(gentle music)
- Dr. Yellowlees, thanks
for being with us.
- Good, well, thank you
very much indeed, Pam.
- Our viewers might notice
that we are practicing social distancing.
- That's right.
(Pam laughs)
Six foot apart.
- We're sitting about six feet apart.
Can you help remind people
why this is important?
- Sure, I mean, look the
coronavirus is spread
by person to person contact.
Essentially droplets.
So people cough, and
they sneeze the droplets,
and go on to some
surface, or somebody else,
or onto their own clothes.
Somebody then touches those
droplets with their hands,
pick them up, move to the mouth,
and the nose, and the eyes,
where they can then be essentially put
into the next person's body.
So it's very simple.
Very easy form of
transmission unfortunately.
And that's why social
distancing is so important.
I mean, the aim is actually
to not transmit like that.
- And this six feet is the
safe distance to do so.
- Basically, because it's hard to sneeze
or cough that distance.
- Okay.
As someone who practices psychiatry,
what does this social distancing,
on a societal level mean to you?
- I think it's something that's
very new to a lot of people,
and it's difficult for people.
We're all used to shaking hands.
- [Pam] Yeah.
- You know, the younger
generations in particular
are used to hugging.
And we simply can't do that now.
So we've got to change a lot
of our most basic sort of
core social interactions.
At the same time, apart from
just not touching people,
we need to actually be cleaner.
We need to wash more frequently,
we need to use sanitizers on
surfaces that we're touching
that other people may touch,
and so we've got to be much more careful
about our whole environment.
So it's a big change.
And it's something that people
find hard to sort of keep up.
It's easy enough initially,
but then it's very easy to
start falling into a sort of,
I guess bad ways.
- You're an expert on
wellness, and mental health.
When it comes to the social distancing,
not all social circles are created equal,
not everyone reacts the
same way to the sort of
self-isolation, it's
harder on some people.
What are some of the elements
that might make it harder
for certain people?
- I mean it depends a lot, quite honestly,
on your motivation, and on your knowledge.
One of the key things in
this whole situation is
to get good quality information,
so that you know why
you're acting on something.
Very few people will
change their behavior,
or change their activities if
they don't know why that is.
So it's really crucial that
people get good information
from places like the CDC, the
World Health Organization,
from good quality professional
news organizations,
local and national.
And this is not a time for
getting most of your information
from social media, quite honestly.
- You know, I think that
the social media is creating
a lot of anxiety for people.
- I think that's right,
and I think that one of
the difficulties here is
that people get frightened,
and we know that if you get
frightened, you get anxious.
And actually, a reasonable level
of anxiety is actually good for
people, it makes you change,
it makes you do appropriate things.
But if you're not anxious
enough, or if you're too anxious,
then you tend to behave
in a way that isn't
in your best interests.
And so, you perhaps, for instance,
start going to a grocery and
taking all the toilet rolls.
(both laughing)
- Don't do that!
- No, there's no reason to do that.
(Pam laughing)
- And so, wheel turned, obviously is
that you ignore the whole
thing and you go to bars,
and you sort of socialize
excessively with people.
And you don't practice social distancing.
So, some anxiety is really good for us.
- Okay, but how to you know if you are,
I think what you're describing
as optimally anxious,
how do you know when you're too anxious,
or not anxious enough, and what do you do?
- So I think one of the traps
here is to spend too much time
looking at the news.
We all want to be informed
about what's going on,
but we do not need to be
informed every five minutes.
We do not need to be constantly
looking at our phones.
It's actually very good
to keep in the moment,
and to ignore news for periods of time,
to do other things that are
perhaps more interesting,
go for a walk, you know,
talk to some people.
Have other sort of interactions
that are obviously socially
distance wise safe,
but which should take your
mind off some of these issues
that are going around us at the moment.
- I'd like to know what you're doing,
what your sources of information are,
how often you're checking them,
and how you are keeping your
anxiety at an optimal level?
- Yeah, I think that's
a very fair question,
and you can see I've got my
phone right in front of me.
- Yeah! (laughs)
- The good news is it's off.
And I'm not getting
any messages right now.
So I try and deliberately
keep my phone off,
and not look at it during
meetings, or during other times.
Clearly if I'm seeing a
patient, I'm not looking at it.
So I think that's very important.
I think exercise, and your physical health
is really important.
