Podcasts about fof

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Best podcasts about fof

Latest podcast episodes about fof

Chuck and Buck
H2: 10-10 Gregg Bell, Tim Rooney/FoF & the Quatro

Chuck and Buck

Play Episode Listen Later Oct 10, 2022 39:28


Gregg Bell (Tacoma News Tribune) joins the show to help us decide if this is the worst Seahawks defense we've ever seen. The coolest teacher in the PNW, Tim Rooney joins the show to talk Mariners. Chuck makes his FoF pick and we wrap up the our with the Quatro!

Mama Tried x Flat Out Friday Show
14 - Scott and Jeremy discuss Flat Out Friday race with American Flat Track

Mama Tried x Flat Out Friday Show

Play Episode Listen Later Oct 4, 2022 44:32


Scott and Jeremy sit down to reflect on the first official FOF race in association with the AFT that took place on September 24, 2022 Can someone on a podcast talk too much? American Flat Track at New Richmond Wisconsin Let the chips fly Being extra juiced Where the corners are longer than the straights How many stars is Cleopatra's Spa? The perfect poopy 10 dive bars in 2 blocks Soup store Crappiness to overcome Lobster tacos Proud yet embarrassed  Hooliganing - is that a word? People on fire Who is paying attention? Kustomfest Indonesia - wish we were there How many islands in Indonesia? Much more huger MMT FOF takeover at Aztalan Elkhorn Limestone Flat Track Stand up at the fence with a beer and someone will help you out 

Chuck and Buck
H2: 10-4 Gregg Bell, M's Opponent preview/FoF & Ashley's New Song

Chuck and Buck

Play Episode Listen Later Oct 4, 2022 37:41


Gregg Bell (Tacoma News Tribune) joins the show as we continue to try and figure out the defensive woes for the Hawks. The Mariners will either be headed to Cleveland or Toronto and today we preview Cleveland. Ashley makes her FoF pick. We have a new song for the Mariners, enjoy!

Chuck and Buck
H2: 10-3 Gregg Bell, Rick Rizzs, FoF and the Quatro

Chuck and Buck

Play Episode Listen Later Oct 3, 2022 42:02


Gregg Bell (Tacoma New Tribune) joins the show with the latest 12th Man News after a Seahawks victory in Detroit. The Voice of Summer, Rick Rizzs joins the show and talks about Friday night and the playoffs; that's right, playoffs! Bucky makes his FoF pick and we wrap up the hour with the top 4 stories in sports.

Chuck and Buck
H2: 10-3 Gregg Bell, Rick Rizzs, FoF and the Quatro

Chuck and Buck

Play Episode Listen Later Oct 3, 2022 41:59


Gregg Bell (Tacoma New Tribune) joins the show with the latest 12th Man News after a Seahawks victory in Detroit. The Voice of Summer, Rick Rizzs joins the show and talks about Friday night and the playoffs; that's right, playoffs! Bucky makes his FoF pick and we wrap up the hour with the top 4 stories in sports.

Focus on the Family Weekend
Focus on the Family Weekend: Oct. 1-2, 2022

Focus on the Family Weekend

Play Episode Listen Later Oct 1, 2022 54:59


This weekend, we revisit our recent Daily Broadcast "Forming New Habits for Your Marriage."Dr. Randy Schroeder returns once more to FOF to discuss habits you can integrate into your marriage! Jim talks to Randy about pursuing the daily essentials of affection in your marriage, promoting emotional closeness, and leaving and cleaving properly.Receive the book Simple Habits for Marital Happiness and the audio download of the broadcast "Forming New Habits For Your Marriage" for your donation of any amount! Plus, receive member-exclusive benefits when you make a recurring gift today. Your monthly support helps families thrive: https://donate.focusonthefamily.com/don-daily-broadcast-product-2022-09-22?refcd=1432006Get more episode resources: https://www.focusonthefamily.com/episodes/broadcast/forming-new-habits-for-your-marriage-part-1-of-2If you've listened to any of our podcasts, please give us your feedback: https://focusonthefamily.com/podcastsurvey/

Chuck and Buck
H2: 9-30 It's all about the Mariners! No Cliche Keys to Victory/FoF & Green Jacket Updates

Chuck and Buck

Play Episode Listen Later Sep 30, 2022 42:40


Gregg Bell (Tacoma News Tribune) is traveling, so we use this time to go nuts about the Mariners! The Hawks face the Lions on Sunday and we give our no cliche keys to victory, then Chuck makes his FoF pick. MLB Green Jacket update time and a chance to look at the surprises from the Mariners this season!

Chuck and Buck
H2: 9-19 Gregg Bell, ABCs/FoF and the Quatro

Chuck and Buck

Play Episode Listen Later Sep 19, 2022 41:44


Gregg Bell (Tacoma News Tribune) joins the show to help us wade through the Hawks' struggles on Sunday with the latest 12th Man News. It's the ABCs of the Mariners after a tough weekend in Anaheim and Chuck makes his FoF pick. We cover the top 4 sports stories of the day in the Quatro!

Front Office Features
The FoF Wives Tell All...

Front Office Features

Play Episode Listen Later Sep 13, 2022 70:56


Happy 3 Year Anniversary! FoF turns 3 and we have our most special guests to date as the wives of Front Office Features join the guys to celebrate the milestone. Prior to Amy and Rachel jumping on, we discuss 2 quick topics around surrounding yourself with smarter people and Rob's fear of social posting. We take a trip down memory lane and hear the wive's take on the start of FoF and their initial thoughts when they first heard about the idea of it. We finally hear Amy's side of the story on her time spent in Battle Creek which of course has a must hear story regarding a hotel stay that would make the most comfortable person squirm. Rachel shares her thoughts on their stop in Albany and the ultimatum that sent them back to Boston. This is a must hear podcast for anyone looking to learn how NOT to communicate with their significant others. And of course learning about Rob's concert going experience as we attended Buno Mars this past weekend at the new MGM Music Hall. THANKS TO EVERYONE FOR A GREAT 3 YEARS! Learn more about your ad choices. Visit podcastchoices.com/adchoices

Groselha Talk
MUCALOL ft. LOIRINHA - Groselha Talk #104 (Rock in Rio GamePlay Arena)

Groselha Talk

Play Episode Listen Later Sep 9, 2022 129:02


O cria Danyel Sena (Mucalol aka Smurf do Muca) e sua namorada Fofão estão no Groselha Talk direto do Rock in Rio GamePlay Arena 2022! Assista a este episódio em vídeo pelo Spotify ou pelo nosso canal no YouTube. --- Send in a voice message: https://anchor.fm/groselha-talk/message Support this podcast: https://anchor.fm/groselha-talk/support

BusinessLine Podcasts
Key things to remember before investing in fund of funds

BusinessLine Podcasts

Play Episode Listen Later Sep 3, 2022 11:42


Asset management companies seem to be on overdrive when it comes to launching Fund of Funds (FoFs). Eight equity-oriented FoFs have been launched in the past six months and the total number of offerings is about 120 today. Compared to a regular MF, FoF invests in other mutual funds for various purposes. They differ in terms of costs, taxation treatment, types, and much more. Tune in to this podcast to understand these differences and find out what should be your approach toward FoF investing. --- Send in a voice message: https://anchor.fm/business-line/message

Heads Up! Community Mental Health Podcast
NATURE'S PLAN: Using Natural Frameworks to Build Mentally Healthy Communities

Heads Up! Community Mental Health Podcast

Play Episode Listen Later Sep 1, 2022 88:49


SUMMARY Creating mentally healthy communities is becoming an issue of increasing importance. Dr. Marilyn Hamilton, an author and international thought leader, and Mark Holland, an author and award-winning community planner, discuss how we can use what we know about nature to plan, design, and build more livable, socially connected, and mentally healthy communities. They also talk about the proven link between healthy built environments and mentally healthy citizens, and how social connection, climate change, and neighbourhood design impact mental health. TAKEAWAYS This podcast showcases: The Integral City framework for community planning How biomimicry can help to inspire better community design The link between the human hive mind and community mental health The characteristics of a mentally healthy community The importance of social connection to community mental health The impacts of climate change on mental health The importance of neighbourhood design to healthy built environments The link between nature and mental health Progressive food systems and healthy communities How housing affects mental health How to improve mental health through active transportation Mentally healthy communities in the future How to inspire and mobilize community leaders SPONSOR   RESOURCES Healthy Built Environment Linkages Toolkit Integral City Biomimicry Institute Findhorn Foundation Center for the Living City Mental Health and Well-being: Considerations for the Built Environment   GUESTS  Marilyn Hamilton, PhD Dr. Marilyn Hamilton is an international thought leader and founder of Integral City Meshworks Inc., a global non-profit that fosters holistic and conscious communities. She is the author of Integral City: Evolutionary Intelligences for the Human Hive Mind. Based on the concept of the human hive mind, Marilyn uses Integral City frameworks and tools to help multi-stakeholder groups transform their cities and eco-regions, into habitats that are as resilient for humans, as beehives are for bees. Marilyn's Profile Linkedin Mark Holland Mark Holland is a LEED accredited, award-winning planner who holds professional degrees in landscape architecture, and community and regional planning. He is also President of Holland Planning Innovations Inc., based on Vancouver Island, is an Adjunct Professor in the Master's in Community Planning program at Vancouver Island University, and is the co-author of the widely referenced book Agricultural Urbanism. Mark's Profile Phone: 250-713-9789 Email: mark@hollandplan.com Twitter Linkedin HOST Jo de Vries is a community education and engagement specialist with more 30 years of experience helping local governments in British Columbia connect with their citizens about important sustainability issues. In 2006, she established the Fresh Outlook Foundation (FOF) to “inspire community conversations for sustainable change.” FOF's highly acclaimed events include Building SustainABLE Communities conferences, Reel Change SustainAbility Film Fest, Eco-Blast Kids' Camps, CommUnity Innovation Lab, Breakfast of Champions, and Women 4 SustainAbility. FOF's newest ventures are the HEADS UP! Community Mental Health Summit and HEADS UP! Community Mental Health Podcast. Website: Fresh Outlook Foundation Phone: 250-300-8797   PLAY IT FORWARD The move toward optimal mental health becomes possible as more people learn about the challenges, successes, and opportunities. To that end, please share this podcast with anyone who has an interest or stake in the future of mental health and wellness. FOLLOW US For more information about the Fresh Outlook Foundation (FOF) and our programs and events, visit our website, sign up for our newsletter, and like us on Facebook and Twitter.   HELP US As a charity, FOF relies on support from grants, sponsors, and donors to continue its valuable work. If you benefited from the podcast, please help fund future episodes by making a one-time or monthly donation. Dr. Marilyn Hamilton, Mark Holland Interview Transcript ...to come

Jovens na Bolsa
Crise e Recessão | Onde Investir?

Jovens na Bolsa

Play Episode Listen Later Aug 26, 2022 11:20


TESTE A PLATAFORMA POR 7 DIAS GRATUITAMENTE: https://hubs.la/Q01kH1Xt0 Estados Unidos entrou em recessão técnica,Taxa de Juros no Brasil bate recorde, Bolsa de Valores no Brasil caindo 20% nos últimos 12 meses, EUA anunciam mais sanções contra Russia, e guerra já causa impacto global! Inflação do Brasil está entre as mais altas do mundo! muita coisa acontecendo ao mesmo tempo, muita gente perdendo dinheiro por não saber investir nessas situações. Por isso o foco nesse vídeo será mostrar de forma clara o que está acontecendo no Brasil e no mundo e como ganhar dinheiro em momento de crise onde investir nesse cenário tão caótico! Capítulos 00:00 - Qual a situação atual do Brasil Financeiramente 02:11 - Como combater a inflação? 03:26 - Como proteger seu dinheiro durante essa crise? 04:42 - Diversifique a sua carteira de investimentos 05:44 - Estude sobre análise fundamentalista 06:52 - Busque uma plataforma profissional (FAST TRADE) 07:44 - Dica importante 08:32 - Qual o melhor lugar para investir seu dinheiro agora? 09:08 - BOVA11 09:20 - Renda fixa 09:59 - Fundos imobiliários FOF fundo de fundos 10:29 - Porque você deve investir em tempos de crise? INSCREVA-SE PARA A PRÓXIMA TURMA DO CURSO INVESTINDO DO ZERO http://edzz.la/HE0AX?a=43347102 CURSO SWINGTRADE EM AÇÕES https://jovensnabolsa.com.br/swing-tr... CURSO INVESTIDOR EM 15 DIAS https://jovensnabolsa.com.br/investid... CURSO AÇÕES DE VALOR: https://jovensnabolsa.com.br/lista-de-espera-acoes/ REDES SOCIAIS INSTAGRAM - https://www.instagram.com/carol.jovens/ PODCAST - https://anchor.fm/jovens-na-bolsa CANAL DO TELEGRAM: https://t.me/jovensnabolsa BAIXE AGORA NOSSO E-BOOK - PRIMEIROS PASSOS PARA INVESTIR https://www.jovensnabolsa.com.br/ebook SOBRE JOVENS NA BOLSA Jovens na Bolsa foi criado em 2018 pela jovem investidora Caroline que percebeu o quanto os brasileiros necessitavam de mais Educação Financeira em suas vidas. Pensando em levar esse conhecimento para o maior número de pessoas, o JNB oferece mentorias, cursos, palestras, além de todo material gratuito disponibilizado diariamente em todas nossas redes sociais. Venha ser um Jovem Investidor junto com a gente! Conheça mais em https://www.jovensnabolsa.com.br/ --- Send in a voice message: https://anchor.fm/jovens-na-bolsa/message

Mitlin Money Mindset
Master Connector, Episode #95

Mitlin Money Mindset

Play Episode Listen Later Aug 24, 2022 48:33


Nkrumah Pierre is the Managing Director of Business Development and head of the Friends of the Firm program at EisnerAmper. After he joined in 2017, he continued to build on the success of the current program by training and leveraging high-potential management groups and the partner group at the firm. He uses his skills as a “Master Connector” to develop new business opportunities both for and from the network. He provides coaching and training to the ambassador team in networking, relationship-building, and sales techniques and strategy. Leveraging the skills and talents of colleagues creates greater participation, leads to the building of business development skills, and more prospect opportunities arise.  Listen to this episode of Mitlin Money Mindset™ for some great takeaways about Nkrumah's journey as a master connector at a major accounting firm and how he connects those he knows in both business and personal life.  You will want to hear this episode if you are interested in... Nkrumah's path to Director of Business Development & Head of Friends of the Firm  Learn more about EisnerAmper and the niche they serve [4:43]  Learn about the Friends of The Firm Program [9:33] What does it mean to be a “Master Connector?” [15:37]  What is the mindset needed to be a Master Connector? [19:32]  Why every business needs to have a Master Connector [23:50]  How being a CPA helps Nkrumah as Director of Business Development [29:15]  Making an impact as a Black man in an accounting firm [32:33]  What are the next big things up for Nkrumah Pierre? [41:05]  What Nkrumah did today that brought him joy [43:55]  Resources & People Mentioned EisnerAmper Connect with Nkrumah Pierre The website On Twitter On Linkedin On Facebook Bio Nkrumah Pierre is a Director of Business Development and head of the Friends of the Firm program (FoF) at EisnerAmper. He provides support to clients seeking to hire accounting, finance and human resources executives. In addition, through the FoF program, Nkrumah will offer a unique support experience for FoF members by providing job search support, job opportunity referrals, networking assistance and coaching. Prior to joining the firm, Nkrumah was the founder and CEO of Pierre Lee Group, a boutique consulting firm that offered executive business development and strategy guidance, thought leadership event curation, diversity and inclusion advisory, and career coaching consulting. He has worked for national executive search firms and built an expertise in matching qualified candidates with hiring organizations. Nkrumah is a frequent speaker before professional organizations, and recently presented at the Accounting Finance Show, a major conference and exhibition in New York. He is the former co-chair of the Apollo Theater's Young Patrons Board and currently serves as an advisor and a past honoree of The Network Journal's “40 Under Forty” Professionals of Color. Guests on the Mitlin Money Mindset Show are not affiliated with CWM, LLC, and opinions expressed herein may not be representative of CWM, LLC. CWM, LLC is not responsible for the guest's content linked on this site. Connect With Mitlin Financial podcast(at)MitlinFinancial.com - email us with your suggestions for topics or guests https://mitlinfinancial.com  Follow on Twitter Follow on Instagram Subscribe on Youtube Follow on Linkedin Follow on Facebook Subscribe to Mitlin Money Mindset™ on Apple Podcasts, Spotify, Google Podcasts

Pod Save The Queens
#46_K-Gay de Medo (Lendas Urbanas PT-BR)

Pod Save The Queens

Play Episode Listen Later Aug 11, 2022 88:09


Qual criança nunca teve medo do Homem do Saco ou da Loira do Banheiro? Qual baladeiro nunca ouviu aquela história do conhecido do primo do amigo do irmão do tio do pai do vizinho que acordou sem os rins na banheira de um hotel? Quem nunca dissecou um boneco do Fofão em busca da lendária adaga demoníaca? Estas e outras histórias de arrepiar até os baby hairs da lace sintética estão todas destrinchadas neste episódio, acompanhadas de outras lendas quase esquecidas e algumas que descobrimos durante a gravação. Quer apimentar o seu mês de Agosto? Então pega seu patuá, pendura um crucifixo no pescoço, veste uma réstia de alho a tiracolo e vem trancar seu cy com a gente. Com: Lúdykah (@showdaludykah), Shy Morningwood (@shy_morningwood), Miss Anubys (@anubysdrag) e a nossa Produssaum (@nathaliatamires) Edição, confecção de bonecas endemoninhadas e colagem de agulhas contaminadas em assentos de cinema: Renan (@reh_davidson) siga nas redes @pstq.oficial --- Send in a voice message: https://anchor.fm/god-save-the-queens/message

Fighting On Film
The Unbroken Line (1985)

Fighting On Film

Play Episode Listen Later Aug 10, 2022 52:37


We delve into the FoF vault this week and talk to David Carson MBE about his role as military advisor on 'The Unbroken line'.  A British Army promotional film that charts the Army from the Battle of Blenheim to the BAOR era. The episode was originally hosted on Robbie's YouTube Channel and can also be found there for viewing. Follow us on Twitter @FightingOnFilm and on Facebook. For more check out our website www.fightingonfilm.com Thanks for listening!      

Friends of Fulham Podcast
FOF'cast - Let's Get Villar-Real

Friends of Fulham Podcast

Play Episode Listen Later Aug 3, 2022 54:21


Welcome back to the first FOF'cast of the new 2022/23 Premier League season, as we are joined by Scott Tanfield, Mike Gregg and Dan Powell to discuss the pre-season mini tournament in Portugal, our Transfer troubles, Villarreal friendly, Wilson's injury, Liverpool game, Tim Ream and Liverpool predictions. Thanks once again for listening, make sure you subscribe to catch any future shows.

Fighting On Film
We Have Ways Fest Wind-down 2022

Fighting On Film

Play Episode Listen Later Jul 27, 2022 35:27


We we're thrilled to be invited back to We Have Ways of Making You Talk's festival to put on our FoF War Movie Quiz. It was great to see old friends and new faces and speak to lots of FoF listeners. The festival had some amazing speakers and some exceptionally cool kit on display - everything from a Matilda I to an early M3 Lee tank which had been used as a range target! In this episode we not only recap some of our favourite parts of the weekend but also hear from historians and some FoF listeners as we asked everyone: Who is your favourite war movie character? We had some great answers! Apologies for some of the wind noise, it was a gusty day! Follow us on Twitter @FightingOnFilm and on Facebook. For more check out our website www.fightingonfilm.com

The Museum Camp
Immature History #76

The Museum Camp

Play Episode Listen Later Jul 21, 2022 17:45


Happy Thursday, Campers! Today we talk about the unsettling children's toy Fofão and the unnecessarily sexual nicknames for US Presidents.

Mamilos
Relaxe com Chico Felitti

Mamilos

Play Episode Listen Later Jul 18, 2022 47:20


Mamileiros e mamiletes, desacelerar se faz necessário diante da nossa rotina intensa de papos profundos. Por isso, durante as férias de julho, o Mamilos sai do formato tradicional, sai das pautas mais polêmicas e te convida para ouvir conversas mais leves e papos mais soltos. Nesse período, Cris e Ju vão dar aquela pausa marota para descansar, respirar bem fundo, contar até dez e recarregar a bateria para voltar com tudo em agosto. Mas claro, elas não iam deixar vocês sem os tradicionais programas de férias - mais leves, acolhedores, divertidos. Já falamos sobre humor, beleza, viagens…e o tema da vez é relaxar. Por isso, deixa pra fora toda ansiedade, expectativa e nervosismo das notícias, mensagens e reuniões e vem com a gente curtir um papo super relaxante! Neste episódio, Cris Bartis conversa com o jornalista, repórter, escritor e roteirista Chico Felitti. Além de tantas profissões, Chico é uma das vozes mais ouvidas das últimas semanas nas plataformas de streaming com o podcast “A Mulher da Casa Abandonada”, lançado em junho de 2022. A produção rapidamente alcançou grande repercussão dentro e fora do Brasil, estando entre os podcasts mais ouvidos das últimas semanas. Chico também trabalhou dez anos na Folha de São Paulo. Morou em Paris, em Istambul e em Nova York. Cobriu assuntos que iam da crise de refugiados sírios no sul da Turquia a festas de um grupo de milionários veganos. Ele também publicou três livros: “Ricardo & Vânia”, a história de vida de um artista de rua pejorativamente conhecido como Fofão da Augusta, “A Casa”, um livro-reportagem que reconstrói os 40 anos da seita que João de Deus fundou e comandou em Abadiânia antes de ser preso pelo estupro de dezenas de mulheres, e “Mulher Maravilha”, a biografia de Elke Maravilha. Com agenda cheia e tanto trabalho, será que sobrou um tempinho pra relaxar? Vem com a gente entender como foi criar, roteirizar e apresentar a série “A Mulher da Casa Abandonada” e o que Chico faz para descansar quando dá tempo. _____ FALE CONOSCO . Email: mamilos@b9.com.br _____ CONTRIBUA COM O MAMILOS Quem apoia o Mamilos ajuda a manter o podcast no ar e ainda participa do nosso grupo especial no Telegram. É só R$9,90 por mês! Quem assina não abre mão. https://www.catarse.me/mamilos _____ Equipe Mamilos Mamilos é uma produção do B9 A apresentação é de Cris Bartis e Ju Wallauer. Pra ouvir todos episódios, assine nosso feed ou acesse mamilos.b9.com.br Quem coordenou essa produção foi a Beatriz Souza. Com a estrutura de pauta e roteiro escrito por Eduarda Esteves. A edição foi de Mariana Leão e as trilhas sonoras, de Angie Lopez. A capa é de Helô D'Angelo. A coordenação digital é feita por Agê Barros, Carolina Souza e Thallini Milena. O B9 tem direção executiva de Cris Bartis, Ju Wallauer e Carlos Merigo. O atendimento e negócios é feito por Rachel Casmala, Camila Mazza, Greyce Lidiane e Telma Zenaro.

