A First Aid Kit For Mental Health Emergencies
NEAL CONAN, host: This is TALK OF THE NATION. I'm Neal Conan in Washington. Many of us have been trained how to respond if a colleague suffers a heart attack or chokes on food, but few know how to recognize a mental health crisis, much less what to do about it.
A program called Mental Health First Aid aims to teach people how to respond to emotional emergencies like anxiety, depression or psychosis. The courses take aim at a major problem. Colleagues might think somebody's a klutz if they break their arm, but can respond very differently to a mental health crisis.
We want to hear from supervisors and administrators. How does this play out in your workplace? Give us a call, 800-989-8255. Email email@example.com. You can also join the conversation on our website. That's at npr.org. Click on TALK OF THE NATION.
Later in the program, New Yorker cartoonist Roz Chast on her new book, "What I Hate: From A To Z." But first, mental health first aid. Bryan Gibb is director of public education for the National Council on Community Behavioral Healthcare, and he leads the mental health first-aid training courses around the country. Nice to have you with us today.
BRYAN GIBB: Thanks, Neal, good to be here.
CONAN: And Bryan Gibb's at our bureau in New York. And you remember - may remember hearing him in a story on MORNING EDITION on mental health first aid, and Bryan Gibb, I was startled to hear you say in that piece last week that we're more likely to encounter a mental health crisis at work than a heart attack or somebody choking.
GIBB: Well, certainly. One in four Americans, in any year, will experience symptoms of severity enough to quality for a diagnosis for a mental illness.
CONAN: One in four - and obviously, that's many more than would be having problems with a heart attack.
GIBB: Certainly, and most of those are low-intensity issues, not crises, but in the course we do prepare people how to respond to a crisis or just someone who's starting to feel unwell.
CONAN: And it's difficult because, as we say, if you see blood, you know there's a crisis. It's a little more difficult in terms of mental health.
GIBB: Yes, it's true. I mean, in the course we teach people how to look for signs and symptoms that show that maybe something has changed in the person, and maybe how to be aware of those and how to respond - ideally, as early as possible.
CONAN: And that would be of help, but people are also reluctant to intervene.
GIBB: Well, it's true because I think there's a stigma around mental illness that is not as much around physical illness. You know, when someone has cancer, you know, we bake a casserole, and we go down and we - you know, we knock on the door, and we provide our support. But if someone got a diagnosis for, you know, severe depression or schizophrenia, we may be less comfortable in approaching them and offering help.
CONAN: And I hate to say it, but in a workplace environment, people can be cruel.
GIBB: Well, certainly they can, but you know, I think HR professionals recognize that the most valuable resource for any organization is their people. And you want to protect that resource. If someone developed diabetes or something at the workplace, you would help that person get the services they needed so that they could be productive. We're just suggesting that someone with depression or anxiety or even a substance use disorder, you know, deserves the same kind of outreach.
CONAN: Take us through the training course. How similar or different from this - is this from traditional first aid?
GIBB: Well, it's similar to first aid in that we don't teach people how to diagnose or treat. We teach people how to recognize, provide comfort, and refer someone to services. You know, in the course we teach, we have an action plan, ALGEE, A-L-G-E-E, much like the ABC of CPR, you know, the mnemonic device to help us remember the steps.
And those steps are A for assess for risk of suicide or harm; L, listen non-judgmentally; G, give reassurance and information; E, encourage appropriate professional help; and the second E is encourage self-help and other support strategies.
CONAN: So as you're going through this process, do you ask for help from a supervisor? Do you go to HR and say, what should I do? But often you're confronted with the situation right in front of you.
GIBB: Sure, and I mean, it certainly depends on the relationship that you have with a co-worker or a person that you're supervising. You know, certainly, HR professionals oftentimes are a little skittish about this issue, rightly so because they have very specific professional requirements about privacy and things like that.
And we often say, you know, treat someone in that case just like you would supervising them. You know, look for observable changes in their behavior, observable signs and symptoms, and ask them, you know, if they're OK and if you can help.
CONAN: If they're OK - that seems pretty basic.
GIBB: It does, you know, and mental health first aid is very basic. And, you know, that's the first step, of course, you know, open-ended questions, encouraging someone to talk about what they're feeling or what, you know, they're aware of as far as they're experiencing their symptoms.
