 for another episode of The Savvy Entrepreneur. Today, we have a very important topic for you, mental health. We will be discussing how COVID-19 self-distancing and self-quarantining can impact your mental health. And to have this conversation, I've invited one of my very good friends, Dr. Kimberly Claggett. Kim, how are you doing today? I'm doing well in yourself. I'm doing best as I can, with the self-distancing and everything. I appreciate you taking the time to join me from your home in Los Angeles. How's everything in LA? Do you know what's interesting? I live in downtown LA, and it's basically a ghost town around here. There's a lot of restaurants, hotels, financial businesses, entertainment venues, and they basically seem to have all closed down. So it's different here. We also found out that there's the first confirmed case in Skid Row, which has a lot of people nervous. It's, one, just a very vulnerable population. They don't have a lot of resources to not only protect themselves, but to prevent the spread of this virus. So I think people are concerned about the effects now that it's in that community and how it will affect us all. But we're holding up. Yeah, that's scary. People who have limited resources or no resources are a affected class that is often forgotten. Yeah. Oh, you know, I myself have been self-quarantining for a few weeks now. And one of the things I shared with my patients before I left was the fact that most of us will be okay. However, not all of us will be. And we have a responsibility, those of us that are in positions to isolate, you know, to even basic things, like wash our hands more often, we need to be doing that for the people that can't do it themselves, or for the people that we know won't be, or think won't be okay. Because there's a lot of people that don't have, they're not lucky enough to really be confident that they're going to get through this. That's scary. So Kim, can you tell us a little bit more about your background, and tell us what you're doing, and how that is important to this discussion? So, I currently, I work for the California Department of Corrections and Rehabilitation. I am a psychologist or mental health clinician within there. I have my PhD in clinical forensic psychology. My emphasis was in victimology, which looks a lot at the effects of trauma on people's mental well-being. Let's see. Part of my duties at work, I do work with the inmates in the prison. My specific population is a little bit higher functioning. They tend to be people with depressive disorders, anxiety disorders, personality disorders. A lot of them suffer from trauma in their background, and a lot of their mental health issues didn't come up really until, or they didn't realize it, until they were incarcerated. And I think part of it is because the effects of the isolation just exacerbated the symptoms that were already there, or in some cases created them. I do a lot of suicide and a crisis intervention, and I am a trainer for suicide prevention and safety planning interventions. All those things are super relevant today, especially since everyone is basically in isolation. Do you wanna talk about how isolation can impact an individual psyche? Of course. I think we can all learn a lot about the effects of isolation by looking at the prisoner population in the United States. There is a lot of research demonstrating how isolation is actually really bad for people's mental wellness. If you look at people that have been kept in complete isolation or in segregated housing, you can see that over time, they tend to develop more and more mental health issues. It's very easy to recognize how it can affect your depression and anxiety, but over long periods of time, it can have even more negative effects. Increased paranoia with some people even going as far as like delusional type disorders. And then over time also increasing suicide risk as well. Wow. So with this self-isolation, people are experiencing things some have never experienced before. Most people haven't been forced to reside in their homes 24 hours a day. So for those who maybe don't realize that this is impacting them, what are some of the things that they should look out for to show that they are maybe experiencing some depression or other type of mental illness? So with depression, we often think of it as people feeling sad and that is definitely one of the symptoms, but it's not the only symptom. And sometimes people don't even realize that they haven't connected that they're feeling sad. I recommend that people look for changes in their just their baseline level of functioning. So if you're seeing things like you're suddenly sleeping a whole lot more or a whole lot less, which I get it is hard right now because a lot of people are sleeping more than usual, but paying attention to see if it's something, if it's something more than that. If you're, for example, not able to sleep because you can't get your mind to turn off and you're constantly worrying about what's going to happen tomorrow or next week or from now. Or if you find yourself staying in bed and you're just saying, like, I don't really, I don't feel like getting up or other reason to get up, that could be a sign. If you no longer want to do things that used to be of interest to you, if you like cooking and suddenly you don't want to, if you're finding yourself withdrawing from people, not answering phone calls, not responding to text messages, things like that can be an indication that you're starting to go down that path. If