July 17, 2024 • 60 mins
Dr. Benjamin Maxwell, Chief of Child and Adolescent Psychiatry at Rady Children’s Hospital, joins host Grant Oliphant to discuss enhancing youth psychological well-being, challenges to mental and behavioral health, and comprehensive solutions that go beyond the clinic. He shares the importance of early intervention and the vital role the community plays in creating environments that help young people flourish. His collaborations with organizations like Sapien Labs, YMCA of San Diego, and Outdoor Outreach showcase how collective efforts can tackle the root causes of mental health struggles, fostering resilience and thriving communities.
They also examine the impacts of social isolation, screen time and social media, and fragmented family connections on the rise of youth mental health crises. Dr. Maxwell reminds us of our ability to take on huge challenges and offers practical ways parents can address these issues.
This episode offers a profound look at how we can collectively support the resilience and growth of the next generation, ensuring they thrive in an increasingly complex world.
This is a production of the Prebys Foundation.
Hosted by Grant Oliphant
Co-Hosted by Crystal Page
Co-produced by Crystal Page and Adam Greenfield
Engineered by Adam Greenfield
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Grant Oliphant (00:10):
Alright. Welcome back to another episode of Stop
and Talk. Thanks for stoppingby. I'm your host, Grant
Oliphant, and I'm joined by myco host, Crystal Page. Hi,
Crystal.
Crystal Page (00:21):
Hi, Grant.
Grant Oliphant (00:22):
How are you doing today?
Crystal Page (00:23):
Excellent, and I'm looking forward to today's
topic.
Grant Oliphant (00:27):
I love today's topic, and I find it a little
bit daunting. We're gonna betalking about youth mental and
behavioral health with, doctorBenjamin Maxwell from Rady
Children's Hospital, a trainedchild psychiatrist and a person
who has been deeply involvedwith this issue. It's an
(00:48):
extraordinary conversation we'regoing to be having in part
because of the subject matterand in part because of how he
approaches it.
Crystal Page (00:55):
You know, because I hear about this topic every
day in the news, and as a parttime slash foster parent, I, I'm
really interested to hear whatdoctor Maxwell has to say
because kids are up against somuch these days.
Grant Oliphant (01:09):
They are. And and 1 of the things I think you
and I would both want to stressgoing into this conversation,
and I know, doctor Maxwell wouldas well, is how incredibly
resilient young people are, howincredibly creative they are. We
were joking before we went onair about the slang that they
use and how we're desperatelytrying to keep up with the
(01:31):
terminology.
Crystal Page (01:32):
You know, Grant, I would try. I would so try to
keep up with it. I go to urbandictionary.com all the time, but
I don't wanna be very cheugy atall.
Grant Oliphant (01:42):
Cheugy.Okay. Explain.
Crystal Page (01:44):
So according to the TikToks or an Instagram
video of the TikToks, cheugy islike someone who's outdated or
trying to be trendy.
Grant Oliphant (01:51):
Oh, okay. So
Crystal Page (01:52):
let's not be cheugy.
Grant Oliphant (01:53):
Yeah. Alright. I think by definition, we are. We
are. But I, you know, all jokingaside, I think the point is
that, in talking about youngpeople, it's important not to
pathologize everyone in makinggeneralizations.
There is a crisis, there is achallenge, there is a problem,
and we've got an extraordinarygeneration coming up that,
(02:19):
offers a lot of promise. And aswe talk about the challenges,
let's not lose sight of that. Ilove this conversation with Ben.
He is, I should say doctorMaxwell, but I I love this
conversation with Ben, and I sayBen because he's so
approachable, because he's doinghard important work and thinking
about how to help an entirecommunity and society respond to
(02:44):
the challenges that we'refacing.
Crystal Page (02:46):
Can't wait to hear what he has to say.
Grant Oliphant (02:49):
Let's dive in. Doctor Ben Maxwell, thank you
for being here.
Ben Maxwell (02:57):
Thanks for having me.
Grant Oliphant (02:58):
It is really a pleasure. You and I have had the
opportunity to talk a few times,but we're gonna dive into a
conversation today about yourwork in youth mental and
behavioral health, sort of whatthe landscape as you see it, and
what's going on. But let's let'sstart by talking about what
you're loving doing right now.Do you have a project that
(03:20):
you're working on that feelsespecially exciting?
Ben Maxwell (03:22):
Well, I I really think, the project I'm working
on is bringing lots of differentpieces together. You know, I've
been a big picture personreally, throughout my training.
And what we're doing now at RadyChildren's Hospital is really
looking at how do we create asystem of care that works from
newborn babies and new parentsall the way up to 17, 18 year
(03:44):
old kids that are strugglingwith more severe mental illness.
So looking at the health caresystem from that perspective, to
me, is just a really, reallyexciting way of looking at it.
Whereas in the past,potentially, I would look at a
single clinic or a singlepatient.
This is really taking a stepback and trying to understand
how we might serve the communitybetter.
Grant Oliphant (04:04):
I really love that framework of of trying to
look at people in a communitycontext, which seems like
medicine doesn't often do, butthere's tremendous value in
that. Maybe a place to beginbecause this is a subject that
so many people in our world areconcerned about right now is the
(04:29):
the apparent crisis of youthmental and behavioral health.
And I guess the logical firstquestion to ask is, is there a
crisis?
Ben Maxwell (04:40):
It's a great question. You know, I I started
my work as a child psychiatristhere in 2010 here at Rady
Children's Hospital here in SanDiego. Remember walking into my
first shift in an emergency inour emergency department. That
first year where I was workingin our emergency department at
Rady, we saw a 167 kids inpsychiatric emergency show up at
(05:01):
our at our front door. Lastfiscal year, we saw over 47100.
So the, the question of whetherthere's a crisis or not, I think
it's really clear that kids andfamilies are feeling
overwhelmed. I think our healthcare system is feeling
overwhelmed, And that's why Ithink it's it's just so
important that we look at how dowe get kids care early and how
(05:23):
do we create a system of carethat we care for them?
Grant Oliphant (05:27):
And to people who who would argue that that
dynamic is driven by just betterreporting or more awareness or
more acceptance? How do youanswer that? Or does it really
matter?
Ben Maxwell (05:41):
Well, I mean, I think what we're seeing is not
only do we see kids that arereporting these things, but we
see suicide rates go go up.Mhmm. We see kids reporting that
they feel lonely more and more.We see companies struggling to
hire young people that canmanage the stress of the day to
day work. We see people familiesbecoming disintegrated based on
(06:03):
psychological well-being or lackof psychological well-being of
some of those people. So I Ithink it's being seen throughout
society and throughout,throughout the different parts
of the community that that weserve. And so to me, it is,
yeah. I mean, I think there'smore awareness. Mhmm.
There's more willingness forpeople to talk about it, but
(06:24):
that doesn't make it any lessreal that these people are
suffering, and and and we needto find a a better solution.
Grant Oliphant (06:30):
Yeah. Well, III appreciate the clarity of your
response on that, and the thereality is, as you're describing
it, real real young peoplehaving real problems and
significant challenges, and youhave been, in your work, looking
at the environmental andlifestyle contextual roots of
(06:52):
what's happening in our societyto drive these dynamics. I'm
curious what inspired you to dothat work in the first place.
Ben Maxwell (06:59):
Well, I mean, as a clinician, you can only hear the
same thing over and over againso much and not question why.
You know, that that data pointI've mentioned of this really
massive increase in number ofkids presenting to our services,
at some point, we have to say,well, what's driving all that?
Mhmm. What what what's causedthis change?
Grant Oliphant (07:19):
Yeah.
Ben Maxwell (07:20):
And so I've been fortunate enough to partner with
a group called Sapien Labs, anonprofit that's a it's really a
data science organizationlooking at what are the
environmental and psychosocialcontext or underpinnings of
psychological wellness andpsychological suffering. And
that's been just a really richconversation that I've had with
those folks because they haven'tsit they haven't sat in front of
(07:42):
a patient or a family.
Grant Oliphant (07:44):
Right.
Ben Maxwell (07:44):
So they don't have that, awareness or learning that
I've had throughout my career.But I have no idea how to manage
big data or the data analyticsthat they use to to really find
what are some of these rootcauses and what we might be able
to do about them.
Grant Oliphant (07:59):
I I love the fact that you're engaged in that
search for the signal in thenoise to figure out what's
what's going on. You opened bytalking about your excitement
about working in a communitycontext, and I think part of
where this journey has led youis to working with organizations
that 1 would not normallyassociate with a medical
(08:21):
doctor's work, including theYMCA of San Diego and an entity
called Outdoor Outreach here inSan Diego, which works with kids
and helping them become familiarwith nature and the outdoors.
Talk to us about that. Why?
Ben Maxwell (08:35):
Yeah. Again, it's, you know, I feel, on the 1 hand,
the work I can do individuallywith patients is is really
wonderful. To take a step backand try to understand how can I
have a bigger impact, that'ssomething I've always been
interested in. And I remembervery early on in my medical
(08:56):
training, I was lucky enough togo on some international medical
trips trying to help out where Icould on these international
medical trips. And 1 of thefirst places I went, we were in
a rural place in Latin America.
And a lot of the people werecoming in with a diagnosis of
Giardia. And we were doing thegood thing of giving them
metronidazole, which is thetreatment for Giardia. But at
(09:19):
some point, a group of us askedthe question, I wonder why all
these people have Giardia. Andthe reality is they were going
home, taking the pill, anddrinking it with water that had
Giardia in it.
So the taking a step back andunderstanding the cause and then
being able to hopefully haveimpact on that is something
that's driven me ever since.Yeah. And so in this context
(09:42):
where we're seeing more and morekids struggle with psychological
challenges, asking, hey. What'shappening in the community?
What's happening in theirpsychosocial context?
What's happening to their theirhealth behaviors that might be
having some cause of this?Because we know now our brain
and our mind is shaped by ourenvironment.
Grant Oliphant (10:01):
That is a particularly poignant example of
the cure containing thecontaminant. Yeah. Really
interesting. So let's go to thatquestion right now. I was gonna
I was gonna ask you this alittle bit later, but since you
brought up that example, let'sgo to what are the causes of the
crisis that we're experiencingin your opinion?
(10:23):
What are you seeing in youranalysis that helps to explain
the crisis in youth mental andbehavioral health that we're
experiencing and that youdescribed?
Ben Maxwell (10:34):
Yeah. You know, it's it's 1 of the questions
I've been asked a lot and 1 ofthe questions I've dodged a lot
at the end of talks and whatnot.
But I but I think the data iscoming out more and more clear.
So social isolation andloneliness is an epidemic in our
country, and it's even worse forkids. Surgeon general Vivek
Murthy has come out reallystrongly on that, and I think
(10:54):
he's done a great job with thatmessaging. The second, that I
think is really important well,even related to that, just to
take a step back, the nuclearfamily, especially in young
people, more and more data isshowing that kids and families
are becoming disindisintegrated. They're not
they're not connected like theyused to.
(11:15):
Older generations have moreconnection with family, younger
generations have less. So that'san interesting data point that I
didn't really expect, but an anexample of social isolation
outside of even having friendsor community outside of the
home. The the next 1 I'd pointto is, what the role of screens
(11:36):
and social media has done to ourdrive to seek social connection.
So I think a lot of people aresort of looking for that social
connection that they all feelthey need . Through their screen
and not necessarily getting whatthey ultimately need on a deeper
level of that in person socialconnectedness.
(11:56):
The the the screens, I think,also create this domino effect
of if you're on your screen moreand more, And let's face it,
kids are on their phonessomething like 2 thirds to 3
quarters of their waking hoursnow.
Grant Oliphant (12:09):
Let wait a minute. I have to stop you. 2
thirds to 3 quarters. They're ontheir phones.
Ben Maxwell (12:14):
Not necessarily phones, but phones, computers,
TV. Screens are taking up abigger and bigger percentage of
all of our lives, and I thinkyou can see that just walking
around town. Yeah. But kids, Ithink, are bearing the brunt of
that even more, and young peopleas well. So those under 30 have
higher higher time that they'respending on on screens.
(12:37):
So, you know, that's a realityof the modern world we're living
in. What do we what are we gonnado about that as a question of
how do you grow up in the modernworld with these things present
and still be able to maintainyour psychological well-being?
That's a question that I'mreally on a journey to find.
What are some answers for? Howdo we inspire people to change
their attitudes and behaviors inthat way?