And it could be as simple as suggesting someone do some reading on the subject or even call the EAP, you know, the Employee Assistance Plan, which many workplaces have. And oftentimes, people aren't aware of the services that they have available.
CONAN: And is this - there are any number of employers who have, as you say, taken up policies. Are these some of the places you go to train?
GIBB: Well, you know, we have 1,350 and growing instructors around the country, in 43 states and the District of Columbia and Puerto Rico. So we have instructors across the country. We teach at workplaces and to, you know, workplace audiences, among many other audiences. But for example, the Society for Human Resources Management, SHRM, the largest professional organization for HR professionals in the country, offers continuing education credits for our course.
So they've recognized that this is something valuable for their members to learn and understand.
CONAN: We're talking with Bryan Gibb of the public education - director of public education for the National Council for Community Behavioral Healthcare. And he leads mental health first-aid training courses around the country. If you're in the workplace, if you're a supervisor or a manager in particular, how does this play out at your workplace? Give us a call, 800-989-8255. Email us, firstname.lastname@example.org. And we'll start with Tracy(ph) and Tracy with us from O'Fallon in Illinois.
TRACY: Hey, good morning, Neal. I'm glad you mentioned the piece and the fact that this was mentioned on the morning...
CONAN: MORNING EDITION, yeah.
TRACY: I was listening to it, correct, and I had gotten a feel for it then. But I have to tell you, it struck me, and then it struck me in my gut because I've been in the military for nearly 25 years; I cannot tell you how much education we've had, especially about suicide prevention, and yet in spite of the fact that training has occurred, I am being - I've been diagnosed with a mental health issue, and it's not a physical issue that's obvious to everybody.
But when you - when it's been brought up, I've been turned into a bad airman as opposed to being a sick airman and - because you can't deal with this. You know, why aren't you able to deal with this? These are questions that my peers, my subordinates, my superiors in my chain of command have asked me over the past two years of my trying to deal with this.
I'm now seeking a medical retirement, and it's just amazing to me that in spite of all the training, like how much ignorance there is still out there regarding mental health issues.
CONAN: And Bryan Gibb, we hear about that problem in particular with veterans returning from combat, but it is much broader than that.
GIBB: It is, and thanks for your question and your comments, Tracy. You know, I think what you've described is that there still is stigma around mental illness in our society, especially in the military. And unfortunately, one in three returning veterans from Afghanistan and Iraq will experience a mental illness in any given year. So the prevalence rates are even higher.
You know, and so part of what we're trying to do with our program, you know, reaching out to everyone so that that stigma around mental illness is less, and it's a - you know, it's a slow process, but the lower that that stigma is, we hope that the more accepting society will be that mental illness is just like a physical illness; it just impacts us in a different way.
CONAN: Tracy, you're applying for a medical discharge?
TRACY: Yes. Actually, it's been an ongoing process now since my release from active duty back in - as a reservist. I was on active duty as a reservist, so going back to November 2008, it's been an ongoing issue now with the reserve side of my business, because I've been in the Air Force for 25 years now, currently in the reserve, and it's just been a nightmare.
CONAN: Well, I - the bureaucracy can be daunting. Good luck.
TRACY: Thank you.
CONAN: Here's an email from Wade(ph) in Kalamazoo: I had to deal with a mental crisis with a colleague. Of more significance than not knowing exactly how to respond was the fact that as a result of HIPAA, it was virtually impossible for me or my co-workers to get help for our colleague - and HIPAA, of course, the federal law that covers the privacy aspect of this.
GIBB: Yeah, and HIPAA, of course, is very important, and HR professionals, you know, understand what the requirements are. And you know, when we work with HR professionals, we say that mental health first aid is just another tool in your toolkit. It doesn't supplant any of your other, legal responsibilities or professional responsibilities.
But you're right that, you know, the privacy of an individual is protected, and that can make it tricky in general, but especially in a workplace. You know, but we really encourage people to, you know, keep trying to, you know, ask - offer help if they can. And, you know, certainly if someone's behavior extends to the point of being unsafe, or the person's performance drops to a level where they, you know, they can't do the job, then that becomes another issue.
But we're really looking at generally, low-intensity conflicts with mental health first aid. So the vast majority of those are going to be people who are just starting to feel unwell, and we want to teach people how to offer help.