thoughts of suicide, if that starts crossing your mind, it doesn't mean you're at high risk, but if you suddenly think like, I'm not going to make it through this where I lost my job, maybe I just better off dead, those kind of things can be a sign of depression. Yeah, that's really scary. Basically, eating patterns is a big one as well. Oftentimes people that get depressed will eat a lot to help them feel better and they'll notice that they start gaining weight, or just eating way more than normal. And then on the other hand, some people eat a lot less. They feel like they're sick if they just don't have an appetite and don't want to eat. So that's a big risk factor for warning signs. And increased drinking, drug use, something like that, because a lot of times that helps people cope. They can't necessarily, they can't say, I feel depressed right now, but they know that they feel better if they're under the influence and they don't necessarily have to think about it. Self-medicating, yeah. So if you happen to have someone in your life, a friend or a family member who might be exhibiting some of these symptoms, what should you do as a concerned friend or relative? I think the best thing that we can all do right now is just reach out and be present for that person. You don't have to give them advice. You don't have to cure anything. You don't have to tell them what to do. You're just being there and being an active person in their life is really helpful. When we use safety planning interventions for patients that are of higher risk or suicide, one of the things we do is identify people in your life that you can just talk to. You don't have to tell them you're depressed. You don't have to tell them that you're anxious or you're having these negative thoughts, but just people that you feel comfortable just talking about sports, talking about TV, whatever it might be. The other thing I think is really important is to really validate the way that they're feeling if they do open up to you. There still is a big stigma against mental health or mental illness and mental health treatment here in the United States. And a lot of people see having depression or having anxiety, having suicidal thoughts as a sign of weakness. And therefore people feel uncomfortable when people can make up about it. I recently, just like an hour ago read an article that said four in 10 Americans have either lost a job or lost a chunk of their income already because of this virus. And that nearly half of all the respondents in the survey which was done by Kaiser have said that stress related to this is taking a toll on their mental health. And that's just the people that can identify that they're having these issues. And if you think about it, it's been at most maybe four to five weeks for some people and we have a substantially longer time that we may be going through this. So we can see those, we'll likely see those numbers increase. So when you're hearing people say things like that, validating that for them, letting them know that it's okay, it's normal, and there's nothing wrong with them because they feel this way. I think feedback is always nice but when you give feedback you have to make sure that you're doing it in a really caring, empathic way. A lot of people that aren't feeling depressed and anxious already have negative thoughts about themselves. So if you, when you're talking to them are giving feedback that maybe sounds accusatory or flaming, that can reinforce those ideas as well. That's a great point. You don't have to fix them. I mean, most people aren't medical professionals. So I love the feedback you gave about just listening and being there for them, showing them that there's people that who care about them and who are there. That's a great advice. So let's say you're the person that maybe is depressed or maybe you don't even know that you're depressed. Do you have some tips and tricks that you can offer our audience about things that they can do to optimize our mental capacity and mental health? So there's a few different ways that you can manage these symptoms. I think first and foremost, if there's something you can do to address the situation that's causing you to feel anxious or depressed, then you should make some attempts to address that. Avoidance is great for coping, especially when you're in kind of a crisis moment, but it doesn't solve the issue. And therefore, lay your eater down the road the next day, a couple hours from now, that's going to come back up. So if you're anxious, say, because you've lost your job and that's then causing some more depression, you can do things to help your employment. So maybe revamping your resume, even if you're not applying for jobs, maybe you can look at some jobs. If you can take an offline course or thing that may make you like increase your employability, that would be nice because you're tackling the problem directly. That's not always an option though. And some of what we're dealing with right now, we can't tackle directly. There's so much unknown. We don't know how much longer we're going to be in quarantine. We don't know the complete pool of job losses with that school to look like. We don't know if we're going to get sick. We don't know if our family members are going to get sick. And so a lot of that is causing an increase in symptoms just because there's so much fear and unknown with it. So in situations like that, I find distraction techniques really helpful, especially when you're in the moment where you can't get your mind off of it. I'm