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President Ruth Watkins: Welcome to the U Rising podcast. I'm Ruth Watkins, president of the university and my guest today is a remarkable asset to the university and a new asset to the university. So, I think you'll be pleased that you're listening.

Now, we're going to talk about mental health. We know that mental health issues and suicide have been high in Utah and this is a concern for all of us. We know that the pandemic has exacerbated anxiety, stress, loneliness for many Utahns, including many of our students. It's also connected with an economic downturn, perhaps less so in Utah than in many other aspects of the country and the world, but certainly of concern. And that increases a lot of pressure on people. All of us who have been working from home or educating children from home—there's a lot happening in the pandemic that has increased stress and pressure in families.

So, what's the good news on the horizon? Better mental health treatments, greater access to care, thanks to the Huntsman Mental Health Institute. My special guest today, Dr. Mark Rapaport, CEO of the Huntsman Mental Health Institute. Dr. Rapaport is going to share with us how this new institute is working to help Utahns to create new models of care, better service, and also to advance research and knowledge that ultimately really changes lives. Welcome, Dr. Rapaport.

Dr. Mark Rapaport: Well, thank you very much, President Watkins. It's a pleasure to be here today. I can't tell you how glad I am to be at the University of Utah. You have done a remarkable job as a leader here and thank you for everything you've done.

President Watkins: We're so pleased that you joined us. The Huntsman Mental Health Institute is really a big deal. Dr. Rapaport, tell us, tell listeners, a little bit about you, about your history, background, and then maybe a little bit about your own story professionally in mental health care.

Dr. Mark Rapaport: Sure. I'm a third-generation physician. Both of my maternal and paternal grandfathers were physicians. My father was a very famous internist and hematologist, and my uncle was a very famous cardiologist. And so, as a child, I was given a lot of choices. My father half-jokingly said, "You can be any type of doctor you'd like to be." And, of course, being the very good son that I am, I immediately rebelled. So, I went on a journey in college. I took a year of experimental music. I took a couple of years of political science. I got involved in student government. I became involved in disability rights actually and ended up writing the first report that was ever internally published in the University of California about disabled students' services and rights. And I meandered some. I had the great, good fortune of being the administrative intern for the chancellor of the university at UCSD.

And during that time, what I learned was that in order to have impact, in order to be really successful, in helping others, one really had to have an advanced degree. And so, on my 21st birthday, I decided I was going to take nothing but science classes then eventually apply to medical school. I taught elementary school for a year, K through 3, which I loved. I loved the kids. I was distressed with the parents at times. Then had the good fortune to go to medical school at UC San Diego and I fell in love with psychiatry. I fell in love with the fact that when you're a psychiatrist, you get to treat the whole person. It's the person's history, the family history, the person's current economic status, as well as one's physical status was important. And so, one got to be a doctor who treated both the mind and the body.

I was blessed to have a wonderful residency in San Diego, spend four years at the NIH, go back to San Diego, and then in my early forties, I made a very conscious decision. And the decision was that the best way that I could contribute to others was to serve as a leader and that the success that others had—my faculty, trainees, that we had with the community—would be how I would gauge my contributions. Now I always continue to see patients. I always continue to do research, but my major thrust since my mid-forties has been to facilitate the success of others. And I've been blessed to do that in a number of different institutions, most recently at Emory, where we not only were able to do this in psychiatry, but we formed a brain health center with the idea of looking, not just at disease, but at brain health as well. And so, I am really excited to be here where you and others have done so much to really promote mental health and brain health.

President Watkins: I love your story. And I'm so grateful the way you shared it. The thread that I see running through there is just a deep interest in connection to and commitment to people, to others. And I often say to leaders, aspiring leaders that the successful turn for many academics into leadership is the ability to redefine your success and your success is everyone else's success now. And that is not for everybody. I really think you are a wise person to cite that. Now, how on earth did we get so fortunate to get you to come to the University of Utah? What opportunity did you see here in us that you wanted to join?