Link Podcast
FOFÃO RELEMBRA SUAS VITÓRIAS NA SELEÇÃO - LINK PODCAST

Link Podcast

Play Episode Listen Later Jun 16, 2022 50:04


Nossa campeã Fofão está no Link Podcast! Uma carreira de sucesso, título de atleta mais vitoriosa do vôlei feminino, apelidada de Fofão, Hélia Rogério de Souza Pinto, já disputou mais de 340 partidas e esteve presente em cinco edições consecutivas dos jogos Olímpicos. E estará aqui para relembrar suas vitórias, contar sobre sua vida como atleta e também sobre os novos projetos. Já sabe, né?! Para ficar por dentro de tudo o que está rolando no #linkpodcast inscreva-se no canal e ative o sininho.#fofão #gottino #reinaldogottino #volei #seleçãobrasileira #olimpiadas

Heads Up! Community Mental Health Podcast
WORLD HAPPINESS REPORT Reveals a Bright Light in Dark Times

Heads Up! Community Mental Health Podcast

Play Episode Listen Later Jun 16, 2022 51:49


SUMMARY The World Happiness Report (WHR) uses global survey data annually to report how people in more than 150 countries evaluate their own lives. The findings are also used to rank countries on a scale of well-being from most to least happy. This 10th anniversary edition reveals that while COVID brought considerable pain and suffering, it also prompted “pandemic benevolence.” Dr. John Helliwell ─ internationally acclaimed economist, well-being researcher, and WHR co-founder and editor ─ shares his story, explains report findings, and talks about well-being issues related to a country's geo-political, social, cultural, environmental, and economic circumstances. TAKEAWAYS This podcast showcases: Survey methods and results from the 10th World Happiness Report Changes in WHR findings and audiences over a decade High- vs. low-ranking countries on the global well-being scale Canada's past and present ranking on the well-being scale Role of upstream mental health care in the move toward happier communities Role of social connection and acts of kindness in building happiness Outcomes of the “wallet experiment” Links between economic prosperity and happiness (changing view of economics) Links between happiness and geopolitical circumstances and social, cultural, and environmental health Future of happiness research SPONSOR   RESOURCES World Happiness Report   GUESTS  John Helliwell, PhD Dr. John Helliwell is a highly acclaimed and prolific economist and well-being researcher. A complete bio can be found here.   Email: john.helliwell@ubc.ca Website: https://blogs.ubc.ca/helliwell/ HOST Jo de Vries is a community education and engagement specialist with more 30 years of experience helping local governments in British Columbia connect with their citizens about important sustainability issues. In 2006, she established the Fresh Outlook Foundation (FOF) to “inspire community conversations for sustainable change.” FOF's highly acclaimed events include Building SustainABLE Communities conferences, Reel Change SustainAbility Film Fest, Eco-Blast Kids' Camps, CommUnity Innovation Lab, Breakfast of Champions, and Women 4 SustainAbility. FOF's newest ventures are the HEADS UP! Community Mental Health Summit and HEADS UP! Community Mental Health Podcast. Website: Fresh Outlook Foundation Phone: 250-300-8797   PLAY IT FORWARD The move toward optimal mental health becomes possible as more people learn about the challenges, successes, and opportunities. To that end, please share this podcast with anyone who has an interest or stake in the future of mental health and wellness. FOLLOW US For more information about the Fresh Outlook Foundation (FOF) and our programs and events, visit our website, sign up for our newsletter, and like us on Facebook and Twitter.   HELP US As a charity, FOF relies on support from grants, sponsors, and donors to continue its valuable work. If you benefited from the podcast, please help fund future episodes by making a one-time or monthly donation. Dr. John Helliwell Interview Transcript ...to come Episode Reviews

Real Estate Asset Management Podcast
Episode #106: Legal Hot Topics

Real Estate Asset Management Podcast

Play Episode Listen Later Jun 3, 2022 19:26


Our guest today is Mauricio Rauld, Founder and CEO of Premier Law Group, a premier boutique securities law firm where he also acts as one of the syndication attorneys who help real estate syndicators to raise the capital to pursue their dreams of financial independence. As a nationally recognized expert on private placements, he works with elite entrepreneurs who seek to increase and protect their wealth through syndications. Mauricio specializes in Reg D exempt offerings and educates investors from around the world on how to navigate the complex world of securities laws. He is also a regular contributor to The Real Estate Guys™ Radio show (consistently one of the most downloaded podcasts on real estate investing) and is Robert Helms' advisor.Key Points From This Episode:*Mauricio shares takeaways from his last week's "Real Estate Syndicator Live" related to new and current accredited investor rules updates and new SEC definitions & what's coming pipeline.*SEC Expands Definition of Accredited InvestorHe says “SEC" has already passed a final rule (2020) expanding the definition of Accredited Investor, allowing individuals to get certified by passing an exam. The Problem is, as of today, no one has yet been certified to award these Accredited examinations and so we continue to wait for the SEC to release the Certified companies and what exactly the requirements will be.”Recent rumors in the SEC circles have the SEC increasing the current $1,000,000 net worth requirement. A recent Bloomberg headline insinuated that the level could be as high as $10,000,000. His thoughts are that an eventual increase by the SEC makes sense. The original $1,000,000 threshold was passed in 1982 and adjusted for inflation, this number is closer to $3,000,000 today. Mauricio more talks about DO'S & DON'Ts about funds of funds (FOF), to be aware of investor advisory rules, and different state exemptions rules.He shares more information on 1031 &  limitations on the tax side as per the IRS Revenue procedure code.Tweetables“It's not the state where your investors are located, it's not the state your LLC is set up in, it's where you technically advise your funds, usually its state where you reside…….. ”@Mauricio_Rauld  “Big one is that You must distribute the profits from the venture proportionately if your 1031 investor owns 10% of property & syndicator owns 90% you can't do preferred returns …………”@Mauricio_Rauld  Today's Show Sponsor :Garzella/Multifamily Risk Advisors https://garzellagroup.com/

SONGMESS
Ep. 370 - Fofé Abreu

SONGMESS

Play Episode Listen Later May 24, 2022 67:12


En este episodio muy especial de Songmess seguimos en Puerto Rico, hoy acompañados por el frontman más icónico del rock Boricua, Fofé Abreu! Reconocido por su influyente trabajo con bandas como El Manjar de los Dioses, Circo, y Fofé y Los Fetiches, Abreu y sus aventurados proyectos han incursionado en el new wave, punk, synthpop y glam rock desde comienzos de los 90s, siempre con humor melodramático y una distintiva identidad musical Borinqueña. Nuestra conversación abarca los inicios musicales de Fofé cantando en el coro infantil a su amor por estéticas glam y oscuras, su espíritu colaborativo, nominaciones al Latin Grammy, sus años en México enfrentándose a nuevos públicos y retos, y su legado como artista visiblemente queer dentro de un género hiper-masculino. Hoy no nos guardamos nada, así que denle play y a rockear! Playlist: Manjar de los Dioses, Circo y Fofé y Los Fetiches. Fofé Abreu Instagram: https://www.instagram.com/fofe_fofe/?hl=en Fofé Abreu Twitter: https://twitter.com/fofetiches?lang=en Fofé Abreu YouTube: https://www.youtube.com/channel/UC_r_0Vt23vxR1zn9Ij4H_AA El Manjar de los Dioses Spotify: https://open.spotify.com/artist/6jL9RHYQVdls19dJolevxE?si=g9qB3YVWTuKPxoOyzkJ6Ag Circo Instagram: https://www.instagram.com/circo_oficial/ Circo Spotify: https://open.spotify.com/artist/5f4yA5jDkv5z75thk9ZNTc?si=bx_z4iwLQyOU0cGXB5oFyg Circo YouTube: https://www.youtube.com/channel/UCpAk8029RQdLUSOm_NRYG5A Fofé y los Fetiches Spotify: https://open.spotify.com/artist/4hkBtgeHonPLcozA8IhR05?si=gE9mjzwTSA-Nro6a0FAVQg Richard Villegas Instagram: www.instagram.com/rixinyc/?hl=en Songmess Instagram: www.instagram.com/songmess/?hl=es-la Songmess Facebook: www.facebook.com/songmess/?ref=settings Songmess Twitter: twitter.com/songmess Songmess Merch: via DM #BOPS Playlist: https://open.spotify.com/playlist/2sdavi01h3AA5531D4fhGB?si=e296271adf0c4d2e

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Heads Up! Community Mental Health Podcast
JO'S JOURNEY: A Personal Story of Healing From Fear & Anxiety

