Q&A: Senator Tina Smith on Mental Health Care Barriers, Awareness

KNSI’s Dene Dryden: “I saw your thread on Twitter about Mental Health Awareness Month, and I felt that this conversation was important to have. … You opened up on Twitter about how you’ve dealt with depression before, and if it’s OK to ask, when did you first realize that you were dealing with that and how has that impacted your life?”

U.S. Senator Tina Smith: “Well, first of all, I want to just thank you for having this conversation; I think it is a really important conversation to have, and not just during Mental Health Awareness Month, but during every month.

“I was inspired to be really open about my own personal story of depression because I think that there are so many people who have experiences with mental health issues or mental illness and yet they don’t feel that they can really talk about it. And so that is what led me to do this, and my experience was this: I was in college and was, you know, by all external measures, thriving. I had a busy social life, and I was doing pretty well in school, and everything seemed to be going great. But I just started to feel like I wasn’t really functioning the way I wanted to function. I wasn’t having joy in the things that I had loved doing before I lost my momentum. At first I thought it was just kind of going through a rough patch, and then my college roommate said, ‘You know, Tina, you just don’t seem yourself, and have you ever thought about getting some help?’ And I did what a lot of people do, I’d said, ‘Oh, I’m fine. You know, I can — I’m just going to suck it up, I’m going to figure it out.’

“But then I realized that I just couldn’t, and it was that reaching out to a counselor at my university that helped me to understand what was going on and help me get some tools for dealing with it. And it made a huge difference to me.

“When I got a little older, I had another experience with depression that I think was more serious — when I was a young mom. Again, I realized I needed help — I had to reach out to get some help. But again, it was really hard for me, but in that process, I learned that asking for help when you need it is a sign of strength and not of weakness, and it made all the difference to me.

“Now I’m fine, I’m happy to report, and have not really had any struggles with depression for many, many years. But telling the story when I was younger seemed important.

Dryden: “And I know that, you know, one barrier to getting the help folks may need is the stigma around talking about mental health issues. Because, like you said, sometimes that first step is the hardest of just actually getting to therapy or getting to whatever support system that you need. And I know that sometimes it can be helpful, whether it is you know, public officials like yourself, or if it’s celebrities or other leaders, being candid about this conversation can help break down at stigma. In this regard, what role do you feel you play in this larger conversation about mental health stigma?”

Smith: “I think that being open about the challenges that I had with depression when I was younger, I hope, will let people see it’s OK to talk about this. It’s not something that I have to be ashamed of. One of the things that happens with mental illnesses or other mental health issues is that you start to feel like the problem is you, that you’re the problem, rather than thinking of it as an illness just like any other illness. I think if we can start to reframe this … it will go a long way towards understanding that you need emotional health and physical health and spiritual health and that all of those things come together. And one of the most important things we could do is to help make sure that people have access to care when they need it. And that is still a big challenge in our country and in Minnesota now today.”

Dryden: “Right, and I wanted to ask about that because we could probably talk for hours about all the different barriers that could impede someone from being able to see a therapist or just, you know, finding that support that they need. And so, what do you see as some of the big barriers to this that Congress or the Biden Administration can take action on?”

Smith: “I think that there are really three main barriers that we need to focus on. The first is what you and I have been talking about right now: the barriers around understanding and awareness and education and then the stigma that’s attached to mental health. So, talking about it, putting it out there, I think, helps to overcome an important barrier. But in addition to that, there are lots of barriers around getting access to care. There is a significant shortage of mental health care providers all over Minnesota and all over the country, especially in rural communities. There are some counties in Minnesota where there might be only one or two mental health providers. Addressing that need and encouraging more people to get into the field is one of the things that I’m working on with my legislation to provide loan forgiveness for people who go into the mental health care field.

“Another really important and useful thing that we can do is to make mental health care services available more in schools for young people. This is happening in some schools; it’s a huge benefit to students, and I’ve seen it in action. I want to make that more prevalent and more easy to do in Minnesota and around the country, and so my second bill would help to expand, make it easier to expand mental health care right in school, so students don’t have all of the barriers around transportation and trying to leave school in the middle of the day that they face today.”

Dryden: “You know, the pandemic highlighted many issues and … exacerbated a lot of issues, but I know one was talking about the social isolation of how has pandemics has played out and how that has aggravated some people’s mental health symptoms, or people might have felt depressed for the first time or anxious for the first time. And as we, at least in the U.S., get to a place where we’re doing better with COVID, are you afraid that this conversation might go away? And [if] so, how can we keep up this conversation about the need for mental health and emotional support, even when we’re out of the woods?”

Smith: “Great question. You’re absolutely right. I think the pandemic and the stress that it puts so many people under — in some ways, it also sort of broke down some of these barriers around talking about mental health. I’ve heard it much more a part of the conversation over the last 15 months, and that’s really a good thing. But, now we need to push forward and make sure that we take the steps that we have to take to address the shortage of providers, make sure that insurance companies are reimbursing providers so that your insurance is covering your mental health care, just like it would cover you if you had a broken arm or you needed help with diabetes, for example.

“There’s still a lot of work to do there, but I see silver linings in what we have learned from this pandemic; I think we are understanding better the massive impact of social isolation and loneliness on people, especially older people, but young people as well. And, I think we’re appreciating also how valuable it is to have those health care services in schools for young people because we’ve seen what happens and how challenging it is for families when they’re not there because students weren’t able to be in school.

“[The] last thing I’ll mention is that we’ve seen some really cool innovations around tele-mental health. And that has been another way of breaking down barriers for some folks who would much rather get their care and treatment remotely. We need to make sure that we continue that progress as we pull out of the pandemic.”

Dryden: “Thank you, and I’m glad you brought that last bit up because I actually see my therapist through telehealth.”

Smith: “There you go.”

Dryden: “Yeah, that’s been a great option, especially with the pandemic.”

Smith: “A lot of people have found that it’s a great way — I heard an amazing story from somebody who was really struggling with some serious depression and they said, ‘I didn’t think I could get out of bed this morning. Because I was able to speak with my therapist remotely, I didn’t have to, and I didn’t miss my appointment. I would have missed that appointment otherwise.’ And that, I think, is such a great example of how powerful it can be to have that remote connection.”

Dryden: “Thank you again for this conversation. I appreciate it.”

Smith: “Great to talk with you. Thanks so much.”

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