(12:58):
But if you're on your phone thatmuch, what also happens to your
sleep? And we know kids aresleeping less, and the quality
of their sleep is less now thanit was in the past. Mhmm. So
there's sleep, socialconnectedness, the the being
present in this unregulatedworld of the Internet that
exists on social media and otherplaces. So I think all these
(13:20):
things are sort of boiling thefrog, so to speak, of, like it's
just slowly changed over time.
When you look at it now, youlook around and you think, oh,
that's just the way the worldis, but it's having real
implications. And I think we'regetting to a point where we've
really got to think about whatdirection do we want the world
to go in.
Grant Oliphant (13:38):
I I appreciated your, thank you for that answer
and I think it is a terrificsurvey of the causes. I also
appreciated the confession withwhich you began, which is that
this is a question you used toduck. Yeah. And I know some
aspects of this answer arecontroversial, you know the
(14:00):
sociologist Jonathan Haidt hasdone a lot of work in terms of
the impact of screens on youngpeople.
Demographers like Jean Twengehave been looking at this issue
of the correlation betweensocial harms for youth and or
(14:20):
negative social outcomes foryouth and the rise of social
media. The intellectualconnections that you just made
make perfect sense. You know,Vivek Murthy, the surgeon
general, is talking about thecrisis of isolation in America.
Of course, young people wouldsuffer it more. Why is it
controversial to talk aboutthat?
Ben Maxwell (14:42):
You know, it's a great question. You know, I I
hear a lot of, people say, well,there's pros and cons to this,
that, or the other. And I thinkthere are pros and cons to this,
but there's, you could say,there's pros and cons to driving
without your seat belt on orpros and cons to smoking
cigarettes.
Grant Oliphant (14:58):
Mhmm.
Ben Maxwell (14:58):
It's not the way we typically frame it. So I think
on balance, a lot of thesethings are, clearly,
problematic. Mhmm. This questionof how do you contain some of
that, what do we do about it?You bring up Jonathan Haidt, and
some of his recommendations fromhis recent book seem pretty
(15:19):
reasonable.
The idea of kids not havingsmartphones at school, kids not
having smartphones until 16, orwaiting for social media until
these later ages seems prettyreasonable. We're we're not in a
world where anybody's doing anyof that. And so I think the
(15:39):
question of how do wecommunicate this in a different
way to inspire people to change,and maybe it's just flipping
what's the priority. How couldwe, you know, people could still
be on social media or otherother technologies, but maybe
the priority is in person socialconnectedness within their
(16:00):
community, within their schools,within their neighborhoods.
That's always been the thingthat's helped humanity deal with
challenges and deal withstruggle.
And so to me, that's it's almostthis generational challenge that
we face. How do we get youngpeople to be psychologically
(16:20):
strong, thriving, able to dealwith the sort of stresses of the
modern world so that we can dealwith some of these other major
issues that we face as a humansociety. Climate change,
democracy, you know, all thesechallenges that we face, we
can't do any of it unlessthere's young people that are
able and willing to be a part ofthat struggle.
Grant Oliphant (16:41):
You, it gave me goosebumps when you just said
that part of the reason we'renot talking about this is that
we're not in a world where we'renot living in a world where,
people are doing any of thosethings that would respond to the
crisis you're describing, whichis pretty scary. Say a little
bit more about thedisintegration of the family
(17:03):
that you're seeing. You said youwere surprised by that result.
Ben Maxwell (17:07):
Yeah. That's a data point from, Sapien Labs, the
group that I've, collaboratedwith over the past couple of
years. And they found thisglobally that if you ask people,
do you have 0 contact with anyof your immediate family? More
and more people in younger andyounger generations are saying
yes to that question.
Grant Oliphant (17:28):
zero contact.
Ben Maxwell (17:29):
0 contact. So, you know, there's there's that's a
real struggle. You know, I thinkthe 0 contact is 1 thing. Think
the United States, we findourselves in this
individualistic society wherethere's a lot of geographic
mobility, which can have greatimpact on economics or job
prospects or individual growth.
(17:51):
A lot of people also findthemselves in as a young person
in new cities on their own,struggling to make new friends
and finding a place that theycan find that community and
connection, which is 1 of thereasons what what you are doing
with this podcast is just soincredible because you're
telling that story and showingpeople the different ways in.
Grant Oliphant (18:13):
Well, I you know, I think we believe, that
community is the antidote to alot of the problems we face.
Community is sometimes also thechallenge Yeah. By the way. But
I very much appreciate youridentifying community as a way
in which we can rally around,young people. Let's go back to
(18:35):
the basics for a moment.
When we describe this, is this amental health challenge or a
behavioral health challenge?What's the best way to talk
about it?
Ben Maxwell (18:44):
I I think the they can be used interchangeably,
personally. I mean, mentalhealth challenge, challenge of
behavioral health. I thinkthere's I think all of those
work.
Grant Oliphant (18:56):
Yeah. And when, when you think about the
dynamics that you justdescribed, it's a pretty big
universal picture, you know,you're describing problems with
the nature of the family. We'vecreated a society. I just got
back from the TED conferenceand, you know it's a it's in in
(19:18):
many ways, TED is a celebrationof technology and its
implications for society.
There's also a lot of soulsearching about the impact of of
technology on society, butyou've just described a world in
which our kids are spending upto 3 quarters of their waking
hours on screens, they'reexperiencing little to no
(19:42):
contact with their familymembers, they're, as a result
suffering from a loss of sleep.It can feel like an overwhelming
set of challenges. Here you are,a doctor, at Rady Children's
Hospital in San Diego. Greatinstitution, by the way.
Ben Maxwell (20:04):
Yep.
Grant Oliphant (20:05):
And you're 1 guy. Yeah. And and you have
counterparts all over thecountry who are struggling with
the same sort of things, butthey're up against these mammoth
social forces. How do you beginto find hope and to convey hope
to parents as they're navigatingthis world. You know, we're
(20:26):
we're talking to an audience ofpeople who care about these
issues.
What are the sources ofinspiration for them?
Ben Maxwell (20:32):
Yeah. I mean, 1 of the things that is inspiration
is looking to our history. Youknow, at what point in our
history were we not up againstinsurmountable odds? We've
always been up againstinsurmountable odds as humans.
And, you know, in that, I cansee, you know, I recently had a
chance to meet Jim Kim, the theformer president of the World
(20:53):
Bank, and he was involved withPartners In Health Yeah.
When the HIV AIDS crisis waskilling millions of people
around the world and people weresaying, well, it's it's it's not
economically possible to getthem medications or, you know,
we we just don't have aninfrastructure to do it. And
they were part of a movement tosay, that's not good enough. We
(21:13):
have a cure for this. Why don'twe go and and and get people
that those those treatments thatcan that can really help? And so
they they were able to, youknow, effectively put an end to
the AIDS crisis.
There's still obviously peopleliving with HIV and AIDS, and
there's still a lot of work tobe done in that space.
Grant Oliphant (21:31):
It's a great example.
Ben Maxwell (21:32):
But they were able to make progress there. And so
finding things like that where,hey, we're up against all these
odds, but we don't need a newpiece of technology or a new,
research breakthrough to figureout how to move forward. We we
know what's happening with kids.We know that in our past, kids
(21:52):
have been psychologicallythriving and flourishing for the
for the main part. We can getback to that.
And I do believe community is 1of the answers to to get us
there.
Grant Oliphant (22:05):
For parents who are listening, I you know, 1 of
the things I read recently thatsurprised me was that how how
significant a percentage ofparents have kind of just
resigned themselves to this soctechnological social media world
in which their kids are growingup. It's easier or necessary for
(22:26):
them in their view to let theirkids engage with screen time so
that they're preoccupied. Itjust feels like it's woven into
the culture, and they just haveto let their kids swim in it.
And I know that's not universal.That's that's not even the
majority of parents.
But for a lot of parents, that'show they're perceiving it. When
(22:51):
you talk to the adults in theroom when you're working with
young people, what is yourmessage to them about what they
can proactively and positivelydo to help young people?
Ben Maxwell (23:01):
Yeah. I mean, I think the proactive approach
isn't saying, hey, no phone. Ithink it's cultivating
alternatives that people reallyfeel good about. So we're not
asking people to do things thatare boring or painful. It's
things that are actually fun.
Hey. What does the kid want tobe involved with? Is it, you
(23:23):
know, horseback riding, squirrelcatching on the weekend, going
to the local park,skateboarding? There are things
that most kids really enjoybeing involved with and really
trying to support kids so thatthey can find community with
that activity.
I think that's a easier approachthan, hey, no more phone. You
reached your phone time limitfor the day, and the kids left
(23:46):
thinking, well, what am I gonnado? Stare at the wall the rest
of the day? So I think reallythat cultivation of the
alternative is really important.
Grant Oliphant (23:53):
You know, I'm I'm going to compliment by
myself by saying you and I aregenerally in the same age
cohort. We're not, but you'reyoung.
Ben Maxwell (24:03):
You fooled me.
Grant Oliphant (24:03):
You're you're younger, but, but around, you
know, sometime between when mykids grew up and when you grew
up, society shifted from whatJonathan Haidt calls a play
based childhood to a tech basedchildhood, and part of the
thinking there was not only wasthe technology available, and
(24:26):
new, and snazzy, andinteresting, and captivating,
but parents were afraid aboutletting their kids go out and
play. When I grew up, you know,you would go out in the morning,
and, you know, the legend wouldhave it that you wouldn't come
home until the end of the day.It was kinda like that. Yeah. We
don't do that today, for goodreason.
(24:47):
The world's a big, scary,complicated place. There was the
whole fear of stranger danger,that rose up in the nineties,
and parents today would beloathed to do that even to the
point where they're afraid ofbeing sued if they let their or
or prosecuted if they let theirkids go out and play on their
own. You're describing a set ofalternatives, playing in the
(25:12):
outdoors, participating inexperiences in nature, you know,
I assume art comes into playhere too. That feels like a
wonderful hearkening back to atime that was. How do we get
back to that?
As you think about this, and andhow community can be the
(25:33):
antidote to some of what we'reexperiencing. How does community
play a role in that?
Ben Maxwell (25:38):
Yeah. You know, I think each individual has a role
to play. We can't do this alone,and that's a lot of the times
the feedback I get from parentsis, well, I'd love to do that,
but nobody else is doing thatthing. So how how do we create
some sort of conversation aroundthis topic so that people can do
it in communities? Now Iregularly as a child
(26:00):
psychiatrist, and I have a 6year old daughter, many of the
the parents of the kids in theschool will talk to me about,
hey.
Do you think I should get my kida phone? Or what do you think
about this, that, or the otherthing? And most of them have the
same feeling that I have thatkids really thrive when they
have an opportunity to fail,opportunity to fall down, get
(26:22):
back up again, learnindependence, learn resilience,
do it in in the absence of anadult saying, oh, be careful
with that. Be careful with this.But also the adults have, as you
point out, this fear about the,you know, exposing their kid to
all the big bad world that's outthere.
There, I think, is a a middleground there, and that's why
(26:43):
places like Outdoor Outreach orthe YMCA, the things that
they're allowing for is peopleto come together in a safe
space, have community, beinvolved in new activities,
learn, grow your self esteembecause of mastery of new
skills. Those are things thatkids really, really can thrive
with, and there's a number ofavenues by which kids and
(27:04):
families can do that. I do thinkit's possible. So, yeah, there's
a lot of things that feel likeinsurmountable obstacles, but I
think we can do it if we reallyput our put our effort to it.
Just just 1 anecdote on that.Whereas, I was recently in the
Basque Country in Spainreconnecting with a pediatrician
I lived with when I was inmedical school. He had been the
(27:27):
pediatrician of this town for 41years. And while I was there, he
was talking about this idea ofsaving the Basque language.
Grant Oliphant (27:35):
Mhmm.
Ben Maxwell (27:36):
So the Basque language for a long time was
oppressed and go to jail if youspoke it. And now the young
people speak Basque better thanthe old people. They valued it.
They put effort towards it, andthey've been able to teach all
the kids through this schoolsystem that they've set up. So I
think just because we're on thisfeels like this cusp of losing
(27:58):
some of the things that we allharken back to and think, oh,
these are great things.
If we value it and we put efforttowards it as a community, I do
think we can preserve some ofthose things.
Grant Oliphant (28:09):
I really appreciate that message. I think
it is incredibly powerful. Andactually there's a through line
between your story about theBasque Country and your story
about AIDS, because in bothcases, both could feel like lost
causes, and in both cases, wefigured out a way past society,
(28:30):
community figured out a way pastthat. You have talked about the
importance of moving past thecrisis conversation that we're
having today to a message thatis more inspiring. Yeah.
