I am Dr. Katrina Roundfield, Yale and UCSF-trained clinical psychologist, researcher, and social impact entrepreneur working to address the teen mental health crisis by expanding access to affordable mental health support. AMA!

Do you think Dr Fauci and the CDC considered teen mental health during covid? Considering covid's affects on people under 20, what would you have done the same? Different?

Honestly, I really don't think Fauci or the CDC thought enough about the mental health of teens or any of us when the lockdowns occurred. I'm a statistics geek and love quantitative analyses, and I could be wrong and not have all the right data, but it seems teens are far more likely to end up with a debilitating long-term mental health disorder due to isolation than end up with dying from COVID or having debilitating effects from COVID.

Thank you for sharing your expertise!

I definitely agree with your overall point that mental health should have been addressed more during lockdown but imho your final claim is a bit ‘reckless’ for lack of a better term. Even overlooking any statistical/quality issues with these studies, comparing the likelihood of adverse mental health outcomes due to lockdown and likelihood of adverse health consequences of COVID-19 as a disease is meaningless at best (directly comparing likelihood of outcomes due to a governmental lockdown policy vs due to a biological disease is not meaningful) and at worst risks implying there is some statistically verifiable associative/causal benefit of rolling back early COVID-19 lockdown efforts in exchange for increased mental health. Just my take. Really appreciate your time!

Well that's the thing about data and prevention. We may never know if we don't have the experiment to test it. We can agree on my primary point that mental health should have been addressed and considered more. One epidemic has clearly led to another. Thanks for engaging. I think your point is valid and I am open to pushback.

I don't think you can say that because if you're over 50 you were more likely to die of the other

Good point. The question above was framed around teens specifically, so the health risk to teens was quite low. In retrospect, maybe it would have been a more thoughtful approach for Fauci and the CDC to consider age-appropriate risk markers and suggested actions based on age. But I'm not criticizing them. I wasn't in the arena and they did the best they could.

As someone who is about to go to a low ranked Clinical Psych PhD program, how can I maximize my chances of being able to conduct research and be a successful psychologist coming from a smaller institution?

Don't count yourself out! At the end of the day, you'll still have earned your PhD and from there you really can do anything if you set yourself up with the right postdoc experiences. During your grad program, you can always work within other universities (as an RA) if you think that you won't have the opportunities in your current institution. I'm also happy to lend my time to help you strategize - email me [email protected]

We humans are social creatures by nature. The past few years have eroded social interactions due to various reasons and measures. Have you seen an increase in mental health issues due to lack of socialization in your research?

What can we do to improve our, and especially children's, mental health when they're not able to be around friends or engage in social events?

We absolutely are social creatures. 100% the research indicates that mental health has worsened due to isolation of the pandemic. No question about it. Here's just one recent article summarizing the affects of COVID isolation on young people.

Here are a few tips I have to support kids during this time:

1) Think about what is safe to do socially and do those things. For example, outdoor playdates, zoom time with friends, visit your pod, etc.

2) Keep kids interested in being outside the home and help them remember that outside the home is still safe. Go on hikes, take walks around the neighborhood, take a drive together, etc.

3) Make educated risk-reward assessments. Sometimes, it's better to take the risk of going on a family trip socially than it is to take the risk of staying isolated.

4) Lastly, my cofounders and I invented appahealth.com because we wanted to create a safe place for teens to connect socially with a mentor from the comfort of their home. I encourage you to take a look if you have a teen in your life.

I have no children myself, but my close friends do. And from their tearful outpourings to me, or just the chaos that I observe in their families regularly, their teenagers that are growing up nowadays seem to be dealing with a massive slate of social challenges and mental health issues that I just don’t remember being a thing when we were their age. It may be a cliche, but I blame social media and constant stimulation. Am I just being a generational curmudgeon? Has it always been this way, and it’s just now presenting to the rest of us? Or is there data that shows objectively that more mental health issues are on the rise?

Rest assured, you are not a generational curmudgeon. :-) There is quite a bit of research to back that the mental health of teens today is worse than before. Now, there is an argument to be made that teens are more aware of mental health issues today and therefore report more symptoms, but still, I've seen enough studies to show true trends in teens suffering. Just look at the suicide rates that have skyrocketed for teens. It's quite sad.