listening to music, reading a book. Some people find TV to be helpful. Some people find it to be the exact opposite because you can have it on and you're still in your head. So sometimes that doesn't work. I personally find and a lot of my patients find puzzles to be really helpful because you have to really focus on like word searches or Sudoku puzzles. You can't put all these numbers together and still think of everything that's happening in the world. So it really pulls you out of that. Another great thing to do is remember that our mind and our body are very connected. And there's a lot of research that says healthy diet and exercise does more for mental wellness than medications do. So first and foremost, really just taking care of your body, making sure you're getting enough sleep, making sure you're drinking plenty of water. If you're able to get into your yard and get a little movement that's great, especially with the sunlight, you know, really helps your mood as well. Break a little sweat. Love to eat junk food right now, but if you can put a little bit of a hold on that and make sure you're getting your fresh fruits and vegetables, protein, and that your diet is somewhat balanced, all of that's going to help you. I think another thing is that a lot of research also shows the best way to make yourself feel better is to do something positive for someone else. So we all have our various blessings in different ways. Some people are lucky to, you know, to be in a situation where they can self-quarantine and not have to worry about paying. Some people are lucky that their job is giving them time off. Some people are lucky that they have family support. Some people just have an ability to talk to people and make them smile. We all have these various gifts and we can get back in numerous ways. And at the end of the day, remember if you are self-quarantining that your actions are literally saving lives and when you're feeling down and you're feeling like it's rough reminding yourself of that, there is a purpose to this sacrifice. That's a great point. It's all in perspective. We're doing this to save lives and hopefully, you know, it works. I've seen, you know, news reporting talking about up to 300,000 deaths. And, you know, luckily we haven't realized that yet but I can only imagine the mental toll it'll have on people. Even in New York, they're having these refrigerated trucks for the deceased. Do you have any tips or ideas on how people can help cope with the impending death of hundreds of thousands of people? We are definitely in unprecedented time with the amount of death we could possibly encounter. Most of us haven't experienced that in our lifetime. And then in addition to that because of how contagious this virus is it's really changing our ability to breathe to get closure in the ways that we usually do. We're not able to fit with our family members in the hospital right now. A lot of times not even having an opportunity to stay your final goodbye. Not being able to go to funeral because of limiting mass gatherings. I think this is something that also very much kind of resemble what we're living in prison. And so a lot of times there is this initial grief when you experience that loss and you hear the news and you find out that that person is no longer with you. And that's hard and that's difficult. But then life resumes when the prisoners are released from jail or prison or in our situation when these quarantines are listed and we're able to go back to work and get back to our normal lives. That grief will hit again because you realize that life is going back to normal but it's going back to normal without those people that we've lost. And you will likely have a whole flood of new emotions as we're trying to navigate this new ground without important people. And knowing the population that it's particularly bad for which is the elderly it's going to be people that have helped us to have these things in the past. I think one of the things that we can really do right now is just remind ourselves that it's okay to feel however you're feeling with grief, you're going to have all kinds of emotions. You're going to be angry. Angry that you didn't get to stay your goodbye. Angry that you didn't get to have this new girl. I wouldn't be surprised if there was a lot of survivors guilt. Maybe pain that you weren't able to do more. There's going to be the obvious depression involved. And what we know about grief is that there are days when you will get hit with all of those emotions and you'll feel like a tidal wave hitting you and you're drowning in your emotions and you can't catch your breath. And then there will be days when you feel a little bit better and over time hopefully it gets better but there will be triggers, there will be dates, there will be reminders that we've experienced all of those loss and it's not just a loss for the individual it's at this point because it's so far reaching it's the collective loss for everybody in our community in our country and world that we're going through this together. So reminding yourself it is okay to feel how you feel and be kind to yourself don't judge yourself don't treat yourself too harshly don't compare yourself to other people and give yourself a break. I said earlier that you know diet and exercise and music and puzzles can help take your mind off of this but when you're going through the loss of this sort sometimes you just need to take a step back and listen to your body and that's okay if you want to stay in bed for