So is that your example of it?Is that is that is that the more
hopeful message that we can dothis by, reacquainting our young
(28:55):
people with the value of beingout in nature, or the value of
expressing themselves throughart, or the value of community?
Or let me not put words in yourmouth.
Ben Maxwell (29:06):
No. I mean, III think it's it's it's all of
that. In the health care space,there are solutions to kids that
are struggling withpsychological suffering.
Depression, anxiety,schizophrenia, all these things
have good treatments. A problemis most people don't get access
to those treatments.
(29:27):
So there's hope in the idea thathumans can come together and
figure out a way to provide highquality access to care. And and
we're doing that at RadyChildren's Hospital. We're doing
that here in San Diego County.It's not sufficient to stop
there in my estimation. I'd liketo be living in a world where
mainly people arepsychologically thriving, and
(29:49):
they're part of a community andthey're feeling connected.
And so there are, again, ways bywhich we can do those things. I
think that's the theconversation that needs to
happen as opposed to the soundbite that gets quoted for me is
how many new kids have come toour emergency room and
psychiatric crisis in creatingthis doom and gloom about this
(30:11):
topic. We're in a tough spot,and we can get out of it with
the current knowledge that wehave, but it it does take more
than me as youpoint out. I mean it's going to take a community working on it.
Grant Oliphant: Yeah but it takes a few people like you who are on (30:29):
undefined
the ground seeing the challengeand able to see the bigger
picture at the same time. Imean, the classic formulation
that I heard even when I arrivedin San Diego, 2 years ago was
that this crisis was reallyprimarily a crisis of the lack
of availability of treatment,and that somehow we just needed
(30:50):
to figure out how to treat morekids, which meant provide more
treatment professionals. Andthen and then some people
started doing the math andrealized it was not possible
actually to hire enough peopleto do all of that treatment.
That has to be a humblingexperience for somebody who is a
clinician and who, you know, youjust said, we we we know the
(31:16):
treatments to apply with with,kids who have very specific
needs. You have laid out for usA-A view of of a way for
society, broadly, to get out ofthe thicket of our apparent
paralysis over the youth mentalhealth crisis.
(31:40):
That's a longer term solution insome ways. In the near term,
there are young people in crisisWho need help and need to talk
to someone, and there aren'tenough someone's for them to
talk to, and you're experiencingthat in the statistics that you
shared. So how do you balancethat long term and near term, I
(32:01):
guess, is what I'm reallydriving at?
Ben Maxwell (32:03):
Yeah. I mean, I I think the the balance is it's
it's a tough one to have. I Ithink the idea, though, when you
see a newspaper article sayingthat the thing we need to figure
out is the number of inpatientpsychiatric beds per capita and
make sure that that's the rightnumber so that all people with
that need can can get care. Ithink that's just insufficient.
(32:25):
I don't wanna be living in asociety where we wait till
people need inpatientpsychiatric care before we do
something about it.
What I'm interested in is how dowe find a way to, at every step
of the way, create an off rampso that people have a place to
go towards psychologicalwell-being. That includes new
parents. Now I was a new parentnot that long ago. You think I'd
(32:46):
know what I was doing when Itook the baby home. I didn't
know what to do.
We we needed support. And so tofind support early on, help get
people off on the right path. Ifpeople fall off that path, have
something in place that they canget back on. And that is places
like, community centers,schools, families, neighborhoods
(33:08):
even just coming together. Youknow, when you have the choice
when you drive home tonight ofwhether you wanna wave at the
person walk the dog or blow byhim at 35 miles an hour on your
neighborhood street.
You know, I think there's thingsthat we can all do that
ultimately help the kids. Ittrickles down to their
psychological well-being. Ifthey can be enveloped in a
(33:28):
community that has that sort ofrichness, people start to trust
each other and have each other'sback.
Grant Oliphant (33:34):
Ben, how do you model psychological well-being
to your kids?
Ben Maxwell (33:40):
How do I model that? You know, I think I talk
to my daughter about what I'mtrying to do when I go to work
is make the world a better placeand help kids and families. And
that that fills me with, joy andcompassion that I think
(34:05):
ultimately leads leads me to myown psychological well-being. I
demonstrate the importance of,for me, exercise and being out
in nature and eating healthy. Weinvite people over, so we have
barbecues and communityregularly.
So my daughter can feel lost inthe buzz of sort of lots of
people being around, especiallyas an only child. We feel that's
(34:26):
important. So it's all thethings, you know, social
connection, connection tofamily, exercise, nature, eating
healthy, all these things that,you know, if I got out, and
said, hey. These are the thingsthat you need to do to be
psychologically well. Mostpeople aren't gonna be surprised
by those ideas.
Grant Oliphant (34:45):
Right.
Ben Maxwell (34:45):
But it's how do you do it? And so I try to
demonstrate to my daughter howdo we do it, but I also try to
live that for other people tosee as well and and hopefully
make an impact on on how theysee they might be able to do it.
Grant Oliphant (34:59):
Now as I listen to you describe that, it's kind
of a it's a beautiful list forany parent out there who is
struggling with how do I do thisin my own child's life, some
simple steps that you justdescribed.
Ben Maxwell (35:13):
Simple steps, and and we've got to acknowledge as
well that there there are peoplethat are overwhelmed with 2
parents working 2 jobs, and noteverybody can do that. And so
how do we create something thatis it takes a village to raise a
child and have something inplace so that other kids can do
that when their parents mightnot be around?
Grant Oliphant (35:34):
So let's talk about that for a moment. The
because what you just pointed tois disparities in youth mental
health, and they are real. Youknow, we we know that LGBTQ
youth experience youth mentalhealth issues at a rate, that is
very high because of thechallenges that they face. What
(35:56):
disparities do you see in in thechallenges that young people are
facing?
Ben Maxwell (36:02):
Yeah. I mean, early on, I think in our conversation,
I mentioned the idea that ourenvironment shapes our brain and
our mind. And so if you'regrowing up in an environment
with a lot of toxic stress,poverty, access to food is
unstable, these sorts of thingshave real impact on the kids
that we see at Rady Children'sHospital. And so, you know, if a
(36:24):
kid comes in and says, hey. Youknow, I don't have any friends
at school.
My parents work 2 jobs. Myclosest friend is some person I
met online that lives inTennessee, and we've never met
in person. And, you know, Idon't really feel all that good
about my life, and I'm wonderingwhat I should do next. In many
ways, that feels like thenatural, outcome of that
(36:46):
environment. So is it a medicalproblem, or is it an
environmental problem?
And I think we have to startthinking about those social
determinants of health in a morecomprehensive way than just,
hey, there's a health caresystem, and within the 4 walls
of the health care system, we'regonna stay there. That's the
conversation I wanna be a partof is how how do we help the
(37:07):
community in a way that can helppeople that are in that
position? And you were sayingearlier, doctors aren't usually
involved with YMCA and outdooroutreach and all these other
things. That's the reason I'minvolved with those is I think
it can have an impact.
Grant Oliphant (37:20):
Well, and I I it makes a it makes a beautiful
statement about the type ofsociety I think we need to
rebuild. I imagine it's also alittle controversial within the
halls of the medicalestablishment. So your rewards
are probably to do the clinicalwork that you were trained to
(37:42):
do. Yeah. What happens to a guylike you when you step out and
start talking about, hey.
We should partner with the y onthese on these things, and we
should think about communitysolutions to some of these
problems. How is that received?
Ben Maxwell (37:56):
I mean, I I think I've just been really fortunate
to be at Rady Children'sHospital where we are the only
children's hospital in SanDiego, and and they really have
stated, hey. We have acommitment to this community to
build and do what's importantfor kids and families. And so I
was worried about that, and I'llI'll tell you that quite
frankly. I was worried aboutsaying these things early on,
(38:18):
and then, fortunately, I broughta few of these things up with
leadership, and they said, hey.That sounds great.
We don't know how that fits intowhat we're doing, but keep doing
it and we'll figure it out.
Grant Oliphant (38:29):
That's remarkable, actually.
Ben Maxwell (38:30):
Remarkable. Yeah. So not only the senior
leadership of the hospital, butalso in meeting board members of
the hospital and worrying aboutwhat they might think, and them
also being totally committed tothe idea that Rady Children's
Hospital and its employees arehere to protect childhood, to
figure out a way to helpfamilies. And there isn't some,
(38:52):
hey. You know, we we need to getyou back in the clinic and just
generate clinical revenue forus.
Grant Oliphant (38:57):
How about more broadly? So it's great that
Rady's has had that reaction toyou. How is your position
received when you speak withcolleagues nationally about it?
Ben Maxwell (39:08):
I I think a lot of my colleagues nationally have a
more zoomed in look at what arethey gonna do in their clinic,
what are they gonna do withtheir program. And I think
that's where I'm just trying tosort of create my own lane of I
think there's somebody needs tobe in this position. Somebody
needs to be saying, hey. This iswhat we're seeing on the
clinical side of things. How howcan I act as an intermediary to
(39:31):
other parts of the community soso we can connect the dots and
really try to create a cohesiveenvironment for kids to grow up
and develop well?
Grant Oliphant (39:41):
I'm I'm I still struggle with the idea, I wanna
come back to something you saidearlier. I still struggle, or or
maybe I'm just, it it feels sobad, that there are kids who
feel that they get 0 contactwith their family. And yet, when
we were talking aboutdisparities, you sort of
(40:04):
perfectly describedcircumstances in which that
happens naturally. Right? Youknow?
You have a parent who's workingall the time, so you never see
them because they're trying tokeep bread on the table. You
know, other life circumstancesinterfere. Health issues may
interfere. So a young person cancome to feel disconnected. And
(40:28):
and you're also saying, on avery positive note, that there's
a way of dealing with this,which is for community to re
embrace its role and to connectkids with community more
broadly.
Here's the question I'mwondering about, which is why
should society care? I, youknow, I think I think we both
(40:52):
know the answer, but I don'tthink the answer is a given in
our culture. So when you'retalking with folks who maybe
don't understand that it's theirresponsibility, what happens
with quote, unquote otherpeople's kids, Why is why is
this a community responsibilityand not just opportunity?
Ben Maxwell (41:14):
Yeah. You know, 1 of the things they taught me in
med school was kids becomeadults. I don't know if you know
that.
Grant Oliphant (41:20):
Yeah. Oh, that thing.
Ben Maxwell (41:21):
Yeah. Yeah. So, you know, we're talking about 15
year old kids a lot of times.
Grant Oliphant (41:25):
Right.
Ben Maxwell (41:25):
They're adults in 3 years. Who are the
Grant Oliphant (41:28):
Yeah. That's such a good reminder.
Ben Maxwell (41:30):
Who who are the people that are staffing,
maintaining the electrical grid,flying the planes, taking care
of, our our parents in inhospitals? Who's gonna care for
us? So, ultimately, this iscritical to society that we are
able to have kids go throughchildhood and become functional
(41:56):
adults that can deal with thestresses that come with the
modern world. And that's achallenge that we're seeing
right now. So you look you lookat there's a recent survey, 18
to 24 year old Californians.
I think it was a year or 2 ago.2, 3000 Californians, young
Californians, were asked lots ofdifferent questions. 1 of the
questions they were asked was,have you thought about ending
(42:16):
your life in the past 12 months?31% said yes. So this data that
a lot of times is thrown outthere of 1 in 5 people struggle
with psychiatric illness,something like that, that data
is old and it's no longerrelevant to what's happening
with young people. If we'reliving in a world where 18 to 20
(42:37):
18 to 24 year olds, a third ofthem are thinking about killing
themselves every year, we'redoing something wrong. Mhmm. And
we have to find a new wayforward or has implications on
all aspects of society.
Grant Oliphant (42:51):
It's almost impossible to know where to go
from there because it's such asobering fact, And you're
drawing the through line fromthat a statistic like that to
the world that will be here in 3years, for everyone, is an
important way for the rest ofsociety to look at this. I
(43:13):
deeply appreciate the connectionyou're drawing between these
dynamics and the opportunitythat exists by reconnecting
young people with experiences ofnature, with self discovery. I I
believe profoundly important isthe opportunity for self
expression through creativityand art. Yeah. Your your work on
(43:37):
this, by the way, has affectedthe work that we're doing in
thinking about how we help youngpeople.
And it is a promising storylinethat begins to counter what the
surgeon general has talked aboutwith the epidemic of loneliness
and what Jonathan Haidt andothers are talking about with
screen time and so forth. Iwanna honor the fact that part
(44:01):
of the way you come to your ownmental health is through
surfing, which is which feels tome not like a community act, but
a solitary act. And solitude, bythe way, is also an important
feeder of mental health. But I'mcurious if you have gained any
lessons from being out on thewaves that have informed the
(44:23):
work that you're doing as achild psychiatrist dealing with
these exceptionally challenging,sobering, some frankly,
depressing Situations sometimes.
