Jessica (“Jessi”) Gold, MD, MS, is an Assistant Professor and the Director of Wellness, Engagement, and Outreach in the Department of Psychiatry at Washington University in Saint Louis School of Medicine. In addition to juggling her role as a professor, she works clinically as an outpatient psychiatrist and focuses her work on the intersection of media, culture, and mental health.
I interviewed Dr. Gold over the phone about the mental health education crisis, especially with the recent implications of the COVID-19 pandemic, ranging in topics from accessibility to breaking the mental health stigma with casual conversations.
The interview has been edited and condensed for length.
Q: It is interesting to see the dynamic between your experience as an outpatient psychiatrist and someone who teaches and mentors students at WashU. Can you tell me a little bit about you and why you decided to pursue psychiatry? What drew you specifically to college mental health?
A: You know, when I was younger, I really liked science and was interested in figuring out what that meant. And when I was in college, I thought pre-medical classes were challenging, and I struggled. I found solace in anthropology classes because they focused more on the intersection of medicine and society.
I took a year off in between and worked at the World Health Organization in Geneva, Switzerland and DC in policy. I was like yeah, it is giving me fundamental knowledge, but I am trying hard to incorporate the interest in the human condition and personal stories. As a doctor, you don’t get too much time to interact with your patients on a deeper level.
Psychiatry was different. You get into their story of the person and all the ways that became incorporated into their illness. I could see hundreds of people with depression with the same diagnosis, but they all have different reasons for what’s going on with them. And all of the things in their lives interact to give you that outcome, and it matters. What’s going on in their brains, their social lives and their environment?
When I was in college, I remember that it was hard for my friends and me. I always felt like I wish someone were like a safe landing for my friends and me.
Like when you try to talk to someone in counseling, and you aren’t sick enough. And I was questioning what that limit meant and how you will get people into a system where they feel safe asking for help. We shouldn’t be saying that to anyone ever.
There’s so much going on in college, and it’s a necessary time where mental illness is concerned, but if you could be that person for someone and you could be that really good first provider for someone, you could make a difference in their whole life and feel safe about mental health. You can make them feel familiar with what it means to have a diagnosis, medication or to ask for help.
Q: In colleges and education in general, there are many barriers and accessibility issues when it comes to mental health care. We see how schools respond to this public health emergency, and mental health is becoming more of a conversation in the frontlines. From your observation, what are some aspects schools are doing well and aspects schools can do better to address mental health issues?
A: Yeah, I mean, it’s so hard. College mental health, for lack of a better word, has been in a crisis for a while now.
The rate of anxiety and depression has been increasing, so the wait times and demands in parallel services have been growing. You can increase college counseling at the centers by infinity and never make that big enough. There is not a perfect model.
And as a psychiatrist, you try to hold as many people as you can on campus and do the best you can to do that.
I started going off-campus, and it can be challenging. It can be scary. But with COVID-19, it only worsened because we were returning to campus. They were processing grief, a new environment, remote learning, social distancing and loneliness between March and now.
The data says in college students, some of the higher rates of depression, anxiety, and suicidal ideation compound what was already a problem. It’s not like in the interim; the college counseling centers can provide care or change it because they didn’t have the resources for the care and services.
I think we need to think about creating models of care where it can be more magnified.
How can you make use of telehealth models and be able to get access to a care provider at home? And how do we get rid of some silly regulations so that people can see their provider even if they are located in a different state? We don’t have to break up the continuity of care. Some of this has to happen, but it’s the rules.
We need to think about how to help people at the prevention stage, instead of the crisis stage, and think about what we as college campuses, in general, can be doing to support the culture on campuses. We should be teaching resilience, warning signs, ways to cope and mental health skills like deep breathing as a course.
There’s also a group of people who transition from high school to college who already have a hard time adjusting or having mental health issues. We need to ensure that they are getting the help they need right away, whether that be medication.
Q: You make great points. What are some things you have been seeing, and how has your school precisely handled mental health care?
A: I know that the undergraduate program is doing a lot of outreach and psychoeducation. Support groups are critically important because you can help many people in a more significant setting, but it’s tough to convince them because they feel like they have to put their soul in front of people they know. But often, the groups are like learning life skills, and it’s like going to class. But when they do it, they like it.
Yeah, and not only are support groups an option, but there is telehealth. It may be more convenient somehow, but it may not be as private as you’d like.
Q: What has been your experience meeting with your clients virtually? What are some benefits you see, and what are some cons as a provider and as a patient on the flip side?