Dr. Mark Rapaport: Oh. There were a confluence of events here at the University of Utah. They're just remarkable and haven't existed anywhere else. It really happened. Those events include the tremendous gift of the Huntsman family. And also, the fact that they're really engaged donors. The Huntsmans really want to participate in the building of the Huntsman Mental Health Institute. They want to ease the way and do what's right for the people of Utah and for the people of the United States, actually. So, you combine that with really the amazing leadership that you and Mike Good and Dan Reed have brought to the University of Utah. As you know, Ruth, most institutions believe that mental health is the third rail. They're going to sweep it under the rug. They're going to ignore it. It's uncomfortable for people and it's expensive. But you and your leadership team said, "No. We're going to address this. We're going to take this on. We're going to make mental health a major priority for the University of Utah and for the people of Utah." So that plus your philosophy of there being One U for Utah was really important to me.

And then you combine that with the remarkable sort of strength of the Legislature which is really unexpected. Our Legislature here in the state of Utah has taken steps to facilitate great crisis care that doesn't exist in other places with the integration of the Crisis Line, the WarmLine, SafeUT and the mobile assessment teams all coordinated from one institution, the University of Utah. And also, their support for suicide prevention has been remarkable in this state. This confluence of events and circumstances really motivated me to leave a wonderful job that I had at Emory to take what I think is a fantastic opportunity here at the University of Utah.

President Watkins: We're so grateful you did, Mark. And I also want to say, I think you've chosen wisely. The potential of a donor family to join with us to drive change, with a Legislature and a comprehensive university that brings all those assets, the critical missing pieces of leadership. And we're so pleased that you chose us. So, I think big future, positive future, ahead. And, of course, we know there's enormous need. I think the past few years, several reports have helped us see Utah's rates of mental health challenges, of suicide, and the need in our state to do more and reach more people. I think it would probably help listeners to have a little more national context on the concerns here. And I don't think Utah is unique in those challenges. What I do think is unique is our opportunity. So, I think a little national context, just on mental health would be helpful for listeners.

Dr. Mark Rapaport: Sure. I'm glad to do that. Unfortunately, as I've mentioned earlier, mental health has been the third rail, but we're actually at a tipping point, a true tsunami, if we look at what's going on nationally right now. Unfortunately, suicide now is one of the top 10 causes of death in the United States. And for young people, it's second only to motor vehicle accidents. In Utah, tragically, between the ages of 10 and 24, suicide is the leading cause of death. And that is a real wake up call. And it is something that fortunately you and the Legislature and the community have said, "We cannot have here in Utah." However, this tsunami that's occurring, the fact that the CDC recently reported with the pandemic over 40% of Americans are reporting symptoms of anxiety and depression. The fact that we not only have a pandemic in terms of COVID-19, but of opioid and substance use disorders, with a myriad of deaths occurring because of opioid disorders.

And at the same time, a true shortage of mental health providers. In fact, over the next decade, it's projected that the number of psychiatrists in the United States is going to decrease by 3,500. We'll go from about 31,500 down to about 28,000. If we look at social workers, if we look at nurses, if we look at psychologists, we're in a real crisis point when it comes to provision of care for people with mental disorders.

And that's why what we can do here is so important because we have the opportunity to begin to change that trajectory and change that curve. And it goes back to what you mentioned earlier, Ruth. Being at a university, an AAU university, where there is a school of nursing and a school of pharmacy and a school of social work, as well as a dental school, allows us an opportunity to combine forces and bring together people in ways that can't be done otherwise. And it also allows us to begin to influence these different professions through their national organizations and the representation of University of Utah people nationally to address these issues. This is such a unique opportunity, to deal with a real challenge that we face.