Ben Maxwell (44:35):
Yeah. Absolutely. You know, it's solitude and
it's, community. You know, forme, I have a group of guys that
I regularly meet up with at atSunrise before work. And when we
go out and we talk about what'sgoing on in each other's lives,
and it can be this reallybeautiful, quiet time where I
can be with other people andhave meaningful conversations.
(44:57):
Sometimes, they're notavailable, and I go by myself.
And it can be this time where Ithink about what I'm going to do
during the day, sort oftransition towards my work life,
from my my home life. But theact of surfing, I mean, there's
a lot of metaphors and clichesto life. You know, there are
times that I'm out there where awave is coming to hit me that
(45:19):
looks like it might kill me.And, you know, I have to find a
way to be calm and find peacethrough that.
There's other times that there'sjust exhilarating rides that I'm
at the at the discretion of thewave, so to speak, to see what
happens. So for me, it's been,that's all been, it's just a
(45:41):
great way to start the day. It'sa very San Diego way to start
the day.
Grant Oliphant (45:44):
It is a San Diego way to start the day. Not
my day, by the way.
Ben Maxwell (45:48):
Yeah. Well, you can do that. We should we should go
out sometime.
Grant Oliphant (45:50):
We'll talk later. Yeah. But definitely, you
know, the other the other thingthat comes up for me around
that, Ben, is just, sportssometimes gets overlooked in
this equation too with withhelping helping young people,
reconnect with withopportunities for seeing
themselves in a larger context.
Ben Maxwell (46:11):
Yeah. It's just great for kids to learn new
skills, find mastery, build selfesteem.
Grant Oliphant (46:16):
Yeah.
Ben Maxwell (46:17):
And that can be just really pivotal for the way
kids grow up.
Grant Oliphant (46:21):
Ben, what inspires you?
Ben Maxwell (46:23):
Man, w you know, grant, you inspire me. When I,
when I first, and I'm not sayingit.
Grant Oliphant (46:29):
That's the ultimate play to the host.
Ben Maxwell (46:31):
You you you can cut this out if you want. But but in
all sincerity, when I first met1 of your, colleagues at the
Prebys Foundation before I metyou, she said, you know, you're
really gonna love Grant. He's avisionary. And so, you know,
quite frankly, I I don't hearpeople say that to me that
frequently. So I looked intowhat you'd been able to do and
what you're trying to do here.
(46:51):
And I think exactly what we'vetalked about. I've been trying
to figure out how to communicateand message some of these things
around the importance ofcommunity, and it's what you've
done so well, I I know here andI think throughout your career.
So, honestly, like, trying tounderstand how to message better
and having somebody that, hasdone that is inspiring to me. I
(47:14):
think the other thing thatinspires me are people that push
up against the odds and say,hey. Like, I could just cave to
this, but I'm I'm gonna try tofind a better way forward.
And so there are people likePaul Farmer as a a person that
had the Partners in Health. Andso very early on in my, medical
career, I saw a documentary filmand read his book and thought,
(47:36):
yeah. I mean, that's that's sortof person I wanna be to push
back against theseinsurmountable odds to try to
have an impact for positive, inin the world.
Grant Oliphant (47:45):
Well, I love that you would have a hero like
him because he really issomebody who took on an
impossible challenge and figuredout a way for society to move
forward on it. And I And thankyou for the nice words. I think
you know what I believe aboutSan Diego and I really believe
you're embodying is that we havethe capacity in this community
(48:09):
because of some of the greatwork that is being done here to
demonstrate the power that stillexists for this country, through
the magic of community. Right.And if we just set our sights
high enough, you know ironicallywhat people often think when
things are bad, and you spoke tothis earlier.
Ironically what people oftenthink when things are bad or
(48:29):
challenging is that you have todumb down your response, and you
have to accept having less. Andwhat I hear you doing is saying,
no we need more. Yeah. You knowwhat we actually needed to do is
up our game, and the way we upour game is by connecting young
people with each other, and withcommunity, and with nature, and
with art, and you know, outdoorexperiences, and that bigger
(48:55):
vision will save us. And IIIlove everybody I meet who
embodies that sort of spirit,and you absolutely embody this
that spirit.
So thank you for the work you'redoing really on behalf of
everyone listening. I think Ispeak for us all in saying thank
you for what you're doing.
Ben Maxwell (49:15):
Thank you, Grant. Great being here.
Crystal Page (49:21):
You know, I have to say I have a lot of hope
listening to what Ben or doctorMaxwell had to say.
Grant Oliphant (49:29):
I do too. I have a lot of admiration too, you
know. I I think that probablycame across at the end of that
interview, but it is not easyfor a medical professional to
step outside of his clinicalrole and talk about what society
has to do or what community cando to address a challenge this
(49:51):
large. But III really my primarytakeaway from this conversation
above all else, and we'll gothrough some others, is just the
way he pointed to how we facedhard challenges before, and
we've dealt with them, and hebelieves that's possible here.
Crystal Page (50:08):
And I think where he said that he really wants to
live in a world where people arethriving and connected, that's a
vision of a future that I alsowanna live in.
Grant Oliphant (50:19):
And so do I. And it's you know, if you think
about it, of course, we do. It'sfundamental to our work, but
it's why we do the work that wedo because we believe that that
is the path forward for not justSan Diego, but for people in
general as we navigate thisconstantly changing world. If we
(50:40):
break down what he talked aboutand why that connection is so
important, you know, I I lovethe 3 challenges that he laid
out. And and 1 was that we thatyoung people, like everybody
else in our society, faces thiscrisis of loneliness and
isolation, which surprisinglyaccording to the data is
(51:03):
manifest in an increasingdisintegration of the family,
which is sad and scary, followedby and associated with the
second point, which was theamount of screen time, and I
found Crystal his data there tobe shocking frankly, you know,
that young people are spending 2thirds to 3 quarters of their
(51:25):
waking lives on screens tellsyou a little bit about what's
feeding this crisis of isolationfor them.
And then 3rd, the connectedpiece, you know, the the impact
on their health and theirwell-being and sleep. And and of
course when you're constantlybeing stimulated that way,
you're not gonna sleep well, andyou're not going to be able to
(51:47):
to attend to your wellness inthe way that you otherwise
might. So he painted thispicture of very real challenges
that are baked into the livesyoung people face, and then the
antidote was exactly what youspoke to. Do you wanna say a
little bit more about that?
Crystal Page (52:05):
You know, I appreciate you going through the
the 3 items because theloneliness piece is not unlike
what seniors are going throughor what we all went through
during the pandemic. Thedifference is all of us as
adults had had a, hopefully, acommunity connection beforehand.
We weren't born into this typeof world. So I think painting
that vision instead of gettinglost in the despair and the gut
(52:27):
punch of 1 out of 3 kids or 1out of 3 18 to 24 year olds
wanting to end their life, whichis such a gut punch. How do we
turn that around and say, let'slet's set up this vision where
we're all connected and wherepeople matter, and we're putting
down our phones and taking thetime just to reconnect.
(52:47):
You know? Like, that is a stepwe can all take. Like, he said
the thing about, like, do youwanna drive past your neighbor
at 35 miles an hour or slow downand wave to him? You know? I
think we all wanna live in theworld of the 35 slowing down
instead of the 35 miles an hour.
But it's hard on a grumpy day ora different day, but every
action matters.
Grant Oliphant (53:08):
It does. And I by the way, I think that I love
that. Every action matters ismaybe 1 of the most important
takeaways from this wholeinterview because what he is
describing is a set of ofsolutions that individually,
each 1 may not seem like thatmuch, but collectively, they
(53:28):
amount to a lot. Right? So he'stalking about reconnecting young
people with nature.
He's talking about reconnectingyoung people with opportunities
for self expression through art.We talked about sports at the
end. We talked about thecommunity that comes from those
activities. We talked aboutbroader community connections,
(53:52):
And the reason that every single1 of those is important and
doable is that, the young peoplewho are experiencing today's
crises are the adults who aregonna be supporting society and
driving society in as little asa year, 2 years, 3 years, 4
years. That by the way was alsoa gut punch, you know, his his
(54:16):
his point about that that wemake this sort of artificial
divide between young people andadults, but as he pointed out,
young people turn into adults,and then they become And
Crystal Page (54:36):
And I think even when he talked about whether it
was surfing or being in nature,you know, as a kid who grew up
in Vista, California, we wouldfundraise in middle school to go
to sea camp.
Ben Maxwell (54:47):
Yeah.
Crystal Page (54:47):
And I would kayak. And let me tell you, being a 12
year old little girl out on thewater in my own kayak,
surrounded by nothing but oceanand some other kids doing the
same thing is, like, the mostfreeing feeling in the world.
Like, you feel like there'ssomething you can control and
there's this whole big world youcan't control. I want kids to
have that even before they'readults. I want them to feel how
(55:09):
magnificent nature is, you know,and and how being connected just
feels good.
You know? So
Grant Oliphant (55:15):
Yeah. His positive framing around that
was, I thought, really helpfulbecause so much of this
conversation is negative. Youknow? It is about the the 1 in 3
young people having contemplatedsuicide, extraordinary. And it
and it is easy to fall intodespair because as you and I
(55:36):
have discovered in our work atthe foundation, there simply
isn't enough money in societynor is there are there enough
people to provide the clinicaltreatment to everyone who needs
it as if that's the solution,You know?
If that's the if that's theprimary modus operandi. If we
(55:57):
really wanna solve this over thelong term, we really have to
attend to the root causes, andwe will get at far more young
people, and we will create farmore, well, better outcomes at
in the end because we do that. Iwas really struck by the way he
described our individualisticsociety and acknowledged some of
(56:20):
the causes of it that are notjust a a way of looking at the
world that's unique to America.Partly it's that. But partly
it's also disparities in oureconomy.
It's parents who have no otherchoices in in how they care for
their children, it's parents whoare just too busy working
(56:41):
multiple jobs, it's it's peoplenot having been given exposure
to other opportunities. It'stheir kids not having access to
the sort of natural amenitiesthat, more affluent families
take for granted. It's all ofthat. And if we can begin to
(57:01):
just acknowledge that and findways of reconnecting kids with
those opportunities, then wehave a path forward in
addressing on a very broad scalethe challenge that we're facing
in youth mental and behavioralhealth.
Crystal Page (57:15):
But I also loved when you asked him the question,
how do you model this for yourdaughter?
Ben Maxwell (57:21):
Yeah.
Crystal Page (57:21):
And you're a dad and grandpa, so so how did that
his response hit you?
Grant Oliphant (57:25):
Well, I you know, I was partly asking that
question out of self interestbecause I think it's so hard for
you for parents raising kidstoday to figure out the right
thing to do by their kids. And Ihis answer was perfect. It was
to the extent that you can, totake care of yourself, to do the
things for your child that alsoare good for you, and vice
(57:49):
versa. To to take opportunitiesto recharge, and to find the
sources of joy that you canshare with your child. You know,
I think he he talked about it ina way that almost every parent,
even the ones who are waystressed out, could identify
with.
(58:10):
And, and it's important torealize that to a certain
extent, everybody's dealing withthat in our culture. And we have
tools. We have tools.
Crystal Page (58:21):
I feel empowered. How about you?
Grant Oliphant (58:23):
I feel empowered, and I feel more
hopeful than I did when evenwhen we began the conversation
because there is a path forward,and somebody who has studied
this issue way more than we havehas identified that, yeah, we
can do this.
Crystal Page (58:38):
Yeah. And it's gonna continue to show up in our
work. So this conversation hasonly begun. Right?
Grant Oliphant (58:42):
It it is. III think for us in our work, what
we're we're seeing over and overagain is, especially in our
community, the convergence ofnature and art and creativity
and, youth mental health ishuge, and we're going to see a
(59:03):
lot more of our activity steeredtowards that particular meeting
point.
Crystal Page (59:08):
With that, I think we have had another great
episode, Grant. It's been great
Grant Oliphant (59:13):
Crystal, I love doing this with you. Thank you
for,
Crystal Page (59:15):
Ditto my friend.
Grant Oliphant (59:16):
For sharing this conversation, and look forward
to doing it again.
Crystal Page (59:20):
See you next time. Alright.
Grant Oliphant (59:25):
This is a production of the Prebys
Foundation, hosted by GrantOliphant, and co hosted by
Crystal Page. The program is coproduced by Crystal Page and
Adam Greenfield, and it'sengineered by Adam Greenfield.