So I certainly, I walk regularly.
I try and keep myself reasonably fit,
within the bounds of
whatever is appropriate social distancing.
But there's no reason why you
can't go walking, running,
and out and about like that,
as long as you're not
interacting with people.
And so I think, keep physically
fit, do yoga, do exercise.
Meditation is good.
I think, you know, for
instance if you are someone
who gets very anxious,
one app that I actually
use is called CBT-i Coach,
which is an anxiety app
that the VA puts out--
- [Pam] Oh nice.
- For veterans.
And it's intended for veterans
who've got post traumatic stress disorder,
who come back from Iraq or Afghanistan.
But that particular app has a huge number
of really good tools on
it that people can use
to help manage their anxiety.
Almost like having a
therapist in your pocket.
- Nice, can you say the
name of that app once more?
- Sure, it's CBT-i Coach.
- There we have it, CBT-i Coach.
- And it's a free app you
can download from App Store,
it's curtesy of the federal government.
- Nice!
What are your suggestions on
how to exercise the sort
of social distancing,
and in ways that promote
emotional and mental wellness.
Especially for people who, say,
have a lot of social contacts
and feel really isolated,
and just feel sort of out of sorts
to not be in constant touch,
or a person-to-person contact
with their loved ones.
- So I think one thing that
is really helpful to do,
and I actually do this personally,
is to think about who really
are the most important people
in your life, who are your
intimate social contacts,
what's essentially your
supportive social network?
Now most adults literally only have
four or five people like that.
They might have a spouse, you know,
a sibling, a parent, a child,
maybe one or two friends.
But think about these people
who are your intimate friends
who could really help
you if you're in trouble,
and actually deliberately
increase your contact with them.
Not necessarily in person,
but using the phone,
or video conferencing, or
some other communication
that you find relatively appropriate,
and spend more time actually
not just connecting,
but reconnecting with the
really important people.
The reality of life is we actually have
relatively few good friends,
we have a lot of acquaintances.
- Yeah.
- Now, ignoring your
acquaintances for a few weeks
actually isn't gonna do you any harm.
But ignoring your really
true friends is a problem.
So I'd look at that.
- I think that a really
interesting way of putting it.
Because when you look
at one's social circles,
there are multiple circles, right.
There's the large one,
of people that you're just in
touch with every now and then,
maybe do holiday cards,
and then it gets smaller and smaller.
And you're talking
about this inner circle.
- Right!
So really focus on that inner circle.
And, in fact, the silver
lining to this whole episode
may be even in fact, a lot
of people actually improve
their relationships with
these really important people
in their inner circle.
- That's a really nice way to look at it.
And you're right!
That much of it is an opportunity.
- Right, exactly, so it's not all bad.
And I think, you know,
but concentrate on those.
I'll give you an example,
I'm one of four children,
I have two sisters and a
brother, in other countries.
We have a simple WhatsApp
group that we use,
and we're on that
constantly, the four of us.
And we send photographs,
we send clips of kids,
we send whatever we're doing at the time.
We give ourselves a bit of
anxiety and trouble about
who we're supporting in
terms of different games
and things like that.
But we keep in close contact.
And I think, you can actually set up
these little social network
groups, and then you use them.
And you actually may
find that you get to know
your really important people much better.
- That's really nice.
When should people see
a healthcare provider?
At what point does
anxiety become something
that needs attention?
- So I think anxiety is very common
throughout our whole population.
Probably about 5% of the population has
significant amounts of anxiety.
I think if you're getting so anxious
that you are excessively
avoiding a whole lot of things,
for no good reason, is a real sign
that you should go and see someone.
So, in fact, you're really
not going out at all,
and you're social distancing
at home to the level
that you become quite agoraphobic,
and actually can't walk out
and go around the block.
Or if you're getting a
lot of panic attacks,
and have episodes when you hyperventilate,
when you get extremely anxious.
These are signs of more severe anxiety
than I think would be
merited by being involved
just with the coronavirus situation.
- At that point then, one would want to,
say contact a doctor, or see a doctor.
People are being discouraged
from leaving the house, though,
for any sort of non-essential matters.
I mean, this would be essential for many,
but there are options too.
UC Davis Health, for instance,
offers video visits to patients,
is this something that
people could consider
if they feel like they need to talk
to a healthcare provider?