Heads Up! Community Mental Health Podcast

Play Episode Listen Later May 23, 2022 70:07


SUMMARY HEADS UP producer Jo de Vries shares her personal story of healing from acute anxiety attacks that started when she was 12 years old. Now in her sixties, and after 20 years of taking two psychotrophic medications, she is in the process of healing with the help of two medical professionals. Family physician/psychotherapist Dr. Warren Bell guides her along a path of discovery to unearth her disorder's root causes, while pharmacist Sahil Ahuja advises her on how to safely taper off medication. In this compelling episode, they dig into how Jo's experiences can inform and inspire others, and explore arguments made by acclaimed journalist and author Johann Hari in Lost Connections, the book that kick-started Jo's empowering encounter with herself and the outside world. TAKEAWAYS This podcast showcases: Personal stories of healing from anxiety and depression Progressive education for pharmacists The role of personalized care and holistic healing from mental health challenges Primary considerations for deciding whether to take medication for depression/anxiety Potential side effects of some medications for depression/anxiety Potential side effects of, and recommendations for, tapering off those medications Role of psychotherapy and other treatments for depression/anxiety Role of trauma and chronic stress in depression/anxiety Benefits of feeling, identifying, processing, and learning from both positive and negative emotions Impacts of COVID on people's willingness to talk about mental health challenges Johann Hari's personal story of depression and arguments for science-based alternatives he subsequently laid out in Lost Connections: Uncovering the Real Causes of Depression & the Unexpected Solutions Using science to debunk the myth that chemical imbalance is responsible for anxiety/depression, and that medication is the only solution Disconnection (the nine causes of anxiety/depression) Reconnection (a different kind of antidepressant) Role of culture in sharing about, and healing from, anxiety/depression Role of livable communities that support the social determinants of mental health in preventing anxiety/depression SPONSOR   RESOURCES Antidepressants Going off Antidepressants Bounceback Patient Health Questionnaire Depression: Resource Guide for Patients   GUESTS  Sahil Ahuja, PharmD Sahil Ahuja is a licensed pharmacist practising at Two Nice Guys Pharmacy in Kelowna, BC. In this setting he provides patient-centered care that starts with listening to the person in front of him. In collaboration with that patient's health care team, Sahil provides a range of services including patient education, medication recommendations, and prescriptions. While completing his Doctor of Pharmacy degree at UBC, Sahil encountered mental health struggles of his own. Having made it through those difficult times, he believes the best way to reduce any remaining stigma around mental health is by openly sharing his own experiences. Professionally, Sahil's current focus is on the Toxic Drug Crisis and ensuring patients experiencing substance-use disorders have reliable and non-judgemental access to medication. These efforts have helped Two Nice Guys' Pharmacy earn recognition as Unsung Heroes in the community. In his personal life, he is prioritizing trying new hobbies and experiences (e.g., skydiving) to continuously expand his comfort zone. Dr. Warren Bell Dr. Warren Bell has been a general practitioner for more than 40 years. For decades he has advocated for peace, social development, the environment, and the anti-nuclear movement, as well as the integration of healing modalities of all kinds. He is past founding president of Canadian Association of Physicians for the Environment, past president of International Physicians for the Prevention of Nuclear War Canada and the Association of Complementary and Integrative Physicians of BC, past president of medical staff at the Shuswap Lake General Hospital, and current president of Wetland Alliance: The Ecological Response (WA:TER). He has written several peer-reviewed clinical pieces and for online publications such as the Vancouver Observer and National Observer. Warren received a College of Family Physicians of Canada Environmental Health Award and the Queen's Medal for Canada's 125th Anniversary in 1992.  Email: cppbell@web.ca Facebook: https://www.facebook.com/warren.bell.714 HOST Jo de Vries is a community education and engagement specialist with more 30 years of experience helping local governments in British Columbia connect with their citizens about important sustainability issues. In 2006, she established the Fresh Outlook Foundation (FOF) to “inspire community conversations for sustainable change.” FOF's highly acclaimed events include Building SustainABLE Communities conferences, Reel Change SustainAbility Film Fest, Eco-Blast Kids' Camps, CommUnity Innovation Lab, Breakfast of Champions, and Women 4 SustainAbility. FOF's newest ventures are the HEADS UP! Community Mental Health Summit and HEADS UP! Community Mental Health Podcast. Website: Fresh Outlook Foundation Phone: 250-300-8797   PLAY IT FORWARD The move toward optimal mental health becomes possible as more people learn about the challenges, successes, and opportunities. To that end, please share this podcast with anyone who has an interest or stake in the future of mental health and wellness. FOLLOW US For more information about the Fresh Outlook Foundation (FOF) and our programs and events, visit our website, sign up for our newsletter, and like us on Facebook and Twitter.   HELP US As a charity, FOF relies on support from grants, sponsors, and donors to continue its valuable work. If you benefited from the podcast, please help fund future episodes by making a one-time or monthly donation. Sahil Ahuga and Dr. Warren Bell Interview Transcript You can download a pdf of the transcript here. The entire transcript is also found below: RICK  0:10 Welcome to the Heads Up Community Mental Health podcast. Join our host Jo de Vries with the Fresh Outlook Foundation, as she combines science with storytelling to explore a variety of mental health issues with people from all walks of life. Stay tuned. JO  0:32 Hey, Jo here. Thanks for joining me and my two special guests as we delve into my own story of healing from anxiety attacks that started when I was 12 years old. Now 67, and after multiple rounds of medication, the latest one lasting almost 20 years, I'm in the process of seeking freedom from fear and anxiety with help from two medical professionals. The first is Dr. Warren Bell, a GP who also practices psychotherapy in Salmon Arm, BC. He's guiding me along a path of discovery to find the root causes of my disorder. Hi, Warren. Warren  1:12 Hi, Jo, I'm delighted to be here. And I just like to say that the fact that you are sharing your story in this public way is an act of courage on the one hand, but it's also something that I think will lead to many other people who listen to this podcast, understanding your dilemma and the trials you've been through, and also be grateful for the fact that you have shared this very personal voyage that you've been on. JO  1:41 The other vital member of my team is pharmacist Sahil Ahuja, who's advising me on how to safely taper off two medications. Welcome Sahil. SAHIL  1:52 Hi Jo. Thank you for having me. Likewise, very grateful to have this opportunity, and appreciative that you're willing to share your story. We talk a lot about decreasing stigma around these concerns. I think this will be beneficial to a lot of people. JO  2:07 I can't tell you how grateful I am to have you both on my side and here today for the podcast. Two things before we get started. First, a big thank you to our sponsors for this episode, the Social Planning and Research Council of BC, Emil Anderson Construction, WorkSafeBC and AECOM Engineering. And second, please note that I'm sharing my story for informational purposes only. This is very important. If you're experiencing mental health challenges or want to taper off medication, please seek advice from your doctor and/or mental health professional. Okay, so imagine you're lying down tied to a railway track. You start to feel vibrations in the ties and a hum on the rails that can mean only one thing, a coming train. As it rounds the corner, you hear the whistle scream warning you to jump or else, but you can't. As the scenario unfolds, your breathing shallows while your heart rate spikes. You feel increasingly weak, dizzy, sweaty, and/or nauseated. You quickly move from feeling agitated to being terrified you'll die, and then maybe even wishing you would so the overwhelming physical and emotional sensations would stop. After what could be minutes or hours, the train roars over you, the danger seemingly past, but in its place comes the fear of what will happen next time you're tied to a track, or more likely must give a speech, or take an exam, or feel uncomfortable, insecure, or unworthy. That's anxiety's gift that keeps on giving. The continual fear of fear itself. My panic attacks started when I entered puberty when my hormones raged for the first time. My second bout was triggered again by a hormonal imbalance after the birth of my first daughter. That time it was more serious and involved depression as well. To make a long story short, I started thinking, what if I hurt my daughter and then spiraled into terror so visceral, I couldn't be alone for fear I'd go crazy and do the unthinkable. I was trapped in a vicious cycle. Feeling depressed made me more anxious and feeling anxious worsened the depression. My father who was a doctor said I was experiencing postpartum depression and prescribed an antidepressant. I also saw a psychiatrist who said that with the medication, I would recover. That's how it was done in 1983. No mention of lifestyle changes, counseling, or other potential treatments. The pills worked, so I took them until after my second daughter was born, too afraid to again face postpartum symptoms. When life settled down and my marriage and career seemed stable, I weaned off the medication and managed well for a number of years. My next experience with paralyzing fear came at the end of my first marriage, emotions were high, my anxiety levels were higher. Again, I was prescribed medication, this time by my GP. I did get counseling, but unfortunately, the counselor decided my husband was a jerk, and that I'd be better off without him. So I concluded the anxiety was situational, and didn't see the need for further counseling to get to its root causes. Fast forward to the beginning of my second marriage. I'm feeling good and decided to taper off medication again, which was fine until I accepted a job that turned into the worst experience of my working life. Eighteen months later, just after I resigned, I descended into what can only be described as hell on Earth. I lived in the emotional storm of an acute, unending, anxiety attack for three days. I couldn't think, I couldn't eat or drink without vomiting. I couldn't be alone for fear I would die. And at times, I wished I would because I didn't think I could stand another minute. I was prescribed three medications in large doses. A benzodiazepine for sleep, an antidepressant, and an antipsychotic, which is sometimes used to treat anxiety and depression when just the antidepressant isn't enough. Well, I don't regret taking the medications as they dulled the anxiety and lifted the depression to manageable levels. They did make me look and feel somewhat like a zombie for a number of months. With that first stage of recovery under my belt, I started thinking again about tapering off my medications. Like many other people who take them, I thought I was weak and wanted to prove to myself that I wasn't. First, I tapered off the sleeping pill. Then I significantly reduced the antipsychotic but decided to stay on the same dose of antidepressant, and there I sat for almost 20 years. In the early years, I tried a few times to wean off the antidepressant, but always experienced low-level anxiety and other minor side effects such as disturbing dreams. Mainly though, I was still afraid of being afraid, not wanting to look inside to find what was hiding there. Fast forward again to a little more than a year ago when I was 65. I must have been ready for a change of perspective, because a transformational book came across my desk while I was researching a Heads Up podcast about depression. It's called Lost Connections, Uncovering the Real Causes of Depression, and the Unexpected Solutions. It's by John Hari, an award-winning journalist and best selling author who has an experience of depression that he weaves throughout his book. Hari's book made me look at my situation differently through a lens of evidence-based findings, on the effectiveness of medication for depression and/or anxiety. And it made me question the medical system's long-standing pharmaceutical approach to symptom management, and the crutch it had perhaps become for me. So with input from Warren and Sahil, I developed a plan for tapering off the medications. I felt ready given that my life is now vastly different than it was 20 years ago, and that I'm truly invested in optimizing my physical, mental, emotional, and spiritual health. The three of us agreed that tapering off should be done very slowly. Given that I'd been on hefty doses for almost two decades. And because I'd had side effects when I last tried to cut down. You'll learn more about this from Warren and Sahil a little later. Starting last spring, I cut my antipsychotic medication over several months by almost 90 percent. It surprised me that I experienced no anxiety during that time, and it thrilled me that I felt increasingly more energetic and alive as the doses dropped. I delayed tapering down from the antidepressant until this spring, given that winter can be a challenging time for me. In April, I reduced the dose of my antidepressant a small amount. As with previous tapering attempts, I felt stirrings of anxiety and had vivid, sometimes disturbing dreams. But I persisted and that past. A week or so ago, I tapered down again, and I'll stay on that dose for a month or so before deciding whether to cut down further. That's slower tapering than people typically do. But I'm fine with that. Most importantly, Warren, Sahil, and I agreed that I needed to be realistic about my ability to taper off completely. I've accepted that and we'll take this process one day at a time, watching for symptoms that might be too much for me. I realized I may have to take medication for the rest of my life. And I have no shame or guilt around that. Nor should you if you're on medication that improves your mental health and quality of life. My journey of finding freedom from fear and anxiety has led me to new places, both within myself and in the world around me. I've embraced proven science while being embraced by compassionate care. I now have feelings that are big, and raw, and real, and so welcome now that I understand they're to be revered, not feared. As Eleanor Roosevelt recommended, I also try to do one thing every day that scares me. Today, it's being vulnerable by sharing my story, which I hope will inspire you to get the help you need. If you're struggling, start by making an appointment with your doctor and/or a mental health professional. And please check out the resources in the Show Notes page on our website at freshoutlookfoundation.org/podcasts. Time now to bring in the experts who can add some meat to the bones of my story, and John Hari's book. Let's start with you Sahil. I found you at Two Nice Guys Pharmacy in Kelowna, BC. Great name by the way. My daughter recommended this because of your amazing, personalized service. We met, and you agreed to help me taper off the medications. You also promised to read Hari's book and then share your insights on this podcast. Let's start by you telling us your story, and why you find such meaning in helping people along their healing journeys. SAHIL  12:31 I'm glad that you've had a good experience. I've never had someone ask me to read a book and be on their podcast. So, it was a neat experience for me as well. My story, the part that's kind of relevant to the mental health conversation here, is that in undergrad I was in sciences and living at home in Kelowna, going to UBCO. And everything was good. But when I was accepted into pharmacy school, and I had to move to Vancouver and go into this Doctor of Pharmacy Professional program, that's where things started to unravel a little bit, I would say. When I moved away, it was great. I was living with one of my friends. But in those first couple of months of being away from home and being in a new program and in a new city, I started to feel a lot of discomfort. I remember times when I was studying, and I couldn't focus anymore on the slides in front of me, and I would have to go lie down. Eventually, I got to the point of having a conversation with my doctor, and we realized that I was having panic attacks, which was very foreign to me. And the identity that I had for myself of being this high achieving person who just is able to do anything and everything, and to have that, quote unquote, what I felt as a setback was tough to process. And I wasn't able to really get a handle on the anxiety in those first few months, then kind of depression was becoming a part of that as well. And they are sometimes related but also very distinct things, and I felt the distinctions there. I eventually started on medications, and I found them to be very helpful. I remember in those first few months of being on fluoxetine that I felt that if everyone was taking this medication, that there would be less crime in the world, everyone be happier. It was amazing. But as in the book, I had a similar experience as the author where that effect faded, and then we would increase the dose I would feel well, and the effect would fade. And that cycle continued whether with new medications or new doses for a few years. And then near the end of pharmacy school, I was getting tired of it. And I tapered myself off the medications and it took probably a year after that for me to feel like okay, I'm actually through this phase of anxiety and depression. It was interesting for me because I subscribed very heavily to the chemical imbalance narrative, in part because I had everything else going for me in life. I had amazing support systems in my family and friends. Even though I had left my family, they were still very supportive. And I had friends there. I had a great career ahead of me with meaningful work. It didn't make sense to me. And that was one of the most frustrating parts of like, why am I feeling this way. So, the chemical imbalance narrative really helped, to be like hey, it is out of your control, but kind of working through it and getting through it. I think it was the purposelessness that really got me and meaning to life that got me, and I found it in social connections, I found it in really savoring the moments that I have with friends. Meaningful conversations like this one, when you're 40 minutes into a cup of coffee with someone, I find so much meaning and joy in those moments, and I soak in that joy. And I would say it's still a work in progress. And not every day is a great day. But I definitely have much more joy in my life. I have more good days than bad days, and the bad days aren't as bad anymore. JO  16:00 Thank you so much for being vulnerable and laying that out for us. And I agree your story too will help other people. How has your experience impacted in a positive way your ability to help your clients who are experiencing mental health challenges? SAHIL  16:17 I think my experience gives me an insight into what the human in front of me is experiencing. I understand how difficult it is to even get to the point of standing at the pharmacy counter. There are so many pieces in between one of just recognizing and understanding what's happening that took me a bit of time, then being willing to address that concern and eventually talking to a physician or whichever healthcare provider getting to the point of like, okay, I have this prescription in my hand, am I going to go fill it? Okay, I go drop it off at the pharmacy counter, am I gonna go back? There's so many points there, where things could fall off or the mind could change. So when that person is in front of me, I have a sense of like, okay, it was not easy to get here. And I want to make sure that I can hopefully make it a bit easier moving forward. JO  17:13 Sahil, before meeting you, my interactions with pharmacists had been what I call clinical, which I guess is fair. But the training you received is changing that. Tell us more. SAHIL  17:26 I graduated in 2019 from UBCs PharmD program, and it is very patient-centered care. We are not just looking at the condition and throwing a medication at it. We're looking at the human that's in front of us and saying okay, this condition is part of what's going on. But let's look at everything else that's going on. And as a pharmacist, our training, the first thing we even think about is, is a medication even necessary, is it even the best treatment? For example, in school, we were being assessed when we were counseling a medication to a patient. We had to give three or four non-medication ways, non-drug measures to help address any particular concern, whether its mental health related or blood pressure or cholesterol. Those non-pharm measures or non-drug measures are very important, and the first line of therapy, frankly, in the majority of conditions. If those don't work, then we look at medication. JO  18:22 When you say patient-centered or personalized care, what does that mean? SAHIL  18:28 It's about assessing what's important to them and what their values are, depending on whether they're in school, what their age is, what their priorities are. It can help us guide the antidepressant we choose, for example, because depending on their side effect profiles, some side effects, for example weight gain, may be acceptable to some and not acceptable to others. So that's where the personalized approach comes in of, okay, let me learn about this person, what's important to them. And then we can make more informed decisions together and give them the appropriate information. JO  19:02 When you speak to your clients first about taking antidepressants, what do you tell them? SAHIL  19:07 Sometimes the majority of the times the benefits aren't immediate. And that's really frustrating when you're living through anxiety and depression. You're feeling unwell in all these ways to hear that, hey, I'm gonna have to stick through this for another 246 weeks before I really feel better. So that's one thing, it is a bit of a process. And also, the first one may not be the right one. We have a lot of options. We have a lot of medications that work in different ways that have different side effect profiles. So we can hopefully over time find the right one. And the things that probably do work more immediately are those non-drug measures, whether it's starting to look at CBT, and there's a lot of free CBT resources out there, whether it's from Anxiety Canada or MindHealthBC? Maybe the first line of therapy is being more mindful about hanging out with your friends, which is really difficult to do when you're living through it. But if there's a way that you can go for that cup of coffee and feel a little bit better, or go for that walk in nature and feel that sense of calm, those things might be more immediately soothing, and that will give the medication some time to kick in. JO  20:18 What about the primary potential side effects? SAHIL  20:24 There's a whole host of things depending on the medication that you take. So to say main potential side effects is a little bit tricky. And everything's in context as well. So I always hesitate from saying things broadly. But I will say some of the big things to watch out for is that, especially in younger patients, there is an increased risk of self-harm. And that's something that is top of mind for me. So when I am talking to my patients I, especially younger patients, I'd like to mention this is something that we've got to watch out for. There's regular things like nausea, and dizziness, and all of these things that usually, we can help mitigate or get better as the weeks go on. Certain ones might have a higher risk of sexual dysfunction, for example, others have very limited risk of that. Some have a little bit of risk of weight gain, and others are less. Some cause trouble sleeping, some help more with sleeping. That's why the personalization part is really important. If I have a patient who has insomnia with depression, then we want something that causes drowsiness, depending on if that's what they want. If we have somebody that they are unable to get out of bed at all, they're sleeping 12 plus hours a day or whatever, and I was on that side I would sleep all day long, we want something that might have energized them a little bit more, a little bit more activating. Side effects are also tricky term because sometimes that effect is something we want to happen. So it's very personalized and patient specific. JO  21:51 What about side effects associated with tapering off, and your tips for minimizing these? SAHIL  21:58 What I've seen in my short career so far practicing for a couple years is we really want to take it slow; we want to go over weeks or months. And that will help minimize the withdrawal symptoms. So it can be some of the things that patients experienced in the beginning, maybe some dizziness, or the strange one to me that I wouldn't think about is flu like symptoms. People can actually feel unwell in that way. There can be some irritability, appetite affects, sleep changes. You might even feel that irritability or depression coming back, but sometimes it's temporary, right? It's just the body getting used to not having the medication. And it's not necessarily that the depression is actually coming back. The other one that I hear patients talk about sometimes even if they miss a dose or two, is brains zaps or just that abnormal sensation there. These are the things to look out for. And if they're happening, this is how we can manage it or just even knowing that something can happen, helps mitigate the surprise of when it happens and makes it less scary in that way. JO  22:59 Thanks Sahil. That's great info and will really help me by the way, which brings us to our next guest, Dr. Warren Bell and his decades-long practice of combining medical and pharmaceutical knowledge with psychotherapy and downhome compassion. Just building on what Sahil was explaining to us, what do you see in the way of side effects or symptoms of people tapering off of these medications? Warren  23:29 The principle that Sahil referred to, which is to do it slowly, is probably more important than any other principle with respect to withdrawing or tapering off medication of this nature, psychotropic drugs. People experience a variety of symptoms when they start to reduce medication, including symptoms that are very similar to the ones that they experienced before they began to take them. These are withdrawal symptoms, but they seem to be very similar to what they experienced prior to starting medication. And as a consequence, there's a sense that maybe their condition that led to them taking medication has recurred. But it's actually a withdrawal process. And the best way to deal with it is to do it very slowly. I've had people who were withdrawn off medication in six weeks by one of my psychiatric colleagues, experience a terrible withdrawal pattern. And when I was involved with repeating it, because they cut back on the medication, we changed it from a six-week withdrawal to a two year withdrawal, and it was effortless. JO  24:36 I'd like to build on Sahil's insights about patient-centered care. You and I have talked about your practice of getting to know people in the round, versus using only biomedical measures for treatment. Why don't you share your story of integrating treatment modalities and how it's helped your patients with mental health challenges? Warren  25:00 My background prior to medicine was not pure sciences. My background was actually, believe it or not, music and creative writing. So I had a sort of artsy kind of perspective on life. So when I came to medicine, it was with a very different perspective from many of my fellow students. I understood science, but it wasn't the only thing that I had studied. As I went through medical school, I found the narrow approach on biomedical matters and physical health issues, to be challenging, because I was only too aware of my own psychological responses. So early on in my training program, one of my preceptors, who was the head of psychiatry at McGill, noticed that I had a bit of an aptitude for exploring the psychological experiences that people were having. And that led to learning about different kinds of approach to therapeutic interventions in that area. And I eventually fastened on a procedure, or a process, or an approach called short-term anxiety provoking psychotherapy, which at the time, short-term meant 12 to 15 visits as opposed to two years of weekly visits that psychoanalysis was focused around. So it was shorter term, but it was still longer term than what is commonly done with psychiatrists these days. And after I had graduated, I worked in a psychiatric outpatient clinic for a year, and I also engaged in palliative care. Much of it is intensely psychologically oriented. When I came back to BC and began practicing in the small town of Salmon Arm, I just felt the need for a variety of reasons to explore other modalities. And I embarked on what amounted to a 20- 25-year process of learning about every kind of therapeutic opportunity that there is ranging from physical interventions like manual therapies, massage, cranial-sacral therapy, chiropractic, and of course physiotherapy, one of the standards, and osteopathy, and then also mind approaches. Sahil mentioned CBT, which is a fairly formulaic form of psychological intervention, but it's been used and has been validated as having some value. But then there's other things like yoga and meditation and mindfulness. And side-by-side with them was the process that I was bringing into my practice, which is insight-oriented therapy, where you spend a long time asking challenging questions and essentially, having patient hear themselves say things that they haven't said before, and understanding things inside their own consciousness that are new, and developing insights. That way, it's not a system where I give people advice. It's a system where I probe, and their responses end up being their therapy. And I've done it now for over 45 years. So it's been a central part of what I do, because once you explore people's minds, you find out what they are like, as you said, in the round. You find out more of the totality of their life experiences, not just the disease, or the condition, or the injury that they present with. So it inevitably makes you think holistically when you approach anybody. JO  28:42 During my psychotherapy sessions, we talk about many things including the mental health impacts of my upbringing, my Type A personality, my perfectionism, and so on. But my biggest takeaway was the realization that I bottled up what I thought were negative emotions for decades, only acknowledging and sharing the positive side of myself. Warren, you along with Brene Brown taught me to sit with my not so nice feelings, to really feel them, and then to identify them, process them, and maybe most importantly, learn from them. I'll give you a simple example of that. About six months ago, I was cleaning out my kitchen cupboards, and I came across a set of china that I had inherited when my Mom passed away. And it brought back wonderful memories of Easter dinners, and Thanksgiving and Christmas dinners and us all around the tables. And my mom loved those occasions. She loved her crystal, she loved her china, and her cutlery, and everything was set so beautifully, and she was so proud. And I decided that I really didn't have room for this china anymore. So I called my sister and I said, you have a lot more room, would you like this china? And she said, sure. I went downstairs, got some boxes, brought them up, and I started packing away this china. And I started feeling increasingly more sad, to the point where I started crying, which is really unusual for me because I'm not a crier. And I just felt worse and worse and worse. And so I went and lay down. And I started thinking about the china and what it meant to me and came to the conclusion that I didn't want to give it away. I really needed to keep this as a connection to my mother. So I packed up the china and I put it in this very special place, and decided that I'm going to use it on occasion, even if it's not a special occasion. So that, for me, was a cathartic experience of feeling something, identifying what it is, processing it, and then responding in a way that met my emotional needs. It has really played a remarkable role in my healing. I've said all that to ask this question. Warren, in the patients you've seen over the years who are experiencing anxiety or depression, what role do you see unprocessed negative emotions playing? Warren  31:34 They play a central role, because they embody things that are unresolved in one's own life experience. There is a social pressure on all of us to hold back expression of any kind of negativity. If you meet somebody in the street and they say, hi how are you, you don't say, well actually I'm having a really bad day, and let me tell you about it. Partly because we know that the chance of them stopping and paying attention to those remarks will be very limited, they might be frightened away. But also, it seems like exposing ourselves to having other people see the vulnerability in us. And so it's quite natural, at a social level in many social situations to suppress the expression of negative feelings, fear, anger, frustration, terror, all experiences which we define as negative. What they are, of course, is responses of our central nervous system to things that are troubling to us, that disrupt our lives, or that appear to threaten our security. When you do that, and those experiences come to the surface, as you described in the story about your mother's china, you often will experience an emotional reaction that takes you by surprise. And if it's the wrong kind of setting, for example, there's a bunch of people looking at you and you're on stage, and you happen to open your mother's china there, you would be under intense emotional pressure internally, to not start to weep on stage. Now, if it was a psychotherapeutic group therapy session, you wouldn't have that same feeling. But if you're on stage, and it's a public performance, you would feel horrified at the fact that you were losing emotional grip on yourself. So setting has a lot to do with it. And often in our early years, we have settings where we are discouraged from expressing our true reactions to things. A parent who tried to be helpful says, "Don't make so much noise in this room, keep quiet." You don't know why they want you to do it, but they tell you to do it. And you want to make a big noise, you feel full of exuberant energy, and you can't do it. And so you learn to put those feelings and that expression away. And then you get into a situation where you start to cheer at a sports event and suddenly you are feeling giddy, you feeling strange and kind of uncomfortable, and maybe a little anxious, like I'm being too exuberant. I'm expressing my feelings too vigorously. So what the negative emotions that are suppressed or unprocessed do is they influence a lot of our day-to-day behavior. But much of that behavior as an experience is of feeling anxious, or in this case that you just described, you feel sad, but they are highly legitimate emotional responses that are present in us when we're first born. And so to suppress them tends to be kind of unhealthy. It's not so much that you express them anywhere. You find out where it's appropriate to express them as you grow older, but you don't get rid of them. That's the key I think. SAHIL  34:38 I'm going to jump in here just to add a little bit more of my story and how I think processing those emotions helped out. When I originally had my symptoms, I felt defective in a sense. It's interesting how you would never think that of somebody else but when it's yourself, there's more harsh judgment, something that I have worked through thankfully. But I went on a self-improvement binge. And in doing so, I think developed a little bit more EQ, emotional intelligence, and self-awareness. With that self-awareness, I noticed and was actually able to see those negative emotions, sit with them, and process them in ways that you two have mentioned. So I think it's extremely important to get to that point where you can recognize and deal with what's happening. JO  35:23 What about the role of chronic stress and depression and anxiety? Warren  35:29 Chronic stress is usually the result of a habit. We live by habits, our lives are guided by habits, habits are shorthand ways of dealing with events that occur over and over again in our lives, and that we have to develop a sort of patterned response to. If there are patterned responses to all or most expressions of a certain part of our own inner world that is valuable and important to us, then it produces a chronic state of feeling anxious, depressed, or just out of sorts. Because we're putting aside a part of ourselves on a day-to-day basis. And the habit of putting that part of ourselves aside, has been so firmly entrenched in our vocabulary, our emotional vocabulary, that we never think about it when somebody says, are you scared, you say, oh no, even though we could be terrified, because we don't allow ourselves to think that we're terrified. Because if we thought we were terrified, we'd start to act like we were terrified. And that would produce the kind of reaction Sahil was just describing, doing things that you feel uncomfortable, that make you look more vulnerable. But in fact, as we become more integrated, our personalities become more integrated, and the different parts of ourselves get to know each other better, then stress levels tend to go down markedly. That's one of the reasons why insight-oriented psychotherapy can be so useful, because at the end of the road, you have an understanding of why you get agitated in certain situations, and not in others. SAHIL  37:04 So just to add to that chronic stress piece, it was stressful to be in a new city and learning how to fend for myself in that way. And the pace of professional school is very different from undergrad. It's hard to keep afloat in those settings sometimes. So I do think that chronic, ongoing feeling of drowning and rat race sometimes, I felt that even in my career, I think that does add to the situation. JO  37:30 For personal reasons, I'm interested in the link between genetics and anxiety and depression, as there's a history of those in my family. My dad experienced anxiety and depression. My paternal grandfather was hospitalized because of mental health challenges. And my maternal grandmother took her life by suicide when my mom was just eight years old. I also wonder about the impact of trauma and have tried to unearth the traumatic event in my past that might have triggered my challenges. Warren what can you tell us about that? Warren  38:06 Trauma is something that depends very much on the context in which a particular behavior occurs. And the trauma is not always explosive, violent, and deeply disruptive. Sometimes trauma can be the lack of a response to a certain behavior on our part as children. The adverse childhood experience body of research is often shortened to ACE, A C E, began in 1988. But it's research that really explores something that's deeply rooted in human experience. And that is that if things go really bad when you're young and vulnerable, then it can shape your response to the future quite dramatically. If somebody has a father who's an alcoholic, the father may never be violent or aggressive or invasive into that child's life, but they may be absent, they may be sort of non-existent, the parenting role could be almost completely removed because of a preoccupation with the state of consumption of alcohol. Sometimes parents are away a lot, they're absent. So trauma takes different forms. I think it's generally recognized that an accumulation of extremely disruptive events, things like a parent going to jail, things like the death of a parent, things like physical, mental, social, and sexual abuse. All of these really invasive, intensely disruptive forms of trauma clearly shake, sometimes shatter the sense of personality, self-esteem, self-trust, trust in others, and that can have impacts throughout a person's life. There's quite strong evidence that if you accumulate a certain number of traumatic experiences in your early years, it will have a permanent effect on your development as a human being. That said, you mentioned the genetic component of mental distress and mental difficulties. There is some degree of that, but with most genetic components, they offer about five, maybe 10 percent of the reason why things happen. What you may have genetically is a tendency, but not necessarily a condition. And so you might be more susceptible to certain kinds of inputs. But it's not that you're going to go ahead and behave in a certain way because of your genes overwhelming your judgment. JO  40:49 Warren, you've been doing this for decades. Have the levels of anxiety and depression increased over the last 10 or 20 years? Warren  40:59 My observation would be that certain kinds of anxieties have increased. And certain kinds of social and environmental, and I mean environmental in the broadest sense of the term, pressures and disruptions have come into the lives of many, many people around the world. On the broad scale, there is widespread anxiety, and particularly among young people, children ages, say six to 15. Anxiety about their future, on a planet that is increasingly degraded by human activity and the presence of so many of us on the planet. That's a genuine anxiety. And there have been surveys. The BBC did one recently that showed in every country, they analyzed children's responses, they found this kind of anxiety underlying their daily lives. They don't go around talking about it all the time, but if you ask them how they feel, they're very explicit and describe quite disabling, sometimes senses of anxiety. One of my colleagues who works in an emergency room here, had three young people over a period of some months who had all come to the emergency room because they were either feeling suicidal, or they had made a suicidal attempt, because they were so depressed about the future of human society. They felt that there was no hope for us. And I think the heat dome and the fires during the summer really intensified those anxieties. There are also other stressors like the enormous disparity between the very well to do and the very underprivileged and financially insecure. So I think there are increased levels of depression and anxiety about those kinds of things. But to be honest, the primary things that bring on anxiety and depression are personal factors, elements, and events, and experiences within a person's own life. That's where those kinds of experiences take place. And I would say, there's probably in this part of the world, more of that going on in communities, and neighborhoods, and individuals to some extent than there are in many other parts of the world where connection and interaction and a sense of community are much more strongly developed. But I would say these broad disruptive impacts are being felt by people all over the world. JO  43:25 Sahil, what's your observation about mental health over the last couple of years since COVID? I have heard that statistically, mental health has declined over that period. But I've also heard very promising statistics about how many people have taken this as an opportunity, like yourself, to build themselves in a positive way. SAHIL  43:54 It's hard for me to assess the exact statistics on what's happening. But what I do feel confident saying is, it's a conversation that more people are willing to have. It's something that became a societal level conversation during COVID lockdowns on how are you actually feeling. I think it prompted a lot of self-reflection in individuals. So maybe that's why we're seeing both improvements, because people are seeing things that they can work on, and maybe more conversations on people not feeling well because you're actually recognizing what's happening. And not just burying it with the busyness of life. JO  44:32 A big chunk of Hari's book outlines his research findings about the effectiveness of pharmaceutical solutions for depression and/or anxiety. He also questions the long-held belief that brain chemistry changes are the primary causes of those disorders. Sahil, what do you think about the book and Hari's arguments? SAHIL  45:00 So I mentioned my story, I did very much subscribe to the chemical imbalance narrative. And I do think there is still some truth to be had there. I think it's good to have a conversation around that on, okay, maybe that's part of the scenario, but maybe not the whole scenario. And there are things that we can work on. I did really enjoy the book. I enjoyed the breakdown of all these connections, and frankly, then all of the solutions that can help chip away at it. I don't know if I bought all the arguments in their entirety. But I think there is enough in that book to reflect on and learn from. Warren  45:38 The book was interesting for me, because I was familiar with a lot of the research that he explores. From a journalist point of view, he went and interviewed the people who had done, for example, the meta-analysis of antidepressants with the SSRI, selective serotonin reuptake inhibitor category. I was familiar with the fact that the full meta-analysis, which was done by obtaining all the studies that have been done on these drugs, rather than the ones that have been published at the time the drugs first came out. It was possible to do say, a dozen studies, find four that said what you want them to say, and then the other eight said things you didn't want them to say. In other words, they were not so positive about the drugs in question and their therapeutic benefits. And never publish those eight and only publish the four that you like. So what the researchers on that particular meta analysis did, they went and got all the studies. They nagged the Food and Drug Administration, so they finally gave them the actual raw data from those studies. And when that happened, it showed that the evidence used to promote many of the psychotropic drugs was quite skewed. It was quite directed towards a marketing end rather than a therapeutic end. And that's nothing new. Nobody should be surprised. The nature of the corporation and most large pharmaceutical companies or corporations, is to deal with the shareholders expectation of profit. And that's the sine qua non, the other part of it is of importance, but it's not the central issue. What I liked about the book was that I was hearing some of the sort of personal trajectories, the narratives of the people who did the research and why they did it, and what they felt about the research when they had done it. And that was adding another sort of personal element to stories that I had heard, written up in clinical journals. I particularly appreciated the fact that Hari was very open about his own struggles, which I think is important. It makes it clear that say an investigative journalist or a public figure, is not somebody who sprang out of the earth fully formed. They are like everybody else, in a process of evolving, and changing, and coming to new understanding about something that they might have thought they understood very well, for sometimes a very long time. So that was helpful for me. And then some of the individual stories about changes that took place in people's lives, I found quite illuminating, and quite heartening, as well. JO  48:20 What were your favorite stories and why? SAHIL  48:23 One of my favorite parts is right at the beginning, when the author talks about the initial experience with the medications which paralleled mine, of there was a benefit, it would fade, there was a benefit, and it would fade. And specifically, there was this part where the author felt compelled to evangelize about the medications. And I felt that as well. I was singing the praises because I had felt so down and so unwell. The correction of that, or the fixing of that, however, I felt in that moment was so significant to me, that I felt that everyone should consider whether or not they need these medications. So that point of relatability from the beginning, stuck with me and probably added to the authenticity of the book for me, or added to the reliability of the author's narrative throughout. Warren  49:15 The story that captured my imagination the most was the story he told about arriving in Berlin, he's originally German so this was kind of like coming home and coming across a small community of people rejected on all sides by society. Some of them were immigrants from other countries that didn't speak English, or German, or other as a first language. Some were people who had been disabled. Some were people with sexual orientation that was not accepted in German society. And somehow, they just didn't feel comfortable in the value system of the society they we're living in. All of them had been kind of isolated from society as a whole but also from one another. And then an elderly immigrant woman decided to just sit out in public and be visible, because she was having trouble with attaining some goals in her life, from the government. And around her coalesced a whole new community that formed, and was established, and strengthened, and sustained by the energy that each of these marginalized individuals brought to the broader nature of their gathering of people. It wasn't just a heartwarming story, it was an analysis of how community is established. You reach out, you find commonality, you ignore the superficial differences, you look for the deeper values that you share. And then when you do that, you gain an enormous sense of personal and shared satisfaction. And I think if there was any way to give an example of how to enhance mental health, I would say that story to me stood out very much so. SAHIL  51:03 I agree. Not only was it heartwarming, I found it to be so empowering. In those most dire of circumstances, they were able to come together. And that sense of community that they built was inspiring and empowering on any time you find yourself in dire straits, you can build that community that will help you through it. Warren  51:22 And I would compare that to say, a very wealthy suburb in a large urban setting where all the houses are grand, the trees are beautiful, and the neighbors don't always know each other. And they're often sort of in competition to have the nicest lawn, or the biggest swimming pool, or whatever. And sometimes, not always, but sometimes, just very wrapped up in material values. And then at some point in time realizing that what they really want is a sense of relationship with others. JO  51:58 Much of the book focuses on what Hari feels are the nine major causes of depression and anxiety, including trauma and genetics. He describes them as disconnection from other people, or meaningful values and work and from status and respect. He also talks about us being disconnected from nature, and from a hopeful and secure future, which are inextricably linked. He goes on to talk about solutions, or what he calls different kinds of antidepressants. And we don't have time to talk about all of these, but I would like to dig a little deeper into what I believe is the most important message in the book. And that's the vital role social connection plays in mental health at all scales, individuals, families, workplaces, and communities. So first of all, Sahil being of Indian descent, your experience with social connection is much different than ours in the Western world. Tell us about that, and how it played out in your life. SAHIL  53:07 My parents are from India, moved here kind of in their 20s. Typical immigrant story, came with very little, have kind of worked their way up the social ladder. I'm born and raised in Canada. Being Canadian is my primary identity. And then I so happen to have this background. And with that background, I think comes a greater sense of family and importance on family. The social connection that I have with my parents and with my sister, that family household connection is so central to my existence. Leaving that when I left Kelowna to go to Vancouver for pharmacy school, that definitely had a role of being further from my greatest support system. And there was never a sense that I would be abandoned. When I look at more Western culture of kids moving out at 18, it seems such a difficult way of life. I don't know if I would have been able to get to where I'm at in life, if that was the culture that I came from, or if that was the situation I was in. So that value on a family and supporting each other, this mindset of my parents support me until I'm self-sufficient, and then eventually, the responsibility becomes mine to take care of them. So we're always being taken care of and supported in that way. There's no sense of time out in the world by myself. Warren  54:33 The Indian culture is, in some ways, far more mature than the kind of hybrid culture that we have in this part of the world. And many, many other cultures really have maintained a sense of community and family. There's no question I've observed in many, many situations how having sometimes just one healthy relationship can mean the difference between somebody being really distressed almost all the time, and feeling a sense of relief and security. Maybe I can recite a story that was told to me by two prominent members of Indigenous community here. They talked about the fact that everything that happened in Indigenous community was for the community. And as a result, everything you did was to make sure the community survived. So if food was scarce, and hunters brought back a deer or something like that, or there was some kind of plant that they could harvest, it would be shared equally among the community. And even if somebody was a hunter and needed more energy, then others would make sure that the hunter had a little bit extra. We certainly don't think of the communitarian values that underlie our behavior all that much. We're doing a better job now, but we've got a long way to go. And I think we can learn a lot from the Indigenous experience. JO  55:59 Sahil, you have one foot in Canadian culture, the other in Indian culture. Tell us what you've learned about your Indian culture that would help us build more mentally healthy communities here. SAHIL  56:12 It's hard for me to speak for all of South Asian culture. Even just India is a country of a billion people, and there's a lot of nuances. But what I can say from my personal experience is, I'm lucky to have a good family dynamic. And that's taken work. It's taking conversations, it's taken establishing and respecting boundaries. So I think the takeaway for me is put time and effort into cultivating the relationships, maintaining the relationships, because that is kind of the foundation of everything else. If you have those, you can work through a lot of the other difficulties that life throws at you. JO  56:55 Warren, you and I have talked a lot about the importance of livable communities that are designed and built to foster social connection. Dig deeper into that for us. Warren  57:08 Absolutely, and with considerable enthusiasm. How you construct a community, how you actually build the infrastructure in a community has an enormous impact on the ability for people to connect with one another. I remember an article in Scientific American that showed a small English village before the advent of the automobile. And the road was narrow, and the paths on the side of it, what we might call the sidewalk was large. And there were people all over the sidewalk, and very few vehicles, and most of them were horse drawn in the roadway. After the advent of motor vehicles, and a few decades gone by, the roadway had expanded, the sidewalk had shrunk. And the vehicles on the road clearly overwhelmed any walking activities that took place, and the sidewalk was really just a kind of a narrow front in front of stores and other kinds of buildings. And the structure there did not facilitate people crossing the road to talk to one another. So when we do that kind of change in a town, even a small English village, without realizing it, we've disrupted social patterns and a sense of social connection. The changes that we've introduced with what they call concrete jungles, downtown areas where every surface has been built. And the only place you can actually meet somebody is by going in a door into a building and typically presenting something about yourself. Either it's you want a hotel room, or you want to buy something. But the interactions that are just the casual interactions are very hard to come by. I live in a small town. I've been here for 45, 43 years, and I walk down the street and it's a social event. I meet people every few feet practically, who I know and have a few words with. So I think how you construct a community has an enormous impact. Walking trails, park benches, park spaces where people can just hang out and be sociable. All of those things and many others make a huge difference in terms of facilitating social connection. SAHIL  59:17 This theme of the environment, and how ever you define it keeps coming up and is really important. And I think that starts even in your bedroom. What do you have there, and what is that promoting in your life? All the way to, yes, the greater community and the planet. And something that I've been reflecting on more recently is cultivating as much as I can, the environment that's going to bring the behaviors out of me or create the mindset in me that I'm wanting. JO  59:45 I've been a public outreach and engagement consultant to local governments in BC for 30 years. And I'm thrilled to say that things are definitely getting better at the community scale. When I started in the early 90s, municipalities didn't have sustainability plans or programs, climate action plans or programs, and very few were thinking about the social and cultural considerations of community well-being. I'm thrilled to say that there have been dramatic changes in these areas. Communities of all sizes across Canada are working with residents to plan and mobilize efforts to enhance and integrate social, cultural, environmental, and economic well-being. Warren  1:00:32 Joanne, that is such an important thing that people who are in governance systems can do to make communities what they have the potential to be, which is hubs for people interacting at multiple different levels and in multiple different ways. And in almost all of them positive. And there are many ways you structure both the physical structures and the social structures. The way support systems are given to people or not given to people can make a huge difference in the way their lives work out. And I think that is a critical element that all leaders and communities can play and make a huge difference. JO  1:01:13 Warren, I know you're also passionate about the social determinants of mental health, and how they impact people's well-being. These include things like housing, employment, education, physical environment, security, and financial stability, to name just a few. Knowing that you promote universal, basic income at every opportunity as a way to optimize these factors, tell us more and why it would improve mental health across the board. Warren  1:01:45 There's two pieces of evidence around mental health and what a universal basic income does to that part of our lives. The empirical evidence is that every experiment that has been done in this area has shown a massive uptick in positive emotional state in the people receiving the universal basic income in whatever form it occurred. There was an experiment done in Dauphin, Manitoba in the 70s and early 80s. And one of the universal findings there was everybody felt so much better about their life. There was an experiment done in Ontario for about three years before it was shut down by a new government. And it showed exactly the same thing, something like 87 percent of people had this enormous uplift in their state of mind, because they felt cared for. They felt nurtured by the community at large. It wasn't that they were given this cheque and they just went off and spent it. They looked at the cheque and they said, "This is all the other people who live in this community, contributing a few cents to my financial security." And that was a very powerful thing. The other piece of evidence is drawn from human health. And if you look at physical health outcomes in countries where there's more income equality, and what a universal basic income does is it puts a floor under which nobody will sink. The evidence from many different countries in the world shows that human health at the physical level improves very significantly. Countries with greater financial disparities between the wealthy and the financially underprivileged. Every study shows that people use hospitals less often, they go to doctors, less often, they suffer from chronic illness less often. So I think it's very hard to argue against universal basic income. SAHIL  1:03:39 I think on a broader scale, it's a great idea. We want everyone in society to be taken care of, to be fed, to be housed. The social determinants of health are something recently learned in school. Income inequality is such a predictor of health along with education and the other determinants. We talk about medications a lot, but these basic foundational societal concerns, if these can be addressed, then were working on prevention rather than treatment, and I think that's a great approach. I am probably not as well educated on the economic consequences of these policies and decisions, but definitely something I'm curious about and want to learn more about, because the promise, I think, is there. JO  1:04:30 This has been an informative and inspiring journey with you both personally and as a producer of this podcast. Thank you from the bottom of my heart, for sharing your stories and your incredible insights and passions. So let's close with a question for each of you. Warren, you've been doing this a long time. What are you seeing in treatment modalities and health care now that gives you hope for the future? Warren  1:04:59 I've been reflecting on this quite a bit recently because I'm veering towards retirement, and it makes you think about what is the nature of healthcare and your role in it. And what is the system itself doing, which I've been observing for nearly five decades overall. One of the big changes is that the information that is now available to people is far more abundant than it once was. At one point, you could only get information about health from either a specific healthcare practitioner or from somebody who was selling you a product. Abundant and accurate information about human health, in all its aspects and every aspect that we've talked about today, it's now available online. Now, there are of course, sources of information that are entirely questionable and distorted. But much of the information is really eye opening for many people. And that's taking the emphasis off just say going to the doctor or going to see another health professional, and sort of democratizing access to information, which I think is a really important step. And I think that's revolutionizing how healthcare happens. JO  1:06:19 Sahil giving your lived experience of depression and anxiety, your expertise as a progressive pharmacist, and what you've learned from Hari's book, how do you see the future for the one in five Canadians who have or will have depression and or anxiety? SAHIL  1:06:37 I see a hopeful future. I think it starts with that first step of that self-awareness and identification of what's happening before it's becoming too severe. Trying out all the non-medication measures, some mentioned in Hari's book, and some we've mentioned throughout the podcast, and then having your health care team in place if you're needing it to work on from the psychotherapy aspect or