Do you think social media is responsible for the teen mental health crisis?

Social media has both good and bad relationships with teen mental health. For example, social media can help self-esteem, but if used in an unhealthy way it can harm self-esteem. Posting images of yourself to be judged by all of your peers on Instagram can be incredibly stressful, especially for young teen girls.

Another factor is that social media sometimes seems to replace in-person interaction. We have seen drastic declines in the amount of time teens spend actually hanging out with each other. Part of that seems to be due to the rise of technology.

That said, it all really depends. As a researcher, I would not say that social media is "responsible" for the teen mental health crisis. Rather, I would say that social media is a key variable that affects mental health - and if you're a teen who does not have other protective factors in place, it can certainly affect your mental health negatively.

Thanks for doing this AMA. I have never heard someone use the phrase “mental health startup.” As someone working in the mental health field, where should I go to learn more about the mental health startup world? Is it primarily app/tech driven? How would one get involved?

You can check out:

https://www.healthtechnerds.com/

https://www.therapistsintech.com/

My advice from having been at a fund that invested in mental health startups, if you ever hear that phrase run the other direction

Which fund were you at?

So just FYI seems kinda ethically sketch. These are startups that turn into private equity based companies looking to dominate the mental health area. Places like Better Help, Appa, Talkspace, all have no ethical obligations or regulations in how they provide services under a "mental health" umbrella. for instance this is on the website.

"Disclaimer: Appa’s Mentoring Program is not therapy and does not substitute for therapy if needed, and does not prevent, cure, or treat any mental disorder, illness, or disease. Neither Appa nor the mentor will offer any medical or clinical advice. Do not disregard, avoid, or delay in obtaining care from a physician or other licensed professional because of information or advice received through the Mentoring Program. " Yet they are using evidence-based practices to teach their clients.

Yup, that's right - we aren't therapy. No - we don't do things unethically. At the end of the day, I'm still a licensed psychologist who has to adhere to my ethical obligations under state licensing boards. Your point may be more valid within health tech companies that do not have clinically licensed leaders.

Also, feel free to read the research on what mentoring programs can do for teens here, especially when they use evidence-based practices:

https://link.springer.com/article/10.1007/s11121-016-0663-2

https://jamanetwork.com/journals/jamapediatrics/article-abstract/383583

https://www.tandfonline.com/doi/abs/10.1080/15374416.2021.1875327

What evidence-based practices are being used? When I hear that I think of CBT DBT etc. Which are all therapuetic based evidence based practices which would imply therapy. So is this more like having a skills trainer? I was one in Philadelphia where I would essentially help kids at school, etc. but they also had a therapist as well.

Our video-based curriculum closely follows a CBT course of care. Research has shown that digital programs that teach CBT skills can be highly effective. Of course, that is assuming that people actually go through them. But the dirty secret of these purely app-based approaches is that most people drop out of those programs really quickly.

That is why at Appa, we have taken a much more human-centered approach to support. Mentors help to make sure that teens are held accountable to our curriculum, but they are not primarily responsible for actually doing CBT. That would be outside of their scope, and why we use video content created by therapists to deliver evidence-based strategies consistently.

Additionally, we see mentors as slightly different from a "coach" or a "skills trainer." Their job is primarily to build a relationship with teens and help them feel heard and understood. Those meaningful relationships are the glue that holds our program together.

I hope that is helpful! I appreciate your skepticism. There are many programs out there that are providing sub-par support, and it can be difficult to figure out which programs are truly evidence-based and worthwhile.

Thank you for clarifying. I'm a primary teen therapist myself! I'd really love to talk more about the company

Let's talk more! Email me and we can set some time: [email protected]

Hi, thanks for this AMA!

Do you have any existing partnerships between Appa Health and schools?

What advice, if any, are you giving parents/teens/teachers with regard to the recent surge of school shootings in the US?

Thanks for asking about Appa. So far we've been working with schools in the Bay Area but not through any formal partnerships. Our schools have been generous to refer us kids or let us outreach to parents. If you have any recommendations, I'm all ears since we are enrolling kids now! :-)

Regarding school shootings:

1. I think limiting access to deadly means is the best answer. Similar to self-harm (suicide) you limit access to means to harm oneself. Keep deadly weapons out of your home, lock up knives. That's first.
2. I would urge parents to be more involved with their kids - I know it's hard with teens, but even having a reasonable pulse on: are they more angry than other kids? More isolated and lonely than other kids? Do they sit in their room hiding things from me (how do some parents not know their kid has explosives??
3. Get teens help. Make sure there's at least one other person besides the parent who a teen feels safe to talk to.