CONAN: I wonder: Do you tailor your course differently? I'm sure if you're training at a university, it might be different than at an office or at a police academy.
GIBB: Well, it's true. We have a standard, 12-hour curriculum. It's a two-day course. And each instructor, we expect our certified instructors to know their audience and to be able to make bridge to those audiences. But at the same time, we are developing additional materials to work with law enforcement and colleges and universities, and different entities.
I, myself, taught at the Washington, D.C., police academy last week, and it was a very interesting audience with a very specific set of challenges. And so part of it is, you know, the instructor knowing their audience, and part of it is some additional curriculum materials that we're developing. We've only been at this about three years.
CONAN: And as you look at the problems that some of the trainees you've instructed faced, how have you revised your course?
GIBB: Well, certainly when you look at colleges and universities, so many mental illnesses present during adolescence or, you know, in their early 20s.
CONAN: Bipolar disease, classically, yes.
GIBB: Exactly, exactly. Schizophrenia, too. I mean, so when we look at those, we really kind of focus on different areas in the curriculum where, you know, mental disorders may present earlier. With police, we tend to focus, say, more on psychosis because police maybe have more contact with individuals who are in an episode. So we'll do more, you know, role-playing activities, more scenario work with a police officer on, you know, how they may respond to someone who's behaving unpredictably.
CONAN: Interestingly, we talked about some of this with the chief of police in Cincinnati - newly appointed there - about his experiences; previously, also in Portland, Maine, where he was chief of police, and talking about what an important element this is of police work these days in every place that they go, and how significant this has become.
Stay with us, if you would, Bryan Gibb. We'll talk more about mental health first aid in just a moment. We'll also talk with somebody who's gone through the training, about her experience. Supervisors, administrators, managers, how does this play out in your workplace? Give us a call, 800-989-8255. Email us, email@example.com. Stay with us. I'm Neal Conan. It's the TALK OF THE NATION from NPR News.
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CONAN: This is TALK OF THE NATION from NPR News. I'm Neal Conan. Most offices stock a first-aid kit in the building. We're talking today about mental health first aid. Nearly a quarter of adults can suffer from a mental disorder, but very few are trained to recognize an emotional crisis, much less be able to help.
MORNING EDITION featured a story on a training program called Mental Health First Aid, in a segment last week. You can listen to that online, at our website. We want to hear from supervisors and administrators today. How does this play out in your workplace; 800-989-8255, email firstname.lastname@example.org. You can also join the conversation on our website. That's at npr.org. Click on TALK OF THE NATION.
Our guest is Bryan Gibb, who heads the mental health first-aid training courses around the country, and serves as director of public education for the National Council for Community Behavioral Healthcare. And joining us here in Studio 3A in Washington is Clare Miller, who works with employers to help them address mental health issues in the workplace. She's director of the Partnership for Workplace Mental Health. Nice of you to come in today.
CLARE MILLER: Thanks so much.
CONAN: And how do you specifically train people to work with this in the workplace?
MILLER: Well, I think as Bryan said, one in four people have a mental health - a diagnosable mental health condition. And so it's really important to sort of start the conversation by reinforcing just how common these issues are. The second really important fact is that two-thirds of people who are suffering don't seek any help at all.
And so just because of sheer prevalence, one thing to just sort of remind employers - and all of our listeners - is that these issues really affect all of us - our individual families, workplace, etc.
CONAN: And if we're working, we're there a third of the day so it's likely to come up there, too.
MILLER: Exactly. Yes, you don't check this at the door.
CONAN: And so as you're talking to people about how to recognize problems, what are you telling them?
MILLER: Well, one of the things that mental health first aid teaches, which is really useful for HR and supervisors, is to look at sort of observable symptoms. In the workplace, as Bryan mentioned, there are some legal ramifications that really come into play for supervisors and managers. So you want to talk about observable signs, and how they affect your work performance.
So you might say, I'm noticing that you're coming in late more often and, you know, want to know if there's a concern that we can help you with. You might notice folks who maybe before were very good in keeping to deadlines suddenly are having trouble; attention. So really, looking again at symptoms and how they relate to work performance.
CONAN: And intervention, how - obviously, it depends what the individual problem is, but are there guidelines?