Friends of Fulham Podcast
FOF'cast - End of Season Review

Friends of Fulham Podcast

Play Episode Listen Later May 12, 2022 66:26


We are joined by Scott Tanfield, Owen Smith and Mike Gregg for this special episode of FOF'cast where we review the season. We discuss the 2021/22 Championship season and how we thought it went. Highlights and lowlights of the season. Friends of Fulham Man of the Match and winner Aleksandar Mitrovic. Marco Silva's first season in charge. The last 7 games form wise, and who we think will win the playoffs and join us in the Premier League. Thanks once again for listening, and please subscribe to catch any future shows.

The Marty Sheargold Show  - Triple M Melbourne 105.1
FULL SHOW | So, what is that on your arm?

The Marty Sheargold Show - Triple M Melbourne 105.1

Play Episode Listen Later May 3, 2022 81:35


FULL SHOW | Today we find out how you proposed to your partner; We play Spotify for your a White Guy; Marty has a story about man who grew something on his arm; and in FoF we cover Richmond's proposed re-development and the sub rule controversy See omnystudio.com/listener for privacy information.

The Marty Sheargold Show  - Triple M Melbourne 105.1
FULL SHOW | Flopping not allowed

The Marty Sheargold Show - Triple M Melbourne 105.1

Play Episode Listen Later Apr 28, 2022 89:06


FULL SHOW | Today can Marty make it two from two in out Year Book quiz; Marty rolls out some workplace memes; We find out how you lost your finger; and in FoF we tackle the flopper See omnystudio.com/listener for privacy information.

De Carona na Carreira
089. Como viver do que você escreve - Chico Felitti

De Carona na Carreira

Play Episode Listen Later Apr 28, 2022 62:12


Nesse episódio: Vida de escritor; Busca por histórias inesquecíveis; Trabalho investigativo; Fins de ciclos; Precificação de trabalho; Como lidar com jobs que não engrenam; Mudança de planos, e de rota; Aprendendo com nossos erros; Liberdade criativa. Hoje Thais entrevista o jornalista, escritor e podcaster Chico Felitti, que tem o dom de dar voz a histórias invisíveis, transformando-as em inesquecíveis. Tornou-se conhecido por sua reportagem sobre o Fofão da Augusta (Ricardo), e já escreveu diversos best sellers - links todos abaixo. O Chico tem coragem de se jogar e viver intensamente tudo que se propõe, por isso, as histórias dele sempre devem ser contadas e sua vida daria um maravilhoso livro. Aproveitem essa jornada. Vambora? Toda semana tem novo episódio no ar, pra não perder nenhum, siga: https://www.linkedin.com/in/thaisroque/ ||| https://www.instagram.com/thaisroque/ Newsletter Assine a nossa news! http://eepurl.com/hSpO4D Links do Chico: Instagram: https://www.instagram.com/chicofelitti/ Instagram Além do Meme:https://www.instagram.com/alemdomeme/ Reportagem do Buzzfeed: https://www.buzzfeed.com/br/felitti/fofao-da-augusta-quem-me-chama-assim-nao-me-conhece Livro Rainhas da Noite: https://www.storytel.com/br/pt/books/rainhas-da-noite-1399531 Livro Ricardo e Vânia: https://amzn.to/39bJpGH Livro A Casa - A história da seita de João de Deus: https://amzn.to/36U7roU Livro Elke, Mulher Maravilha: https://amzn.to/3yfUscH Mala de viagem Livro - Estação Carandiru - https://amzn.to/3EZxCaj TED - O perigo da história única - https://www.ted.com/talks/chimamanda_ngozi_adichie_the_danger_of_a_single_story/transcript?language=pt Equipe que faz acontecer: Criação e coordenação: Thais Roque Consultoria de conteúdo: Alvaro Leme Supervisão: José Newton Fonseca Sonorização e edição: Felipe Dantas Identidade Visual: João Magagnin *Contém links afiliados

Kindle and Kerosene
The Programming Change at Fixed on Fitness

Kindle and Kerosene

Play Episode Listen Later Apr 28, 2022 26:45


Changing programming. It's a scary leap, but changing the way we train at the FOF Training Center has been such a positive experience. After a few weeks of blending the programming we had used for two years with programming from Functional Bodybuilding, we made the official switch to the new program on February 28th. As a gym, we have now gone through one full 6-week cycle, a benchmark week, and are in week 2 of the current cycle. The work, the transition, the change has been 100% worth it. We are watching the movement patterns and strength improve in our members every single day. Body composition is improving. Strength imbalances are improving. Confidence is improving. Aerobic capacity is improving. Body awareness is improving. For me, this change was necessary because if I want longevity…like I want to be doing this forever…I need to be using tools other than just intensity, speed, and heavy loads. I need days where I work at 70-80% effort. I need days where I push the pace. I need days that are lighter and days that are heavier. I need to work my mobility and push my joints to get stronger at end range. I need to learn to control each and every movement. I need less kipping pull ups and more strict pull ups. I need time to slow down and focus on moving as perfect as possible. I need dumbbell and unilateral work. At {almost} 40… I want to look good. I want to move well. I want to feel good. I want to be strong. I want to be healthy. I want to stay injury free. I don't want to track all of my workouts. I don't want to count macros. I don't want to be sore all the time. I don't want to perform the most complex skills. I encourage you to take a look at your training. Is it in alignment with your goals? Do you feel good? Can you do this style of workout for the next 30 years? We'd love to show you how we are doing things at FOF. You can come in, try a week for free, and see how you feel. Shoot us a message or just fill out the form on our website, www.fixedonfitness.com. Enjoy! KP

The Marty Sheargold Show  - Triple M Melbourne 105.1
FULL SHOW | Matt the Flapper's Birthday

The Marty Sheargold Show - Triple M Melbourne 105.1

Play Episode Listen Later Apr 21, 2022 99:29


FULL SHOW | Today it's Matt's Birthday; Marty finally wins his favourite game; Dave Hughes stops by; We waffle on in FoF; and we have a Tale from the Tabernacle See omnystudio.com/listener for privacy information.

MEMORIA DE LA HABANA
Gaby, Fofó y Miliki, los payasos que alegraron la televisión.

MEMORIA DE LA HABANA

Play Episode Listen Later Apr 21, 2022 55:48


En noviembre de 1946, tras la muerte de su padre, deciden irse a Cuba, embarcando en Cádiz para un contrato del circo Santos y Artigas, el más importante del país. Contrato de cuatro meses que se convierten en 27 años de estancia en América. En un primer momento Gaby, Fofó y Miliki se instalaron en Cuba, donde hicieron sus primeras incursiones en el mundo de la televisión a partir de 1949. En ese mismo año actúan en los principales locales de La Habana como el cabaret Tropicana y tuvieron un espacio en la radio: “Radio circo”, considerándose que son los primeros artistas que hacen radio vestidos de payasos. --- Support this podcast: https://anchor.fm/ramn-fernndez-larrea/support

The Marty Sheargold Show  - Triple M Melbourne 105.1
FULL SHOW | Can you call them that?

The Marty Sheargold Show - Triple M Melbourne 105.1

Play Episode Listen Later Apr 20, 2022 94:00


FULL SHOW | Today find out how Marty accidentally did a runner; Will devises a very hard Loren's Little Quiz; We induct a serial offender into the Dunce Academy; and we welcome callers to FoF! See omnystudio.com/listener for privacy information.

Heads Up! Community Mental Health Podcast
SENIORS' MENTAL HEALTH: Part 2 – Social Influences, Life Circumstances, Personal Choices & Better Care

