Shireen: Dr. Rebecca Corona is a licensed psychologist who has been engaged in providing mental health services in various settings, including the Parkland health and hospital system. Dr. Corona is passionate about assisting those in her community who face barriers to behavioral health services due to stigma, culture, language, and finances. Welcome, Dr. Corona.

Rebecca: Thank you, I really am happy to be here.

Shireen: Great. Well, diving right in, I first want to touch upon your interest in the mental health space, what drove you to it?

Rebecca: You know, it actually started off in my childhood, my mother, her, my youngest brother, I should say, was born with Down syndrome. And it was a real learning experience for all of us, we wanted to understand what that meant, and how that might impact him in our family. And it actually turned our whole family more towards a service type of profession for all of us. Many of us ended up working helping people, I have a number of family members who became police officers. And I also have some family members who went into social services, as a result of, you know, learning more about my brother, and how different yet wonderful he is. And I think that was really the catalyst for me to decide I wanted to help people as well. And I wanted to help children in particular, which is really interesting, because I now work primarily with adults. But I think that it was really my brother, and learning about him and trying to figure out how we can create the best environment for him to learn and grow and succeed. That really had an impact on all of us.

Shireen: Well, thank you for sharing. We are currently near the end of May, as of this recording, which is Mental Health Awareness Month, can you tell us a little bit about why mental health is important and how treatment can actually change lives?

Rebecca: Well, mental health is important because it's part of the whole person. Oftentimes, when we think about health, we tend to focus on physical health, not necessarily paying attention to how we feel, and how we think can have an impact on how we take care of our physical health and how we move about within the world. And so if we ignore that, we find that we end up carrying a lot of stress, maybe even depression and anxiety with us throughout our lives. And that won't allow us to achieve many of our goals, or have that success that we're hoping for. And so I find that working in the current setting that I do, we're able to take that whole person and address their needs, whether it's diabetes, or high blood pressure, but also the impact of that on their mood, and how their mood impacts their ability to take care of themselves. So if someone is feeling down depressed or hopeless, it's quite likely that they're not going to be able to eat healthy or exercise or remember to take their medications. Likewise, if they're concerned about having a chronic illness, they're not going to be able to address it, they may find themselves in denial, or they may do the opposite of what's being recommended for them out of fear, and out of concern. And so I think that we always have to remember that mental health goes hand in hand with every part of every person's life, and that can't be ignored.

Shireen: In your bio, it mentioned, you know, working around the stigma of mental health. How do you approach that? Why do you think that stigma exists?

Rebecca: I work with a very culturally diverse population here in Dallas. And in particular, I do tend to work more with a large Latino population just based in the clinic where I'm particularly working, and being taken on myself, I've seen how that can have an impact on people, especially because a lot of people assume maybe you're crazy, or there's something wrong with you. If you want to talk to somebody in the mental health field, you most definitely are not going to be taking any of that medication that they're going to give to you because it's going to make you worse, you're going to become addicted. So those are a lot of the communications that I get to hear from my my patients that they're learning from the people that they love, and they trust. And so I have to go in and build a relationship and give them facts, but also be empathic to their experience and understand where they're coming from in order to help them understand where this may also have a place in their life. So it may be that there is the stigma of not getting involved with behavioral health because that is a familiar or cultural or even a religious issue. Or it may be just a matter of not having enough information. And so again, I try to present that in a way that respects where that person is coming from, but also holds true to facts. Facts are really important. And once people Understand what the medication really is, what the treatment really is, a lot of those barriers do come down. And it's also helpful that I don't have a couch in my office because I think that's pretty fearful for my patients, because what they see on TV can also distort what they perceive mental health services are.

Shireen: And then what is the, what is the impact of getting that kind of service? Is there a quantifiable number where you've seen a reduction in symptoms, perhaps, through getting the kind of help that is needed?