days it's okay. If you want to eat a whole bunch because it makes you feel better that's okay but there will come a point when you have to ask yourself how long is this going to past and am I okay to keep doing this or do I need to push myself a little bit more and it's such a personal question because everybody agrees differently Such an important message everyone goes through this differently and the message that it's okay is really profound it's really important and because there's so many people who are being impacted by this just the other day it was so unfortunate I heard someone committed suicide on the railroad tracks a few blocks away from where I live here in Longmont Do you want to talk about any other tips or tricks for dealing with suicide prevention or helping reaching and connecting with people who might be at risk? I would again first like the reiterate that having depression, anxiety, thoughts of suicide past suicide tips is not a sign of your depression at all it is normal most Americans go through one major depressive episode in their lifetime it's why we talked about what people experience these things and it's okay reach out for help a few days it doesn't say anything bad about you experiencing them we are also currently facing several triggers that increase suicide risk a big one is the perception of loss of social support and I wanted to say the word perception because it's how individuals perceive these circumstances not how you or I might see them so someone might say you know I've lost everyone around me and you're like oh you still have your husband or you still have your wife there or you know your family's okay they're alive they're just in a different state and we can make sense of it that way but that's not how they're experiencing it a lot of this is based on their perception so the perception of loss of social support is a big one of these social creatures our our whole livelihood is basically dependent on how we interact with others how we connect emotionally how we connect even if people don't realize what's happening supporting on another who's in different minds and so when you feel like that is taken away from you it's one of those things that just just increases your risk another one that we should expect to run around now is the loss of jobs and financially how that will affect people we do know that during economic recession there is increase in completed suicides and we are facing that on levels we never have before in this country like I stated earlier already they're saying 4 out of 10 families have experienced the loss of job or the loss of income of some sort because of this some people and there's various ways to look at people some people find a lot of meaning and purpose in their lives through the work they do some people find a lot of pride in being able to work it's part of their identity and part of who they are and that's lost another part of it is the anxiety that comes up from not knowing how you're going to get by from day to day how long is your savings going to last will you be able to pay rent by groceries are you going to end up homeless on the streets you know and that sounds like it's going from 0 to 60 really quick but that's what anxiety does and depression does it makes your thoughts race to the point where you can very clearly see I lost my job so I'm living in a tent and it just happens you can't almost like you can't control it they just move so fast and so then people start to worry they start to feel like they they can't provide after the 2008 recession we saw in facing suicide in middle age middle age and middle class of white males because I think in part because they were hit very hard by the recession and they also tended to be family providers and so we know with one of the thoughts of people having a suicide is that people will be better off without me and I I have no good anymore you can imagine for a whole provider who can't do that what kind of tool must that take on his overall sense of self or her overall sense of self so recent losses is another risk factor we just talked about that some estimates a quarter million people passing away is big and how many families does that impact and so when we see people that have these increased risk factors we do we do a safety plan and it's to give them steps that they can follow step by step to help them as these as these thoughts towards the depression starts to get worse the first thing you want to do is acknowledge that it's there people that have experiences in the past they kind of know their triggers they know their warning signs and so it can be much easier for them to say I'm going down this road but for people that have never experienced this before it's going back to what we talked about in the beginning identifying are there changes in your behavior changes in your mood that lead you to think you might be more depressed and then with that are you having thoughts of suicide even if it's casting one thing that a doctor told me one was that having those thoughts isn't necessarily bad again they're very normal but it's a red flag and it's something that you tell yourself like okay I just need to pay attention a little bit more and so after that once you identify that you might be going down this road you want to start to implement something that can help distract you from it so these are the things we were talking about like listening to music, puzzles working out things that you can do on your own and you want to make sure that the things that you can