Heads Up! Community Mental Health Podcast

Play Episode Listen Later Apr 15, 2022 64:01


SUMMARY Senior's mental health is affected by social threats such as stigma, ageism, and racism, and impacted by individual circumstances such as isolation, loneliness, poverty, poor physical health, lack of independence, and abuse. In Part 2 of this podcast, Marjorie Horne (seniors' advocate and founder of CareSmart Seniors Consulting), Naomi Mison (caregiver and founder of Discuss Dementia), and Dr. Anna Wisniewska (geriatric psychiatrist) shed light on these contributing factors and the complex choices seniors are often faced with ─ separation vs. connection, resignation vs. resilience, and invisibility vs. legacy. They also talk about the role of spirituality in seniors' mental health, and the healthcare changes needed to make healthcare systems and cultures more integrated, personalized, and compassionate for seniors. TAKEAWAYS This Part 2 podcast will help you understand: Prevalence and impacts of macrosocial (or society-wide) influences such as stigma, ageism, and racism Prevalence and impacts of personal circumstances such as isolation, loneliness, poverty, elder neglect and abuse, poor physical health and/or chronic pain, and lack of independence People who embrace aging vs. those who resent aging and resist change Impact of seniors' attitudes and behaviours on mental health Life-affirming choices seniors can make (separation vs. connection, resignation vs. resilience, invisibility vs. legacy) The role of spirituality in seniors' mental health Mental Health Commission of Canada's 2019 Guidelines for Comprehensive Mental Health Services for Older Adults in Canada Vital values for adequate care (recovery based, accessible, comprehensive, evidence-based) Mental health promotion and illness prevention Cultures of compassion within the healthcare system SPONSOR   RESOURCES World Health Organization Canadian Coalition for Seniors' Mental Health Mental Health Commission of Canada Active Aging Canada Alzheimer Society CanAge Canadian Association for Retired Persons (CARP) Canadian Centre on Substance Use and Addiction Canadian Frailty Network Canadian Mental Health Association Canadian Suicide Prevention Network Deprescribing Network Elder Abuse Prevention Ontario National Institute for Care of the Elderly (NICE) Seniors First British Columbia The Centre for Addiction and Mental Health Caregivers Alberta Carers Canada Caregivers Nova Scotia Canadian Hospice Palliative Care Association Families for Addiction Recovery: FAR Canada Family Caregivers of British Columbia Canadian Research Centres on Aging   GUESTS  Marjorie Horne, Dipl. T. Nursing Marjorie Horne was 16 when she knew that the way we see and treat elders had to change. Her journey involved training as a registered nurse, becoming the Executive Director of the Central Okanagan Hospice Society, working in management in seniors housing and, finally, starting her own business, CareSmart Seniors Consulting Inc. She is also a Conscious Aging Facilitator and a Certified Professional Consultant on Aging. As an entrepreneur, Marjorie's goal was to bring a holistic, ‘Circle of Care' approach to supporting seniors and their families through the many transitions encountered in the third chapter of life. Her community endeavors of creating and hosting her own radio show, Engaging in Aging, every Sunday morning on AM1150, writing a bi-weekly column, facilitating workshops on Conscious Aging, and speaking at local events, are all driven by the desire to be part of a new paradigm where we reimagine later life with courage, resilience, passion, and purpose. Phone: 250-863-9577 Email: resources@caresmart.ca Website: www.caresmart.ca Facebook: https://www.facebook.com/caresmartseniorsconsulting Twitter: https://twitter.com/caresmartsenior Linkedin: https://www.linkedin.com/in/marjorie-horne-46bb8937/ Naomi Mison, BA Naomi Mison is a public speaker, vocal advocate, and a champion of change. She has spent the last four years bravely sharing her journey as she cares for her mother who was diagnosed with frontotemporal dementia, when Naomi was just 22 years old. She has spoken publicly through the Alzheimer Society of Canada National Anti-Stigma Campaign, CBC's Out in the Open podcast, Globe and Mail, Embrace Aging Okanagan, Pecha Kucha, and many more. Naomi volunteers with the Alzheimer Society of BC's Leadership Group of Caregivers, is on the planning committee for IG Wealth Management Walk for Alzheimer's, and for the Seniors Outreach and Resource Centre. Naomi holds a Bachelor of Arts in Political Science and English, and a Diploma in Public Relations.  Phone: 780-885-3956 Email: mailto:naomi@discussdementia.com Facebook: https://www.facebook.com/nam956 Twitter: https://twitter.com/NaomiMison Linkedin: https://www.linkedin.com/in/naomimison/ Dr. Anna Wisniewska, MD, FRCPC Anna Wisniewska completed her undergraduate medical training at the University of British Columbia and her postgraduate training in psychiatry at the University of Calgary. Her clinical career has always focused on the care of the elderly and their families. Dr. Wisniewska is currently a consulting geriatric psychiatrist at the Kelowna General Hospital and the Kelowna Mental Health Centre. She also works in her private practice in Kelowna and is a sub-investigator with Medical Arts Research.  Her passion for her work and compassion for her patients were inspired early on by her very close relationship with her grandparents, and maintained by the many wonderful patients, families, and colleagues met along the professional path. Email: DrAWisniewska@gmail.com HOST Jo de Vries is a community education and engagement specialist with 30 years of experience helping local governments in British Columbia connect with their citizens about important sustainability issues. In 2006, she established the Fresh Outlook Foundation (FOF) to “inspire community conversations for sustainable change.” FOF's highly acclaimed events include Building SustainABLE Communities conferences, Reel Change SustainAbility Film Fest, Eco-Blast Kids' Camps, CommUnity Innovation Lab, Breakfast of Champions, and Women 4 SustainAbility. FOF's newest ventures are the HEADS UP! Community Mental Health Summit and HEADS UP! Community Mental Health Podcast. Website: Fresh Outlook Foundation Phone: 250-300-8797   PLAY IT FORWARD The move toward optimal mental health becomes possible as more people learn about the challenges, successes, and opportunities. To that end, please share this podcast with anyone who has an interest or stake in the future of mental health and wellness. FOLLOW US For more information about the Fresh Outlook Foundation (FOF) and our programs and events, visit our website, sign up for our newsletter, and like us on Facebook and Twitter.   HELP US As a charity, FOF relies on support from grants, sponsors, and donors to continue its valuable work. If you benefited from the podcast, please help fund future episodes by making a one-time or monthly donation. Marjorie Horne, Naomi Mison, Anna Wisniewska Interview Transcript You can download a pdf of the transcript here. The entire transcript is also found below: RICK  0:10 Welcome to the HEADS UP Community Mental Health podcast. Join our host Jo de Vries with the Fresh Outlook Foundation, as she combines science with storytelling to explore a variety of mental health issues with people from all walks of life. Stay tuned. Joanne  0:32 Hey, Jo here again with Dr. Ania Wisniewska, Marjorie Horne, and Naomi Mison, as we continue this vital conversation about seniors' mental health. We'll dive deep into the social influences and individual circumstances that impact seniors' well-being, the personal choices they can make to extend and enrich their lives, and the systemic changes needed to optimize the aging experience through prevention, personalized care, and integrated mental health care. NAOMI  1:03 Thanks for having us back. MARJORIE  1:05 We had so much fun the first time we wanted to do it again. ANIA  1:08 Thank you, Jo. And nice to be doing this again with you beautiful ladies and of course with Rick. JO  1:14 To start, can each of you share a little about your work as seniors' mental health care professionals and caregivers for the listeners who didn't hear Part 1? Ania, let's start with you. ANIA  1:26 I am a geriatric psychiatrist working in Kelowna. My work focuses on the care of seniors. I work at the Kelowna General Hospital, caring for patients with mental illness, and I also provide support to the Kelowna Mental Health Center to the seniors' mental health program. I also am involved in a small way in a local drug study program that looks at novel medications for the treatment of Alzheimer's disease. I also spend quite a bit of time in my private practice where I see patients for assessments, and also for follow up long term. I guess I should also add, I'm also involved in teaching at the University of British Columbia. I am involved in teaching medical students as well as residents, which is a wonderful and enriching experience. Joanne  2:13 Marjorie. MARJORIE  2:14 I was trained as a registered nurse and then did a number of things over the course of my career. And I then went back to my first love, which was working with seniors. And that's where I started in my nursing career and worked for about 10 years in seniors housing within the elder care environment. I just saw during that time, sort of a gray area that didn't seem to be addressed as far as all the different transitions that both the older clients I was dealing with and their families, were going through all of these transitions and a lot of emotions come up. We're talking about grief and loss. So I almost felt compelled to start my own business, which I've been running for 10 years now, to try to bring a holistic approach where we really look at the physical dimensions of aging and also the emotional aspects of change and the grief and loss that many people are dealing with. JO  3:16 And Naomi. NAOMI  3:16 I have been a caregiver to my mom, who was diagnosed with early onset dementia, for over 13 years. On the 10th anniversary of caregiving, I decided I really wanted to use my voice to advocate for systemic change. So I reached out to the Alzheimer's Society of Canada and became a media spokesperson, public spokesperson for them. I'm currently involved with the leadership group of caregivers for the Alzheimer's Society of BC. So that's really rewarding being with other caregivers. In my professional life, I'm in marketing and communication, so I'm just trying to utilize my skill set. And really again, advocate for that systemic change in the area around older adults. JO  4:03 Thank you for all the great work you're doing, it's just incredible. In Part 1 of this in-depth look at seniors' mental health, Rick introduced us to macrosocial or society wide influences that seniors face. Things like stigma, ageism, systemic racism, and inequality. I'd like to touch on a few of those today starting with stigma. We won't go into detail about mental health stigma, as there's an entire episode on the topic on our website at freshoutlookfoundation.org. But for the purposes of this conversation, let's say stigma begins with negative stereotyping or the labeling of perceived differences between groups. In this case between the young and old. This separation often leaves seniors feeling diminished, devalued, and fearful due to the negative attitudes our youth focused culture holds toward them. Which means that sometimes people with mental health challenges don't get the help they need for fear of being discriminated against. I want to know how each of you see stigma through the eyes of the seniors you serve. ANIA  5:21 Stigma is so so essential to consider. And obviously podcasts that you have done would speak to that quite a bit. But I think in terms of a story, I guess would be kind of a general one. For some of my patients, they are quite reluctant to share their illness, or the diagnosis, or what they're going through with family or friends, for the fear of being rejected or stigmatized. And I also see sometimes how caregivers will sometimes minimize what's going on at home for the fear of, again, being stigmatized. So they will minimize the symptoms or cover up the symptoms with family or with friends, because they are afraid of what people may think or say. And it's really quite heartbreaking because it can lead to, in the cases of the say caregivers, a delay in getting the help that the patient actually needs. MARJORIE  6:11 Many times, if when I'm talking to groups of seniors and asking them about some of the emotional things that they may be going through, they just sort of look back at me and stare at me and I just wait and I wait. What is it do you think within you, that doesn't permit you to share what might be going on? They all look at each other, and one person always puts their hand up and they said, well, it's partly about my pride. And then they all look at each other and nod that there's some sense of, if I'm losing my memory, or if I'm feeling depressed, or if I've had a fall, I'm not going to tell anybody about it. Because this will show weakness. And then this may mean that my family feel I can't handle things. When one person expresses it in a group, then they all of a sudden all open up and begin to just again share what they're feeling about that. NAOMI  7:09 I also saw a lot of that sort of real concern around loss of independence, when I was working within the clinical research space. I was talking to hundreds, if not thousands of older adults and trying to encourage them to come for cognitive assessments, even if they weren't demonstrating any signs that just to get a baseline. The most prevalent answer I would hear was that I don't want to come in because if I have an issue, then you're going to take away my license, and I'm not going to be able to be independent anymore. Joanne  7:43 Can each of you share one thing you think we could do generally to reduce the mental health stigma seniors face? MARJORIE  7:51 We need to listen more. I see this a lot when working with seniors and their families. If we can listen and less be trying to advise. I'd see this often in adult children that they have their own fears coming into play that really interrupts the process of an older senior being able to talk about how they are feeling. ANIA  8:15 Sometimes it's education about having realistic expectations. What is a realistic expectation? What isn't? What is it that we could actually improve? What could we not? What's worth taking a risk? And for me, those discussions are typically focusing on quality of life. What are things that are important to your loved one, based on what you know about them? To me, it comes down to the quality of life. NAOMI  8:39 I work in communications and marketing. And so I really do believe that words matter. And the language that we use every day can be one area that we can focus on in the here and now. Oh, I'm just feeling crazy, or that person's senile, or they've totally lost their marbles, these different terms of phrase that we have in our everyday vernacular. And it's definitely only strengthening those stereotypes. So I really would love to see some really thoughtful discussions and considerations around language and really being intentional to dispel some of those prevalent stereotypes and increase overall understanding. Joanne  9:24 So let's talk about ageism next, which in simple terms is discrimination based on a person's age. In its Changing Directions, Changing Lives report, the Mental Health Commission of Canada noted that, "Older people have sometimes been viewed as simply a burden to society. Not only do the stereotypical views discount the contributions seniors have made throughout their lives, but they also underestimate their ongoing contribution to our communities and social life in general."  Ania, what are your observations around ageism? ANIA  10:05 What I would start off with is that there is definitely a cultural variation in terms of how aging is perceived. So in some cultures, the elderly are much more revered or put on a pedestal and seen as a source of wisdom, and matriarchs or patriarchs of the family. In our more westernized cultures, we tend to sort of focus a little bit more on the individual. We're less likely to have intergenerational living arrangements, maybe that's a good thing, sometimes. But it does make a difference. Just to give you an example, my much younger cousin who was born in Canada, and did not grow up with his grandparents. When he went back to Poland to visit his very elderly grandparents, he was terrified of them. And it's interesting, it's not anything they did or said. It was just the appearance of a much older person. And I found that so fascinating to kind of see a young child react that way to people who obviously adored and loved him. But initially, he was just scared because he wasn't accustomed to seeing a much older person. So we do need more of that sort of sense of intergenerational living. And I'm not exaggerating, there's situations where we have patients literally dropped off at emergency, because the family wants to go on a holiday, and they don't have a caregiver for the elderly mother or father. I'm not exaggerating this, this does happen. And it's obviously heartbreaking. But it's beyond comprehension that that can happen. And it does happen in Canada. So I do think that intergenerational connections is really important. JO  11:37 So what's one vital step we could take to tackle ageism? NAOMI  11:42 Sharing those stories and putting a face to a name or putting a story to a subject matter, I think is vitally important. And just really increasing awareness and prevalence of people living, no matter the age but really as an older adult, their best lives. I often find, we don't hear enough of those stories. And so I think that would be one way to really start tackling this subject matter. MARJORIE  12:12 I started to write a column in the newspaper about eight years ago. And at first, I was trying to be very professional. And while I was looking after my mom, sort of 24 hours a day, and then I finally went, oh, I'm just going to tell people what's happening. What I'm going through my own aging journey and also my Mom's was really like. And what fascinated me was that I started to receive so many calls and emails from people. And they all were saying the same thing that they had all these concerns about their own aging life, but they just didn't know how to talk about it. So we all need to talk about it together. ANIA  12:51 The only other thing I would add is, it's also leading by example in our professional lives, but also as people in our lives, our families or friends, focusing on the positives. One thing that gives me a little bit of hope is a lot of trends in our society, particularly kind of Western society have been driven by the baby boomers, because they are such a large demographic group. And because I look after patients who are by definition ill, or experiencing health difficulties, and we kind of tend to sort of see a very narrow section of the senior population. And yet many seniors are living healthy, fulfilling lives. And I'm, again, hoping that we're seeing the baby boomers come through that stage of life that will actually help improve that dialogue and improve the perceptions on the education as well. JO  13:37 The final societal influence I'd like to discuss is systemic racism. And again, with all of the podcasts on the summits that I've been producing, systemic racism comes up over and over and over again. So I'd like to know from each of you, how does racism appear in your corner of the mental health care world? Ania? ANIA  14:05 The one population of patients we've heard about is Aboriginal patients, who are really struggling with the systemic racism that exists within the healthcare system. But interestingly, there is also the fact that I think that we are having those discussions and being more honest and more open about how it is impacting patients. I'm hopeful for systemic change as well, and improvement in access to care and just the day-to-day care that we provide to patients. I'm not saying that we're there or even close. Taking the first step in improving the significant problem is developing that awareness and being honest and accepting of how much of a problem it is, and what it is that hopefully we can do to improve. MARJORIE  14:49 I don't see a lot of that just within the work environments that I'm in. I do see it sometimes coming up within independent living sites. Sometimes I will hear maybe a comment or I just sense when I'm being within a group, that there is some racial bias going on. And it's always very hurtful. And if I'm able to, I sometimes try to talk to that person that is initiating that. But that's really within my environment of working in elder care, it is quite limited that I do see it. I just think COVID has really brought so much more to the forefront for all of us, to be thinking about the inclusiveness of how much work there is still to be done. I noticed myself I'm just personally thinking about it a lot more. JO  15:41 Any ways you think we can minimize the impacts of racism on senior's mental health and the care they receive? NAOMI  15:49 One way is really developing culturally responsive, safe, accessible services that really meets mental health needs of a diverse population. Right now, I think what we have is not sufficient enough. And there's a lot that can be done to identify and decrease these disparities in rates of illness and outcomes. Joanne  16:18 Before moving on to talk about how a senior's circumstances can impact his or her mental health and well-being, I'd like to thank our sponsors, the Social Planning and Research Council of BC, Emil Anderson Construction, WorkSafeBC, and AECOM Engineering. These amazing folks fuel our drive toward improved mental health literacy throughout Canada and beyond. And we couldn't be more grateful. JO  16:47 Let's talk about isolation and loneliness and their increasing impacts on seniors, especially since COVID. These words are often used interchangeably, but they mean very different things. Isolation is a physical state. For example, we've been isolated due to pandemic restrictions. Loneliness, on the other hand, is an emotional state, meaning that some of us are feeling lonely because of the isolation. Seniors who are isolated may not be lonely, and lonely ones may not be isolated. So Ania, how do isolation and loneliness play into the mental health challenges faced by seniors? And what are the most common causes? ANIA  17:32 One of the things that I think has become much more obvious over the course of the last year and a half during the pandemic, of course, is that sense of physical isolation that was, of course, a result of the pandemic and trying to protect everyone in the community from COVID. And it certainly has exacerbated that in many ways. And I think one of the things we don't always think about is the impact not just on the patients themselves, but also on the supports and isolation from the support of their caregivers. In terms of loneliness, the recent pandemic has, I think, exacerbated that for some of our patients, leading to increased sense of loneliness. And that of course, can lead to increased depression, anxiety, as well as a sense of hopelessness. Other outcomes that can contribute to isolation and then also loneliness are declining physical health, that may lead to difficulties with mobility. Therefore, a patient becoming more shut in in their home because of inability to get out. Some physical difficulties may lead to loss of ability to drive again, increasing that sense of isolation, and then possibly leading to sense of loneliness as well. Unfortunately, as we age there's a greater chance that those who we feel connected to will become ill and pass on. There may also be other factors like physical frailty that I mentioned earlier, and loss of sensory abilities. For example, vision or hearing, that can also lead to isolation. Many of my patients will struggle with hearing loss are especially affected in kind of larger group settings, where there's a lot of sources of auditory stimulation, and they find it very difficult to take in conversations. So even though they may seem not to be isolated, they may not be able to enjoy or partake in conversation as much, because they are having trouble hearing. And then of course, sometimes we see things like family estrangement that can happen and that again, can lead to a sense of loneliness and isolation. Joanne  19:29 What do you recommend to help people become less isolated and more connected? ANIA  19:34 I think some of it is to try to look for strengths that we have, and also to make adjustments. For example, if interacting socially in a larger setting or a larger physical space, which can cause echo and other kinds of troubles when you have hearing aids, maybe plan for having a get together with one or two people in a smaller setting, where there won't be as many issues related to you hearing. Sometimes some of my patients and families, we discuss the idea of relocation. Some patients move, say to the Okanagan for the obvious benefits during retirement. But some of my patients, as they age and become frailer and develop more complex medical difficulties, find it difficult to be away from family. To some patients, I do encourage them to consider relocating to be closer to their support network. Sometimes living on your own can lead to a sense of that isolation. And then from that loneliness and consideration of alternative housing options like supportive housing, may also be a good idea that allows for increased socialization and interactions with others. And sometimes it's just a matter of being brave and taking some risks and putting yourself out there to find others. There are a lot of different resources available. Senior centers are wonderful resources to connect with others. The Society for Learning and Retirement is also an amazing resource for seniors, that can provide a lot of stimulation and opportunities for social connections with like-minded seniors. Joanne  21:04 Naomi, what are you seeing as you care for your Mom? NAOMI  21:08 I certainly believe that there has been an increase of loneliness, especially at the beginning of the pandemic when the doors were shuttered to all caregivers, and other forms of social engagement. I do think part of the issue in terms of long-term care is even the design of the physical space. For example, in my mom's home, there are three wings that are long hallways, with rooms adorning each side. And there's limited interaction, unless you're on that wing or going for mealtimes, which again has been changed in response to COVID. So for the majority of the day, other than a meal time, you would be spending alone in your room. Joanne  21:55 Another circumstance that some seniors face is poverty. And the outcomes can be things like poor nutrition, inadequate housing, or lack of transportation, just to name a few. And these will certainly all impact seniors' mental health. Ania, can you tell us about the psychology of poverty? ANIA  22:16 When we consider the impact of poverty on individuals, we can think of it in different ways. People can become more, sort of, ashamed of their circumstances, afraid to reach out for help, and focus on the basics and trying to get by from day-to-day. Poverty can then result in increased, kind of, physical as well as mental disorders, and can also decrease cognitive functioning just because of chronic stress. Joanne  22:46 So how can we start turning this around? ANIA  22:49 I think there are certainly increasing initiatives to look at decreasing poverty in our society in general. Seniors are certainly an affected group as well. Obviously, affordable housing is a big one, particularly in Canada, given the astronomical prices of housing. And that's not just for purchasing real estate, but also rental. For seniors who do not own their own properties, improving access to coverage for medications. Some medications are still out of pocket expenses that are not even covered by PharmaCare. And they can be extremely expensive. And some of my patients are not able to afford those medications, limiting the options for them. There has obviously been a lot of discussion in Canada and other countries looking at the concept of minimum income, and whether or not that would be something that will be of benefit. There's obviously differing opinions on that whether it's something worth considering as well. And also the role of families and how they are involved in supporting seniors, in terms of helping them with some of their financial concerns, I think would also be important to consider. Joanne  23:52 Marjorie, what have you learned about the impact of poverty on seniors' mental health? And again, how can we turn this around? MARJORIE  24:00 There's quite an issue with so many people as their aging, and particularly if they don't have the security of a good financial portfolio. There's a lot of fear that revolves around that. But also seniors have a great sense of pride. And it does limit them, I think, in reaching out to gain the support that maybe even is available. They don't know where to go, they don't know where to look. The generation of my parents, that's very much there that they don't want to be a burden to anyone else, even in their family or on society. They're proud and they've worked hard. Joanne  24:41 Naomi, what have you learned about the impacts of poverty on mental health, both in your caregiving and advocacy work? NAOMI  24:49 So what I am seeing, a lot of it tends to be this catch-22, where poor mental health leads to lower income and then vice-versa, lower income results in poor mental health. So I believe when you're navigating this both from a caregiving side and advocating, you really do need a lot of resilience to navigate, because you are met with a lot of obstacles along the way. And that really takes a toll on you. And when you're already worried about putting food on the table, paying your rent, it's really hard to steel yourself to fight the good fight on a daily basis. So, I'm seeing that people are just exhausted. They simply, especially from a caregiving perspective, as we had discussed that the supports that once were available to people, whether it's adult day support, or respite care, are not available in the same way. So the different areas that you may have had an opportunity to have a break or reprieve aren't really available. That compounds the stress to the point that you're often left just burnt out. Joanne  25:59 Let's move on to the conditions of trauma and elder neglect and abuse. Ania, what kinds of trauma follow people into their senior years. And how did they effect those seniors' capacity to live full and rewarding lives. ANIA  26:17 Trauma is obviously a complex issue. And it's generally kind of considered an emotional reaction to something that's quite distressing or stressful. And of course, those types of events can take place at any given point. Traumatic experiences can include exposure to combat or war. Of course natural disasters can also be very traumatizing. Accidents, be it a motor vehicle accident, or as seniors age, unfortunately, there is a high risk for falling. There are also experiences that can happen in terms of abuse, that includes both physical, emotional, and sexual abuse. And those experiences can take place in adulthood, but also in childhood. And of course, that can lead to some difficulties later on. Various studies that look at the experience of trauma and seniors will estimate that between 70 to 90% of seniors have experienced trauma in their lives, which is obviously not surprising given the average age of a senior in Canada. Now, in terms of looking at how trauma can impact a senior, I think a lot of it depends on how that trauma is experienced and processed over time. The way we experience trauma is sort of, I guess, in a way filtered through our sort of life experience, our personality, and also the circumstances. So for example, if we experienced something traumatizing, but we have tremendous support from family or friends, our reaction to it may be a bit more muted, versus if you are not supported or isolated, and may be much more difficult to cope with the trauma. But there's also, of course, concerns about delayed reactions and also chronic post traumatic stress disorder, which we will see in seniors as well. JO  27:15 What kinds of successes do you see in the treatment of seniors with trauma related mental health challenges? ANIA  28:07 Some of it actually starts off with maybe even looking at prevention, particularly when you look at seniors who are at risk for falling. So, looking at prevention to try to diminish the risk of trauma, being more in tune with what may be happening for them at home in terms of monitoring for any concerns related to abuse or neglect. Another thing that can happen in terms of prevention is even staying in hospital can be traumatizing, particularly for patients who are in the ICU. So looking at strategies in the ICU to decrease the experience of trauma in that environment. So prevention is one piece. And then of course, if a traumatic experience happens, counseling can be quite effective. And that can include more supportive grief counseling, cognitive behavioral therapy, and other modalities of counseling. Some seniors do better with one-on-one counseling related to their trauma, and others will benefit from either group therapy or a support group. That sense of connection with other people who may have experienced trauma or similar traumatic experiences, can be really empowering and also normalizing for patients. And sometimes we do need to resort to medications. Patients who have severe post traumatic stress disorder can be quite affected by it, and post traumatic stress disorder can be associated with other psychiatric illnesses such as depression. So sometimes medications are also an important tool that can improve the quality of life for a patient who has a history of trauma. Joanne  29:32 Naomi, what have you learned in your caregiving and advocacy work about how to respond if you think a senior is being neglected or abused? NAOMI  29:42 If you are aware that a senior is being neglected or abused, you should seek out provincial or territorial resources on elder abuse. They will depend on the location, but really reporting what you're seeing. If it's a staff member, reporting that to a higher level, or if it's a family member, any means that you can just bring it to someone's attention is a first step. And if you're not comfortable doing that within a home setting, then seeking out government bodies to help support or guide, I think, would be the best first approach. Joanne  30:15 Next, I want to talk about the mindset us seniors have, the choices we make, and the behaviors we adopt that can help us live long, fulfilling lives. Now, bear with me, I'm thinking there might be an aging spectrum here. On the one end, could be people who embrace the aging process and choose to be responsible for aging, while on the other end, there could be those who resent aging and resist change. What's likely for most of us is that we inhabit the middle ground between positive and negative circumstances, attitudes, and behaviors. So honestly, does that make any sense? Ania? ANIA  30:59 Definitely, I think the way you have summarized it focuses on not just some of the responsibilities you mentioned, but the sense that it is an individual experience. So the mindset is very much a personal experience that can be shaped by the person's individual personality, but also their life experiences and sense of support from their community or families. It also I think, comes from a sense of purpose, and acceptance of changes. So I think if we look at all these factors, certainly we have to consider every individual in terms of their own life experiences, and their approach to how they want to lead their lives. And yes, I agree, I think we all need to take personal responsibility for our health and well-being. We talked in the earlier podcast about factors that can increase our risk of having various medical or psychiatric conditions later on in life. That may be, for example, smoking or dietary choices. So those are some of the things that we need to think about when we want to think about responsibility for aging well, is that sense we are looking at prevention as well. That's a complex decision for sure. JO  32:08 Marjorie? MARJORIE  32:09 I work a lot with people around change in many different capacities during workshops and webinars. Because I find that as so many people as they're getting older, they are afraid to step out of their comfort zone. And it's not that they're particularly happy in their comfort zone. But I do feel that as we're getting older, sometimes we lose a bit of sense of courage to move into the unknown. And I really do feel we need to support each other with that. And I'd see the benefit of doing that within some of these wisdom workshops that I've done for the last five or six years. And there's such a broad spectrum of why do people resist change. But if you help educate them, change has a lot to do with how we have dealt with losses and grief in our life, and Ania spoke of trauma. And of course, many people have had trauma in their lives that they haven't yet healed. And so coming together and sharing that vulnerability of perhaps exploring why people resist change, and bringing some of these components forward around loss around that, it's okay to make mistakes, and to embrace imperfection. Because I think older people somehow thinks, well, I should know how to do that, or I should be able to handle that. They're a little bit more afraid of looking foolish. And so when we just bring that out on the table and talk about it, and then people hear other people sharing that they feel that way, I think it helps people to move forward with a greater awareness of how to go about change. Joanne  33:55 Naomi, what are your thoughts on what I call the aging spectrum? NAOMI  34:00 I think that makes a lot of sense. I do find aging well takes concerted effort. And sometimes people might not be ready to put that effort forward, or like you pointed out, resistance to change, which I think is quite interesting considering the age-old adage, there's only one constant in life and that's change. I believe inhabiting that middle ground really is the key to aging with grace, as no extreme really works. I'm not there in that older adults state at the moment, but I can imagine that it would be difficult when you physically cannot do the things that maybe you once did. But accepting that things change and finding maybe new activities, new hobbies really will allow you to discover things about yourself and learn new skills that you didn't even know you had. I think living life to the fullest in whatever ability you are at like physically, cognitively really will ease potential burdens. And again, to speak to what we were talking about that stress and poverty, the more you focus on the aging side of things, the more it will stress you out. And that's going to cause some other unintended consequences. I really do believe embracing what's happening in your life is the best step forward. Joanne  35:26 So let's see how this might play out in real life. We talked earlier about isolation and the huge role it plays in defining seniors' mental health, and therefore their life expectations and experiences. What if isolation and/or loneliness were choices for some seniors? And what if they chose human connection instead? Ania? ANIA  35:53 I think it is important to recognize that we're all very different in terms of our personalities. Folks who are more introverted will tend to feel a little bit more comfortable in a world that's a bit smaller and has less going on. So I think there may be an element of choice, for some people to be maybe perceived as being more isolated or more separated. And yet, it is something that they feel quite content with. So I think that will be something that is important to keep in mind that we can't expect everyone to fit into the same expected behavior. We need to ask, is this something that you're content with? Is it something that makes you happy? But I think if there is an element of choice, we also sometimes need to accept that some people just feel more content. When I see that sometimes play out in my offices, where I have a senior who is more introverted, who actually does like staying at home all day and reading a book, and maybe their family member would like to see their mother or father be a little bit more active or socialize more. And it can actually lead to some degree of conflict between the caregiver and my patient where the patient is trying to say, I'm actually happy living like this. And the families sometimes struggle with accepting that. So I think we do need to consider those personal preferences. But if there is that desire for increased connection, then I think we need to look at options for people, and as I said, we've discussed those already. Joanne  37:19 Naomi? NAOMI  37:20 In my caregiving scenario, I think in the beginning, I really tried to get my Mom to do the things that I thought she might want to do or would like to do, or that I wanted her to do. And like Ania said, some people would rather just read a book, and she is one of those people. Over time, I have learned to just cultivate that. If that's what she enjoys doing, then I want to do it. But to harness that connection, as well as respecting what somebody enjoys spending their time doing, I brought forward the idea to the long-term care home. What about a book club, or coming up with some creative ways so that you're still cultivating that hobby, but also bringing in an engagement piece as well? And I think the pandemic, one positive thing that has come out of that is that we're really getting creative about connecting, whether it's Zoom, or telemedicine, or these different ways that weren't available to us or we weren't exploring, suddenly seems more possible. One thing I have also learned is that sometimes it doesn't even take words to have that kind of human connection. I know sometimes when I'll visit my mom, she'll be in a mood that day, and she's not really up for talking, and she doesn't want to listen to me rattle on about whatever else I'd be asking or talking to her about. So sometimes I just sit there with her and hold her hand. And there are no words, and that can speak volumes. So I think really living to what the other person that you're caring for, if that is the situation, and cultivating things that they enjoy will make both of you the most fulfilled, has the most possibility of success. JO  39:14 And Marjorie. MARJORIE  39:15 Music is a wonderful thing to use. And there's a wonderful documentary on Netflix, if anybody wants to watch it, called Alive Inside. And it's all about the aspect of music and that we retain the memories and the joy of music that we heard between 14 and 21. And you can find that if you play some songs for that person that maybe is disconnected from that time period, this look, they suddenly open their eyes and they begin to just open into their emotions again, and a beautiful, beautiful connection is formed that way. NAOMI  39:55 I have also seen that film and it is so touching. And I've seen it in my Mom's home as well, that people that don't really speak, almost mute to some extent, you put them in front of a piano, and then suddenly they're playing Beethoven. Or somebody comes in and plays some music, and they're singing along, and otherwise they're not conversing, they're not making those kinds of eye contact. So I agree, coming up with some different approaches can make a world of difference. Joanne  40:24 The next contrast we'll examine is one between resignation and resilience, which are both frames of mind. I know that many seniors experience challenges beyond their control and prevent them from living full lives. But I also know from experience that some of us give in to the challenges of aging. Marjorie, I know you embrace an approach called conscious eldering. Tell us about that, and how it can help build resilience. MARJORIE  40:54 I really came to myself when I just had turned 60. And I felt, boy, how am I going to approach this next chapter of my life? One great book is by Richard Lewis. And he talks about the stages where we have to really look at our past. And it's a letting go, that this is where we are at, this is the stage. And what have all those experiences come together to make us who we are, and that we may have had difficulties, we may have made mistakes, but it's an accepting process, and sometimes not a process of forgiveness, as well. And then it is about adapting to the stage of life. And that yes, physical challenges do happen. We are facing a death at the end of this stage of our life, and what are our fears about that, and exploring that? It's also called gerotranscendence. And it's really where we are looking at perhaps our tendency to resist change as well. Because this time of life is really about wanting to have an experience of more grace in our lives. And I define grace as being aware that everything that happens to us sometimes does happen for a reason, and that the spiritual component of it is that we are taking care of. And so it speaks a bit to developing trust, in even a bigger way as we're coming through this stage of our life, and allowing ourselves to let go of what was and be fully present with where we're at, as we go on each step of our journey. And it's very, very powerful in bringing, I think, a different awareness of what are the golden aspects of this time of life, which often do include all of these challenges that we've never faced before. And it takes a change in your mindset, I think, to form this type of acceptance. And also a trust that there is something bigger that is there, supporting us as we come through this stage of our journey is very, very valuable to look at. And I think it makes us feel where we can also find new passions and new ways of expressing who we truly are, that might have gotten buried over the second half of our life and gives us this chance to explore some of those aspects of ourselves. And that don't come out in whatever way feels right for each individual person. Joanne  43:34 Naomi, can you help us understand aging in place, and the infrastructure we need to help seniors stay resilient? I know this is important to you. NAOMI  43:45 There are different definitions of aging in place. But basically what it is, is meaning that you have access to services, and health, and social supports. You need to live safely and independently, whether in your home or your community for as long as you wish, or are able in terms of physical infrastructure. Aging in place would accommodate the different levels of aging. So in a physical space, there'll be a section for independent living, then maybe some supported living, long-term care, and then palliative care. And that would be all in one place so that you could graduate to the different levels without having to have so much disruption of moving to a new location, which I have seen firsthand can cause some regression cognitively, when they have to make that kind of move. Just from my experience with my Mom, and as I previously spoke about, part of the actual design of the homes at the moment, really don't foster the ability to age in place. Just to give you an example, my mom was about 53, 54 when she entered the home, and a lot of the people that were there were either palliative or in their later stages. So kind of placing her in an area where she's not with other people in a similar condition, I think can cause decline. And I had seen that as well. So I really believe looking at infrastructure when it comes to residential care is so important. And there's a lot of countries that are ahead of us, including the Netherlands. There's a home called the Hogawick. This is basically the leading model for aging. And that is a dementia village specifically, but just really allowing the space for people to live their best life in whatever stage they're at in their journey. Joanne  45:47 Ania, from your professional perspective, what does resilience look like for seniors? ANIA  45:53 Resilience is probably one of the most important factors that I consider when I see my patients and consider treatment options. And resilience, I guess, in a brief way could be summarized as an innate ability to adapt to either change, and/or stressful situations. It is something that offers a sense of perspective, and also an opportunity for growth. And that's definitely something that I try to tap into when I do talk to my patients. Some of them may have lost that sense of resilience or have a hard time accessing it. So some of our conversations were really focused on looking at previous life experiences when they were able to deal with situations that were quite difficult. And sort of we talked about how they were able to get through it, what helped them, and try to apply some of those strategies to their current circumstances. So it's definitely something that is quite important in terms of the work that I do with my patients. Joanne  46:55 Knowing that some seniors can make choices, what is one vital step they can take to move from resignation to resilience? ANIA  47:04 When I think of resilience and making those choices, resilience is actually something that can be learned or developed if one applies themselves. So even folks who may perceive themselves over the course of their life as maybe less resilient, can be encouraged through ongoing support to become more resilient. That resilience can also be fostered by a sense of close relationships. And we've talked about that quite a bit during our podcast today and also the last time. It can also be improved by a sense of physical and mental well-being. And I think the other thing that I look at also is a sense of purpose, because I think having a sense of purpose allows someone to feel more confident. And we talked about loss of confidence and how that can impact seniors as well. And then I think the last thing I would mention in terms of making choices and looking at resilience is also that there will be some changes that are inevitable, and that's part of our good outlook. And accepting those changes is also important in terms of our well-being, because if we dwell on the changes that are inevitable, we kind of get stuck and we can't move forward and look into the future. JO  48:09 Marjorie. MARJORIE  48:10 Well, I was just reading Brene Brown, of course, has written many books and studied resilience. And she had a quote that says, "Joy collected over time fuels resilience, ensuring we'll have reservoirs of emotional strength when hard things do happen." And so sometimes people that have become resigned and sort of stuck, they're not feeling a lot of joy. They're not looking for, or exploring inside themselves. What does bring me joy? And sometimes we, I think, have to sit with that for a while and have some enquiry of ourselves. Do I want more joy in my life? Because you can't make people do things. They have to have some desire within them to have more joy or to extend themselves again, out to people. Just what Naomi was saying about giving, I think that's an important part. Whenever I feel stuck, I think okay, I need to go and give somewhere because it moves me out of that space. But people have to have desire to move from resignation to resilience. I've watched both my sister and her husband have gone through enormous challenges. And I remember when he had a massive stroke at the age of 61. And it is through love, it was the love that was all around him with his family that fueled that desire for him to say, and his mantra was what Churchill said was, if it's to be it's up to me. Joanne  49:44 Let's now look at invisibility versus legacy, which I must admit interests me now that I'm a young senior. So Marjorie, can you tell us what you think are seniors ongoing contributions? MARJORIE  49:57 A lot of people as their ageing feel like they are a burden. And so how do we help them to engage. And I think the intergenerational component is so important, because I've just turned 70 and I do find that people in their 30s do recognize the wisdom that I have gained over all the experiences that I've gone through in my life. I think it takes some courage to feel that, gee, my ideas are of value, I do have wisdom. And so that's an inward place that we each have to come as we're getting older, to let go of even what society perhaps feels in some ways about aging. For us as boomers, as we're moving into this time of our life, it's to discover what do I have to express? Where can I express that and how? And that does maybe take an engagement in a certain way that not everybody wants to do, but many of us do. Many of us do want to still be contributing. And so it takes a confidence to not listen to what other people may be telling you, "Oh, you shouldn't start that business. Or you shouldn't go and do that. What are you doing that for?" If it feels right for you, then find the courage to do it. That's where I think we're going to have healthier aging lives without as much chronic disease. And we're going to have more joyful aging lives even amid very difficult challenges that do come. ANIA  51:41 I would think of it as sort of a gradual process and trying to help them gain a sense of perspective, and a sense of pride in what it is that they have accomplished. I think it also helps to involve family members to try to help the patient gain that sense of perspective. So they do feel more valued and more appreciated, rather than invisible. And also consider some of the cultural differences that may impact the perception of a legacy. Because of course, there will be some cultural differences in terms of how contributions, either past or present, of seniors are perceived by their families or their communities. Joanne  52:23 Naomi, does your Mom or did she ever talk about her legacy and how it would be affected because of her illness? NAOMI  52:31 We didn't have an opportunity to have those conversations. Joanne  52:35 Does that make you think about your own legacy? NAOMI  52:38 Absolutely. Her dementia diagnosis, and it's inevitable conclusion has made me more cognizant of what time I have and how precious time is. And I know that I really want to leave my stamp or something that can live on beyond me, especially considering what I have facing me as a child of somebody living with early onset. There is a 50/50 likelihood that you would potentially be diagnosed with the disease, plus as a woman that Alzheimer's disease is often more prevalent. That's kind of ever present in my life. So if that is where life goes, I really want to in the time that I have now try to make a change that outlives me. Joanne  53:26 Before we touch on the mental health care system. I'd like to talk about the role of spirituality in seniors' mental health. Ania, are you aware of any research that demonstrates a link between senior spiritual beliefs and their mental wellness? ANIA  53:42 There is research that does reveal that there is a correlation between a heightened sense of spiritual connection and a sense of psychological well-being, for example, a sense of comfort, of peace, and more hopeful view of the world. Joanne  54:00 And do you see this in your patients? ANIA  54:03 Yes, it's sort of interesting because we think of spirituality particularly in the context of maybe more religious spirituality, as something that is generally beneficial. But surprisingly, there are circumstances where religious beliefs especially can present some challenges. For example, my patients who suffer from more severe depression, sometimes will have a greater sense of guilt or failing God, that can actually exacerbate their depression. Having said this, one of the protective factors that we see when it comes to suicide is a sense of faith and connection, spiritual connection, and quite often when I asked my patients who do feel like life is not worth living, or they have thoughts of suicide, and yet they are not acting on them. One of the more common answers I get is it's the faith that keeps them going. Joanne  54:57 Lastly, I'd like to touch on seniors' mental healthcare in our overall health care system? Can each of you share briefly what you think are the greatest challenges that seniors face within those systems? Ania. ANIA  55:13 That could be probably a podcast of its own. What I would like to see the most and I struggle with the most is the recognition or early detection of mental illness. Sometimes we end up meeting with patients where they've had symptoms for quite a long time. And one cannot help but wonder what if we had recognized it earlier? What if we had treated it earlier? Would it have led to that same degree of disability, loss of quality of life, or a burden on the caregivers? But I think in general, what the system will require to improve upon is a more continuous and more integrated system of care, including our acute care system and also our community. For example, we now have a Minister for Mental Health and Addictions, which I'm hoping is a sign that there is going to be greater importance paid to the treatment of mental illness amongst our community, including our seniors. But again, I think that early recognition, prevention, and also developing a more cohesive, more seamless system would be essential. JO  56:20 Marjorie. MARJORIE  56:20 A more family centered approach, if that's possible, so that everyone within the family is understanding what are the components of that mental health issue. And how can they deal with it themselves? And also, how can they support that person? I think that's an education component and an inclusiveness that perhaps needs to improve. And especially as far as seniors in the older senior population, the accessibility and availability has to change somewhat, because so many of them aren't that comfortable with computers. JO  56:21 Naomi. MARJORIE  56:21 Access to services in a timely manner, super important. Just to give you an example, we were looking for support for my Mom at the beginning of the journey. So we reached out to our GP, who had recommended or referred her to a neurologist, but it was over a year to get an appointment. And like Ania said, there could be a decline. And you wonder what could have happened if they had that timely response. NAOMI  57:27 Trying to get a dementia diagnosis, very, very difficult. There's not one test that you can get, it's a battery of tests, and the services are often siloed. And they don't always talk to each other. So as the caregiver or the person trying to get the best care for their loved one, we're really left trying to navigate all these systems that don't always make sense and are at times in contravention with one another. I would love a coordinated clear pathway of how to navigate the system, because I find that that is a lot of my time is spent just doing that. Joanne  58:08 For our listeners who are interested in more information about needed change to our seniors' mental health care system, you can find the Mental Health Commission of Canada's 2019 Guidelines for Comprehensive Mental Health Services. For older adults in Canada, you can visit the Commission's website at mentalhealthcommission.ca. We're on the homestretch now, and I can't believe how much ground we've covered. As a senior with mental health challenges, I thank you all from the bottom of my heart for sharing such great stories and helpful information. So let's bring this all to a finer point. Ania, if you could share the most important thing you've learned about seniors' mental health with other medical professionals, what would that be? ANIA  59:06 I would look at hopefulness as the most important thing that I have learned. Basically, it's that sense that there is hope that there is possibility for improvement. And that we should always strive towards the goal of improving not only that sense of well-being but also quality of life, and the well-being of the caregivers. Because often, the sense of improvement is tied into the relationship between the patient and the caregiver. So I think hope is the most important thing I have learned. Joanne  59:38 Ania, thanks so much for sharing your incredible insights. It's been a pleasure getting to know you and your work, and I'm really so grateful for people like you who use your talents and passions to serve a demographic that's often overwhelmed and overlooked. ANIA  59:56 Thank you again Jo, for taking on this really important topic. Joanne  1:00:00 Marjorie, if you could say one thing to seniors about the opportunities available to them at this time of life, what would that be? MARJORIE  1:00:09 I'm a lifelong learner. And I know many people say that to me that that's what they want to do as well. And that I think creates a sense of hope that this stage of life is wonderful in so many ways. Joanne  1:00:23 Thanks for joining us, Marjorie. Your broad understanding of the issues has helped us build a robust argument for improving seniors' mental health care. And I wish you loads of love and fulfillment in your golden years. MARJORIE  1:00:37 Thank you. I'm really trying to take that saying, 'the golden years' and really find where there are those nuggets of gold, even despite challenges that we go through and the resilience that we're cultivating as well. JO  1:00:50 And Naomi, what do you envision for the future of caregiving for seniors with mental health challenges? NAOMI  1:00:57 What I envision is really having somebody to accompany you through this journey of caregiving, that understands how to navigate these different health care systems and will help guide you along a defined path. I also see for the future of caregiving, increased access to respite care and at home care, and of course, an outlet for advocacy to make these systemic changes. Joanne  1:01:24 Naomi, your devotion to caregiving in general and your mother's care in particular, is truly inspiring. On your Discuss Dementia website, you asked the question, who will speak if I don't. I suggest that because you speak, many will listen, and positive change will follow. So keep up the great work. So that's a wrap for Part 2 of this podcast on seniors' mental health. So much great information. To connect with Ania, Marjorie, or Naomi visit freshoutlookfoundation.org and look for Seniors Mental Health under Podcasts. There you'll find their contact info, bios, a list of resources, and the podcast transcript. Another big thank you to our sponsors for this episode, the Social Planning and Research Council of BC, Emil Anderson Construction, WorkSafeBC and AECOM Engineering. And thanks to you as well for hanging out with us. You are very much appreciated. Please visit our website to sign up for our monthly e-newsletter, which will alert you to new episodes of the podcast and for podcast information as it drops. Follow us on Facebook at FreshOutlookFoundation and Twitter at FreshOutlook. In closing, be well and let's connect again soon. Episode Reviews