Production assistance isprovided by Tess Karesky. And
(59:46):
our new theme song is by misterLyrical Groove, a local San
Diego artist. Download episodesat your favorite podcatcher or
visit us at stop and talkpodcast.org.
If you like this show, and wereally hope you do, the best way
to support it is to share,subscribe, and review our
(01:00:09):
podcast. Thank you for yoursupport, your ideas, and most of
all, for listening. This programhas been recorded at The Voice
of San Diego Podcast Studio.
Alright. Welcome back to another episode of Stop
and Talk. Thanks for stoppingby. I'm your host, Grant
Oliphant, and I'm joined by myco host, Crystal Page. Hi,
Crystal.
Crystal Page (00:21):
Hi, Grant.
Grant Oliphant (00:22):
How are you doing today?
Crystal Page (00:23):
Excellent, and I'm looking forward to today's
topic.
Grant Oliphant (00:27):
I love today's topic, and I find it a little
bit daunting. We're gonna betalking about youth mental and
behavioral health with, doctorBenjamin Maxwell from Rady
Children's Hospital, a trainedchild psychiatrist and a person
who has been deeply involvedwith this issue. It's an
(00:48):
extraordinary conversation we'regoing to be having in part
because of the subject matterand in part because of how he
approaches it.
Crystal Page (00:55):
You know, because I hear about this topic every
day in the news, and as a parttime slash foster parent, I, I'm
really interested to hear whatdoctor Maxwell has to say
because kids are up against somuch these days.
Grant Oliphant (01:09):
They are. And and 1 of the things I think you
and I would both want to stressgoing into this conversation,
and I know, doctor Maxwell wouldas well, is how incredibly
resilient young people are, howincredibly creative they are. We
were joking before we went onair about the slang that they
use and how we're desperatelytrying to keep up with the
(01:31):
terminology.
Crystal Page (01:32):
You know, Grant, I would try. I would so try to
keep up with it. I go to urbandictionary.com all the time, but
I don't wanna be very cheugy atall.
Grant Oliphant (01:42):
Cheugy.Okay. Explain.
Crystal Page (01:44):
So according to the TikToks or an Instagram
video of the TikToks, cheugy islike someone who's outdated or
trying to be trendy.
Grant Oliphant (01:51):
Oh, okay. So
Crystal Page (01:52):
let's not be cheugy.
Grant Oliphant (01:53):
Yeah. Alright. I think by definition, we are. We
are. But I, you know, all jokingaside, I think the point is
that, in talking about youngpeople, it's important not to
pathologize everyone in makinggeneralizations.
There is a crisis, there is achallenge, there is a problem,
and we've got an extraordinarygeneration coming up that,
(02:19):
offers a lot of promise. And aswe talk about the challenges,
let's not lose sight of that. Ilove this conversation with Ben.
He is, I should say doctorMaxwell, but I I love this
conversation with Ben, and I sayBen because he's so
approachable, because he's doinghard important work and thinking
about how to help an entirecommunity and society respond to
(02:44):
the challenges that we'refacing.
Crystal Page (02:46):
Can't wait to hear what he has to say.
Grant Oliphant (02:49):
Let's dive in. Doctor Ben Maxwell, thank you
for being here.
Ben Maxwell (02:57):
Thanks for having me.
Grant Oliphant (02:58):
It is really a pleasure. You and I have had the
opportunity to talk a few times,but we're gonna dive into a
conversation today about yourwork in youth mental and
behavioral health, sort of whatthe landscape as you see it, and
what's going on. But let's let'sstart by talking about what
you're loving doing right now.Do you have a project that
(03:20):
you're working on that feelsespecially exciting?
Ben Maxwell (03:22):
Well, I I really think, the project I'm working
on is bringing lots of differentpieces together. You know, I've
been a big picture personreally, throughout my training.
And what we're doing now at RadyChildren's Hospital is really
looking at how do we create asystem of care that works from
newborn babies and new parentsall the way up to 17, 18 year
(03:44):
old kids that are strugglingwith more severe mental illness.
So looking at the health caresystem from that perspective, to
me, is just a really, reallyexciting way of looking at it.
Whereas in the past,potentially, I would look at a
single clinic or a singlepatient.
This is really taking a stepback and trying to understand
how we might serve the communitybetter.
Grant Oliphant (04:04):
I really love that framework of of trying to
look at people in a communitycontext, which seems like
medicine doesn't often do, butthere's tremendous value in
that. Maybe a place to beginbecause this is a subject that
so many people in our world areconcerned about right now is the
(04:29):
the apparent crisis of youthmental and behavioral health.
And I guess the logical firstquestion to ask is, is there a
crisis?
Ben Maxwell (04:40):
It's a great question. You know, I I started
my work as a child psychiatristhere in 2010 here at Rady
Children's Hospital here in SanDiego. Remember walking into my
first shift in an emergency inour emergency department. That
first year where I was workingin our emergency department at
Rady, we saw a 167 kids inpsychiatric emergency show up at
(05:01):
our at our front door. Lastfiscal year, we saw over 47100.
So the, the question of whetherthere's a crisis or not, I think
it's really clear that kids andfamilies are feeling
overwhelmed. I think our healthcare system is feeling
overwhelmed, And that's why Ithink it's it's just so
important that we look at how dowe get kids care early and how
(05:23):
do we create a system of carethat we care for them?
Grant Oliphant (05:27):
And to people who who would argue that that
dynamic is driven by just betterreporting or more awareness or
more acceptance? How do youanswer that? Or does it really
matter?
Ben Maxwell (05:41):
Well, I mean, I think what we're seeing is not
only do we see kids that arereporting these things, but we
see suicide rates go go up.Mhmm. We see kids reporting that
they feel lonely more and more.We see companies struggling to
hire young people that canmanage the stress of the day to
day work. We see people familiesbecoming disintegrated based on
(06:03):
psychological well-being or lackof psychological well-being of
some of those people. So I Ithink it's being seen throughout
society and throughout,throughout the different parts
of the community that that weserve. And so to me, it is,
yeah. I mean, I think there'smore awareness. Mhmm.
There's more willingness forpeople to talk about it, but
(06:24):
that doesn't make it any lessreal that these people are
suffering, and and and we needto find a a better solution.
Grant Oliphant (06:30):
Yeah. Well, III appreciate the clarity of your
response on that, and the thereality is, as you're describing
it, real real young peoplehaving real problems and
significant challenges, and youhave been, in your work, looking
at the environmental andlifestyle contextual roots of
(06:52):
what's happening in our societyto drive these dynamics. I'm
curious what inspired you to dothat work in the first place.
Ben Maxwell (06:59):
Well, I mean, as a clinician, you can only hear the
same thing over and over againso much and not question why.
You know, that that data pointI've mentioned of this really
massive increase in number ofkids presenting to our services,
at some point, we have to say,well, what's driving all that?
Mhmm. What what what's causedthis change?
Grant Oliphant (07:19):
Yeah.
Ben Maxwell (07:20):
And so I've been fortunate enough to partner with
a group called Sapien Labs, anonprofit that's a it's really a
data science organizationlooking at what are the
environmental and psychosocialcontext or underpinnings of
psychological wellness andpsychological suffering. And
that's been just a really richconversation that I've had with
those folks because they haven'tsit they haven't sat in front of
(07:42):
a patient or a family.
Grant Oliphant (07:44):
Right.
Ben Maxwell (07:44):
So they don't have that, awareness or learning that
I've had throughout my career.But I have no idea how to manage
big data or the data analyticsthat they use to to really find
what are some of these rootcauses and what we might be able
to do about them.
Grant Oliphant (07:59):
I I love the fact that you're engaged in that
search for the signal in thenoise to figure out what's
what's going on. You opened bytalking about your excitement
about working in a communitycontext, and I think part of
where this journey has led youis to working with organizations
that 1 would not normallyassociate with a medical
(08:21):
doctor's work, including theYMCA of San Diego and an entity
called Outdoor Outreach here inSan Diego, which works with kids
and helping them become familiarwith nature and the outdoors.
Talk to us about that. Why?
Ben Maxwell (08:35):
Yeah. Again, it's, you know, I feel, on the 1 hand,
the work I can do individuallywith patients is is really
wonderful. To take a step backand try to understand how can I
have a bigger impact, that'ssomething I've always been
interested in. And I remembervery early on in my medical
(08:56):
training, I was lucky enough togo on some international medical
trips trying to help out where Icould on these international
medical trips. And 1 of thefirst places I went, we were in
a rural place in Latin America.
And a lot of the people werecoming in with a diagnosis of
Giardia. And we were doing thegood thing of giving them
metronidazole, which is thetreatment for Giardia. But at
(09:19):
some point, a group of us askedthe question, I wonder why all
these people have Giardia. Andthe reality is they were going
home, taking the pill, anddrinking it with water that had
Giardia in it.
So the taking a step back andunderstanding the cause and then
being able to hopefully haveimpact on that is something
that's driven me ever since.Yeah. And so in this context
(09:42):
where we're seeing more and morekids struggle with psychological
challenges, asking, hey. What'shappening in the community?
What's happening in theirpsychosocial context?
What's happening to their theirhealth behaviors that might be
having some cause of this?Because we know now our brain
and our mind is shaped by ourenvironment.
Grant Oliphant (10:01):
That is a particularly poignant example of
the cure containing thecontaminant. Yeah. Really
interesting. So let's go to thatquestion right now. I was gonna
I was gonna ask you this alittle bit later, but since you
brought up that example, let'sgo to what are the causes of the
crisis that we're experiencingin your opinion?
(10:23):
What are you seeing in youranalysis that helps to explain
the crisis in youth mental andbehavioral health that we're
experiencing and that youdescribed?
Ben Maxwell (10:34):
Yeah. You know, it's it's 1 of the questions
I've been asked a lot and 1 ofthe questions I've dodged a lot
at the end of talks and whatnot.
But I but I think the data iscoming out more and more clear.
So social isolation andloneliness is an epidemic in our
country, and it's even worse forkids. Surgeon general Vivek
Murthy has come out reallystrongly on that, and I think
(10:54):
he's done a great job with thatmessaging. The second, that I
think is really important well,even related to that, just to
take a step back, the nuclearfamily, especially in young
people, more and more data isshowing that kids and families
are becoming disindisintegrated. They're not
they're not connected like theyused to.
(11:15):
Older generations have moreconnection with family, younger
generations have less. So that'san interesting data point that I
didn't really expect, but an anexample of social isolation
outside of even having friendsor community outside of the
home. The the next 1 I'd pointto is, what the role of screens
(11:36):
and social media has done to ourdrive to seek social connection.
So I think a lot of people aresort of looking for that social
connection that they all feelthey need . Through their screen
and not necessarily getting whatthey ultimately need on a deeper
level of that in person socialconnectedness.
(11:56):
The the the screens, I think,also create this domino effect
of if you're on your screen moreand more, And let's face it,
kids are on their phonessomething like 2 thirds to 3
quarters of their waking hoursnow.
Grant Oliphant (12:09):
Let wait a minute. I have to stop you. 2
thirds to 3 quarters. They're ontheir phones.
Ben Maxwell (12:14):
Not necessarily phones, but phones, computers,
TV. Screens are taking up abigger and bigger percentage of
all of our lives, and I thinkyou can see that just walking
around town. Yeah. But kids, Ithink, are bearing the brunt of
that even more, and young peopleas well. So those under 30 have
higher higher time that they'respending on on screens.
(12:37):
So, you know, that's a realityof the modern world we're living
in. What do we what are we gonnado about that as a question of
how do you grow up in the modernworld with these things present
and still be able to maintainyour psychological well-being?
That's a question that I'mreally on a journey to find.
What are some answers for? Howdo we inspire people to change
their attitudes and behaviors inthat way?
(12:58):
But if you're on your phone thatmuch, what also happens to your
sleep? And we know kids aresleeping less, and the quality
of their sleep is less now thanit was in the past. Mhmm. So
there's sleep, socialconnectedness, the the being
present in this unregulatedworld of the Internet that
exists on social media and otherplaces. So I think all these
(13:20):
things are sort of boiling thefrog, so to speak, of, like it's
just slowly changed over time.
When you look at it now, youlook around and you think, oh,
that's just the way the worldis, but it's having real
implications. And I think we'regetting to a point where we've
really got to think about whatdirection do we want the world
to go in.