- Absolutely.
I mean, for instance, on the anxiety side,
the department of psychiatry
at UC Davis Health has,
for a long time, offered
video visits to patients,
if they wish.
And it's been a choice.
What we've done literally
in the last week or so,
is ring almost every
single patient we see,
and we're now seeing 95% of all patients
who are coming to our psychiatric
out-patients on video.
- [Pam] Oh wow!
- So we've almost exclusively converted
what was a traditional in-person clinic
for psychiatric treatment
into an online clinic.
Now, a few people are still coming
and there are reasons for that,
there's nothing wrong with that.
- [Pam] Yes.
- What we will eventually I think move to,
and I think, again, this
is another silver lining
in this virus crisis, is we'll
increasingly be seeing people
in a hybrid manner, as physicians.
Not just in psychiatry,
but in all disciplines.
And patients will make the
choice as to whether they come
and see us in person, or electronically.
Using either video, or the
phone, or asynchronous methods,
like going through MyChart
and things like that.
And I think we're going to find
that this virus situation is
actually going to speed up
our move towards using
more electronic means
for consultations in general.
- Your research, and you
know a lot about this,
your research focuses a
great deal on telemedicine,
or using technology to deliver care,
so this must be a really
interesting time for you,
as a scholar, to observe what's going on.
- It's fascinating, and in
fact, it's actually really,
it's almost painful on one level.
I mean, I've spent the
last 20 years trying
to relax regulations
and make things easier
to be able to see patients at home,
and in their home environment on video,
and within a week of the
coronavirus really being taken
seriously by the federal, sort of leaders,
they've relaxed all of the
rules about telemedicine.
And literally today.
And so, now, suddenly there
are essentially no barriers
for any of the payment or
regulatory systems that we have.
They've all been taken
away with this emergency.
And so people are now
going to get used to seeing
their doctor on video.
And doctors gonna get
used to working on video,
so there's no reason why,
when some of these rules
and regulations come back,
as they inevitably will,
why we shouldn't continue on working
in a slightly different way in the future.
And quite honestly, in a way
that is better for patients,
because their healthcare will
be more accessible to them.
- We have found that
our patient satisfaction
with video visits is quite high.
- Right, and I think that's what we found
all over the world.
And so people can see
their primary care docs,
their surgeons, their
physicians in internal medicine,
obviously their psychiatrists,
an awful lot of disciplines,
now taking out telemedicine.
And I think this is going
to be clearly accelerated by
what is a dreadful situation
with the coronavirus.
- So many people are working from home,
including here at UC Davis Health,
how do you suggest people
maintain their wellness
and emotional wellbeing while
they're working from home?
- I think the first thing
is to think about structure.
- [Pam] A routine?
- A routine, absolutely.
I mean, that's one of the reasons
why work is so good for us.
I mean, you know there's
nothing almost more stressful
than just being unemployed
with nothing to do all day.
- [Pam] Indeed.
- So, if you're at
home, develop a routine.
If you're working,
obviously work from home.
Work in the same way as
you would work from work,
with set hours, and set tasks.
If you're not working at home,
then give yourself some tasks,
and get yourself into a routine,
whether it's looking after the children,
whether it's helping with other
people who need caring for,
or else take on some new projects at home.
And do something useful
while you're there.
- I've found myself that
when I am working from home,
the routines are really
important to really sort of,
hone in on working, otherwise
the lines get very blurry,
if you try to do something,
like a home-related task,
and then a work-related task,
and then a home-related task.
Is this one of the reasons
why that sort of structure is
so important to draw boundaries?
- Yes, I think it is.
I mean, you know, again, as
humans we actually do better
if there are boundaries.
I mean, you know, that's not
necessarily a popular view,
but it is true.
And so, if you can set
those boundaries at home,
so give yourself a schedule.
Actually diarize in
what you're going to do,
what tasks you're going to do,
as if you were sitting at work.
- Do you have advice for people
who are starting to find
that they're getting a little
stir crazy in their homes?
Their children are home from school,
you know, to maintain good relations
with the people that your
sharing these four walls with?
- Yeah, I mean it's very hard.
I mean, I think everybody knows exactly
what you're talking about.
- [Pam] Yes.
- There isn't a single magical answer.
I think that's the reality of life.
Sometimes people just have
to try and get some space.