MILLER: Well, mental health first aid does offer this protocol that allows you to kind of walk through and use this framework, which is very helpful in having - really, these conversations that as a society, we're not really used to and comfortable having.
CONAN: Starting with that, observe - and be careful - that somebody is a danger to themselves or others.
MILLER: Exactly. And I mean, the other thing to keep in mind is really - you know, there's crises, and something that we would do if it was a real emergency. But really, there's great utility in the program just dealing with stressful situations and sort of not the crisis but the day-to-day problems that result from a mental health condition.
CONAN: And Bryan Gibb, I wanted to bring you back in here, too. There are moments that are beyond any of us, first aid - no matter what kind of first aid. When does 911 come into this?
GIBB: Absolutely. Well, we encourage people who take the course - I say it at least every 20 minutes - that if you're uncomfortable with a situation, you know, bring in extra help. Or if somebody has a weapon or is behaving dangerously, you know, we really encourage people to dial 911.
That said, when you look at the kind of the universe of individuals who experience mental illness, people with mental illness are no more likely to be violent than the general population. I think sometimes the media - forgive me - sometimes...
CONAN: I'm shocked, shocked.
GIBB: ...sometimes focuses on the extreme when in reality, individuals with mental illness are our loved ones, our friends, our neighbors, our co-workers, just like anyone else.
CONAN: And if they are likely to be violent, more likely to themselves than to anyone else.
CONAN: Let's get another caller on the line. Let's go to Cathleen(ph), Cathleen with us from Greenwood in South Carolina.
CATHLEEN: Hi, I really appreciate what all the speakers have shared. I've supervised over 2,000 individuals at different times, and also have managed inpatient and outpatient mental health programs, and also taught human resources at a local college here for a number of semesters.
And it's fascinating to hear what everyone has to say. I think my first warning is, we're such a litigious society that before we institute any kind of intervention such as you're speaking of, that everyone gets - makes a move to a common ground, to say that we all agree that - for example, CPR, we're going to introduce CPR under the following circumstances. And so I think that's a fair warning to all but also...
CONAN: So that there was a protocol, and you followed it.
CATHLEEN: I beg your pardon?
CONAN: So that there is an established protocol, and you can show that you followed it.
CATHLEEN: Exactly, exactly - and that the protocol is based on training, and that the training is professionally produced and is monitored. I also feel, though, that we do two things. One is, we sometimes under-treat as professionals, looking - or, as individuals trying to identify persons, co-workers, etc., who have a long-standing depression that's slowly worsening. We tend to maybe turn a blind eye. And/or if someone's having a brief episode of severe anxiety because of perhaps a death in the family or, you know, whatever example one might bring up - I personally had one through some mix-up in medication at a hospitalization - that one gets over-treated. And so how do we find this common ground in between? And I hope that training, you know, looks at that.
And also, I think, just basic awareness, as several of your speakers have said. October, for example, is Breast Cancer Awareness Month. Ten years ago, if you heard your neighbor had breast cancer, you might never even approach her about it or speak about it because it was such a frightening disease. And now, it's front-page news all the time, and people are doing marches and walks, and people stand up in my church and announce that they are survivors and, you know, would you support this, that or the other thing. And if we could find ourselves approaching mental health awareness with the same intensity, I think we would all be much better off.
CONAN: Interesting. I just wanted to read this email that we got from Francis in Sonoma County: Your speaker touched on an issue that we discuss in HR classes in regard to violence in the workplace - and again, this is the minority of cases, we should emphasize - and recognize signs that an employee may need some intervention.
It's important that employees know they won't be fired if they admit they need some help. A depressed employee can be suffering from problems in their families, illness, a short-term crisis. The EAP services can be helpful if available, but sometimes a day or two off to care for the employee can be the beginning of a solution.
So take the rest of the day off, might be something to go to before you go to 911.
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GIBB: That's a good self-help strategy.
CONAN: Cathleen, thanks very much for the phone call, appreciate it.
CATHLEEN: You're very welcome.
CONAN: Let's see if we can go next to - this is Joe(ph), and Joe's on the line with us from Norman, Oklahoma.
JOE: What do you do when it's the boss? I recently sold a business, and I agreed to work for the guy who bought it - and did not find out until a couple of days before he took it over that he is diagnosed as bipolar. And he refuses to take his medicine, and he will be as pleasant and sugary sweet as can be and all of a sudden, he turns violent and to the point where he has actually done some mild assault.