The Rise Guys
WE GOT SOME NEW STICKERS BABY: HOUR ONE: 03/29/22

The Rise Guys

Play Episode Listen Later Mar 29, 2022 30:44


We got some new FOF stickers, now we gotta figure out how to get em out there Headlines with Will Smith apologizing for what happened at the Oscars Sports with the Detroit Lions featured as this year's HBO Hard Knocks team

¿Me lees un cuento?
Los comiclowns

¿Me lees un cuento?

Play Episode Listen Later Mar 25, 2022 34:31


¿Qué tienen en común Miliki, Buster Keaton, Fofó, Charles Chaplin y Gaby? Que en el episodio que os narramos, los payasos y el cine mudo están homenajeados. ¡Escúchalo! Los Comiclowns es un cómic sin texto publicado por la Editorial Cornoque / Asociación Malavida en 2017. Escrito por Daniel Tejero, Roberto Malo, Jesús Mesa e ilustrado por Morata. Recomendado para niños y niñas a partir de 3 años. ¡Apoya a tu podcast amigo! Compra nuestros libros en tu librería preferida o desde www.holamonstruo.com/books Patrocina ¿Me lees un cuento? en patreon desde https://www.patreon.com/holamonstruo y colabora con el podcast. Escribe una reseña con tu opinión y valora ¿Me lees un cuento? con 5 estrellas en Apple Podcasts. bit.ly/meleesuncuentoApple Comparte este episodio o podcast con tu familia y amigos. Habla con los monstruos sobre literatura infantil y juvenil, de los episodios del podcast o sobre nuestros libros ¡Te esperamos en el canal de telegram! https://t.me/holamonstruo Música del episodio: Sneaky Adventure, Sneaky, Súper Circus, Waltz Of The Carnies, Wanoune March de Kevin McLeod y Tomorrow de Scott Buckley. Todas con licencia CC BY.

The Marty Sheargold Show  - Triple M Melbourne 105.1
FULL SHOW | You Proud of that Goatee?

The Marty Sheargold Show - Triple M Melbourne 105.1

Play Episode Listen Later Mar 17, 2022 93:11


FULL SHOW | Today Marty fires up at an AFL Coach; We find out about when you had a brush with death; FOF makes it debut; and we play Year Book See omnystudio.com/listener for privacy information.

Friends of Fulham Podcast
FOF'cast - Blackburn'd Swans

Friends of Fulham Podcast

Play Episode Listen Later Mar 9, 2022 69:01


We are joined on this episode of FOF'cast by Scott Tanfield, Owen Smith, Mike Gregg and Gerry Pimm as we discuss the 2-0 home win over Blackburn Rovers, the 5-1 away win over Swansea City, 5 away games in a row, QPR tickets and loyalty points, Thoughts on Scott Parker now, Barnsley away and Barnsley predictions. Thanks once again for listening, please make sure you subscribe to catch any future shows.

Meu Nome é Correria
#33 - Meu Nome é Chico Felitti

Meu Nome é Correria

Play Episode Listen Later Mar 9, 2022 69:57


Jornalista, escritor ou, como diria Cazé, investigador da alma humana, o Correria do 33º episódio é Chico Felitti! Famoso por desvendar a história de Ricardo Corrêa, conhecido como Fofão da Augusta, ele fala sobre seus livros, seus processos de investigação, o risco de vida que já correu diversas vezes e muito mais. Solta o play!

Friends of Fulham Podcast
FOF'cast - Clouded in Midfield

Friends of Fulham Podcast

Play Episode Listen Later Mar 3, 2022 52:29


In this episode of FOF'cast, we are joined by Owen Smith and Mike Gregg as we discuss the 1-0 away win to Cardiff City, Our best midfield combinations, Thoughts on where we need to strengthen in midfield over the summer, Games in March and how many points, Any worries about not getting automatic promotion, The Blackburn game and Blackburn predictions. Thanks once again for listening, please make sure you subscribe to catch any future shows.

Kindle and Kerosene
From the beginning....

Kindle and Kerosene

Play Episode Listen Later Mar 3, 2022 27:51


Today I look back and tell the story of Fixed on Fitness...from the beginning. A few weeks ago, we were asked if FOF was a franchise. We are not. It's been Josh and myself from the beginning, and both of us are still incredibly hands on in the business. That question got me thinking...it's been a very long time since we've told the story of FOF from the beginning. The story of FOF...It's always a fun story to tell, and each time I tell it, I am reminded of how each and every setback and obstacle has turned into an opportunity for us. Here's a fun fact you might not know...Fixed on Fitness wasn't always Fixed on Fitness. We actually incorporated back in 2007 as Operation Fitness. The ride has been full of ups and downs, wins and losses, good decisions and poor decisions. But, we are still going...and so are you. As you listen today, I want to encourage you to take a look back at a few areas of your life. Go all the way back to the beginning. Ask yourself these questions. Where did you start? What have you learned? Where are you wins? How have you grown? What is your story? We all have a story. However, most of us haven't told it in a very long time. I want to encourage you today to tell it...you will learn from it, and someone around you might benefit from it. Enjoy!

商界早知道|一早速览商业事
02月11日【商界早知道】“牙茅”董事长自曝找关系进寺烧香;宁德时​代市值蒸发2000亿

商界早知道|一早速览商业事

Play Episode Listen Later Feb 10, 2022 5:41


今日聚焦【500亿A股董事长自曝找关系进寺烧香】2月7日,通策医疗董事长吕建明微博晒出的径山寺烧香祈福活动,不经意间将自己违反当地防疫政策的行为暴露,迅速引发关注。吕建明微博原始文字中提到“因为疫情,最近径山寺不对外开放,朋友联系了寺僧,得以进大殿烧了三支香。”随后火速修改了博文。对此,官方回应称,“确实存在个别僧人把人从偏门放进寺庙的情况,已向上级政府汇报。” 【欢瑞世纪回应欠税传闻:历史遗留问题】2月10日,针对网上出现的“欢瑞世纪欠税”等相关文章,欢瑞世纪发布声明称,相关文章与事实不符。国家税务总局重庆市涪陵区发布信息中的“欠税余额”所涉及的问题,系因2008年之前的相关事实引发,彼时星美联合尚未纳入欢瑞体系,与欢瑞世纪的经营无关,且上述问题早在星美联合破产重整阶段即已经得到了解决,亦不会对欢瑞世纪的经营产生进一步影响。企业动态【宁德时代市值蒸发2000亿】 2月10日早盘,万亿“宁王”宁德时代再度大跌,盘中一度跌超8%至500元,股价创去年10月以来新低。截至午间收盘,宁德时代跌7.9%,收报503.99元,前总市值1.17万亿元。受权重股宁德时代等大跌影响,A股创业板指大跌2.36%。虎年以来,宁德时代4个交易日中有3个交易日大跌,上演“开门黑”,总市值缩水2065亿元。【广州最大民企雪松控股广州总部被围】2月10日,网传雪松控股楼下聚集了一批投资者进行维权。据悉,雪松控股于2021年信托暴雷。2022年1月30日,雪松控股向投资人发布《致歉信》称,公司外部协调资金的压力,未能取得实质性效果,致使原本定应于本月底完成的兑付无法完成。春节过后将进一步与投资人对话商议方案、取得共识,确保2月底前完成兑付承诺的履行。【中欧基金回应葛兰产品遭巨赎:不实】2月10日,一则传言指向葛兰,称有大型险资、理财子、FOF专户等赎回葛兰旗下产品金额达400亿,主要为新能源,其中宁德时代赎回最高。为此,中欧基金回应称,网传“大额赎回”为不实消息,请勿轻信谣言。【鸿海精密称今年将推出两款电动汽车】 2月10日,鸿海精密称今年将推出两款电动汽车,将于2022年2月在美国俄亥俄州开始生产电动汽车。【西贝回应餐厅大屏播放不雅视频】近日,西贝莜面村一餐厅的屏幕上出现不雅视频,电视屏幕面朝商场过道,经过的顾客都看到了这一幕,而店内则有母亲抱着孩子快步避开。对此,西贝相关人士表示,已通过监控视频排查确认非员工所为,目前已报警处理,门店也已关闭Wi-Fi投屏的功能。【好时巧克力否认退出中国市场】今年1月,“好时甜品概念店”微信公众号发文称,好时线下多地撤柜关店,并且已经从位于上海市浦东的办公点撤离。2月9日,据北京青年报,好时称不会退出中国市场,目前线下和部分线上渠道仍在正常售卖。好时巧克力官方微博回应称,淘宝旗舰店“正在装修中”,调整后会恢复运营。产业纵深【夫妻借个人破产逃债被法院终止:将调查】浙江一对经商失败的夫妻自称“个人破产”向法院申请个人债务集中清理,期间他们却对外投资多家公司且并未向法院如实申报,不少收入未用于清偿债务。日前,该院依法对该夫妻所涉个人债务集中清理程序案件作出裁定,当事人违背“诚实而不幸”,依法终止胡某、吴某夫妻个人债务集中清理程序。下一步法院将继续调查。【多地爆出冰墩墩代购骗局】近日浙江多地爆出代购“冰墩墩”骗局。有人转账3500元预付定金在网上代购冰墩墩,想退款时却发现已被对方拉黑。浙江宁波、嘉兴、温州、绍兴警方相继发布反诈提醒,提醒市民不要相信价格炒作,理性消费。【房企年内到期债券近万亿,并购贷或缓解压力】2022年开年,房地产行业融资并未出现明显放松。贝壳研究院监测数据显示,2022年仍然是房企偿债的高峰之年,年内到期债券总额接近万亿元,房企偿债压力仍较大,专家表示,从开年房企发债结构看,境外债持续低温,当前以境内债券融资为主,但并购贷已登场,或成为全年新趋势。(证券日报)【惠州大亚湾出台楼市新政?官方回应】2月10日,一份关于征求《促进大亚湾区住房消费健康发展若干措施》意见的函在网络流传。对此,官方回应称,“这只是一个意见稿、讨论稿,不是最终的文件,现在正在征求意见”意见稿提及了促进住房消费健康发展的若干措施,包括实施人才购房补贴、鼓励企业和房企合作开展团购、加大停车位去库存力度、支持商业市场发展、加大公积金政策支持力度、实行人才购房入户入学政策等。(澎湃)国际视野【入选美国工程院院士,马斯克:万分感谢】近日,美国工程院发布2021年度增补院士名单,其中,特斯拉以及SpaceX CEO埃隆·马斯克入选。对此,马斯克表示“万分感谢”。关于获选原因,美国工程院写道,马斯克在可重复使用的运载火箭和可持续运输和能源系统的设计、工程、制造和运营方面取得了突破。

