Transcript: Mental Health and Well Being During a Pandemic | May 07, 2021

Nam sits inside a living room with gray walls and houseplants in the background. She's in her early forties, with shoulder length straight brown hair. She's wearing glasses and a black blazer over a floral print shirt.

She says THE AGENDA THIS WEEK LOOKED AT: ONTARIO'S PANDEMIC RESPONSE; THE FUTURE OF VIRTUAL HEALTH CARE; AND DECLINING MALE FERTILITY. WE BEGIN WITH THE STATE OF KIDS' MENTAL HEALTH.

Music plays as an animated slate reads "The week in review."

In a clip, Steve and a guest appear on split screens. He's in his fifties, clean-shaven, with short curly brown hair.

A caption on screen reads "Helping kids bounce back amid COVID-19."

Steve says WHAT DO YOU THINK HAS BEEN THE MOST DAMAGING RISK FOR KIDS, BOTH NOW AND IN THE LONG TERM?

The caption changes to "Javeed Sukhera. Western University. @javeedsukhera."

Javeed is in his forties, with short gray hair and a stubble. He's wearing a gray suit and a blue shirt.

He says THE MOST DAMAGING THING IS REALLY HARD TO DISTILL BECAUSE I THINK THIS IS LIKE A COMPLEX STRESSOR, NOT JUST KIDS BUT WE'RE ALL EXPERIENCING COLLECTIVELY AS ADULTS. IN THE CONTEXT OF THAT WHAT I'VE SEEN AND HEARD WITH THE YOUNG PEOPLE I WORK WITH REALLY ARE TWO MAIN CONCERNS. THE FIRST IS HOW THIS HAS AFFECTED LEADERSHIP. THERE'S NO ONE-SIZE-FITS-ALL. EVERYBODY IS DIFFERENT. SOME PEOPLE ARE THRIVING AND DOING OKAY. SO WE HAVE TO RESIST A GENERALIZATION. BUT THERE ARE MANY YOUNG PEOPLE WHO ARE REALLY STRUGGLING WITH DISTANCE LEARNING. THEY LACK THE KINDS OF INDIVIDUAL SUPPORTS THAT THEY NEED, PARTICULARLY YOUNG PEOPLE WHO MIGHT STRUGGLE WITH ATTENTION OR LEARNING DIFFICULTIES ALREADY, AND THAT'S LEADING TO FURTHER DETERIORATION IN THEIR MENTAL HEALTH. THE OTHER GROUP ARE PEOPLE WHO STRUGGLE WITH SITUATIONS WHERE THERE'S HIGH DEGREES OF CONFLICT IN THEIR HOME AND THEY'RE FEELING STUCK. THEY'RE FEELING LIKE THEY DON'T HAVE AN OUTLET. AND MANY OF THESE YOUNG PEOPLE, LIKE WAS SAID EARLIER, ARE STRUGGLING WITH HOPE. AND THAT'S REALLY WHAT KEEPS ME UP AT NIGHT IS THAT SENSE OF DREAD AND HOPELESSNESS, WHICH IS IMPORTANT FOR US AS ADULTS TO HELP COUNTER BY SHARING HOPE AND SPREADING HOPE WHEREVER WE CAN.

Steve says Sheri, CAN I FOLLOW UP WITH YOU? YOU MENTIONED HOPE AS WELL. IS THE LOSS OF HOPE RELATED TO THEY THINK THIS PANDEMIC IS NEVER GOING TO END, OR WHAT IS IT?

The caption changes to "Sheri Turrell. Life in Balance Therapy."

Sheri is in her thirties, with chin-length blond hair with pink highlights. She's wearing a red tank top and a black choker necklace.

She says I THINK IT'S PROBABLY QUITE MULTIFACETED. I THINK IT IS THE IDEA THAT IT'S NOT GOING TO END. THE END DOESN'T SEEM TO BE IN SIGHT ANY TIME SOON. AND I THINK IT'S JUST WHAT OTHERS HAVE MENTIONED AROUND THE LOSS OF THEIR PEER GROUP, THEIR SOCIAL SUPPORTS, THEIR EXTRACURRICULARS, AND I'M STILL HEARING FROM MANY THAT THERE'S THE... THE EXPECTATIONS AREN'T CHANGING. THEY'RE STILL EXPECTED TO DO WELL AT SCHOOL, GET THEIR A'S, ATTEND CLASS. THERE'S AN IMBALANCE BETWEEN WHAT THEY'RE GOING THROUGH, FUNCTIONING, AND WHAT'S EXPECTED.

Steve says WELL, I SHOULD ASK, I SHOULDN'T ASSUME. SHOULD WE NOT STILL EXPECT KIDS TO GET GOOD MARKS?

The caption changes to "The Week in Review. @theagenda. Tvo.org."

