
quarantine which you really still
haven't done
uh as a nation and of course getting
universal access to health care
and then in closing I'd like to I'd like
to point out um
Martin Luther King's quote where he says
nothing in the world is more dangerous
than sincere ignorance and conscientious stupidity
and i think we have far too much of this
today
with that i'll thank you and i'm happy
to take any questions that
people might have
thank you very much and Dr. Benjamin
um that really was a great great
uh pleasant presentation a lot of
information in it
so um
yep so we um so we'll be we're
monitoring the
the group chat to see if there are any
uh questions for
uh for Dr. Benjamin
Valerie while we're
waiting
uh I wonder if Dr. Benjamin could say
something about the opioid epidemic
and what he's seen happen uh during
COVID and also how
he may tie that in with health equity
uh health equity yeah thank you Brian
yeah you know and
one of the things is we just saw a
report from the CDC the other day that
showed us that uh
the opiate epidemic is back you know we
had
have begun to see some reductions um in
um the opioid epidemic and now um
it's back why am I surprised well we
don't we don't have the capacity to
manage multiple epidemics unfortunately in our
country
uh and a lot of us have had to pull our
attention away from from the opioid
epidemic
but then the other thing is we've got
people um
who are frankly um at home
there's a lot of despair um that's going
on
and you know we're not necessarily
providing the services
to behavioral health services that
people need whether it's
mental health or substance misuse
we just have not provided those services
as aggressively as we can
um our our global
effort to address um
on a population basis the mental health
needs of the country
have not yet been met um it's been a
sideshow
in many many ways with many people in
the mental health community
um really struggling to get their voice
heard and getting this issue to the
table
um has has been a real challenge and
I'm working with the coalition that's
that's beginning to try to do this
um but even we have not had the capacity
to fully engage
um with the mental health coalition as
much as we would want
um so yeah both both issues around
mental health substance abuse
we're seeing more violence in the home
um we're seeing
we're hearing about more child abuse
spouse abuse
um obviously
now that we're it's hot uh more gun
violence
we know there's a correlation between
the heat and
um and some of the violence we're seeing
in our communities today
um so yeah we've got a lot of work to do
and that's that's the real challenge we
have
thank you
I don't see another question up there so
is that okay if I ask another question
Valerie
sure sure absolutely
okay um so Dr.
Benjamin
uh one of the areas that we've been
focused on is
how do we decrease police response to
behavioral health crisis
and uh the FCC has recently championed
using
uh or accepted using 988
for crisis calls so we're
trying to move forward uh you
thinking about setting up a 988 culture
as opposed to a 911 culture
so um i'm asking a couple of things one
is your support as we move forward
to try and do this to decrease the
police involvement
but the other is to get your perspective
on what you think would be helpful
to decrease the police involvement
in behavioral health often which is
started with the 911 call
yeah so let me start with going back to
my experience as
an emergency doc and of course having to
run you know oversee
to some degree 911 systems and
we've gone from 911 to 311
for social services um and the failure
when we've had those systems even a
911 system
is the inability to have them staffed 24
hours a day seven days a week adequately
for them to have effective algorithms
that um
that that sort people to the right folks
and then having the right folks to
respond
so I do think there is a concern that I
have that we have too many
um kind of an alphabet of numbers
for people to call I hope that works
but just remember there is another
number
everyone has to have in their head and
but at the end of the day the more
important the issue is who responds to
the call
and so we do need to think first okay
how do we have
safe communities how do we provide the
supports that people need in their
communities
and then we need to figure out how to
send the right person who they work for
may be less of
importance than how they're trained in
what they do
so you know do we need to have our
police officers
as uh traffic
cops directing the traffic on corners
I remember when I was in grammar school
as a patrol boy I wore a little white
belt
and nobody got hit on my corner you know
um in many places I have become an adult
activity because
of the uh traffic uh in our communities
but my point being made is that that you
gotta send the right person
um yeah domestic violence calls can be
really really dangerous
and maybe you do need to have a police
officer go
but that police officer may not be the
right person to go alone
maybe you need to have a behavioral
health specialist with that police
officer
it could be a social worker um who's
properly trained
in in de-escalation activities um
but there are many things that we don't
need a police officer for yu
we absolutely don't need police officers
go for
um calls around graffiti um we don't
