Mental Health and a Dose of Compassion

Mental health and substance use, especially among the younger adults (teens and up to age 25), has been a consistent theme of concern and discussion in the healthcare industry as well as mass media over the last few years, particularly during and after the pandemic. But who is to say what the best course of action – preventative as well as during- and post-treatment – would be?

Last month, my youngest had a sports camp over a long weekend at my alma mater in the Bay Area. We decided to make it a family weekend and brought our eldest, who is 15, along for the trip. While waiting for our youngest to finish up at camp, we took BART[1] into San Francisco for some day-trip fun.

On our way back on BART, we were in the same car as a young man who looked like he may have been 20 or 21. He wore clean clothing and shoes, was of average height and weight, and had a small bag of common items like gum and snacks next to his feet.

There was nothing out of the ordinary with this young man, except he was bent over in his seat, in that classic “frozen” position that some of us have witnessed while going to the office or a meeting in a major city like San Francisco.

This scene, however, was new to my teenager, who watched the young man with quiet alarm while I watched for signs of overdose in case we needed to call for help. An older, out-of-town couple behind us scooted further into the walls of the train and quietly debated whether to exit the train early to Uber to their destination.

When I relayed this encounter to friends later, some common reactions I received was “this is why I don’t take my kids to the city,” or “this is why we don’t ride public transportation” or “this is why we moved away from ‘all that.’” While no friendship was lost over the comments (chuckle), I am glad my teenage son saw what he saw. No parental lecture or school presentation would have the same impact as what he witnessed. We had a candid discussion afterward in terms of what fentanyl or opioid use can do to a person, and what he can do if someone he knows needs immediate help.

The question that lived in my mind for weeks after that BART ride, was “what?” What could (realistically) be done to both prevent and treat the cause and abuse of fentanyl, xylazine or similar drugs?

Much has been discussed in academic publications and the broader media about how more than 1 in 5 adults aged 18 or older in the United States has some kind of mental illness[2] as well as the additional social determinants that may lead to drug abuse and related overdose deaths[3], which has increased by 45% from 2020 to 2024[4]. Evidence-based medication assisted treatment programs (MAT) as well as medication for opioid use disorder (MOUD) programs have been implemented by some state and local agencies, employers, and other research centers to various degrees of effectiveness[5]. Policy makers like those at U.S. Department of Health and Human Services have also gotten involved, expanding access to select medications key to MAT and MOUDs like methadone, naltrexone as well as utilization of telehealth to initiate treatment[6]. From a tech-enablement perspective, digital start-ups, established electronic medical records players, and healthcare services providers have solutions specifically targeted for behavioral health and substance use disorders treatment. While these are all steps in the right direction, there needs to be orchestrated coordination to holistically choreograph these different actions together to maximize outcomes, as there is no magic bullet to quick reductions in opioid-related overdose deaths. The questions that remain in my mind are: “Are we doing enough?” and “What if those who need help, don’t want help?” The latter is an especially difficult question to answer.

Recently, a local news station did an investigative report on the opioid abuse situation in San Francisco; the story ended on a positive note - a successful treatment story centered around a man who received drastic, forced intervention due to his dire health situation[7]. While personally I believe that forced treatment may backfire and is unlikely to maximize effectiveness, perhaps that’s what was needed in certain situations such as the one depicted in the news story. Just as abuse and addiction may be caused by a variety of factors, I believe the treatment – especially for the root cause – may also require a combination of near- and long-term approaches from policy makers, care providers, family members as well as the community at large.

Although there is no easy solution, compassion for those in need should be a starting point. As someone who struggled with undiagnosed postpartum depression from medical complications, I found it challenging to explain why compassion is needed in these types of situations to my teen son and others who has never experienced such issues. A more natural and immediate reaction may be to “find the exit” as quickly as possible – like the couple sitting behind us on BART. With my teen, I’m glad I had the the opportunity to discuss this complex social and healthcare issue with him in real time, with compassion and empathy that I hope he will remember later in life.

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Christine is a strategic growth and execution leader who has spent the last 17 years in the broader healthcare industry. This is an article reflecting only her opinions. It was not written with AI, so pardon any imperfections in grammar or style (smile).

#MentalHealth #BehavioralHealth #substanceuse #MAT #MOUD #compassion #healthcare

[1] Bay Area Rapid Transit

[2] Or an estimated 57.8 million adults – source: https://www.nimh.nih.gov/health/statistics/mental-illness

[3] https://www.health.state.mn.us/communities/opioids/prevention/socialdeterminants.html

[4] CDC National Center for Health Statistics data, Provisional count of deaths from drug overdose in the United States, from January 2020’s reported 72,124 to January 2024’s reported 104,551. https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm

[5] https://substanceabusepolicy.biomedcentral.com/articles/10.1186/s13011-021-00424-4

[6] White House press release

[7] https://youtu.be/H-Il9w-hIgg?si=wPFkGOgsFULBTVKB