A: By far, the positive thing is that access is magnified. The barriers to driving and the time it gets to get somewhere would be increased. Now, you could open your computer and make a 30-minute appointment. It takes so much stress off to know that you can take less time out of your day to do that.
One of the more challenging things is that it requires a tablet, phone or WiFi. There’s a whole population of people who often can’t access help because they don’t have a phone, WiFi or money to afford it. These barriers are often left out of the conversation, but it shouldn’t be. If you are already worried about paying for a mental health appointment, let alone the rest.
As a provider, it’s harder to understand the nuances of facial expressions and build rapport. It feels like there’s a little bit of a barrier to people because there’s a computer there. I think it’s easier to burn out because you are back to back on the screen.
From both sides, I think if you were in an office, there’s tranquility and a safe space. Now, I see many animals in the background, and some people talk while they are driving in their car. I’ve seen people at work and go to the backroom, conference room, or the cafeteria. It’s convenient in that way, but it’s also hard to find privacy.
Q: What has been your favorite part of interacting with college students or as a psychiatrist? What are some moments that influenced you as a person or in your career? You know, that kind of nod like “This is where I am supposed to be”?
A: I think for me, it’s when people get better.
For many things in medicine, people don’t get better when you are in psychiatry training like the mental health system is pretty sad and frustrating.
You see many people who want to get better, but they don’t because nobody is protecting or supporting them when they fall through the cracks and don’t take their medication.
In college mental health, you see people who get better in school, socially, get their jobs, better interacting with people, making friends and more. They are excited and proud of it, and they write to you about it. They feel comfortable in their identity, like coming out to their family and they couldn’t do that before.
All of those things are subtle, and there isn’t a huge moment. It makes me feel so good when I know I helped someone, and sometimes we don’t always get to do that.
Q: I love that you can find joy in the small and big victories in life. And you touched on this idea of support. What are some ways educators, schools, or even friends can create and increase this casual dialogue about mental health and increase connection, even if that means going virtual?
A: When people think about mental health, they feel like they have to unveil their whole history and trauma. That’s not what it means. It means normalizing feelings, talking about when we’re stressed and not pretending that everything is easy when it isn’t — like school.
It feels silly and doesn’t feel huge, but they are probably the best ways to communicate about mental health. Talking about this out loud and feeling like you’re not alone is the answer.
Try to figure out how to start these conversations at a level that is not a high entry barrier.
Just standing up for yourself like saying that test was horrible, I don’t like being pressured to drink and once you learn being truthful about life is like, that’s when we change these things and don’t feel alone. Normalize the imperfections of everything.
Nobody is doing ok, especially in a pandemic. On top of systematic racism, impending election and so much more…nobody is doing ok. Pretending is just exhausting on this additional layer and a waste of time.
I think it’s important that faculty members or administrations are above the fray on this conversation from a top-down, bottom-up situation. That moment of ‘I’m human, and I’m vulnerable too.’
And if I was a friend trying to think of how we can teach people to communicate, it’s essential to teach people that people can’t read minds. And sometimes our friends can, but like, it can be helpful to tell people within or asking your friends that I noticed that you have been a little angrier. I am just checking in to make sure everything is ok with you. Is there a way I can check in with you and make sure everything is ok? Ask people how they want to talk about these conversations.
Sometimes you might know that your friend had depression, an eating disorder, or anxiety, and people ask you all the time if you are ok and they worry about everything. But people would prefer to be asked what is helpful because you can’t recognize everything on your own.
Part of it might be that you don’t know you are struggling. And I think that it’s important for you to trust your friends to say something is off. You also need to trust that your friends tell you the way you want them to tell you.
Q: People struggle with telling their close loved ones about what they are going through, but how do students reach out to teachers or administrators without making it sound like an excuse?
A: If you’re the kind of teacher that’s open about talking about how you are doing, you need to signal that this is a safe place early in a way that feels genuine to you and that this conversation is a place for that. If they need accommodations, they might have to write or tell you something because they don’t want to screw up their grades.
I think we need to do a better job of educating educators about how to recognize signs, symptoms and how to communicate with people who have mental illness and realize that it is not their fault on both ends. They didn’t get trained at all, but more often than not, they are the first to respond, and we need to support them in that. I’ve heard from teachers that they feel like they don’t know enough about it, and they always have to deal with mental health topics.
A lot of the concept of understanding mental health is getting comfortable talking about what’s wrong.
To learn more about Dr. Gold, check out her website.