I haven't - I can't leave because I have agreed to work with him and help him keep the business running because he is paying me out, and if I leave, then that puts the business in jeopardy, and I may not get any of my money. So...
CONAN: That's an awful...
JOE: You were talking about Catch-22 last time...
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CONAN: There you go.
JOE: There you go.
CONAN: Clare Miller, any advice for Joe?
MILLER: I mean, I guess my - the first red flag is the potential assault. So I think the first thing to think about is, you know, making sure that you're safe. Another question that I would have - or a suggestion is to contact the Employee Assistance Program, if you have one, because you may be able to learn some strategies that you can deal with so that when a situation arises, you can de-escalate it. You can at least sort of do what you - is in your power, in terms of your reaction.
JOE: Where would I find an Employee Assistance Program? What is that? Is that through the state or something, or what?
MILLER: Many employers offer these programs. They're often in conjunction with your health plan.
JOE: Yeah, I can't very well go to him because he's the problem.
MILLER: Well, you can go to your health plan and often, they offer an Employee Assistance Program.
JOE: All right.
GIBB: Yeah, the telephone number, oftentimes, on the back of your health card will have an option to talk to somebody - an advice nurse or a mental health professional - and you can get some help there. But you know, Joe, you bring up a tough issue, which is that sometimes, individuals with mental illness will not participate in, you know, the recovery plan.
And you know, we - unfortunately or fortunately, we cannot force people into treatment. I mean, people have a right to not be treated in our society. It's a civil rights issue. But you know - so sometimes, we can get in a position that could be very uncomfortable where we believe somebody needs help, but we can't compel them into treatment.
CONAN: Joe, is it also possible for you to document what's going on, even memos to the file, if there are no other people in the workplace?
JOE: Well, I've done a little of that, but I failed to do it when it was critical. And now, I'm going to have to kind of be careful about it. So...
GIBB: And if someone has committed a crime, whether they're mentally ill or not, they should be held responsible for that, Joe. So certainly, if there is an assault - I mean, we would encourage you to, you know, seek the redress, call the authorities.
JOE: I mean, it's minor assault. It amounts to shoving. But that's - by definition, that's assault, so...
CONAN: I don't envy your situation, Joe. Good luck.
JOE: Thank you.
CONAN: Here's an email we have from Linda(ph) in Iowa City: In addition, when someone returns to work following the death of a loved one, most co-workers have no idea how to react and behave. This first-aid approach in regards to mental health would address that issue as well since grieving, while not a mental illness per se, is something that can impact a person's mental health in much the same way as a physical injury can impact a person's physical health. My dad died in May. My co-workers, other than an initial gesture of sympathy, seemed completely helpless to be supportive, and their inability to be supportive makes it difficult to feel like it's OK to still be grieving five months later. I wonder, Clare Miller, if you have any experience with that.
MILLER: Yeah. I mean, I think it's - part of it is just a snapshot of our society, where we don't really - when we don't know how to talk about something, we just sort of shut down. And in all of these different instances, I think the key is, you know, improving the communication and trying to treat one another as human beings. And the ALBEE, the mnemonic that mental health first aid - helps to walk you through sort of that idea. And one of the big ones that I always remember is, listen non-judgmentally. And if we all sort of did that on a more regular basis, I think our workplaces would look a lot different.
CONAN: I can't imagine - that as you go around in workplaces and train people, that people don't take you aside from time to time and say: Wait a minute, how would you deal with this problem?
MILLER: Oh, yeah. Yeah.
GIBB: Every time.
CONAN: Every single time.
GIBB: And we have to...
MILLER: You could face a room full of people and there's no questions, and the Q and A period is very quiet. And then afterwards, you're deluged with folks who have individual stories. So it is, it is really interesting.
GIBB: And mental health first-aid instructors are, in general, not clinicians. They may have a clinical background outside of the training to teach mental health first aid. But you know, many of us - myself included - are not trained clinicians. And so there are times when we have to, you know, refer people on or give people resources.
CONAN: And going back to one of the first things, Bryan Gibb, you said: Don't diagnose.
CONAN: None of us, unless we're trained professionals, we don't have the skills to do that.
