 Good morning, everybody. I'd like to encourage you to please take your seats. We're going to get started. So my name is Cecilia Oregone-Ceverria, and I am the executive director for the Institute for Health Policy in Kaiser Permanente's National Government Relations Department. Very happy to be here today. This is our sixth IHP forum, and this is the fourth that we're doing on mental health issues. So we've been very committed to these issues, and I think today's conversation will be as robust as our previous conversations have been. So before we get started, I'd like to do a little bit of housekeeping. You should all have a folder in front of you. The folder includes pieces of information that could be very useful. The agenda is included. There is a two-pager on suicide prevention in there that we'd encourage you to look at. We also have a survey evaluation for today, and I would just encourage everyone to take some time before you leave today to give us feedback. We definitely listen to it, and we've made a number of changes over the course of our series based on the feedback we receive. So please do complete that and send it our way. I will also say that at your tables, you have information about social media handles, our Twitter handle. Please feel free to tweet throughout the day. We'd love to share this information outside of the walls of the Center for Total Health, so please take a look at that. So we also have restrooms for those that haven't been in this facility. You'd go through the corridor to my right, out a door, and then to the left, and so the restrooms are in the medical office building. The emergency exit, in case there's an emergency, is right behind us where you came in. And I would like to also encourage people, if you're going to take a phone call today, to please do it outside. There are other rooms here, but they are reserved for other purposes, so please take calls outside. And if you need help with anything throughout the day today, please look for a staff member. And I'm going to ask our staff members to raise their hands so that you can take a look at who you can talk to. The ladies in the back table there are also available to talk to if you need anything or there's anything we can do to support you today to be more comfortable. We also have a counselor that will be joining us on site a little later today. The room immediately behind you near where the coffee and tea is, is the room that's going to be used for reflection if you need just to take a break, because today's content is serious. We'd encourage you to take a few minutes in that room, and there will be a counselor available. We'll make sure that we connect you if you need to. If you'd like to speak with the counselor, you can talk to one of us as well, OK? So we will also be doing question and answers throughout the day. There's microphones up against the screens. And so please make notes, think about your questions, and we'd love to make sure that there's plenty of dialogue today. Lunch will also be served at 12.30. So before I introduce Dr. Mordecai, I would like us to do a poll. And the instructions for the poll are on your tables as well. So you can text KPIHP to 37607 to participate in the poll. So you should get a little notice that lets you know that you are ready to participate in the poll. So I'll give you a second to do that. OK, folks got it? OK, so the question today is, what do you hope gets discussed today as it relates to suicide prevention? So a single word, a couple words would be helpful. And we'll start to see what comes up. Great. So we have social media impact, solutions, compassion, local public health engagement, alternatives to hospitalization, prevention, public policy solutions, schools, isolation awareness, using online means to prevent suicide at scale, increased funding for research, safety net, tracking outcomes, youth, policy solutions, evidence-based assessment, stigma, faith community partnerships. Great. Wonderful. Inspiration. Great. Well, thank you all for participating in that. I think there may be others coming in. But this is a really great way, I think, for us to start today's conversation and for the moderators and panelists that are sitting with us just to sort of hear a little bit about what's on everybody's mind today. Reaching people in rural areas. Very good. So with that, I'm going to ask Don to come up. And I'll tell you a little bit about Don as he comes up. So Dr. Don Mordecai is Kaiser Permanente's national leader for mental health and wellness. He's been with Kaiser Permanente since 2003. He trained at Stanford University School of Medicine in child and adolescent, as well as adult psychiatry. His clinical work is with patients with developmental disabilities, ADHD, and the range of general psychiatry issues. He sees patients of all ages, though he's particularly interested in working with adolescents and young adults. He also serves as adjunct clinical associate professor of psychiatry at Stanford University School of Medicine. Welcome, Don. Thank you, Sessi. Good morning, everybody. Oh, good. I got a few good mornings. That's nice. This is a tough topic, right? We all know that. I love that people put inspiration down, too, because what we hope is that we can do both. Talk about a very difficult topic and leave with inspiration. I'm also hoping that I'm not going to spill the coffee that I've set up right next to me. Very dangerous. All right. Thank you, everybody, for joining us. We have a really diverse group of people here today from many different organizations that care about this topic. And that's why we do this. So thank you. I guess my job is to really set the stage here. And what I would say is that something is not right in our society. As simple as that. We live in a time when rates of depression and anxiety are increasing. And we're seeing that, I would say, particularly among our young people, but really across the board. Maybe