Grant Oliphant (13:38):
I I appreciated your, thank you for that answer
and I think it is a terrificsurvey of the causes. I also
appreciated the confession withwhich you began, which is that
this is a question you used toduck. Yeah. And I know some
aspects of this answer arecontroversial, you know the
(14:00):
sociologist Jonathan Haidt hasdone a lot of work in terms of
the impact of screens on youngpeople.
Demographers like Jean Twengehave been looking at this issue
of the correlation betweensocial harms for youth and or
(14:20):
negative social outcomes foryouth and the rise of social
media. The intellectualconnections that you just made
make perfect sense. You know,Vivek Murthy, the surgeon
general, is talking about thecrisis of isolation in America.
Of course, young people wouldsuffer it more. Why is it
controversial to talk aboutthat?
Ben Maxwell (14:42):
You know, it's a great question. You know, I I
hear a lot of, people say, well,there's pros and cons to this,
that, or the other. And I thinkthere are pros and cons to this,
but there's, you could say,there's pros and cons to driving
without your seat belt on orpros and cons to smoking
cigarettes.
Grant Oliphant (14:58):
Mhmm.
Ben Maxwell (14:58):
It's not the way we typically frame it. So I think
on balance, a lot of thesethings are, clearly,
problematic. Mhmm. This questionof how do you contain some of
that, what do we do about it?You bring up Jonathan Haidt, and
some of his recommendations fromhis recent book seem pretty
(15:19):
reasonable.
The idea of kids not havingsmartphones at school, kids not
having smartphones until 16, orwaiting for social media until
these later ages seems prettyreasonable. We're we're not in a
world where anybody's doing anyof that. And so I think the
(15:39):
question of how do wecommunicate this in a different
way to inspire people to change,and maybe it's just flipping
what's the priority. How couldwe, you know, people could still
be on social media or otherother technologies, but maybe
the priority is in person socialconnectedness within their
(16:00):
community, within their schools,within their neighborhoods.
That's always been the thingthat's helped humanity deal with
challenges and deal withstruggle.
And so to me, that's it's almostthis generational challenge that
we face. How do we get youngpeople to be psychologically
(16:20):
strong, thriving, able to dealwith the sort of stresses of the
modern world so that we can dealwith some of these other major
issues that we face as a humansociety. Climate change,
democracy, you know, all thesechallenges that we face, we
can't do any of it unlessthere's young people that are
able and willing to be a part ofthat struggle.
Grant Oliphant (16:41):
You, it gave me goosebumps when you just said
that part of the reason we'renot talking about this is that
we're not in a world where we'renot living in a world where,
people are doing any of thosethings that would respond to the
crisis you're describing, whichis pretty scary. Say a little
bit more about thedisintegration of the family
(17:03):
that you're seeing. You said youwere surprised by that result.
Ben Maxwell (17:07):
Yeah. That's a data point from, Sapien Labs, the
group that I've, collaboratedwith over the past couple of
years. And they found thisglobally that if you ask people,
do you have 0 contact with anyof your immediate family? More
and more people in younger andyounger generations are saying
yes to that question.
Grant Oliphant (17:28):
zero contact.
Ben Maxwell (17:29):
0 contact. So, you know, there's there's that's a
real struggle. You know, I thinkthe 0 contact is 1 thing. Think
the United States, we findourselves in this
individualistic society wherethere's a lot of geographic
mobility, which can have greatimpact on economics or job
prospects or individual growth.
(17:51):
A lot of people also findthemselves in as a young person
in new cities on their own,struggling to make new friends
and finding a place that theycan find that community and
connection, which is 1 of thereasons what what you are doing
with this podcast is just soincredible because you're
telling that story and showingpeople the different ways in.
Grant Oliphant (18:13):
Well, I you know, I think we believe, that
community is the antidote to alot of the problems we face.
Community is sometimes also thechallenge Yeah. By the way. But
I very much appreciate youridentifying community as a way
in which we can rally around,young people. Let's go back to
(18:35):
the basics for a moment.
When we describe this, is this amental health challenge or a
behavioral health challenge?What's the best way to talk
about it?
Ben Maxwell (18:44):
I I think the they can be used interchangeably,
personally. I mean, mentalhealth challenge, challenge of
behavioral health. I thinkthere's I think all of those
work.
Grant Oliphant (18:56):
Yeah. And when, when you think about the
dynamics that you justdescribed, it's a pretty big
universal picture, you know,you're describing problems with
the nature of the family. We'vecreated a society. I just got
back from the TED conferenceand, you know it's a it's in in
(19:18):
many ways, TED is a celebrationof technology and its
implications for society.
There's also a lot of soulsearching about the impact of of
technology on society, butyou've just described a world in
which our kids are spending upto 3 quarters of their waking
hours on screens, they'reexperiencing little to no
(19:42):
contact with their familymembers, they're, as a result
suffering from a loss of sleep.It can feel like an overwhelming
set of challenges. Here you are,a doctor, at Rady Children's
Hospital in San Diego. Greatinstitution, by the way.
Ben Maxwell (20:04):
Yep.
Grant Oliphant (20:05):
And you're 1 guy. Yeah. And and you have
counterparts all over thecountry who are struggling with
the same sort of things, butthey're up against these mammoth
social forces. How do you beginto find hope and to convey hope
to parents as they're navigatingthis world. You know, we're
(20:26):
we're talking to an audience ofpeople who care about these
issues.
What are the sources ofinspiration for them?
Ben Maxwell (20:32):
Yeah. I mean, 1 of the things that is inspiration
is looking to our history. Youknow, at what point in our
history were we not up againstinsurmountable odds? We've
always been up againstinsurmountable odds as humans.
And, you know, in that, I cansee, you know, I recently had a
chance to meet Jim Kim, the theformer president of the World
(20:53):
Bank, and he was involved withPartners In Health Yeah.
When the HIV AIDS crisis waskilling millions of people
around the world and people weresaying, well, it's it's it's not
economically possible to getthem medications or, you know,
we we just don't have aninfrastructure to do it. And
they were part of a movement tosay, that's not good enough. We
(21:13):
have a cure for this. Why don'twe go and and and get people
that those those treatments thatcan that can really help? And so
they they were able to, youknow, effectively put an end to
the AIDS crisis.
There's still obviously peopleliving with HIV and AIDS, and
there's still a lot of work tobe done in that space.
Grant Oliphant (21:31):
It's a great example.
Ben Maxwell (21:32):
But they were able to make progress there. And so
finding things like that where,hey, we're up against all these
odds, but we don't need a newpiece of technology or a new,
research breakthrough to figureout how to move forward. We we
know what's happening with kids.We know that in our past, kids
(21:52):
have been psychologicallythriving and flourishing for the
for the main part. We can getback to that.
And I do believe community is 1of the answers to to get us
there.
Grant Oliphant (22:05):
For parents who are listening, I you know, 1 of
the things I read recently thatsurprised me was that how how
significant a percentage ofparents have kind of just
resigned themselves to this soctechnological social media world
in which their kids are growingup. It's easier or necessary for
(22:26):
them in their view to let theirkids engage with screen time so
that they're preoccupied. Itjust feels like it's woven into
the culture, and they just haveto let their kids swim in it.
And I know that's not universal.That's that's not even the
majority of parents.
But for a lot of parents, that'show they're perceiving it. When
(22:51):
you talk to the adults in theroom when you're working with
young people, what is yourmessage to them about what they
can proactively and positivelydo to help young people?
Ben Maxwell (23:01):
Yeah. I mean, I think the proactive approach
isn't saying, hey, no phone. Ithink it's cultivating
alternatives that people reallyfeel good about. So we're not
asking people to do things thatare boring or painful. It's
things that are actually fun.
Hey. What does the kid want tobe involved with? Is it, you
(23:23):
know, horseback riding, squirrelcatching on the weekend, going
to the local park,skateboarding? There are things
that most kids really enjoybeing involved with and really
trying to support kids so thatthey can find community with
that activity.
I think that's a easier approachthan, hey, no more phone. You
reached your phone time limitfor the day, and the kids left
(23:46):
thinking, well, what am I gonnado? Stare at the wall the rest
of the day? So I think reallythat cultivation of the
alternative is really important.
Grant Oliphant (23:53):
You know, I'm I'm going to compliment by
myself by saying you and I aregenerally in the same age
cohort. We're not, but you'reyoung.
Ben Maxwell (24:03):
You fooled me.
Grant Oliphant (24:03):
You're you're younger, but, but around, you
know, sometime between when mykids grew up and when you grew
up, society shifted from whatJonathan Haidt calls a play
based childhood to a tech basedchildhood, and part of the
thinking there was not only wasthe technology available, and
(24:26):
new, and snazzy, andinteresting, and captivating,
but parents were afraid aboutletting their kids go out and
play. When I grew up, you know,you would go out in the morning,
and, you know, the legend wouldhave it that you wouldn't come
home until the end of the day.It was kinda like that. Yeah. We
don't do that today, for goodreason.
(24:47):
The world's a big, scary,complicated place. There was the
whole fear of stranger danger,that rose up in the nineties,
and parents today would beloathed to do that even to the
point where they're afraid ofbeing sued if they let their or
or prosecuted if they let theirkids go out and play on their
own. You're describing a set ofalternatives, playing in the
(25:12):
outdoors, participating inexperiences in nature, you know,
I assume art comes into playhere too. That feels like a
wonderful hearkening back to atime that was. How do we get
back to that?
As you think about this, and andhow community can be the
(25:33):
antidote to some of what we'reexperiencing. How does community
play a role in that?
Ben Maxwell (25:38):
Yeah. You know, I think each individual has a role
to play. We can't do this alone,and that's a lot of the times
the feedback I get from parentsis, well, I'd love to do that,
but nobody else is doing thatthing. So how how do we create
some sort of conversation aroundthis topic so that people can do
it in communities? Now Iregularly as a child
(26:00):
psychiatrist, and I have a 6year old daughter, many of the
the parents of the kids in theschool will talk to me about,
hey.
Do you think I should get my kida phone? Or what do you think
about this, that, or the otherthing? And most of them have the
same feeling that I have thatkids really thrive when they
have an opportunity to fail,opportunity to fall down, get
(26:22):
back up again, learnindependence, learn resilience,
do it in in the absence of anadult saying, oh, be careful
with that. Be careful with this.But also the adults have, as you
point out, this fear about the,you know, exposing their kid to
all the big bad world that's outthere.
There, I think, is a a middleground there, and that's why
(26:43):
places like Outdoor Outreach orthe YMCA, the things that
they're allowing for is peopleto come together in a safe
space, have community, beinvolved in new activities,
learn, grow your self esteembecause of mastery of new
skills. Those are things thatkids really, really can thrive
with, and there's a number ofavenues by which kids and
(27:04):
families can do that. I do thinkit's possible. So, yeah, there's
a lot of things that feel likeinsurmountable obstacles, but I
think we can do it if we reallyput our put our effort to it.
Just just 1 anecdote on that.Whereas, I was recently in the
Basque Country in Spainreconnecting with a pediatrician
I lived with when I was inmedical school. He had been the
(27:27):
pediatrician of this town for 41years. And while I was there, he
was talking about this idea ofsaving the Basque language.
Grant Oliphant (27:35):
Mhmm.
Ben Maxwell (27:36):
So the Basque language for a long time was
oppressed and go to jail if youspoke it. And now the young
people speak Basque better thanthe old people. They valued it.
They put effort towards it, andthey've been able to teach all
the kids through this schoolsystem that they've set up. So I
think just because we're on thisfeels like this cusp of losing
(27:58):
some of the things that we allharken back to and think, oh,
these are great things.
If we value it and we put efforttowards it as a community, I do
think we can preserve some ofthose things.
Grant Oliphant (28:09):
I really appreciate that message. I think
it is incredibly powerful. Andactually there's a through line
between your story about theBasque Country and your story
about AIDS, because in bothcases, both could feel like lost
causes, and in both cases, wefigured out a way past society,
(28:30):
community figured out a way pastthat. You have talked about the
importance of moving past thecrisis conversation that we're
having today to a message thatis more inspiring. Yeah.
So is that your example of it?Is that is that is that the more
hopeful message that we can dothis by, reacquainting our young
(28:55):
people with the value of beingout in nature, or the value of
expressing themselves throughart, or the value of community?
Or let me not put words in yourmouth.
Ben Maxwell (29:06):
No. I mean, III think it's it's it's all of
that. In the health care space,there are solutions to kids that
are struggling withpsychological suffering.
Depression, anxiety,schizophrenia, all these things
have good treatments. A problemis most people don't get access
to those treatments.