need to have police officers go
for to get people for petty petty
activities
uh public nuisance things yeah can those
be dangerous yet you bet they can be
but most of the time they're not we
don't need
police officers in picking up people who
are homeless
we know that people who have mental
illnesses
are not any more dangerous than anyone
else
so the last thing we need to do is be
seeing police officers
on mental health calls at least in my
view so
i think we're sending um however we
construct
the response system that's one thing um
and Brown we should talk about that we
can talk about that offline
um but then the second question is how
do who do we send
and I think that is really the important
question
and as people talk about you know moving
the money around
figuring out how we fund things for
police officers
we do need to demilitarize them that's
for sure
um and that needs to stop um but we also
need to
properly fund the social service
agencies
so they can they can respond in
partnership to our criminal justice
institutes
thank you
thank you Dr. Benjamin we
actually have a couple of questions
um here in our chat box um the first is
from
Doug Thomas in Utah and he's asked what
approaches have you seen
to be most effective to keep the
discussion based on the emerging science
versus the politic politicization uh
that we keep seeing
yeah the way to do is try to stay away
from try to stay away from the politics
and try to say above it
you know my view is
give people the facts
tell them what you know tell them what
you don't know tell them why you know it
um and you will get accused of
politicization you know
um and I've been accused by saying we
don't have the national leadership we
need to do
this um of making a political statement
I'm not making a political statement
that's a fact
we have not had the national leadership
that we need um and in some states we
haven't had the state leadership
and in some some cities we don't have
the state the city leadership
and I call on elected leaders who work
lock step in line with their health
people
um work out their differences behind the
scene um
and then come out and work together
collaboratively um
to do that and don't don't you know get
a plan make the plan
stay on the plan adjust it as you need
to do so
um but but when you make tough decisions
don't duck for cover as soon as those
tough decisions get questioned
um you know if you make the wrong
decision then you should own up to it
very quickly and make the right one
and make a correction but far too often
people know the science but for
political reasons
um they decide that they're going to
make a different decision
and that never turns out well that never
turns out well
yes thank you thank you and we have um
one last question
we'll be able to get to uh this
afternoon
it's from Andy brown in Kansas
so when the surgeon general tried to
call attention to disparities among
minority populations
with COVID-19 he caught a lot of flack
from the VIPOC community members
about how he messaged it is there
something that we can help with
within terms of getting accurate
information
out about disparities while anticipating
the need for cultural sensitivity
especially when adding the lens of
behavioral health to the messaging
yeah he you know especially he used um
some ebonics that folks weren't
comfortable with
I think we need that we
need to stand behind the surgeon general
um and and understand like like
everybody else he's in a tough situation
so when one of the um when one of the
white scientists says something
that is um trying to
walk that fine distance between um
presidential leadership and other
members of the cabinet
who are saying something that isn't
correct and they're walking that fine
line
we say that's okay but when the guy that
looks like me does that
we get we we don't stand behind him
my response is stand behind the brother
he got a really really tough job
and um i remind you this is a guy
who grew up in rural Maryland who has a
brother who has substance abuse
is in jail with a substance misuse issue
um who has a story to tell
and has a good heart as well as he's
being trained in public health
he's also a competent anesthesiologist
so i encourage people to stand behind
him
work with him and if he misspeaks which
by the way he has done on a couple
occasions
um then we should understand that's what
that is
and I get to yell at him privately
some of you may get that opportunity
to when he says something not well but
give it give the brother a little space
um but we have to work collectively we
can't we can't duck for cover every time
um you know when one of us puts us up on
out in front
that's a big stage that's a big stage he
sits on
um and every surgeon general in the
country um has been on that stage
and we've criticized a lot of them over
the years
but in Dr. Adams case we need to find
a way to stand behind him
and support him in what he's trying to do
um and when he's wrong we should call
him out for it
but that doesn't mean we should run from
the brother
thank you uh very much Dr. Benjamin so we
have a couple of more
a couple of more um minutes um
so I have a question um so
in your presentation um you certainly
talked about different
um interventions and preventative
measures and strategies
um you know pertaining to COVID...