What's the correlation between crazy teens and tiktoks, if there is any?

Haha! I'm not sure what the research says about tiktok specifically, but social media definitely has both good and bad relationships with teen mental health. For example, social media can help self-esteem, but if used in an unhealthy way it can harm self-esteem. It all really depends. As a researcher, I always like to say correlations do not equal causality. So you are right to just highlight the correlation piece, rather than saying social media causes "crazy teens." :-)

I was pointing toward the rise in faking mental illnesses

Ahh I see. Got it. I definitely have seen a proliferation of obscure disorders that teens say they have because they watched it on tiktok or now all their friends seem to have this rare disorder. For example, all of a sudden, with the rise of tiktok, I've seen a correlation between teens reporting having dissociative identity disorder (formerly multiple personality disorder) and I've seen some tiktoks with teens showing they have DID.

Favourite snack at 23:00?

Artisan cheese.

What is happening in that Killingly school where parents are against their kids getting counseling?? I know “parents just don’t understand” but it seems like parents want kids to suffer.

I've been tracking this in the news as well. I think there is a long history of people feeling like you can "pray" your mental health symptoms away. In Killingly, I think this has also become a bit political because therapy can be thought of as another way to "give my kid advice." Parents, reasonably so, should be discerning of who gives their kids advice. But if parents don't trust mental health care or systems in general and don't really understand therapy or believe mental illness is real, you end up with a Killingly situation.

How does Appa work? After teens match with a mentor, how often each day do they exchange messages? How does the curriculum come in?

Teens meet with their Appa mentors once/week for live 30 minute video or audio calls. They can text their mentors on the platform anytime and mentors respond within 24 hours via text M-F (in addition to their scheduled weekly 30 minute video live sessions).

For 12 weeks, teens get access to our content that is delivered through our platform each week. Mentors help the teens stay accountable to viewing that content. See more at appahealth.com

Appa explicitly states "Appa’s Mentoring Program is not therapy and does not substitute for therapy if needed, and does not prevent, cure, or treat any mental disorder, illness, or disease. Neither Appa nor the mentor will offer any medical or clinical advice. Do not disregard, avoid, or delay in obtaining care from a physician or other licensed professional because of information or advice received through the Mentoring Program. "

How is this different from Life Coaching? How do you make sure you don't blur the lines between providing therapeutic-based interventions and actual therapy. It seems like doing therapy without the oversight....As a clinical psychologist this doesn't fully seem ethical...

Looks like we answered most of your concerns above. I do appreciate your interest in seeking clarity. Us therapist have an obligation to protect the people who we serve! :-)

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The entitlement is strong with this one

:-)

Respectfully, this is not an app. This is a service that gives people weekly virtual mentorship with a real human being. I think it's exploitative to not pay hardworking caregivers, like my mentors.

What do you think about body dysphoria due to RIC in USA? Have you ever noticed it? Do you think genital autonomy is meant for all? Can you see any correlation between genital autonomy and youth mental health? Situation is quite different here in Europe. The prevalence of genital cutting on infancy is very low. Human rights are a thing here.

r/CircumcisionGrief

I think Appa can be a solution for embarrassing questions.

Hi there. Super interesting question. Forgive my ignorance. I'm going to read the link you have and see if I can respond thoughtfully to this once I have more information. Thanks for the question!

Thanks. It's quite hot topic. Outside of an American continent it looks like an infant is a toy there. Mentality is like you feed them, you own them. They have only partly human rights. You mostly don't cut baby girls there, but even puritan Feminist might allow genital cutting for a baby boy.

Genital autonomy and sexual well-being

Thanks for these links and for educating me on this topic! Though I have not personally heard my clients bring up these concerns in therapy - so I cannot speak to your body dysphoria question - I do not deny that these concerns are real and have lasting affects for some people. I look forward to learning more about this topic now that you've introduced it to me. Thanks!