President Watkins: I couldn't agree more. And I think the full assets of the university will help as you identify, rollout, priorities for the future. Before we talk specifically about kind of how you're starting to see the landscape and what you put as priorities, I wonder if we could talk just a little bit about early intervention and the power that early intervention has? Now, you may or may not know that this actually is my field, right? And a whole different way with very young kids. And certainly, one of the things we know is not only the individual benefits of early intervention in communication development and disabilities when it's needed, but also frankly, the economic ROI of early intervention. A dollar spent for a three-year-old on a better educational trajectory pays off every step of the way societally. I'm just kind of interested in your perspectives on early intervention and how that landscape looks in the mental health world.

Dr. Mark Rapaport: Well, one, I'm very grateful for the work that you've done with early intervention with children with speech and language disorders. Our youngest had that and he's thriving now. He works at Oracle and is very successful. But it's only because of the tremendous work of specialists and experts like yourself. So, thank you very much for that. What you're talking about is absolutely correct. We know that the majority of psychiatric disorders have onset during adolescence and young adulthood. Part of that is because of the neural pruning of the brain that occurs during adolescence and young adulthood up to age 25 or so. What we also know is that the antecedents of this occur much earlier.

And what's exciting about the Huntsman Mental Health Institute, and what's exciting about one of the priorities that you and the Huntsmans negotiated, was a real focus on early intervention and on preemptive interventions for young people. We have the opportunity here to change the trajectory of not just those individuals themselves, but entire families. Because when someone is ill, when a child is ill in the family, it affects everyone. It affects the other siblings. It affects the parents. It affects the grandparents. And by intervening early and appropriately, we can make a difference. And that's what's so exciting to me.

I have a colleague who's developed an intervention for at-risk middle school and high school children. That intervention is being used in Iceland and it's being used in Portugal and in Greece and in Sweden, but not in the United States. Well, I've told my colleague, "It's going to be used in United States because we're going to bring it to Utah. And we're going to work to partner with the schools. We're going to work to partner with parents and the churches to bring this intervention that is life-changing not just for the child, but the family, here to Utah."

There is so much work we can do in this area that's very exciting. We're recruiting a young faculty member right now whose entire work with artificial intelligence is looking at how can we identify who's at risk and how can we develop new treatments? Because the old treatments aren't going to work, you've got to figure out new interventions that are going to work. And it's so wonderful that we here at the University of Utah with the Huntsman Mental Health Institute will have the opportunity to truly be at the leading edge of creating models of care, not just for the people of Utah, but ones that can be then used nationally.

President Watkins: So powerful. And of course, we have this fabulous 33,000 living/learning lab among our students on our campus. And you may not know this, but I want to just take this moment to tell you, we've had a group of students that are really leading—one of them was a presidential intern so I worked fairly closely with this student—and they really began to develop an idea about sort of mental health help prevention models and won some funding nationally in a competition supported by Schmidt Futures. And it really was, is work in progress all linked to if we can support mental wellbeing, we help people stay in school, finish their degree, more productive work lives and there is ROI in that way. So, I'm going to be sure that we connect you with that fabulous student, Alex Becraft is his name, and he's leading out in that area.

Now, I think it would be great for our listeners to get kind of a broad sense of how you are going about developing priorities for the Huntsman Mental Health Institute and how you're sort of seeing this early phase in your leadership as you begin to chart the course.

Dr. Mark Rapaport: Well, I hate to do this to you, but it isn't me. It's a “we.” It's a “we.” It really is. And I'm blessed to have come into an environment that's just remarkable. I can't tell you how warm and friendly and welcoming and open people have been here at the University of Utah and in the larger community. And so right now, a lot of my time is being spent getting to know the territory. There are so many tremendous strengths, both at the University of Utah and throughout the state of Utah, that, really, I'm trying to learn about so that when we create the Huntsman Mental Health Institute, what we do is augment existing strengths and then fill in gaps in areas of need. So, in order to do that, right now, we're spending a lot of time within the Department of Psychiatry and within health sciences creating, and we're at the beginning of this, our strategic planning groups and teams.