pertaining to COVID-19 and
and also within the context of you know
health disparities
are there any strategies that you might
suggest and
um that we might want to consider in
terms of making
access available to uh communities
that otherwise struggle with you know
access to
um to some of those preventive
strategies and measures that you talked
about
so I think one of the strategies of
course is when if anyone's planning
testing
is to um recognize it you know identify
the places where people
um are at highest risk and then find
creative ways to get there so
um you know you folks
have lots of community-based
um behavioral health programs and that
means you're gonna have to go out to
those programs
and do testing um that means you're
gonna have to maybe
set up for those of you who still run
the institutions
of for folks with behavioral health
problems
you're going to have to test your
institutions you're going to come up
with a testing program there
for those who have community-based
programs you're going to need to build a
testing program within your community
community-based programs um for testing
what you need is a van
some swabs the test tube and a place to
to properly store it you know cool it
until they can get to where it needs to
go
um and so you can do mobile testing um
um you can go from group home to group
home if you have to to make sure
that those folks get tested obviously
people with symptoms
you also have to test um and you of
course have to do that in the context
of um you know maintaining um
confidentiality and the rights of your
your
your clients
for those you who run centers for
people with disabilities the same thing
other disabilities other than
than mental mental disabilities um you
have to do that
um i think the other thing for um in
contact tracing
um obviously when you come up with a
positive you're going to have to figure
out how you handle that
you know someone lives in a group home
and that individual becomes positive
um you know that conjugate living
environment is not a place
where that person um can properly
not infect anybody else both the
the mental illness as well as just
living with a family
which is what those groups become right
makes it difficult to do that
on the other hand I know that sometimes
when you move a client from
even if you set up another facility
quote unquote a COVID house
for those folks which I have some
concerns about you want to make sure
those are still small community-based
groups if you do that
if you know moving a person from one
place to another can destabilize their
mental illness
so you're the experts you're going to
have to figure out how you maintain
their mental their mental illness
as well as protect the other people in
that house
and I don't have an answer for you
how to do that
um but you're gonna have to
come up with a best practice I think
as a profession working with you
know good infection control
specialists and do the best you can and
then recognize
that you may have to quarantine the
whole house for 14 days
um and then with good close clinical
monitoring
so if anybody really gets real sick you
can move them to appropriate place
and that also means um that you've got
to be able to move them to a facility
where they can get proper medical care
and the proper
care for their for their um for their
mental health as well
which I can imagine is a probably a
nightmare to find but we need to build
those facilities
you know not build them physically but
we need to construct those programs
right now
look this is not gonna be over we're
gonna be doing this for another year
easily and then if this disease turns
out to be
a seasonal issue and it becomes endemic
we're going to be doing it forever so we
might as well build those programs now
That help you?
It does thank you
and I think on
align with that is some of the things
that we've seen is you know some of the
our programs they share staff from one
home to another
and so when you have a program to
another so when you have
an outbreak they're potentially
spreading
you know COVID if they don't
particularly they don't know they're
positive to other individuals
in other facilities so
Yeah, you need to have an occupational
health program for those folks very
similar
to it and and O don't have an exemplar
in the nursing home community because
the nursing home community really hasn't
done this very well
but but but it's exactly the same
problem for nursing homes and assisted
living facilities right
you have staff that rotate they work for
a company they rotate
they're independent contractors they
rotate um and so people are going to
have to tell you where they were
where their side jobs are and you're
going to have to do that in a way that
they're not afraid to tell you
because sometimes your rules don't let
them do that
and sometimes they won't tell you
because they won't tell you
um and that means you work in a
way that's collaboratively particularly
working with the mental health
associations in your communities
your um developmental disability
associations in their communities
so they can help because you know
they provide guidance to many of
the contractors that do this in Maryland
we had
um very very good
associations that we work
collaboratively with with the health
department
and Brian obviously has
has the experience in doing that and and
can leave that lead that discussion
quite well and I'm sure many of the
other
directors um you know obviously have
that experience as well
great well we've come to the the close
of um
our time here but thank you so very much
for being so generous with your
time and information and responsive to
our questions um
Dr. Benjamin it really has been very
informative and very enlightening
and we appreciate what you do
thank you thank you very much and i'm
glad i could be here
thank you thank you Georges it was great
really appreciate it
that was an excellent presentation by Dr. Benjamin
he's truly a leader in the field and we're
hoping that we can
do more work with him over the next few
years he's terrific
so thank you everyone