(29:27):
So there's hope in the idea thathumans can come together and
figure out a way to provide highquality access to care. And and
we're doing that at RadyChildren's Hospital. We're doing
that here in San Diego County.It's not sufficient to stop
there in my estimation. I'd liketo be living in a world where
mainly people arepsychologically thriving, and
(29:49):
they're part of a community andthey're feeling connected.
And so there are, again, ways bywhich we can do those things. I
think that's the theconversation that needs to
happen as opposed to the soundbite that gets quoted for me is
how many new kids have come toour emergency room and
psychiatric crisis in creatingthis doom and gloom about this
(30:11):
topic. We're in a tough spot,and we can get out of it with
the current knowledge that wehave, but it it does take more
than me as youpoint out. I mean it's going to take a community working on it.
Grant Oliphant: Yeah but it takes a few people like you who are on (30:29):
undefined
the ground seeing the challengeand able to see the bigger
picture at the same time. Imean, the classic formulation
that I heard even when I arrivedin San Diego, 2 years ago was
that this crisis was reallyprimarily a crisis of the lack
of availability of treatment,and that somehow we just needed
(30:50):
to figure out how to treat morekids, which meant provide more
treatment professionals. Andthen and then some people
started doing the math andrealized it was not possible
actually to hire enough peopleto do all of that treatment.
That has to be a humblingexperience for somebody who is a
clinician and who, you know, youjust said, we we we know the
(31:16):
treatments to apply with with,kids who have very specific
needs. You have laid out for usA-A view of of a way for
society, broadly, to get out ofthe thicket of our apparent
paralysis over the youth mentalhealth crisis.
(31:40):
That's a longer term solution insome ways. In the near term,
there are young people in crisisWho need help and need to talk
to someone, and there aren'tenough someone's for them to
talk to, and you're experiencingthat in the statistics that you
shared. So how do you balancethat long term and near term, I
(32:01):
guess, is what I'm reallydriving at?
Ben Maxwell (32:03):
Yeah. I mean, I I think the the balance is it's
it's a tough one to have. I Ithink the idea, though, when you
see a newspaper article sayingthat the thing we need to figure
out is the number of inpatientpsychiatric beds per capita and
make sure that that's the rightnumber so that all people with
that need can can get care. Ithink that's just insufficient.
(32:25):
I don't wanna be living in asociety where we wait till
people need inpatientpsychiatric care before we do
something about it.
What I'm interested in is how dowe find a way to, at every step
of the way, create an off rampso that people have a place to
go towards psychologicalwell-being. That includes new
parents. Now I was a new parentnot that long ago. You think I'd
(32:46):
know what I was doing when Itook the baby home. I didn't
know what to do.
We we needed support. And so tofind support early on, help get
people off on the right path. Ifpeople fall off that path, have
something in place that they canget back on. And that is places
like, community centers,schools, families, neighborhoods
(33:08):
even just coming together. Youknow, when you have the choice
when you drive home tonight ofwhether you wanna wave at the
person walk the dog or blow byhim at 35 miles an hour on your
neighborhood street.
You know, I think there's thingsthat we can all do that
ultimately help the kids. Ittrickles down to their
psychological well-being. Ifthey can be enveloped in a
(33:28):
community that has that sort ofrichness, people start to trust
each other and have each other'sback.
Grant Oliphant (33:34):
Ben, how do you model psychological well-being
to your kids?
Ben Maxwell (33:40):
How do I model that? You know, I think I talk
to my daughter about what I'mtrying to do when I go to work
is make the world a better placeand help kids and families. And
that that fills me with, joy andcompassion that I think
(34:05):
ultimately leads leads me to myown psychological well-being. I
demonstrate the importance of,for me, exercise and being out
in nature and eating healthy. Weinvite people over, so we have
barbecues and communityregularly.
So my daughter can feel lost inthe buzz of sort of lots of
people being around, especiallyas an only child. We feel that's
(34:26):
important. So it's all thethings, you know, social
connection, connection tofamily, exercise, nature, eating
healthy, all these things that,you know, if I got out, and
said, hey. These are the thingsthat you need to do to be
psychologically well. Mostpeople aren't gonna be surprised
by those ideas.
Grant Oliphant (34:45):
Right.
Ben Maxwell (34:45):
But it's how do you do it? And so I try to
demonstrate to my daughter howdo we do it, but I also try to
live that for other people tosee as well and and hopefully
make an impact on on how theysee they might be able to do it.
Grant Oliphant (34:59):
Now as I listen to you describe that, it's kind
of a it's a beautiful list forany parent out there who is
struggling with how do I do thisin my own child's life, some
simple steps that you justdescribed.
Ben Maxwell (35:13):
Simple steps, and and we've got to acknowledge as
well that there there are peoplethat are overwhelmed with 2
parents working 2 jobs, and noteverybody can do that. And so
how do we create something thatis it takes a village to raise a
child and have something inplace so that other kids can do
that when their parents mightnot be around?
Grant Oliphant (35:34):
So let's talk about that for a moment. The
because what you just pointed tois disparities in youth mental
health, and they are real. Youknow, we we know that LGBTQ
youth experience youth mentalhealth issues at a rate, that is
very high because of thechallenges that they face. What
(35:56):
disparities do you see in in thechallenges that young people are
facing?
Ben Maxwell (36:02):
Yeah. I mean, early on, I think in our conversation,
I mentioned the idea that ourenvironment shapes our brain and
our mind. And so if you'regrowing up in an environment
with a lot of toxic stress,poverty, access to food is
unstable, these sorts of thingshave real impact on the kids
that we see at Rady Children'sHospital. And so, you know, if a
(36:24):
kid comes in and says, hey. Youknow, I don't have any friends
at school.
My parents work 2 jobs. Myclosest friend is some person I
met online that lives inTennessee, and we've never met
in person. And, you know, Idon't really feel all that good
about my life, and I'm wonderingwhat I should do next. In many
ways, that feels like thenatural, outcome of that
(36:46):
environment. So is it a medicalproblem, or is it an
environmental problem?
And I think we have to startthinking about those social
determinants of health in a morecomprehensive way than just,
hey, there's a health caresystem, and within the 4 walls
of the health care system, we'regonna stay there. That's the
conversation I wanna be a partof is how how do we help the
(37:07):
community in a way that can helppeople that are in that
position? And you were sayingearlier, doctors aren't usually
involved with YMCA and outdooroutreach and all these other
things. That's the reason I'minvolved with those is I think
it can have an impact.
Grant Oliphant (37:20):
Well, and I I it makes a it makes a beautiful
statement about the type ofsociety I think we need to
rebuild. I imagine it's also alittle controversial within the
halls of the medicalestablishment. So your rewards
are probably to do the clinicalwork that you were trained to
(37:42):
do. Yeah. What happens to a guylike you when you step out and
start talking about, hey.
We should partner with the y onthese on these things, and we
should think about communitysolutions to some of these
problems. How is that received?
Ben Maxwell (37:56):
I mean, I I think I've just been really fortunate
to be at Rady Children'sHospital where we are the only
children's hospital in SanDiego, and and they really have
stated, hey. We have acommitment to this community to
build and do what's importantfor kids and families. And so I
was worried about that, and I'llI'll tell you that quite
frankly. I was worried aboutsaying these things early on,
(38:18):
and then, fortunately, I broughta few of these things up with
leadership, and they said, hey.That sounds great.
We don't know how that fits intowhat we're doing, but keep doing
it and we'll figure it out.
Grant Oliphant (38:29):
That's remarkable, actually.
Ben Maxwell (38:30):
Remarkable. Yeah. So not only the senior
leadership of the hospital, butalso in meeting board members of
the hospital and worrying aboutwhat they might think, and them
also being totally committed tothe idea that Rady Children's
Hospital and its employees arehere to protect childhood, to
figure out a way to helpfamilies. And there isn't some,
(38:52):
hey. You know, we we need to getyou back in the clinic and just
generate clinical revenue forus.
Grant Oliphant (38:57):
How about more broadly? So it's great that
Rady's has had that reaction toyou. How is your position
received when you speak withcolleagues nationally about it?
Ben Maxwell (39:08):
I I think a lot of my colleagues nationally have a
more zoomed in look at what arethey gonna do in their clinic,
what are they gonna do withtheir program. And I think
that's where I'm just trying tosort of create my own lane of I
think there's somebody needs tobe in this position. Somebody
needs to be saying, hey. This iswhat we're seeing on the
clinical side of things. How howcan I act as an intermediary to
(39:31):
other parts of the community soso we can connect the dots and
really try to create a cohesiveenvironment for kids to grow up
and develop well?
Grant Oliphant (39:41):
I'm I'm I still struggle with the idea, I wanna
come back to something you saidearlier. I still struggle, or or
maybe I'm just, it it feels sobad, that there are kids who
feel that they get 0 contactwith their family. And yet, when
we were talking aboutdisparities, you sort of
(40:04):
perfectly describedcircumstances in which that
happens naturally. Right? Youknow?
You have a parent who's workingall the time, so you never see
them because they're trying tokeep bread on the table. You
know, other life circumstancesinterfere. Health issues may
interfere. So a young person cancome to feel disconnected. And
(40:28):
and you're also saying, on avery positive note, that there's
a way of dealing with this,which is for community to re
embrace its role and to connectkids with community more
broadly.
Here's the question I'mwondering about, which is why
should society care? I, youknow, I think I think we both
(40:52):
know the answer, but I don'tthink the answer is a given in
our culture. So when you'retalking with folks who maybe
don't understand that it's theirresponsibility, what happens
with quote, unquote otherpeople's kids, Why is why is
this a community responsibilityand not just opportunity?
Ben Maxwell (41:14):
Yeah. You know, 1 of the things they taught me in
med school was kids becomeadults. I don't know if you know
that.
Grant Oliphant (41:20):
Yeah. Oh, that thing.
Ben Maxwell (41:21):
Yeah. Yeah. So, you know, we're talking about 15
year old kids a lot of times.
Grant Oliphant (41:25):
Right.
Ben Maxwell (41:25):
They're adults in 3 years. Who are the
Grant Oliphant (41:28):
Yeah. That's such a good reminder.
Ben Maxwell (41:30):
Who who are the people that are staffing,
maintaining the electrical grid,flying the planes, taking care
of, our our parents in inhospitals? Who's gonna care for
us? So, ultimately, this iscritical to society that we are
able to have kids go throughchildhood and become functional
(41:56):
adults that can deal with thestresses that come with the
modern world. And that's achallenge that we're seeing
right now. So you look you lookat there's a recent survey, 18
to 24 year old Californians.
I think it was a year or 2 ago.2, 3000 Californians, young
Californians, were asked lots ofdifferent questions. 1 of the
questions they were asked was,have you thought about ending
(42:16):
your life in the past 12 months?31% said yes. So this data that
a lot of times is thrown outthere of 1 in 5 people struggle
with psychiatric illness,something like that, that data
is old and it's no longerrelevant to what's happening
with young people. If we'reliving in a world where 18 to 20
(42:37):
18 to 24 year olds, a third ofthem are thinking about killing
themselves every year, we'redoing something wrong. Mhmm. And
we have to find a new wayforward or has implications on
all aspects of society.
Grant Oliphant (42:51):
It's almost impossible to know where to go
from there because it's such asobering fact, And you're
drawing the through line fromthat a statistic like that to
the world that will be here in 3years, for everyone, is an
important way for the rest ofsociety to look at this. I
(43:13):
deeply appreciate the connectionyou're drawing between these
dynamics and the opportunitythat exists by reconnecting
young people with experiences ofnature, with self discovery. I I
believe profoundly important isthe opportunity for self
expression through creativityand art. Yeah. Your your work on
(43:37):
this, by the way, has affectedthe work that we're doing in
thinking about how we help youngpeople.
And it is a promising storylinethat begins to counter what the
surgeon general has talked aboutwith the epidemic of loneliness
and what Jonathan Haidt andothers are talking about with
screen time and so forth. Iwanna honor the fact that part
(44:01):
of the way you come to your ownmental health is through
surfing, which is which feels tome not like a community act, but
a solitary act. And solitude, bythe way, is also an important
feeder of mental health. But I'mcurious if you have gained any
lessons from being out on thewaves that have informed the
(44:23):
work that you're doing as achild psychiatrist dealing with
these exceptionally challenging,sobering, some frankly,
depressing Situations sometimes.
Ben Maxwell (44:35):
Yeah. Absolutely. You know, it's solitude and
it's, community. You know, forme, I have a group of guys that
I regularly meet up with at atSunrise before work. And when we
go out and we talk about what'sgoing on in each other's lives,
and it can be this reallybeautiful, quiet time where I
can be with other people andhave meaningful conversations.