actually do in this situation so going to the movies isn't going to help maybe you can change that to watching a field movie on TV you're not going to be able to go to your favorite workout class but maybe you can do some jumping gags or push-ups or squats or something in your living room if that isn't helping then you want to move on to the next step which is to reach out to people that you're comfortable with that you are happy when you talk to and you're not necessarily telling them that you're having these thoughts of your feelings you're just really talking to them for social purposes so that you can maybe laugh a little check in on how they're doing so you're not so focused on yourself all the time talk about TV talk about sports whatever it may be if that doesn't work then you're going to want to find people you can reach out to and let them know that you're struggling so this doesn't have to be someone that you trust it doesn't necessarily have to be a best friend or family member and sometimes those can be the hardest people to talk to reaching out to someone that you trust their opinion and how they will respond and you can let them know I have feelings which is having these thoughts that won't work for me I kind of keep and see if you can get some help maybe maybe in some more situations sometimes it's just having someone to hear you out and then it's departing and it's like a breath of fresh air that you were able to stay all of that if you're still finding that these thoughts are not going away then you'll want to reach out to a professional there are hotlines that you can call at least in a way and I've heard also from New York the mental health department the county mental health department are setting up services so they can do some telehealth their phone contacts with people almost every mental health provider that I know right now is either still going into the office or they're working or they're doing telehealth appointments so reaching out to somebody that will be unbiased, non-judgmental and a little more equipped than some of your basic community people to help you really understand what's going on and how you deal with it beyond that if it's still not working then you want to talk about implementing ways to really keep you safe and a lot of times this is where friends and family come in as well one of the things you want to do if you're really still having these thoughts and they're strong you do what you might ask on them is a main restriction which means pulling the things out of your home that you can use to harm yourself so if you have firearms you want to move if you have lots of over-the-counter medication or prescription medication you can work these on you want to start removing those obviously you can't get rid of everything but what we do know is that the harder you make it to act on those thoughts the less likely it is that you will act on them and then you should also start considering going into a medical facility whether you're calling 911 or taking yourself to an emergency room and letting them know and being very clear not to do that telling them I am here because I am impressed and these are the thoughts that I am having and I know the thing I can keep myself safe that is so important which you just shared with us and I thank you for all those suggestions one thing that I also wanted to talk about is relationships I mean sometimes people are stuck in the house with their significant other for more hours than they're used to do you have any tips or ways to deal with your spouse or significant other that may be getting on your nerves I by no means a relationship expert but I will say working with people that hear this hits my 12-cell to people communication is letting each other know how you're thinking how you're feeling you know really I think this is also a time when you get to learn each other is like a piece of that irritate each other because you are just basically on top of people so community is letting you know what you're thinking really if you're upset if you need some space if possible find a way to give a little space for each other you know just go to different rooms whatever it might be working out at different times something because we as much as we're talking about how we need each other we also need our own time and so that can be really important really caring for giving an understanding as we've said we're all going to manage this crisis some people their depression might come out more and anger or agitation or being short feelings or something like that some people just want to isolate more and don't want anything to do with anybody other people are like an angel an angel and that can be extremely difficult if you're responding in different ways if you're not in the same household so letting them understand if that's what you can why it is that you're responding that way and that way you guys can just adjust a little bit for each other better and like I said being really caring and forgiving that is so important being patient with your significant other being compassionate understanding that this is tough on everyone those are lessons that we should try to carry over after this whole thing is done with as well Dr. Clegg I really appreciate your time talking to us about all these very important issues and to you in the audience if you have a friend or family member who is a potential person who needs help or maybe is lonely reach out to them talk to them engage with them when we work together as a community everyone benefits