CONAN: It's awkward. Anyway, Bryan Gibb is with us. He leads mental health first-aid training courses around the country. He's director of public education for the National Council for Community Behavioral Healthcare. Also with us, Clare Miller, director of the Partnership for Workplace Mental Health. And she's with us here in Studio 3A. Bryan Gibb is with us from our bureau in New York. And you're listening to TALK OF THE NATION from NPR News. And Rosa(ph) is on the line. Rosa with us from Edina in Minnesota.
ROSA: Yes, thank you for your show. I really like it. I was diagnosed at 19 with manic depression. I always took my medication religiously. And about at age 32, I became psychotic on the workplace just for two days because I - my doctor had switched me to another medication. I was always very peaceful, very nice even when psychotic. There's a myth that people are violent. That's not true. And I was fired just because I was kind of spaced out and didn't make good judgments. And they could see I was kind of spacey and incoherent.
I was fired, and I just think that's such a waste. You know, I was highly trained. I was a good employee, very good work ethic. And, you know, if I had had a heart attack and been in the hospital for two days, they would've welcomed me back with flowers and candy. But because I had this physiological ailment that was no fault of my own, I was fired. I tried to appeal through Americans with Disabilities Act, and there was a Catch-22. I hadn't told them ahead of time that I was bipolar so I - my suit had no standing. And I just think the stigma needs to be erased, that people with mental illness are generally nonviolent. And it's no fault of their own, and they should be welcomed back to work.
CONAN: And very difficult, obviously, for you, Rosa. But the other point that you brought up - and, Bryan Gibb, it's a waste. A trained employee has to be dismissed - or they feel she has to be dismissed because of behavioral issues, quote-unquote, when this is a brief episode.
GIBB: Sure. Or, I mean, even to look at something that's less dramatic - and not to minimize the caller's experience. But it's far more likely that someone is going to have lower productivity because of a mental illness, whether it's depression or something. I mean, various statistics out there - one of the lowest numbers I've seen is that depression, just depression, costs the U.S. economy $50 billion a year in lost productivity. And I saw a statistic this morning, released by the CDC, that showed that heavy drinking costs our economy $200 billion a year in lost productivity - just productivity, that's not medical costs. So you know, we're, as a society, there's a huge opportunity here to not only help people who are suffering but also to just, you know, work smarter.
CONAN: Rosa, we're sorry for what happened to you. Thanks very much for the phone call.
ROSA: Thank you.
CONAN: We just have a couple of minutes left. I don't know if it's enough time to deal with this email from Elizabeth(ph) in Portland: I train police officers in crisis intervention. What were some of the challenges your speaker faced in Washington, D.C., with the MHFA training?
GIBB: Oh, yeah. How much time do you have?
CONAN: A minute and a half.
GIBB: Well, the first thing I should say is, you know, mental health first aid is a program of the Maryland Department of Mental Health, the Missouri Department of Mental Health and the National Council. And also, if somebody is looking for a course out there, they can go to our website at mentalhealthfirstaid.org, and they can find a course in their community. They can plug in their ZIP code and find a course in their community. But you know, the challenges for police are A, that they deal with much more intense situations. They have some very specific protocols on how they can respond.
For example, if they respond to someone who's experiencing psychosis but there happens to be, say, a domestic violence charge there as well, there are some things that they have to do tactically, that we wouldn't necessarily suggest through mental health first aid. You know, the idea is to reduce anxiety, where a police officer may actually be required, tactically, to go in more aggressively.
So they have, you know, some - and we - when we work with police officers, we say, just like we do with HR people, we are not suggesting that mental health first aid supplants your tactical requirements of your job. It's another tool in your toolkit. It's another thing that you can use to make your job easier, to serve the public and ideally, to de-escalate crisis so that you don't end up in the emergency room; you don't have to take someone into custody.
CONAN: Bryan Gibb, thanks very much for your time today.
GIBB: Thank you.
CONAN: Bryan Gibb, director of public education for the National Council on Community Behavioral Healthcare, with us from our bureau in New York. Clare Miller, thank you for coming in as well.
MILLER: Thank you.
CONAN: Clare Miller, director of the Partnership for Workplace Mental Health. Coming up next: from flying to X-rays, New Yorker cartoonist Roz Chast lays out her anxieties in a new book, "What I Hate: From A to Z." Stay with us for that. It's the TALK OF THE NATION from NPR News.
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