- [Pam] Yeah.
- And that's often the best thing to do.
To just, you know, go into separate rooms,
or somebody go for a walk,
the other person stay at home.
Just try and do your own thing.
It's particularly difficult with children,
especially if the children are anxious,
and are maybe a bit afraid themselves,
because they don't
understand what's going on.
So, again, you know it's
important to give children
reasonable information, but
not enough that it's scary.
- Yeah.
What role does physical activity play?
You mentioned how nice
it is to get outside.
How important is physical
activity to overall wellness,
especially in a stressful time like this?
- Well, we know that
physical health is good
for your mental health.
And there's no question about that.
So, you need to eat well.
One thing people forget about is sleep.
Sleep is really, really important.
Try and get, you know, seven
or eight hours of sleep.
Don't skimp on that.
And, essentially look after yourself
with as good food as you can,
and through trying to
keep reasonably calm,
and through setting the
schedule that we talked about,
that it can include, you
know a walk at lunchtime,
or a walk in the evening.
Something like that.
- For people who are
exercising outside too,
I presume the six feet of
distance still counts, as well.
- Oh absolutely, no,
no, it's very important.
And again, you know, gyms
have essentially been closed,
and that's because people are sweaty
and coughing and sneezing
all over the place.
You know, if you're lucky enough
to have an indoor machine,
then that's fine.
But I think walking is a
perfectly good exercise.
And again, in this situation,
there's no reason why you can't walk.
But again, don't go
touching lots of things.
- Yeah.
- And don't touch the
mailbox all over the place.
Take your wipes with you,
make sure that you're actually clean,
and you're touching clean surfaces.
So, you can walk, but just be careful.
- Okay.
Another one of your areas
of scholarly research is
the wellness and mental health of people
who work in healthcare.
What are healthcare workers
going through right now?
- So, it's a very
difficult situation being
a healthcare worker in this environment,
because the reality of life,
is the reason for all
of the social distancing
is because we don't have
enough intensive care beds,
we don't have enough ventilators,
and we don't have enough
healthcare workers
who may remain fit and healthy,
to be able to look after patients
who will need intensive
care in our hospitals.
- Right, and that's if the spike
that we've all seen on that,
the curve graphic that we've all seen,
if it spikes as high as it could,
which is why we're trying to flatten it.
- Right, and so healthcare
workers actually have to think
of themselves as being
a bit like ventilators.
They've gotta actually think of,
they've gotta keep themselves well.
They've gotta be extra
careful, and extra concerned.
So that they, themselves
don't have to go off,
and be self-quarantined
for currently two weeks.
So, I mean I think for
all healthcare workers,
it's a difficult situation,
because we're used to
looking after everybody,
and a lot of us feel guilty
about the cancellations occurring,
and typically in out-patient clinics.
But in fact, those sorts of cancellations
are actually good for us,
because they give us a bit
of chance of remaining well.
And I think actually carrying on,
and doing our normal work
is probably the best thing
most healthcare providers can do.
- How do you recommend that
people support friends or family
who work in the healthcare industry?
- I think it's like in
any other situation,
a friendly phone call, a
nice email, a nice note.
Just making sure that people know
that they're not forgotten.
It's been fascinating
looking at some of the video
from overseas, in Italy the
doctors have been coming home
and they've had crowds of
people applauding them.
- [Pam] Aww!
- And, I think people are acknowledging
what some healthcare workers are doing,
and how important that job is.
And how courageous many
healthcare workers who are,
particularly in emergency
departments and intensive cares,
are having to be in
this current situation.
- This current situation is really,
sort of raising the gamut
of human emotions, I think.
And to hear you talk
about how important it is
to cut yourself some slack,
and give other people space,
seems to me like it'd be a
really important message too,
to extend some patience to
your fellow human beings.
- I think that's true.
And at the same time
also, be very aware of,
and try and be in the moment.
Try and look around you,
and value what we have.
We're still, you know
the great majority of us
are going to survive fine,
we're gonna get through this,
this is not the end of the world,
and we're going to be okay in the end.
So, as we go through what
is a difficult situation,
let's just also look
at the world around us.
You know, smell, literally
smell the flowers.
Look at the green grass
as you're walking around.
Try and actually think
about some of the beauties
of the world, not just all
the pains and the horrors.
(gentle music)