Rebecca: Yes. And in our practice, we do administer questionnaires at the beginning of service throughout service, and of course, at the end of service, so we are able to track their depressive symptoms, their anxiety symptoms, and also their use of substances if they happen to be abusing those as well. So we can over time see a decrease in symptoms. Now, of course, life is unpredictable. So something can happen. Maybe they initially come in with a high score on their depressive depression screen, they start to decrease their symptoms, and then they lose their job, or there's a death in their family, or maybe they become ill. And of course, we can certainly see some spikes. But again, overall, we hope to see that there's a decrease. And there's also that risk, that subjective report from the patients that we listen to, they may be reporting something on paper, that still looks very high, that just may be their chronic baseline, they may have those symptoms and may have those symptoms for a very long time. But they themselves are perceiving a change in how they're feeling or how they're learning how to manage or address the situation. So I think taking those two things, the objective and the subjective together really gives us a good picture of what's going on with that particular person.

Shireen: Now, given COVID-19, how are you noticing the impact on mental health and just the end, you mentioned anxiety and depression earlier, what kind of impact has COVID-19 had on the overall health and well being of the patients that you see?

Rebecca: Well, unfortunately, it's had a negative impact on our patients, there has been a greater level of anxiety than we've probably seen previously. And a lot of it is due to misinformation, no information or too much information. It's hard to find a middle ground at this point, because we really don't know what this is; we weren't trained to handle a pandemic. And so I think everybody's doing the best that they can. But in doing so some are floundering more than others. And I think that again, a lot of it can be due to those issues of having no information or too much information. And so what we're finding is that people are making some assumptions about what this pandemic is and what it means. And maybe they're choosing to isolate, maybe more than they should. I've spoken to some people who haven't left their homes in the past 60 days or so, because they're so fearful of what that could potentially mean. And then I've also spoken to some people who maybe don't understand the importance of wearing a mask or the importance of social distancing. And who could potentially be putting themselves in danger, not realizing it. But again, doing so because they're fearful of what it means to acknowledge or fully address it that this is occurring. We are also seeing some people who are experiencing physical symptoms related to anxiety, but assuming that it could potentially be symptoms of COVID-19. And so I think there has been an increase in calls to our pack line and our patient assistance line at Parkland, trying to get some answers, you know, I feel this way does it mean this. And thankfully, we have that frontline staff were able to screen and give good information and schedule, any testing that might be necessary. So I would recommend that if anyone is feeling increasing anxiety or stress related to COVID-19 that they reach out, ask to get facts, don't necessarily rely on what your neighbor is telling you or or what you think might be true. Talk to the professionals. We're here, we're available, and we want to help.

Shireen: And then how are you offering that mental health support? Because a lot of patients I would assume that are not coming in, you know, into the system right now. And they're also fearful of going into the hospital, and we're hearing a lot of that as well. So how are you reaching these patients and providing them the support they need?

Rebecca: Well, you're absolutely correct. And, you know, I feel like I didn't fully answer your last question. What we're also saying is that they may not be taking their medications as prescribed or picking up their medications from the pharmacy, because of that reason, they're afraid to maybe come into the clinic, or maybe they are fearful that they might not be able to afford their prescriptions or their fees to see their doctors. So what we've chosen to do as a response to that is to contact Our patients by phone. As behavioral health providers, we don't necessarily have to touch our patients, we don't necessarily have to see them in person in order to address their needs. So we've offered both telephone and video visits. And we found that they've been very successful, our show rate has been much higher than I think it has ever been. I think that we're also able to meet people where they are struggling. working in outpatients is being available to our patients when they're available. Now, if they work during the day, if they're caring for kids, if they don't have transportation, and are dependent on others, that eight to five schedule may not work for them, many of them will make the effort and the sacrifice to come and see us even if it means not getting paid for that hour or two that they're driving over to see me. So being able to contact them by phone and be available to them during their lunch hour or during one of their breaks has really been successful for us. So I think they've really enjoyed that. And I hope that that's something that we can continue. But I also know that there's a larger system that needs to learn how to integrate that a lot better, including the different payer sources. And I think a lot of our platforms to make sure that we're providing safe and private services to our patients.