Heads Up! Community Mental Health Podcast
SCHIZOPHRENIA: Part 2 – Integrating Bio-Psycho-Social-Vocational-Spiritual Recovery Approaches

Heads Up! Community Mental Health Podcast

Play Episode Listen Later Feb 2, 2022 57:30


SUMMARY In Part 2 of this podcast on Schizophrenia, we're joined again by Katrina Tinman (peer support worker with lived experience of schizophrenia), Chris Summerville (CEO of the Canadian Schizophrenia Society), and Dr. Phil Tibbo (clinical/research psychiatrist who specializes in psychosis-related illnesses). They dig deep into emerging holistic recovery approaches that integrate biological, psychological, social, vocational, and spiritual supports. They also explore stigma, impacts of COVID-19, needed changes to public policy and the mental healthcare system, and the world of schizophrenia 20-30 years from now. TAKEAWAYS This Part 2 podcast will help you understand: Emerging diagnostic practices and medications Integrated healing that incorporates biological, psychological, social, vocational, and spiritual recovery supports Benefits of meditation/mindfulness and positive lifestyle choices Benefits of creative therapies that use art, music, drama, and writing Advances in personalized/precision medicine Advances in technology and the Internet to support recovery Effects of COVID-19 Stigma's impact on recovery Challenges for families of people with schizophrenia What medical professionals need to know about schizophrenia What public policy changes would support recovery Why changes should be made to the mental healthcare system What the world of schizophrenia could look like in the future SPONSORS RESOURCES RECOVERY: Research Into Recovery Recovery Model of Mental Illness: A Complementary Approach to Psychiatric Care A National Framework for Recovery in Mental Health Recovery-oriented Practice − An Implementation Toolkit PEER SUPPORT: Peer Support  The Future is Peer Support Using Peer Support in Developing Empowering Mental Health Services MENTAL HEALTH STIGMA: Fighting Stigma and Discrimination Is Fighting for Mental Health Stigma and Discrimination Addressing Stigma Five Ways to End Mental Health Stigma SCHIZOPHRENIA: Hope and Recovery Schizophrenia Treatment and Self-help   GUESTS  Katrina Tinman Katrina Tinman is a peer support worker for Peer Connections Manitoba, formerly the Manitoba Schizophrenia Society, and is located at the Mental Health Crisis Response Centre in Winnipeg, Manitoba. Katrina is currently working toward formal peer support worker certification with Peer Support Canada, though she already has peer support certification through the Ontario Peer Development Initiative. Katrina received a university education in journalism and political science in 1998, from North Dakota State University in Fargo, North Dakota. Since then, she's had a wide range of life experiences from working in the professional arena, extensive travel, motorcycle riding, alpine skiing, and SCUBA diving, to homelessness and mental illness. Regardless of some negative life experiences, Katrina's greatest achievement was a sense of fearlessness that carried her through along with hope for the future. Now she's able, through her peer support work, to use her life's insights to help others in their recovery from crisis and mental illness. Email: k.tinman@peerconnectionsmb.ca Website: www.peerconnectionsmb.ca  Facebook: www.facebook.com/katrina.tinman.5 Twitter: https://twitter.com/tinman_katrina Linkedin: www.linkedin.com/in/katrinatinman Chris Summerville, BA, MDiv, M.Miss, D.Min, LLD (Honorary) Chris Summerville is from a family with mental health challenges (father and brother with bi-polar disorder, a brother with schizophrenia, siblings living with depression, and two suicides). He has also received mental health care himself, which has informed and inspired his work as CEO of the Schizophrenia Society of Canada since 2007. Chris has been involved with the schizophrenia-recovery movement for nearly 30 years, having served on the boards of the Mental Health Commission of Canada, Mood Disorders Society of Canada, National Network for Mental Health, and Psychosocial Rehabilitation Canada. Chris earned a doctorate from Dallas Theological Seminary, is a certified psychosocial rehabilitation recovery practitioner (CPRRP), and received an honorary Doctor of Laws from Brandon University in 2014. He is a regional, provincial, and national leader and advocate for a transformed, person-centered, recovery-oriented mental healthcare system, and believes mental health concerns should be addressed using integrated bio-psycho-social-spiritual-vocational approaches.  Email: Chris@schizophrenia.ca Website: www.schizophrenia.ca Facebook: https://www.facebook.com/SchizophreniaSocietyCanada Twitter: https://twitter.com/SchizophreniaCa LinkedIn: https://www.linkedin.com/company/schizophrenia-society-of-canada Phil Tibbo, MD, FRCPC Phil Tibbo was named the first Dr. Paul Janssen Chair in Psychotic Disorders, an endowed research chair, at Dalhousie University in Halifax, Nova Scotia, Canada. He is a professor in the Department of Psychiatry with a cross-appointment in psychology at Dalhousie University, and an adjunct professor in the Department of Psychiatry at the University of Alberta. He is also director of the Nova Scotia Early Psychosis Program (NSEPP) and co-director of the Nova Scotia Psychosis Research Unit (NSPRU). Dr. Tibbo is funded by local and national peer reviewed funding agencies and well published in leading journals. His publications are primarily around schizophrenia, and his current foci of study include individuals at the early phase of, and individuals at risk for, a psychotic illness. Dr. Tibbo's areas of research include application of in vivo brain neuroimaging techniques, to study psychosis as well as research interests in co-morbidities in schizophrenia, psychosis genetics, addictions and psychosis, stigma and burden, pathways to care, education, and non-pharmacological treatment options. Dr. Tibbo is president of the Canadian Consortium for Early Intervention in Psychosis (CCEIP), helping to advance early intervention care at the national level. He is a recipient (2015) of the Michael Smith Award from the Schizophrenia Society of Canada for research and leadership in schizophrenia, recipient of the Canadian Alliance on Mental Illness and Mental Health's Champion of Mental Health Research/Clinician award in 2017 and, most recently, recipient of the 2018 Regional Prix d'excellence – Specialist of the Year – Region 5 by the Royal College of Physicians and Surgeons of Canada. Email: phil.tibbo@nshealth.ca LinkedIn: https://www.linkedin.com/in/phil-tibbo-62170b18/ HOST Jo de Vries is a community education and engagement specialist with 30 years of experience helping local governments in British Columbia connect with their citizens about important sustainability issues. In 2006, she established the Fresh Outlook Foundation (FOF) to “inspire community conversations for sustainable change.” FOF's highly acclaimed events include Building SustainABLE Communities conferences, Reel Change SustainAbility Film Fest, Eco-Blast Kids' Camps, CommUnity Innovation Lab, Breakfast of Champions, and Women 4 SustainAbility. FOF's newest ventures are the HEADS UP! Community Mental Health Summit and HEADS UP! Community Mental Health Podcast. Website: Fresh Outlook Foundation Phone: 250-300-8797   PLAY IT FORWARD The move toward optimal mental health becomes possible as more people learn about the challenges, successes, and opportunities. To that end, please share this podcast with anyone who has an interest or stake in the future of mental health and wellness. FOLLOW US For more information about the Fresh Outlook Foundation (FOF) and our programs and events, visit our website, sign up for our newsletter, and like us on Facebook and Twitter.   HELP US As a charity, FOF relies on support from grants, sponsors, and donors to continue its valuable work. If you benefited from the podcast, please help fund future episodes by making a one-time or monthly donation. Katrina Tinman, Chris Summerville, Phil Tibbo Interview Transcript You can download a pdf of the transcript here. The entire transcript is also found below: RICK  0:10 Welcome to the HEADS UP Community Mental Health podcast. Join our host Jo de Vries with the Fresh Outlook Foundation, as she combines science with storytelling to explore a variety of mental health issues with people from all walks of life. Stay tuned. JO  0:32 Hey, Jo here. Thanks for joining me again with my three incredible guests as we continue our conversation about schizophrenia, this time focusing on integrated recovery support, emerging science, and advancing technology. We'll also touch on the stigma faced by people with the illness, and gaps in the current mental health care system. But before we dig back in, a big shout out to our amazing sponsors, the Social Planning and Research Council of BC, Emil Anderson Construction, WorkSafe BC, and AECOM Engineering Canada. We celebrate them as their continued support is fueling our passion for improving mental health literacy. Again, my three guests are Katrina Tinman, a peer support worker with Peer Connections Manitoba, Chris Summerville, Executive Director of the Schizophrenia Society of Canada, and Dr. Phil Tibbo, a Canadian psychiatrist who studies, treats, and advocates for people with psychosis and schizophrenia. In Part 1 of this podcast, we heard personal stories and learned about signs of the illness, myths, and recovery movements. Dr. Phil Tibbo also talked about past diagnostic practices. To start this episode, we'll connect with Phil again about diagnostic practices today, and what research is telling us about them. PHIL  2:06 It's a big area of research. And I think I mentioned earlier, we're still not at a point where we can do a blood test similar to other medical illnesses, and from that result in a diagnosis. So there's still a lot of work going on here, and especially at early phases of illness as well. And so a lot of the research is looking at multimodal or multifaceted approaches to diagnosis, that can include not only from interview and behavioral, looking at symptoms, but as well as what we call the biological markers, biological indices, which can be some of the neuroimaging research. Some very exciting work going on even EEG type of research within brainwaves, but as well as in genetics too. The one difficulty with schizophrenia, and again, different from some other medical illnesses where it's a single gene, and something wrong with that gene causes a medical illness. We know that's not the case for psychosis and schizophrenia. And often what it's called is an illness with multiple genes of small effect. Research is active in here, but really that focus is to really help us to identify early. But it'll probably be, like I say, multifaceted or a multimodal sort of approach to diagnosis. I wish I can kind of drop in in 20 30 years time and see what the approach is going to be. I think we're going to see a difference from how we're approaching things now to what it will be in the future, which is of course, the way that it should be. I mean, we're doing things differently than what we were doing 20 30 years ago as well. JO  3:38 Let's now hone in on current treatment strategies that focus on integrating biological, psychological, social, and vocational support, as well as psychosocial rehabilitation. And we're gonna break that down, so don't worry about all those big terms. Starting with biological support, Phil from what I understand, biological or brain-related effects are still best treated with anti-psychotic medications, which ideally, are only one part of an overall treatment plan. Is that what you're seeing? PHIL  4:17 Yes, you still have to consider that schizophrenia is a brain illness which needs to be treated, and medication can be a cornerstone of that treatment. But as a result of the illness, there are other things that may be needed when we were looking at other non-biological therapies. Definitely have psychotic medications are a cornerstone. Now that said, the amount of medication or the length that somebody is on a medication really depends on the individual and really what their needs are as well. Because I have individuals that I see that may need medications for actually a fairly short period of time, and they've been doing well with no medications at this point. It really is kind of individual, but yet yes from biological standpoint, the anti-psychotic medications are a cornerstone treatment. JO  5:04 Kat and Chris, in your personal experience and as shared by your peers, what are the pros and cons of anti-psychotic medication? And are people's responses changing over time as the medications change? KATRINA  5:21 It gets to symptoms versus side effects. As I went through the process of finding what medication would work, it was a journey that lasted about 10 years. And I'd ran the gamut of, well, three I can remember Lexapro, Risperdal, and Zyprexa. But nothing really fit. Remember the description of the spectrum, and trying to find where things fit. And for me, it wasn't until 2013 when I ended up fortunate enough to have a doctor to work with me at length, to find the right medication that would actually be the best fit for me, in communication with me. And it turned out it was one of those that hadn't even been invented until right around that timeframe. Abilify turned out to be the right one for me. CHRIS  6:15 Well, certainly, antipsychotics and antidepressants can address the symptoms of psychosis and mood disorders and minimize them. But as one of our former chiefs of psychiatry here in Manitoba said, "If only the medications did everything that we hoped that they would do." Unfortunately, as Katrina stated, there can be significant side effects. And there are many side effects that we don't have time to go into. But the two that I would mention most pronounced are cardiovascular illnesses and metabolic illnesses. And that's one reason why many people don't want to take the medications or discontinue after a while, because of that fear. JO  6:57 Phil, what advances are being made to make these medications more accessible and effective with fewer side effects? PHIL  7:05 There's a lot of research and development going into newer medications. And I think we always have to be careful in our discussion around this. Because while there may be cardiovascular, may be metabolic side effects, it's not a given. Significant number of individuals that I see that do not have any side effects with their medications. That's with our open and honest discussions. But we have to be mindful of when that can occur, and just be able to catch it early. I know we'll talk about stigma, but there is a stigma about medication that has resulted and it's probably from the older medication. The research and development these days, the focus is on developing an effective medication with little to no side effects. With a better understanding of the illness, with better understanding of brain receptors, there's more targeted, more focused research on the development of these types of medications. I have to agree that there was a period of time where there's a lot of sort of what I call 'me to' medications being developed, very similar to ones that are already out there. But what we're seeing now is just that more focused, more targeted development. JO  8:14 Phil, what about options for people who might forget to take their medications, or choose not to take them for whatever reason? PHIL  8:21 We've had, I'll use the term LAI's, long-acting injectable medication. We've had them for a while. But for similar reasons Katrina and Chris mentioned, you know, they've kind of fell out of favor because of their side effect profile. But recent developments have allowed us to have newer medications in that particular format with much fewer side effects. People can just be on a once-a-month injection medication, or once every three months. And there's product and development for other medications for once every two months. I have this conversation with individuals that I see. It allows them to focus on their recovery, because they don't have to remember to take their medication. And I think that's an important piece. What some of young adults tell me is that they have to take a pill every day that just reminds them that they have an illness. But if they just need to come into the clinic once a month, or every three months for an injection, that helps them focus on their recovery as well. JO  9:18 And Phil, while doing research for this episode, I came across information about using cannabis to treat psychosis. Is that legitimate? PHIL  9:27 No. First of all, a couple of points around that. When we talk about cannabis, keep in mind if we're talking about just overall cannabis plant, there's over 100 active compounds within that. The two most common compounds people hear about, of course, are THC and CBD. And we know that THC is actually more of the risk factor with respect to psychosis development, and poor outcomes after the development of psychosis. There have been some studies trying to look at CBD, cannabidiol, and its potential role within a psychosis, but honestly, there's not a lot. And we just recently published a position statement for the Canadian Psychiatric Association as well as a systematic review and meta-analysis, examining this literature and looking at randomized, controlled trials of different cannabis or cannabinoid products. There's actually only six studies in schizophrenia where they've looked at cannabinoid products, really not much effect. I'm not being negative about it. But just highlighting that we do need a lot more research into this area. And we have to be very clear on what sort of cannabinoid product that we're talking about. JO  10:39 Let's talk about another piece of the recovery puzzle, which is psychological support. Psychological or mental and emotional effects associated with schizophrenia can include depression, anxiety, substance-use, suicidal ideation, and others. These often respond well to treatments such as cognitive behavior therapy, and other emerging approaches such as reality therapy and cognitive remediation. Phil, how do these work? And how can they be integrated with biological solutions? PHIL  11:16 Well first of all, our approach is integrated. We look at, say, medication plus as well as the psychotherapy and psychosocial treatments as well. Having more tools in our toolkit to be able to address the illness. We will have some people who will definitely benefit from cognitive behavioral therapy for psychosis. And that really allows an individual to learn how to adapt, and respond, and develop strategies to work with their symptoms, for example, so that an individual is not as stressed by their symptoms or able to manage them so that they can do what they want to do, basically, in their day-to-day lives. There's a number of different strategies and therapies along these lines. Some are more similar to each other than not. We have a sort of service and commitment therapy as well, ACT, plus as you mentioned, CBT. But they're really there to help augment that individual's experience with their symptoms, or for example, with comorbid symptoms as well, such as depression and anxiety. JO  12:17 So Chris and Kat, are your peers ever hesitant to add these therapies to their recovery plans? KATRINA  12:25 I know I wasn't. In talking with peers, we usually do touch on some of these possibilities. And there's usually enthusiasm at the idea. Oh yeah, I heard of that, or along those lines where they are willing to engage. CHRIS  12:43 I don't think there would be a hesitancy in general, if people were aware of what their various therapies are. There are many what I call, talk therapies that we can utilize today. Some have been mentioned, cognitive remediation, cognitive behavioral therapy, dialectical behavioral therapy, and acceptance commitment therapy, and family therapy. People in general, I think, have a fear of going into therapy because someone's going to try to fix me, and I have to expose them to, and I have to reveal all of my problematic thinking or what have you. So, I think the goal of these therapies have to be clearer for the patient or the client, and that is helping one to manage difficulty in the area of cognition and their thinking, helping them in their executive skills, helping them to improve their communication skills and relationships. So, the therapy has to be explained to people that it will be more than a supplement to the medication, where the medication is not able to address certain issues. Talk therapies have been demonstrated to promote the recovery process. JO  13:47 What are the biggest barriers to people not receiving the psychological support they need? CHRIS  13:53 Well number one, here in Canada, psychological support services are not covered by our health care system unless you're a patient in the hospital. But once you're out in the community, you have to shell it out of your own pocket, and most people can't afford psychological support therapies. And also, the lack of awareness about the role that trauma can play in psychosis and recovery. A lot of people don't know about that. And many service providers may not actually be trained in trauma informed care, due to the lack of trauma informed services. So all those things that I've just mentioned, can be great barriers to people receiving the appropriate psychological supports that they need. PHIL  14:32 I'll have to step in and agree with that. Access and availability is a big thing. The other thing to consider as a barrier. Families talk to me about this kind of at the beginning, when is psychotherapy going to start? And sometimes the barrier, of course, is the illness itself and that person to be able to engage and work within some of these therapies, they have to get to a certain cognitive level to be able to do that. And that's where sometimes we have to wait a little bit of time until we get some better control on some of those symptoms, so that people are then able to engage in some of the psychosocial and talk therapies that would be helpful. JO  15:08 What about creative therapies that use art, music, drama, and writing? KATRINA  15:14 Those, speaking from a person of lived experience and pure perspective, can be very, very useful for meditations and journaling, because really it helps somebody walk through and process thoughts, feelings, and experiences. And I personally think that can be very valuable, as it's really helped me in many ways. PHIL  15:40 I'd have to agree. We've been researching areas of this as well, and we published on this too in a number of different formats and looking at mindfulness-based support groups for families looking at self compassion, and mindfulness, in relation to depression and anxiety. And interestingly too, we've even published on claymation art therapy in our youth and young adult population and the benefits of that. One person may do well with claymation art therapy, and another person not interested at all. So, it helps to be able to investigate and to know that these types of therapies and creative therapies can be helpful. JO  16:14 In your stories and insights, I'm hearing that social support is also vital for people recovering from schizophrenia, this being available through peer support, self-help programs, and family education and support. Chris, what are the biggest barriers to people receiving the social support they need? CHRIS  16:35 Society in general and the media as well, they tend to think that it's just all about medication. You wouldn't believe how many times I've been asked this question through the over 1500 media interviews that I've done, in which I will be asked, "well, how do we make sure these people stay on their medication?" As if medication was the cure all? Again, education is needed that, quote, the treatment of mental illness, and particularly schizophrenia that we're talking about today, is very holistic, so a holistic approach. And that means, what do we do to help people when they're in the community, back at home, back in the community? What kinds of social supports do they need? Whether it's peer support, support groups, whether it's accommodations in pursuing education, accommodation and getting a job, adequate housing, decent income, all those factors. As a society, I think we get it with most other illnesses. These kinds of questions didn't come up when my wife was experiencing breast cancer. There was pure support, there was family engagement, there was family education. There was not just attempts but helping her to connect with various community agencies. One of the things that perhaps gets in the way, which we'll talk about later, is that this profound stigma and prejudice towards people who have a mental illness that live in our community, that affects our policies, that affects our funding. It's a great misconception out there that to address mental illnesses is just a matter of the medical. But as we've listened to Dr. Tibbo and Katrina, they've articulated well that psychological, social, the communal aspects involved in recovery are equally important. JO  18:35 Kat, can you share a story of how important social support is? KATRINA  18:40 The way I'll share it is actually to state that sometimes we hear feedback as peer support workers from our peers, as we're going through the process and discussing with them where they're at and where they're going, and what they're working on, and what they're trying to accomplish. And one of my peers sent back the message, for instance, that I made them feel comfortable, and that I connected with her, that I was nurturing, and calming, and helped that peer make their own decisions that were right for them. And that's, I think, an important piece, that connection to the recovery process and that non-aloneness. And I think that is something that peer support is demonstrating. What we're doing right now at the Mental Health Crisis Response Center is a pilot program. The feedback that we're getting is huge, phenomenal to positive that, yes, this is worth it. JO  19:41 I know you're researching the effectiveness of non-pharmaceutical treatment options like therapy and peer support. What have you learned so far? PHIL  19:52 Well, I think the high-level approach to this question is really important. And that we need to continue with our research in looking at non-pharmaceutical options, and the different types of therapy and peer support. Specifically finding out what we can use, what has the best effect, will be important for the population that we work with as well. We have researched peer support and we have found, yes definitely, it is needed and people, as Katrina mentioned, do benefit from it in many varieties of ways. JO  20:21 Chris as a recovery practitioner, you're very familiar with psychosocial rehabilitation, which I've learned among other things, includes case management, advocacy, structured living residences, and rehab centers, for example. Tell us more about that. And what are the biggest barriers to people receiving the rehabilitation they do need? CHRIS  20:46 We have here in Canada, what's called Psychosocial Rehabilitation Canada, an organization that promotes psychosocial rehabilitation of all mental health service providers. So it's not just limited, let's say, to social workers or mental health workers. So let me just define it. First of all, psychosocial rehabilitation, also sometimes called psychiatric rehabilitation, it promotes personal recovery, successful community integration, the satisfactory quality of life for persons who have a mental health problem or mental illness. Psychosocial rehabilitation services and supports, they're what we call collaborative, person directed, individualized, and we believe they're essential element of human service prospective. And so the goal of psychiatric rehabilitation, or psychosocial rehabilitation is focused on helping individuals develop skills, and access the resources needed to increase their capacity to be successful and satisfied, in what we would call living, working, learning, and social environments of their choice. And so you need a wide continuum of services and supports. The approaches, they are evidence based. And they are promising practices in key life domains of, let's say, employment, education, leisure, wellness, and basic living skills. And family involvement, family peer support, individual peer support are very important aspects of psychosocial rehabilitation. JO  22:18 Chris, what needs to be in place for this to happen? CHRIS  22:22 Truly integrated comprehensive mental health services in which the various sectors are endorsing and creating relationships with each other. So whether that's psychiatrists, social worker, a mental health worker, spiritual health care director. The team of support around the patient, they're not in competition with each other. They are to be working as a team when they have their meetings, and hopefully, with the patient there, listening to the patient. Again, that's that question. What do you feel would help you? What do you feel you need at this point? And as well as offering, what I want to say as wisdom through listening, offering a wisdom back to the patient in helping them to find the various supports and services in and outside of the hospital, that can promote the recovery experience. JO  23:15 Let's expand upon that and look at vocational rehabilitation, and or training that prepares people with schizophrenia for work that best meets their individual wants and needs. Chris, can you tell us more about that? CHRIS  23:31 So let me just tell you a story to illustrate this point about vocational training. This individual's true-life story who had schizophrenia and he had gone through four mental health workers. Well, what happened with the fourth mental health worker? Began to listen to the individual because he was always very persistent with his mental health workers, that he wanted to be an astronaut. They would just dismiss that, "There's no way you can do that, because you have schizophrenia." Well, the fourth mental health worker began to listen to him and ask him, let's just assume that his name is Joe, and said, "Joe, why would you like to be an astronaut?" And he had seen the first moon landing and other things, and he was very enchanted that he wanted to be an astronaut. So, she asked him then in the course of not just in one conversation, but as they developed their relationship. "Well Joe, what do you think would help you to be able to reach that goal?" And they talked about that, and perhaps hygiene could be a problem. Of course, they began to focus on education. "And so what school do you think there might be, and where would you like to go to school to learn more about this?" And so she encouraged him. "Well, why don't you try for one course?" And he took the course and guess what happened? He failed. But that's not the end of the story. She continued to encourage him about other options, and again, a true-life story. He eventually found work and began to work in a space aeronautics museum, welcoming guests and introducing them to the museum. So did he fulfill his goal and his dream? Yes, but it had to be adjusted. But she didn't give up hope on him in terms of his vocational desire. JO  25:06 What a great story. In my research, I continually came upon the term personalized medicine. Phil, what is personalized medicine? And how could it revolutionize diagnosis and treatment strategies for schizophrenia? PHIL  25:24 Personalized medicine, and sometimes people refer to it as precision medicine as well. So sometimes you hear those terms interchangeably. And really what it is, is the tailoring of the medical treatment to the individual, to the individual characteristics of each patient. It does rely on research, it does rely on an understanding of a person's own unique, molecular, and genetic profile as well, and how that can influence treatment. If you think about a personalized medicine, it is really what's going to be appropriate, what's going to work for you specifically based on who you are, both biologically and otherwise. And really, this sort of came out of the advent of trying to figure out from a genetic perspective, how can we use an individual's unique genetic makeup to guide treatment decision? We're not quite there yet, in that respect, but it allowed us to be able to step back, though, and still think about, okay, what is appropriate for this person that's sitting in front of me. And I think that's a little bit more of a holistic approach to our treatment, and that is truly personalized. Now, if we get to that stage where we can do a cheek swab, get a genetic makeup, and then say, okay, this particular treatment, either medication or otherwise, this is specific to you and will work the best. Obviously, that's a great outcome. Are we there yet? No. But research is going in that direction. JO  26:46 One topic I didn't come across in my research is the role of lifestyle choices in recovery. Healthy habits, like getting enough sleep, eating well, and exercising regularly. Kat, how important have lifestyle choices been in your recovery? And do you teach life skills as part of your work with peers? KATRINA  27:09 Lifestyle choices are very important in my recovery. It's something I pay very close attention to. As far as teaching life skills, we do workshops that do some form of teaching, but teaching as an agenda. It's more of an exploration type discussion. JO  27:30 Phil, what do you see in your research and hear from your patients about the importance of lifestyle choices? PHIL  27:36 Research obviously has shown that it's very important, these lifestyle choices. What are lifestyle choices? These could be anything from smoking, cannabis use, to sedentary lifestyle, activity, diet, a number of different choices. We know that individually each of those, and accumulatively each of those can have an effect on outcomes. And the research is pretty solid with respect to that. And so a lot of our focus, so once we get to some of the early sort of phases is, okay really, how can we improve lifestyle, what kind of healthy choices we can help people with lived experience make. We do things, we have a project where we got some funding currently from our Mental Health Foundation, where we're trying to target our rural population. So we got Fitbits. So that allows us to measure and monitor some things along the lines of sleep and steps and exercise. But to be able to send that to their clinicians and to be able to have those discussions, that's sort of great talking points about lifestyle. CHRIS  28:36 Let me combine that question about lifestyle choices and the previous one about personal medicine. Personal medicine, in terms of consumer movement or people who live with mental illnesses, it was really first introduced in early 2003 as a result of qualitative research conducted by Dr. Patricia Deegan. Now, Patricia Deegan is a psychologist, PhD, has lived experience of schizophrenia and experience of recovery. And so personal medicine along with what Dr. Tibbo said, is also about what we do that's medicinal for us in managing, let's say, my depression. What are those lifestyle choices that I know helped me in terms of managing all the stress associated with living with a mental illness? And stress can lead to relapse, we know. So it's not necessarily something prescribed by a doctor or nurse. It comes from within, and it's finding that right balance of what to do and what we take in our pathway to recovery. So that can be mindfulness, can be spirituality, it can be running and exercise. Those things that you know help you to manage your illness in terms of stress management, increasing your resiliency, and your mental health as well, because people with a mental illness can have positive mental health. We know that. And so that word as Patricia Deegan has written about it, personalized medicine has to do with those things that we know that are uniquely medicinal for us, and helping us move forward in our recovery. JO  30:16 Thanks Chris, great comments. Phil, is there any science to support the role of practices such as meditation in recovery? PHIL  30:26 Yes, there is research on this. It's not necessarily for everyone. But for people who can do mindfulness-based practices and meditation, it definitely has been shown to be quite helpful in a number of different ways. I don't say for individuals with lived experience, but we published actually on mindfulness-based techniques for family members, and definitely see the benefits within that group as well. JO  30:50 Advancing technology is another thing I'm hearing a lot about for diagnostic and treatment purposes. Phil, from your perspective and in your practice, can you bring us up to speed on that? PHIL  31:02 Our advances of technology, we're trying to utilize those as best as we can, as quickly as we can as well. And also moving from research to clinical applications, of course, is really quite important. Kind of alluded to this a little bit earlier. We have had advances in the various brain imaging techniques to help us with diagnosis. And there's a lot of different types of brain imaging techniques that are focused either on brain structure, but as well as brain function, and of course, the different parts of the brain, white matter and gray matter. And then other types of diagnostic technologies are there, treatments as well, such as rTMS. There's a lot of this that's happening. And I don't want to minimize that there's a lot of research that have gone into the development and use of smartphone apps as well, and their utility within helping people move forward with their lives and on their treatment to recovery goals. JO  31:56 Chris, what about that technology for social support services? CHRIS  32:01 Well, there are two things that COVID has surfaced for us. Number one has placed mental health definitely on the radar. Ninety-eight percent of Canadians are more concerned about the impact of mental health. Secondly, the use of virtual technology, and that will not go away after the pandemic. In fact, about a year and a half ago, I had my first FaceTime experience with my GP. I never thought that would happen. So use of Zoom and other technology to offer peer support individually, to offer support groups. Many of the schizophrenia societies across Canada are doing education with family members through virtual technology. So that's not going to go away after the pandemic. It is all in a state of development. I think Dr. Tibbo, when he and I've had discussions on this, we have to look at safety, confidentiality issues, privacy, and having good standards. And then, are the various apps that have been developed and ought to be developed, are they evidence based and effective? So I'm excited about where virtual technology can lead us, especially for people who live outside of urban areas. But the great challenge is that many people with mental illnesses, especially if they're on income security, they don't have access to internet, they can't afford a laptop or an iPhone. JO  33:24 Kat, how willing are your peers to take advantage of advancing technologies? KATRINA  33:30 It's hard to conjecture, because every peer is different. As Chris pointed out, even the ability of some might be limited. But from what I'm hearing as we compare notes, peers and I, now hey I have that app, this app that works really good for me. It comes up. So I think, for the most part, it's very favorable in that direction. JO  33:53 Chris mentioned COVID-19, and just a very quick question. Phil, how has COVID affected your patients with schizophrenia? PHIL  34:03 Keep in mind that for my particular patients that I see, it's mainly youth and young adults, and actually the resilience there is really quite high. And the adaptation to virtual technologies, such as Zoom and having meetings along those lines, they're actually fairly quick to adapt to. However, what is also interesting is that a lot of the youth and young adults that I see actually didn't want to have their meetings via Zoom. They'd rather be in person. So we've tried our best to work with that. We obviously want to make sure that nobody is going to have relapse or have any ill effects because of COVID. I think we did a pretty good job of pivoting and shifting service delivery and care to accommodate that. COVID-19 overall in the general population, there's a lot of research that has gone into that and we have seen an increase in, for example, substance use in this population. We've also studied acute care admissions to the inpatient units, and I've seen a shift during the height of COVID in states of emergency declarations, where the substances have played a role, a more significant role in admissions than they did before, as well as in a little bit older age group than what we would normally see in a non-COVID year. JO  35:15 Chris, what are you seeing with your peers and their families as a result of COVID? CHRIS  35:22 Each of my workdays, two to three hours now, have been devoted to taking phone calls and answering emails since the pandemic began, by individuals and family members who are looking for additional help. There is evidence that people with schizophrenia are more likely to develop the illness resulting from COVID-19, as opposed to the general population. I think fundamentally, what some recent reports have indicated is that it's become somewhat harder for people with pre-existing mental illnesses to consistently get not only psychiatric care, but also primary health care. JO  36:02 Kat has the pandemic been difficult for you? KATRINA  36:07 It's been challenging in ways for myself and for my peers. For instance, some describe that it slammed them when they were in healthy spaces. It actually slammed them right back into illness because it looked the same. Now, we were isolating, so they were isolated, again, or still. And that just took them back into it. Just as one example alone. For me, I have to admit riding buses to commute to and from work is a challenge because of what I see. And it causes me a little stress. The people that pull their masks down on the bus when they're supposed to have it up, and stuff like that. But for the most part, I think it's, we're just all hanging in there. JO  36:57 Before moving on to talk about stigma, I'd like to thank our major sponsors again, the Social Planning and Research Council of BC, Emil Anderson Construction, WorkSafeBC, and AECOM Engineering Canada. As a registered charity, we rely on support from sponsorships, grants, and donations. If you'd like to support our HEADS UP programming, please visit freshoutlookfoundation.org/donations. As I say on every podcast, you can't have a conversation about mental health, without talking about stigma. Phil, how does stigma affect people you've researched and treated biologically and psychologically? PHIL  37:40 Stigma can be a huge part of the illness. There are a number of elements to stigma as well. And I'm sure Chris and Katrina will elaborate on these as well, and some we've already alluded to as well within our discussion. Because stigma can affect people's entry into care. And that because of the stigma around the illness, or stigma actually even towards mental health, either themselves or even within their family members as well, can actually affect their pathways to care. And we've done some research on that and have been able to show that. And then when somebody is in care too, and we do have to work with what we sometimes call self stigma, people's perceptions and ideas of what a diagnosis of schizophrenia means and what it can mean. And so there's those elements as well. And of course, we're trying to be the best advocates that we can for patients and our families. And that's where we try to work with the stigma in other areas around society towards the illness, towards mental health, of course, in general. Being those advocates and supports towards vocational or educational pursuits as well. We've definitely gotten a lot better with respect to that over the last number of years, but there still exists some of that stigma out there. JO  38:54 Kat, how would you describe stigma from the perspective of a person with schizophrenia? KATRINA  38:59 I would describe it as a belittlement. And a discreditation is a way of writing somebody off to make them not count. It's even, now how many times do you see it on TV used in a court of law, theoretically, to discredit somebody so much that that witness doesn't even count. It's a write off, and that's not fair. JO  39:21 Chris, what about the impacts of social and vocational stigma on the people you're advocating for? CHRIS  39:28 Well, first of all, we need to understand that all stigmas are built on the same formula. And that is misconceptions and myths, plus lack of education multiplied by fear, results in prejudice, and none of us are immune from prejudice. We all as a human experience. And what we need to do is to be able to look at our attitudes, confront them, and be willing to grow up, to change. Because there is societal stigma, and then when an individual with a mental illness internalizes society's stigma, we call that self stigma. So they think, well, I must have a broken brain and I'm not deserving. And then there's structural stigma in terms of laws, and policies, and practices that result in unfair treatment of people with a mental illness. Now, what does it all result in? It's not just about hurt feelings. Stigma results in a reluctance to seek out treatment. It delays treatment, it increases morbidity and mortality, it results in social rejection, avoidance, and isolation. It results in worse psychological well-being for individuals living with a mental illness. There's poor understanding amongst friends and families. Stigma can lead to harassment, violence, and bullying, poor quality of life, increased socio-economic burden. That's above and beyond the shame and the self doubt that the individual may face. That is perhaps our greatest enemy in promoting comprehensive mental health services and recovery oriented mental health services. That's why we have to advocate as Martin Luther King did, as other leaders and various other movements did, to claim our voice and to identify injustices where they are, and what impedes our being able to see people with mental illnesses as our brothers and sisters, our neighbor, and the fact that we should love one another as we love ourselves. JO  41:33 Kat, you and Chris have both experienced the mental health care system. Just wondering what you've seen, as far as stigma goes within that system. CHRIS  41:43 Well, the Mental Health Commission did a study a number of years ago amongst mental health service providers, and it found that stigma is alive and well within our mental health system, and those who provide psychiatric supports and services. So that might be surprising to people. None of us are immune to stigma, it has to be addressed. And whether you're a doctor, a psychiatrist, a police officer, a correctional guard in one of our prisons, people have to receive supportive education, which helps them to identify their attitudes, which leads to actions of discrimination, or improper behavior, or working with clients, patients, prisoners, etc. So this is a huge issue. JO  42:36 So we're on the homestretch. Now, given what you've learned over the years, what would you say to give hope to people who are early in their recovery journeys? CHRIS  42:48 What I would say is, I want you to meet Katrina. Katrina has lived experience of psychosis. But she also has found ways to move forward and live beyond the limitations of mental illness. She's a peer support worker. And so Katrina, through her lived experience, she will listen. And she will give you realistic hope. Because the hope for recovery is possible. I know this is a difficult time for you right now. And the next couple of years, it may seem like you're not coming out of this deep, dark hole. So what I'm saying here is that I think introducing patients to a peer support worker as soon as possible, can help with the depression and the forlornness that a person may be experiencing by receiving a diagnosis of psychosis or schizophrenia. We need to be realistic, but also, we need to communicate hope that things can get better. And the person who can communicate that the best is a peer support worker who's been down that road and knows what helps and hinders recovery. JO  43:53 Kat, what have you learned about hope? KATRINA  43:56 I've learned that it is the most wondrous and beautiful thing in existence to have hope, and that life without hope, isn't life at all. JO  44:06 Chris, what would you say to family members who are confused, fearful, and frustrated? CHRIS  44:13 I would say that it's normal. It's very normal to be confused, and frustrated, and fearful, and to feel shame. It's normal. And that is not your fault. But that help is available. We know more than we've ever known before about schizophrenia, psychosis, treatment modalities, what helps in the recovery process. And so I would encourage the family who's new at all of this, that there are individuals known as family navigators, or family peer support workers, and that there's family education. There are support groups because the family is in recovery too. The individual with schizophrenia or psychosis, they're not the only one in recovery. But the family is also on a recovery journey, in terms of dealing with their stigma. Dealing with their fears and their frustration, learning communication skills with their loved one who has a mental illness, and that there's hope for the entire family. And things can get better, but not minimizing the barriers and the frustrations that are there. JO  45:17 Phil, what would you say to medical and mental health professionals to help them better understand schizophrenia, and to respond more compassionately? PHIL  45:26 A lot of it is that storytelling, and a lot of what we're doing here tonight too, as well, and just appreciate that a diagnosis of schizophrenia is not necessarily a negative diagnosis, and that people can have great outcomes. And its outcomes based on the individual and what they perceive that their own personal sense of well-being and psychological well-being. And so appreciating and having them appreciate the various outcomes that can exist within schizophrenia and psychosis. So it really comes down to still a lot of that education, that's important. It's not necessarily education, for example, from me from the medical community. It's also education for family members. It's education from people with lived experience, as well. And these are very important stories for the medical community to hear. JO  46:08 How would you pitch the need for wholesale change in mental health care to the people making those policy and funding decisions, Chris? CHRIS  46:18 Well, in terms of policymakers and politicians, I think that we not only point out to them, and most the time they know this already, that our current mental health system is not adequate. And it fails many people. And that most people struggling with a mental health problem or mental illness, are not getting the kinds of supports and services that we've talked about on this podcast today. But then I would move forward, promoting transformation of the mental health system through the recovery philosophy. Australia, New Zealand, Scotland, England, has moved towards recovery oriented mental health services. In fact, the fastest growing occupation in the mental health system in England is that of peer support workers, embedding peer support workers in the mental health system, which can help transform the mental health system. We have to educate those who make policy, in politicians. And we have to get to administrators and hospitals and other domains, and not just write recovery into policies, but develop toolkits to help practitioners to move towards a recovery environment. We have to be patient, but we have to be persistent. And we have to be consistent in our advocacy. And we have to speak with one voice. The best advocacy is collaborative advocacy. Unfortunately, there is still much debate within the mental health community about the medical model versus the recovery philosophy. But we have to persist, we have to be determined we can overcome. PHIL  47:57 So it's a great question. And I guess I kind of go back to some of a little bit what I mentioned earlier, it shouldn't be me doing this pitch for wholesale change. And sometimes I really think it needs to come from those individuals who are living it, both the individuals with lived experience, and their family members. And oftentimes, our major changes in either service delivery, or funding, or policy have come because of the advocacy of family and individuals with lived experience as well. We can be there in the medical community to help support, and give that research, and give the data, and look at cost analysis. But the pitch needs to be unified with all the important stakeholders. JO  48:38 And what would you say to those of us who may not know enough about schizophrenia, but who are willing to explore our ignorance and our conscious and or unconscious biases? CHRIS  48:50 Well, it's all about contact-based education. So what I would say to a person is get to know someone, get to know that relative who has schizophrenia, and get to know that neighbour who is experiencing psychosis the same way I had to do when I was a racist in the deep south. In the first part of my life, as a child, as a teenager and young adult, I had to confront my racism. And the way I did that was by moving out of my supposed circle of safety. And that was getting to know people different from me, people of colour. Eating with them, praying with them, interacting, listening to their hopes and dreams. And then you see a person. So we have to do the same thing in terms of going beyond our comfort zones, to learning the truth about the reality of people who live with psychosis or any mental illness. JO  49:44 Kat, any comments? KATRINA  49:46 To those who are willing to explore, you'll find a whole new world because you'll rediscover people that were there the whole time. JO  49:56 What I've discovered is a whole new world of potential. So, not only for people with schizophrenia, but for collaborative change. CHRIS  50:06 Exactly. You mentioned a wonderful word, their potential. In fact, that is the mission of the Schizophrenia Society of Canada. Build a Canada, where people living with psychosis and schizophrenia achieve their potential. And that's what recovery is all about. JO  50:26 So in closing, I have just one more question for each of you. Given what you've learned, personally and professionally, and what we're collectively learning through research and advancing technology, how do you envision the world of schizophrenia changing over the next 20 or 30 years? Kat, let's start with you. KATRINA  50:48 That there won't be the fear of the illness to stop people from finding out if they need help, how to do it. That there won't be this belittlement that can lead to the self stigma, which feels horrible. That there will be treatments that encompass the wholeness of who you are, working together in greater capacity than where we're at now. We have made some progress, but we're not there yet. JO  51:23 Chris, your vision? CHRIS  51:24 We will live in a society in which no one is left behind. Not because they have schizophrenia or psychosis. That stigma will basically be a thing of the past, and it will not be our big albatross. That in fact, that treatments will go beyond anti-psychotics and won't even have to use antipsychotics. And that the recovery philosophy will be fully ingrained within our mental health system. That's what I hope for. PHIL  51:56 I think we'll have a better understanding of the illness and understanding, for example, from the biological underpinnings of the illness. That will in itself help us to understand the best treatments for schizophrenia. So I think we'll see some advancement there within the biological treatments, but as well as the psychosocial or psychotherapy type of treatments, as well. And I think really what we're seeing as well, is just that better understanding and appreciation. I think in 20 or 30 years, we'll see some of the stigma being reduced as well. I think what will continue to happen is that understanding of illness, and it's really getting back to that early intervention piece. And people understanding that if things aren't really quite right, they should get it checked out. And I do make that analogy when I do some public speaking about skin cancer, and that we've had enough education at this point to realize, okay, if we have a funny looking mole, we should get it checked out. May not be anything, but it may be something that needs a little bit more attention. Hopefully, we will be in 20 or 30 years with mental health and wellness as well, is that enough education there to say, okay, if things aren't really quite right, then we should get it checked out. Again, maybe nothing, but it may be something that needs attention. The earlier that attention is there and the treatment than the better the outcomes. JO  53:10 Thanks so much to all of you for your profound insights, ideas, and passions for making the world a much better place for people with schizophrenia, their families and friends, their employers, and society at large. Phil, I so admire and applaud your attention to the ever-changing details of diagnosis, and both pharmaceutical and non-pharmaceutical treatment options. Your boundless curiosity will certainly make schizophrenia less mysterious, and perhaps one day even curable or preventable. PHIL  53:46 Thank you so much for that. And importantly, as these venues, these educational opportunities, these podcasts, are really going to help us to those eventual goals as well. Thank you very much for this opportunity. JO  53:58 Kat and Chris, your willingness to be vulnerable so that others might be helped, is truly inspiring. And I'm sure will help to inform and transform the evolving conversation around social support and advocacy. KATRINA  54:14 It's a pleasure to help. I know, if I would have had peer support years ago, things would have been different. And that's why I'm working so hard to be a peer support worker is to make that difference. JO  54:31 Chris? CHRIS  54:31 I hope that the listeners of this podcast will be inspired and motivated to take a different approach to seeing people who have a mental illness. And here's the statement, ask not what illness a person has, ask what person the illness has. See a person, not an illness. JO  54:53 Thank you both. This is one of the most robust and powerful discussions I've had. The three of you, what you bring to the conversation individually is astounding, but how well you blended your experiences and insights is really truly remarkable. This has been a wonderful, wonderful experience for me. That's a wrap on Part 2 of our podcast on schizophrenia. Be sure to catch Part 1, which focuses on stories, signs, myths, and recovery philosophy. Huge thanks again to our guests for sharing their amazing minds and spirits. To connect with Kat, Chris, or Phil, check out the episode show notes at freshoutlookfoundation.org/podcasts where you'll find contact info, complete bios, and a transcript. I'd appreciate you leaving a review as well. I'm also grateful for all you listeners and hope this information inspires and mobilizes you along the rapidly changing road to recovery. If you haven't already signed up for monthly HEADS UP e-blasts about new episodes, please visit freshoutlookfoundation.org. And for ongoing information, follow us on Facebook at FreshOutlookFoundation and Twitter at FreshOutlook. In closing, be healthy and let's connect again soon. Episode Reviews