we're seeing decreasing stigma, which I think is a hopeful thing. And we can talk about that maybe a little bit. We're seeing increasing demand for mental health and addiction services. We at Kaiser Permanente, obviously, we're a service provider organization as well. And the demand goes up and up and up. And we are doing our best to meet that demand. And the system nationally is incredibly stressed at a time when only about half of people who have a mental health condition are actually getting any treatment yet. So we've got a mismatch here. And we have an aging workforce in this area. We really need to step up our game at a national level in terms of creating opportunities for people to go into this field. It's a wonderful field to be part of. But the pipeline needs to grow substantially if we're going to take care of the people who want to be taken care of. And while it's tempting to say, well, maybe the increasing rates are because stigma is going down. Or maybe we're getting better at identifying people. And that's why the rates are going up. But the most difficult statistic of all are the statistics around suicide. Because if it was just about finding people who had the illness and that's what's causing the rate to go up, you wouldn't expect the suicide rate to be going up. But of course, the suicide rate has been going up very substantially. So from 2001 to 2017, it went up 30% across the population. Among young boys, it went up 70%. Among young girls, it went up 300%. So these are pretty devastating statistics. It's now the second leading cause of death among people, 10 to 34. I was in Colorado last week at a mental health conference about in schools. And it's the leading cause of death among young people in Colorado. Suicide, not accidents, not the other things that take people's lives, suicide. So we have to get our arms around this. We can't tell this story without talking somewhat about guns because they're lethal. Almost 40,000 Americans died by guns in 2017. 60% or 6 out of 10 of those were suicides. 24,000 of the gun deaths that we are rightly so concerned about were people taking their own lives. That's over half of the 47,000 plus suicides that happened. So over half of suicides are by gun. So we can't have this conversation without talking about guns. By the way, there were somewhat more than 19,000 homicides last year. So suicides, people who die by guns are people taking their own lives mostly. The deaths of despair, so-called, suicide addiction overdose are largely driven by, excuse me, have driven down the life expectancy in the United States for the past three years running. We know these stats. I repeat them maybe at my peril because we have to own these stats and not just let them wash over us. There were two recent pieces that you may have seen that came up in the media. And this comes up in the media on a periodic basis. I was a little distressed by the tone of the pieces. One was an op-ed in the New York Times that said the empty promise of suicide prevention. And I just got a thumbs down in the audience and I agree. It was like, it's a terrible headline. I mean, you're right. Reading the op-ed, it was a little more nuanced than that. And they were talking about the fact that a lot of suicides are impulsive. It's hard to know who maybe has suicidal intent. All true. But we need to keep track of some other facts as well. The other is the news about 13 reasons why the television show and the Journal of the American Academy of Child and Adolescent Psychiatry. Wow, I got that all out in one. Which is the most respected Child and Adolescent Psychiatry Journal in our country published a study that showed an association, stop, keyword, between the running of that show, which is about a girl who takes her own life, and an increase in suicide, interestingly, particularly among boys. But there was a really good article in the LA Times, I thought, that kind of unpacked that a little bit in the nuances. But the message was sort of like, well, what can we do? I mean, media is driving this. It's out of our hands. It's not out of our hands. It really is not out of our hands. Yes, suicide is often an impulsive act. But it's an impulsive act that comes at the end of a long chain of other events. And I really believe that we can break that chain. And to me, one of the most hopeful statistics around suicide is that 90% plus of people who make an attempt on their life do not end up dying by their own hand, 90%. So there's a huge opportunity there to work with people, even people who have gone and made an attempt. But to me, that means there's an opportunity way upstream of that too, to people way before they make an attempt. So we need to get on top of those short term crises and help people to get past the suicidal impulse. So this is the right place to focus. There is opportunity here. It is not hopeless. This is a top priority for Kaiser Permanente, for the mental health and addiction leaders of operations of Kaiser Permanente in all of our regions. We're committed to ending stigma as well. We have a find your words public health awareness program. Maybe some of you have seen our ads. We're going to show some today, I think. And this year, we've focused on the risks of self-harm. And we've partnered with NAMI and with the Crisis Text Line and with the Suicide Prevention Lifeline to let people know that there's hope and that there are resources. And finally, we're committed to moving upstream on mental health conditions. So we did the original adverse childhood experiences study along with the Centers for Disease Control. And basically, that tied directly into the diseases of despair later in life. Those who had had four or more adverse childhood experiences in childhood as adults had seven times the likelihood of substance abuse and 12 times the likelihood of self-harm attempts. So we think this starts in childhood and that we can make a difference in childhood.