Shireen: And I like that you talked about reaching them, because you don't need to physically, you know, examine them or do anything. So you're able to sort of see them over a video and provide the help that they need even telephonically with that and you know, I'm thinking about all the different avenues in which we're getting information. You mentioned about talking to your neighbors and you know, talking to others, and then seeking the help of a professional and seeking sort of that guidance from from a professional who knows what's going on, you know, what overwhelms me at times has been everything that I hear on the TV on the radio, it gets overwhelming, right? So what would you say to that? Because now this is coming from credible sources, right? What would you say to the constant news cycle that is providing us I mean, valuable information, but it can also get daunting at times? What would you say to that?

Rebecca: Well, what I've actually told people is to turn it off, go outside, do something different, focus their attention on something that's enjoyable, that 24 hour news cycle is very important. And I'm very grateful that it's there. But oftentimes, it's a lot of the same information that's being reviewed. Sometimes there is new information, but sometimes there isn't. So what I would recommend to them is to select the time that they prefer, maybe they still enjoy watching the six o'clock news on their local channels. Or maybe there's a preferred figure on one of the cable channels who they like to watch, I would suggest they select one of them, or some of them prefer to watch the news in the morning, and in the evening. So they feel that they get the most relevant and newest information throughout the day. So instead of sitting there all day, and watching TV, only select a time that is important to you. And then fill the rest of your day with something else. Because if there's any urgent or breaking news, you will certainly hear about it because most of us are on our phones or have some sort of social media. There's no need to sit in front of it all the time.

Shireen: And when we're sort of hearing all this news, and all this information is coming our way. What have you seen with patients, especially as you see them now telephonically and over video? What are some of the themes that you are seeing emerge? How are you addressing those for them?

Rebecca: I would say that a lot of the themes are concerns related to their health and the health of their loved ones. I do work with a lot of older women in particular, whose children are adults, and who are going out into the world and they may be essential workers and so they don't necessarily have the opportunity to shelter in place. So there's a lot of anxiety over their adult children having to go out and work and be amongst the people. So they're sitting at home worrying and thinking and imagining everything that could potentially happen, but also forgetting that their children are probably taking every precaution, their job is making sure that they're trying to be as safe as possible. So I would say that that's one of the major factors is maybe not necessarily fear for themselves, but fear for their loved ones. Another major concern that I hear from my patients is related to finances. Again, a lot of my patients are blue collar workers. This is the very first time they've ever been in therapy. So it feels a little bit indulgent to them, but they're excited to have somebody who's there for them who can hear them. But one of the things that they're missing is actual work. A lot of their jobs have been cut down or taken, getting rid of gotten rid of all together. Some of the women who I work with clean houses, so of course they're not being invited into homes at this time to clean people's homes out of fear of potential. infection or contamination, or those people who are undocumented, there are jobs, there are jobs available. But unfortunately, these people are not eligible to apply for these jobs at this time. So a lot of them are concerned about paying their bills, feeding their children, making sure that they have a roof over their heads. And thankfully, I think a lot of cities, counties, states, across this country have found ways to maybe delay eviction of people or have created some funds to help with certain bills or, again, are working with people to delay payment of bills for a period of time. But then what happens at the end of those two, three months, eventually, they have to pay it back. And if they're not working, they're not making any money to save. So they're really trying to be forward thinking in that sense and figure out well, what comes next? And I think that's a lot of what's on their mind. So I think it varies from person to person. But those, those two are probably the biggest issues that I see at this time.

Shireen: I want to now turn specifically to people who have chronic illnesses like diabetes, the type of people we you know, we serve? And how are you seeing sort of those who already have chronic illnesses, like diabetes, or heart disease? How were you seeing them sort of manage not only everything that's going on right around them, but also their own health, and then tying all of that to their mental health? How were you seeing them sort of adjust to all of this and manage their health at the same time?