We've already identified a minimum of six different constituency groups that we're going to reach out to. One, of course, are patients and families, because that's why we're here in healthcare, is to help patients and families. A second major group will be different professionals and professional groups and organizations, including everything from law enforcement to psychiatry, psychology, social work, to the clergy in order to really get a sense of what's going on and what the needs are that are perceived by others. We, of course, are looking at doing a series of focus groups and interviews with faculty from throughout the university. And one of my real goals there is to engage the whole campus in these efforts. I have some wonderful fantasies I'd love to bring forward, particularly when it comes to stigma with our undergraduates. I'd love to have our visual arts and film school help sponsor competitions so that our undergraduates can be creative and create films that then will be judged and then, hopefully, if we're lucky enough, we can engage the Sundance Film Festival and the Utah Film Festival and those professionals to help curate what we're doing there.

So, another group that we'll be engaging is the university as a whole. And I've been really lucky to meet so far with some of the deans in the social sciences, to meet with deans in most of our professional schools. So that's another major constituency that we'll be involved with. And I could go through all six, but that would take up the whole rest of the time. But I guess what you're seeing is that we've got to get to know the territory, we've got to engage many people, and then together we'll create the mission, the vision, the values and work on the articles of strategic of intent.

President Watkins: I think it's so wise on your part. As the proverb says, "If you want to go fast, go alone. But if you want to go far, go together." And you're doing that, you're going to build this plan and identify the priorities with the people who will help you deliver on them. And it's just so wise. I know that some of the people who helped you deliver on the plan are, as you mentioned earlier, our Legislature and the other kinds of investments that are happening. Perhaps for listeners, you could just do a brief overview of the kinds of resources that are out there to help individuals and families and where people can go now if they need support and help.

Dr. Mark Rapaport: Sure. I think one of the best innovations has been SafeUT. SafeUT is an app that is now available in all the public schools, not just the universities, but from K through 12. And that app is available on any type of phone, be it an Android, be it an Apple phone. And it allows one to have access 24/7, be it by voice or be it by text, to professionals that can help. They can help with bullying, they can help if someone's in crisis, they can help if there's a concern that there's a threat against a school or against an individual. It's a wonderful innovation. It is anonymous, so people don't have to worry about being somehow "outed," but it is tremendously valuable and powerful. We also have the Crisis Line. The Crisis Line right now is receiving over 11,000 calls a month, which is a remarkable number of calls. And really speaks to the utility of having a crisis system, particularly one like we have here that's fully integrated.

There's also a Warm Line. And a Warm Line is for someone who isn't necessarily in crisis, but is feeling distressed or just wants to know, "Is there a way I can feel better or get any help?" And that's available again, and in what it does is it allows people to get plugged into resources throughout the state of Utah, which is a wonderful opportunity.

And then if there is a real need, if there is a real crisis, we're able to send out throughout the state for both adults and children, we're able to send out emergency crisis teams that are made up of health care professionals that understand how to work with people and families in crisis. So here in Utah, we really have unique opportunities there. And then within the university itself, some of the innovations that deans of students have done here have just been remarkable. The presence of social workers that are available essentially all the time to intervene for students, whether they're on campus or off campus. It's really remarkable. Also, the tremendous work that the, sort of, protective forces have done in partnering again with mental health professionals so that you have sophisticated people going in and helping individuals with the right skill set. These are really prescient sort of initiatives that you and your team have launched, Ruth. So, thank you for doing so.

President Watkins: Well, I think the opportunity through the new institute to innovate and evaluate some of these new approaches is just so powerful. And I want to just say, listeners, how fortunate are we to have a leader of the talent, caliber and vision of Dr. Mark Rapaport to join us here at the University of Utah? Mark, thank you so much for being with me today and even more for taking on this exciting leadership role.

Dr. Mark Rapaport: Ruth, it's my pleasure. And I love working with you and I look forward in your other capacity to work together, too.

President Watkins: Yes, indeed. And I know good things will happen here. Oh, and a little bit of a pun—really good things will happen here because, listeners, my next guest is Dr. Mike Good. Dr. Good is taking over as interim president in April and good things will happen here. So please join us for the next edition of the U Rising podcast. Thank you.