(44:57):
Sometimes, they're notavailable, and I go by myself.
And it can be this time where Ithink about what I'm going to do
during the day, sort oftransition towards my work life,
from my my home life. But theact of surfing, I mean, there's
a lot of metaphors and clichesto life. You know, there are
times that I'm out there where awave is coming to hit me that
(45:19):
looks like it might kill me.And, you know, I have to find a
way to be calm and find peacethrough that.
There's other times that there'sjust exhilarating rides that I'm
at the at the discretion of thewave, so to speak, to see what
happens. So for me, it's been,that's all been, it's just a
(45:41):
great way to start the day. It'sa very San Diego way to start
the day.
Grant Oliphant (45:44):
It is a San Diego way to start the day. Not
my day, by the way.
Ben Maxwell (45:48):
Yeah. Well, you can do that. We should we should go
out sometime.
Grant Oliphant (45:50):
We'll talk later. Yeah. But definitely, you
know, the other the other thingthat comes up for me around
that, Ben, is just, sportssometimes gets overlooked in
this equation too with withhelping helping young people,
reconnect with withopportunities for seeing
themselves in a larger context.
Ben Maxwell (46:11):
Yeah. It's just great for kids to learn new
skills, find mastery, build selfesteem.
Grant Oliphant (46:16):
Yeah.
Ben Maxwell (46:17):
And that can be just really pivotal for the way
kids grow up.
Grant Oliphant (46:21):
Ben, what inspires you?
Ben Maxwell (46:23):
Man, w you know, grant, you inspire me. When I,
when I first, and I'm not sayingit.
Grant Oliphant (46:29):
That's the ultimate play to the host.
Ben Maxwell (46:31):
You you you can cut this out if you want. But but in
all sincerity, when I first met1 of your, colleagues at the
Prebys Foundation before I metyou, she said, you know, you're
really gonna love Grant. He's avisionary. And so, you know,
quite frankly, I I don't hearpeople say that to me that
frequently. So I looked intowhat you'd been able to do and
what you're trying to do here.
(46:51):
And I think exactly what we'vetalked about. I've been trying
to figure out how to communicateand message some of these things
around the importance ofcommunity, and it's what you've
done so well, I I know here andI think throughout your career.
So, honestly, like, trying tounderstand how to message better
and having somebody that, hasdone that is inspiring to me. I
(47:14):
think the other thing thatinspires me are people that push
up against the odds and say,hey. Like, I could just cave to
this, but I'm I'm gonna try tofind a better way forward.
And so there are people likePaul Farmer as a a person that
had the Partners in Health. Andso very early on in my, medical
career, I saw a documentary filmand read his book and thought,
(47:36):
yeah. I mean, that's that's sortof person I wanna be to push
back against theseinsurmountable odds to try to
have an impact for positive, inin the world.
Grant Oliphant (47:45):
Well, I love that you would have a hero like
him because he really issomebody who took on an
impossible challenge and figuredout a way for society to move
forward on it. And I And thankyou for the nice words. I think
you know what I believe aboutSan Diego and I really believe
you're embodying is that we havethe capacity in this community
(48:09):
because of some of the greatwork that is being done here to
demonstrate the power that stillexists for this country, through
the magic of community. Right.And if we just set our sights
high enough, you know ironicallywhat people often think when
things are bad, and you spoke tothis earlier.
Ironically what people oftenthink when things are bad or
(48:29):
challenging is that you have todumb down your response, and you
have to accept having less. Andwhat I hear you doing is saying,
no we need more. Yeah. You knowwhat we actually needed to do is
up our game, and the way we upour game is by connecting young
people with each other, and withcommunity, and with nature, and
with art, and you know, outdoorexperiences, and that bigger
(48:55):
vision will save us. And IIIlove everybody I meet who
embodies that sort of spirit,and you absolutely embody this
that spirit.
So thank you for the work you'redoing really on behalf of
everyone listening. I think Ispeak for us all in saying thank
you for what you're doing.
Ben Maxwell (49:15):
Thank you, Grant. Great being here.
Crystal Page (49:21):
You know, I have to say I have a lot of hope
listening to what Ben or doctorMaxwell had to say.
Grant Oliphant (49:29):
I do too. I have a lot of admiration too, you
know. I I think that probablycame across at the end of that
interview, but it is not easyfor a medical professional to
step outside of his clinicalrole and talk about what society
has to do or what community cando to address a challenge this
(49:51):
large. But III really my primarytakeaway from this conversation
above all else, and we'll gothrough some others, is just the
way he pointed to how we facedhard challenges before, and
we've dealt with them, and hebelieves that's possible here.
Crystal Page (50:08):
And I think where he said that he really wants to
live in a world where people arethriving and connected, that's a
vision of a future that I alsowanna live in.
Grant Oliphant (50:19):
And so do I. And it's you know, if you think
about it, of course, we do. It'sfundamental to our work, but
it's why we do the work that wedo because we believe that that
is the path forward for not justSan Diego, but for people in
general as we navigate thisconstantly changing world. If we
(50:40):
break down what he talked aboutand why that connection is so
important, you know, I I lovethe 3 challenges that he laid
out. And and 1 was that we thatyoung people, like everybody
else in our society, faces thiscrisis of loneliness and
isolation, which surprisinglyaccording to the data is
(51:03):
manifest in an increasingdisintegration of the family,
which is sad and scary, followedby and associated with the
second point, which was theamount of screen time, and I
found Crystal his data there tobe shocking frankly, you know,
that young people are spending 2thirds to 3 quarters of their
(51:25):
waking lives on screens tellsyou a little bit about what's
feeding this crisis of isolationfor them.
And then 3rd, the connectedpiece, you know, the the impact
on their health and theirwell-being and sleep. And and of
course when you're constantlybeing stimulated that way,
you're not gonna sleep well, andyou're not going to be able to
(51:47):
to attend to your wellness inthe way that you otherwise
might. So he painted thispicture of very real challenges
that are baked into the livesyoung people face, and then the
antidote was exactly what youspoke to. Do you wanna say a
little bit more about that?
Crystal Page (52:05):
You know, I appreciate you going through the
the 3 items because theloneliness piece is not unlike
what seniors are going throughor what we all went through
during the pandemic. Thedifference is all of us as
adults had had a, hopefully, acommunity connection beforehand.
We weren't born into this typeof world. So I think painting
that vision instead of gettinglost in the despair and the gut
(52:27):
punch of 1 out of 3 kids or 1out of 3 18 to 24 year olds
wanting to end their life, whichis such a gut punch. How do we
turn that around and say, let'slet's set up this vision where
we're all connected and wherepeople matter, and we're putting
down our phones and taking thetime just to reconnect.
(52:47):
You know? Like, that is a stepwe can all take. Like, he said
the thing about, like, do youwanna drive past your neighbor
at 35 miles an hour or slow downand wave to him? You know? I
think we all wanna live in theworld of the 35 slowing down
instead of the 35 miles an hour.
But it's hard on a grumpy day ora different day, but every
action matters.
Grant Oliphant (53:08):
It does. And I by the way, I think that I love
that. Every action matters ismaybe 1 of the most important
takeaways from this wholeinterview because what he is
describing is a set of ofsolutions that individually,
each 1 may not seem like thatmuch, but collectively, they
(53:28):
amount to a lot. Right? So he'stalking about reconnecting young
people with nature.
He's talking about reconnectingyoung people with opportunities
for self expression through art.We talked about sports at the
end. We talked about thecommunity that comes from those
activities. We talked aboutbroader community connections,
(53:52):
And the reason that every single1 of those is important and
doable is that, the young peoplewho are experiencing today's
crises are the adults who aregonna be supporting society and
driving society in as little asa year, 2 years, 3 years, 4
years. That by the way was alsoa gut punch, you know, his his
(54:16):
his point about that that wemake this sort of artificial
divide between young people andadults, but as he pointed out,
young people turn into adults,and then they become And
Crystal Page (54:36):
And I think even when he talked about whether it
was surfing or being in nature,you know, as a kid who grew up
in Vista, California, we wouldfundraise in middle school to go
to sea camp.
Ben Maxwell (54:47):
Yeah.
Crystal Page (54:47):
And I would kayak. And let me tell you, being a 12
year old little girl out on thewater in my own kayak,
surrounded by nothing but oceanand some other kids doing the
same thing is, like, the mostfreeing feeling in the world.
Like, you feel like there'ssomething you can control and
there's this whole big world youcan't control. I want kids to
have that even before they'readults. I want them to feel how
(55:09):
magnificent nature is, you know,and and how being connected just
feels good.
You know? So
Grant Oliphant (55:15):
Yeah. His positive framing around that
was, I thought, really helpfulbecause so much of this
conversation is negative. Youknow? It is about the the 1 in 3
young people having contemplatedsuicide, extraordinary. And it
and it is easy to fall intodespair because as you and I
(55:36):
have discovered in our work atthe foundation, there simply
isn't enough money in societynor is there are there enough
people to provide the clinicaltreatment to everyone who needs
it as if that's the solution,You know?
If that's the if that's theprimary modus operandi. If we
(55:57):
really wanna solve this over thelong term, we really have to
attend to the root causes, andwe will get at far more young
people, and we will create farmore, well, better outcomes at
in the end because we do that. Iwas really struck by the way he
described our individualisticsociety and acknowledged some of
(56:20):
the causes of it that are notjust a a way of looking at the
world that's unique to America.Partly it's that. But partly
it's also disparities in oureconomy.
It's parents who have no otherchoices in in how they care for
their children, it's parents whoare just too busy working
(56:41):
multiple jobs, it's it's peoplenot having been given exposure
to other opportunities. It'stheir kids not having access to
the sort of natural amenitiesthat, more affluent families
take for granted. It's all ofthat. And if we can begin to
(57:01):
just acknowledge that and findways of reconnecting kids with
those opportunities, then wehave a path forward in
addressing on a very broad scalethe challenge that we're facing
in youth mental and behavioralhealth.
Crystal Page (57:15):
But I also loved when you asked him the question,
how do you model this for yourdaughter?
Ben Maxwell (57:21):
Yeah.
Crystal Page (57:21):
And you're a dad and grandpa, so so how did that
his response hit you?
Grant Oliphant (57:25):
Well, I you know, I was partly asking that
question out of self interestbecause I think it's so hard for
you for parents raising kidstoday to figure out the right
thing to do by their kids. And Ihis answer was perfect. It was
to the extent that you can, totake care of yourself, to do the
things for your child that alsoare good for you, and vice
(57:49):
versa. To to take opportunitiesto recharge, and to find the
sources of joy that you canshare with your child. You know,
I think he he talked about it ina way that almost every parent,
even the ones who are waystressed out, could identify
with.
(58:10):
And, and it's important torealize that to a certain
extent, everybody's dealing withthat in our culture. And we have
tools. We have tools.
Crystal Page (58:21):
I feel empowered. How about you?
Grant Oliphant (58:23):
I feel empowered, and I feel more
hopeful than I did when evenwhen we began the conversation
because there is a path forward,and somebody who has studied
this issue way more than we havehas identified that, yeah, we
can do this.
Crystal Page (58:38):
Yeah. And it's gonna continue to show up in our
work. So this conversation hasonly begun. Right?
Grant Oliphant (58:42):
It it is. III think for us in our work, what
we're we're seeing over and overagain is, especially in our
community, the convergence ofnature and art and creativity
and, youth mental health ishuge, and we're going to see a
(59:03):
lot more of our activity steeredtowards that particular meeting
point.
Crystal Page (59:08):
With that, I think we have had another great
episode, Grant. It's been great
Grant Oliphant (59:13):
Crystal, I love doing this with you. Thank you
for,
Crystal Page (59:15):
Ditto my friend.
Grant Oliphant (59:16):
For sharing this conversation, and look forward
to doing it again.
Crystal Page (59:20):
See you next time. Alright.
Grant Oliphant (59:25):
This is a production of the Prebys
Foundation, hosted by GrantOliphant, and co hosted by
Crystal Page. The program is coproduced by Crystal Page and
Adam Greenfield, and it'sengineered by Adam Greenfield.
Production assistance isprovided by Tess Karesky. And
(59:46):
our new theme song is by misterLyrical Groove, a local San
Diego artist. Download episodesat your favorite podcatcher or
visit us at stop and talkpodcast.org.
If you like this show, and wereally hope you do, the best way
to support it is to share,subscribe, and review our
(01:00:09):
podcast. Thank you for yoursupport, your ideas, and most of
all, for listening. This programhas been recorded at The Voice
of San Diego Podcast Studio.
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