Rebecca: What I'm finding, unfortunately, is that due to the high anxiety that's being left to the wayside, again, they're focusing more so on their family or their finances or their own well being in the sense of not getting the actual virus, as opposed to the day to day, I've spoken to people who've stopped checking their blood sugar, because they just forget about it, you know, they're so busy about everything else that they're doing. And so working with them, and reminding them that it's not a failure, there's always an opportunity to try again later or tomorrow. And it's something that is a small measurable goal that they can definitely achieve, and always trying to provide a lot of positive reinforcement when they do the things that they need to do. The other thing that I would say that is getting in the way of their particular care is because they are distinct from their providers in a way that they never have been before. They're not reaching out or asking questions the way that they normally would. Again, they have concerns about getting to the clinic, because they don't want to come in contact with anyone who might be sick. So they may not be coming to pick up their prescriptions, which they need to take, and they're running out. And then because I do have more consistent contact with them, they might say, you know what, I didn't pick up my medication for hypertension, I don't know, if I have refills anymore, I'm not sure what to do. Nothing has changed, the process is the same, you know, call the pharmacy, let them know you need a refill. If you don't have refills, they will connect with your provider. So walking them through that, again, it's almost as if this has made people forget that we are still here and that nothing has changed. So I think they're so caught up in this web of COVID-19 that they're forgetting that everything remains the same, including their own self care. And so working with them and teaching them again, you know, yes, you can't go walk in the mall anymore. You may choose not to go walk in the park, even though parks you know are still open, as long as you maintain social distances, you can still go walk outside in your yard. And if you don't have a yard, maybe you live in an apartment, you can still walk around, you know, your your apartment, most of my patients will tell me I love music, turn on some music, you know, maybe take your medication, turn on some music, do some dancing around, you know the house, get some exercise in, make sure to pair those important things like your medication, your blood sugar, with things that you're doing every day. So that way you don't forget having to remind people, you remember, you bought that pill box before pull that out again, it helped you before let's use that again. So unfortunately, it feels like we have to go back to basics. But those basics are important. Because right now, people aren't focusing on the basics. They're they're trying to survive this pandemic, but they're forgetting that they also have to continue to maintain their health. And so I think our conversation helps bring them back to that. And if I was gonna also say that in our particular job, I am co located and integrated into a primary care facility. So I do have access to that information in their medical record. And I can say Hi, my name is so and so I noticed that you haven't got your medication. Or I've noticed that you know, your agency this last time was a lot higher than usual. How can I help you with that? And a lot of times it is more related to stress, it could be related to their concern that they can't get off from work to pick up their medications, it could be related to them working in a job site that doesn't allow them to keep their medications in a cool and safe space. And so being able to serve as that goes between them and their provider, to try and brainstorm some ideas to make sure that they are safe and doing what they need to do.

Shireen: Great. So with that, I want to do a mental health exercise with you, Dr. Karen, if you will, if you can walk us through sort of what we can do within two minutes to just center ourselves and focus on you know, sort of be mindful.

Rebecca: Take deep breaths, slowly inhale and expand your stomach like a balloon. Then slowly exhale, and deflate the balloon. These deep breaths calm you and slow your heart rate. practice mindfulness, instead of worrying about what's going on in the world, or what may happen in the future. Focus your attention on the here and now noticing the sights, sounds and smells around you and what you were feeling in your body. noticing the sights, sounds and smells around you and what you were feeling in your body. Focusing on the present moment can reduce anxiety. There are many mindfulness apps available. Turn off the news, put down your phone, and go outdoors. Whether it's going into your backyard or walking around the block, getting outside. And limiting media for as little as a few minutes can help reduce stress. Be kind to yourself and express gratitude every night before you go to sleep. Think of three good things that happened that day and write them down. This exercise has been found to increase happiness and appreciation. So remember that as we practice social distancing, to ensure our physical health, maintaining our mental health is just as important.

Shireen: Thank you so much, Dr. Corona for that is a much needed exercise for me. I know that. So with that, we're rounding out toward the end of the episode, I'd love to let our listeners know how to connect with you, how to stay connected and know more about your work.

Rebecca: I can be reached through the Parkland health and hospital website. We have a number of resources available there discussing all of the services that we have available medical, as well as psychological. And we also have a really great website available to discuss different COVID-19 resources as well. So if you have any questions about potential testing here in the Dallas County area, or if you just want to learn a little bit more about treatment, and what this is, please feel free to look at our Parkland health and service Health Services website.

Shireen: And we'll make sure we'll make sure to link that so folks can accident access it as well. So thank you so much again, Dr. Corona for your time, truly appreciate it. I know you have busy days ahead. So I really appreciate you taking the time out to talk to us.

Rebecca: Thank you. I had a really great time.

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