Friends of Fulham Podcast
FOF'cast - Over the Muniz

Friends of Fulham Podcast

Play Episode Listen Later Jan 27, 2022 63:45


On this episode of FOF'cast, we are joined by Scott Tanfield, Mike Gregg and Gerry Pimm, as we discuss the 3-2 win over Stoke City, the 6-2 wins over Bristol City and Birmingham, Stoke Man of the Match Rodrigo Muniz, Jay Stansfield's contract extension, the right-back situation, Mike's latest stats on promotion, the Blackpool game and Blackpool predictions. Thanks once again for listening, make sure you follow us to catch any future shows.

Business Standard Podcast
How can investors benefit from putting their money in silver?

Business Standard Podcast

Play Episode Listen Later Jan 11, 2022 5:02


ICICI Prudential Mutual Fund and Nippon India Mutual Fund are tapping into the latent demand for silver investments, with the recent launch of their silver exchange-traded funds (ETFs) and fund of fund (FoF).  Other fund houses like DSP, HDFC and Mirae Asset will soon come out with their offerings too. So, does an investment in silver bode well for the retail investor in current times?    Analysts say yes, pointing to the metal's low but positive correlation with equities. Chirag Mehta, senior fund manager-alternative investments at Quantum Mutual Fund, told Business Standard that around 70 per cent of silver's usage comes from industrial applications. When economic growth is high, rising demand pushes its price up.     So, while gold has a negative correlation with stocks, silver is more likely to work the other way around.  While silver has declined 12.5% over the past year, experts expect it to begin performing again in the coming few months. The metal is trading at around Rs 60,000 per kg in key metro cities, but Naveen Mathur, director-commodities and currencies, Anand Rathi Shares and Stock Brokers told Business Standard that the metal could reach a price of around Rs 67,000 in the coming few months. In the last decade, gold has definitely outperformed silver in terms of returns.    So, experts suggest only considering silver investments as one option in a basket of commodities. For those considering investing only in silver, experts suggest having a 10-year plus horizon. Business Standard's Sanjay Kumar Singh explains more.  For those planning to invest in silver, you could benefit from an industrial upturn. One could allocate 5-10 per cent of the pro-cyclical component of their portfolio to it. Long-term investors should take the systematic investment plan (SIP) route to benefit from silver's volatility.   Watch video