Sheri says I THINK WE CAN HOPE THAT THEY WILL AND I THINK WHEN THE MOMENT'S RIGHT WE CAN EXPECT THEM TO, YET I THINK IT JUST FEEDS INTO THAT PRESSURE THAT I WAS SPEAKING ABOUT A FEW MINUTES AGO. MANY OF THE KIDS I WORK WITH AND THAT I'M HEARING ABOUT FROM COLLEAGUES, THEY'RE HAPPY IF THEY GET OUT OF BED IN THE MORNING AND EAT BREAKFAST. AT THIS POINT, ESPECIALLY AT THE END OF THE SCHOOL YEAR, THEY'RE COMPLETELY EXHAUSTED. THEY HAVE NO FULFILLMENT, THERE'S NO SPONTANEITY IN THEIR DAY. THEY ARE JUST DREADING EVERY MINUTE OF THEIR DAY. SO I DO THINK THAT WE HAVE TO LISTEN TO THEM AND WE HAVE TO DIG INTO THEIR EXPERIENCE AND WHAT THEY'RE GOING THROUGH, AND I DO THINK THE EXPECTATIONS HAVE TO SETTLE DOWN A LITTLE. I THINK WE'VE GOT TO TAKE OUR FOOT OFF THE GAS PEDAL.

Steve says KATHY, I DON'T KNOW HOW TO ASK THIS WELL SO I'M JUST GOING TO ASK IT AND IT WILL BE INELEGANTLY ASKED BUT YOU'LL GET THE DRIFT OF WHAT I'M TALKING ABOUT HERE. OF COURSE THE KIDS THAT THE THREE OF YOU ARE DEALING WITH ARE, YOU KNOW, HAVING AMONG THE TOUGHEST TIMES IN THE COUNTRY. DO YOU THINK THEY ARE REFLECTIVE OF THE ENTIRE, SAY, UNDER-18 POPULATION RIGHT NOW?

The caption changes to "Katherine Hay. Kids Help Phone. @KathyHay."
Then, it changes again to "For help: 1-800-668-6868 or kidshelpphone.ca."

Katherine is in her fifties, with long brown hair and side-swept bangs. She's wearing a light gray blazer and a pink shirt.

She says IT'S A GREAT QUESTION, AND WE ARE SEEING THE KIDS IN EVERY PROVINCE AND TERRITORY. SO I DO AGREE THAT THE SENSE OF HOPELESSNESS, ISOLATION, FEAR... THERE IS A LOT OF FEAR WE'RE HEARING FROM KIDS ACROSS CANADA RIGHT NOW. AFRAID FOR THEIR OWN HEALTH, FOR THEIR FAMILY'S, THEIR WELL-BEING. I ALSO AGREE THAT THE ISOLATION IS PUTTING DIFFERENT DYNAMICS WITHIN THE HOME AND THE EXPECTATION DAY-TO-DAY IS REALLY STRESSING OUR KIDS OUT AND WE HEAR IT EVERY SINGLE DAY [INAUDIBLE]. SO ANSWERING YOUR QUESTION, THIS IS A NATIONAL CRISIS THAT WE ARE SEEING, AND I ALSO WANT TO MAKE SURE WE REMEMBER THAT WHAT WE'RE GOING THROUGH NOW... AND I DO SEE A LOT OF HOPE, ACTUALLY, FROM THE YOUNG PEOPLE THAT REACH OUT.

The caption changes to "For more stories and information: tvo.org/MentalHealthWeek."

Katherine continues AND THE HOPE I SEE IS THAT THEY ARE REACHING OUT, THAT THEY ARE LEARNING HEALTHY BEHAVIOURS AND THEY CONTINUE TO DO SO. THAT IS A GOOD RESILIENCY COPING MECHANISM THAT WE ARE OPEN SEEING AT KIDS' HELP PHONE. WHAT WE ARE WORRIED ABOUT IS THE TRAUMA THAT IS COMING FROM THIS PAST YEAR, AND LET'S REMEMBER, IT'S NOT JUST COVID... AND IT SOUNDS WEIRD TO TALK ABOUT "JUST COVID" BECAUSE IT'S BEEN PRETTY TRAUMATIC. THERE'S BEEN THE SHOOTING IN NOVA SCOTIA, HUGE UNREST AROUND SOCIAL INJUSTICE, AND WE SAW MAJOR SPIKES AROUND THE MURDER OF GEORGE FLOYD. I AM INCREDIBLY WORRIED ABOUT THIS YEAR, NEXT YEAR, THE YEAR AFTER. THIS TRAUMA AS A COUNTRY AND AS GOVERNMENT WE WILL

Now music plays as an animated slate reads "The week in review."

Steve sits in his attic.

A caption on screen reads "The politics of Ontario's COVID-19 response.

Steve says LAST WEEK WE SAW TWO PRETTY SIGNIFICANT DEVELOPMENTS HAPPEN. FIRST THE AUDITOR GENERAL, WHO WAS A NEUTRAL ARBITER OF THINGS AT QUEEN'S PARK, SHE CAME OUT WITH A REPORT, AND THEN THE PREMIER'S OWN APPOINTED LONG-TERM CARE TASK FORCE GAVE ITS FINDINGS AS WELL. SO TWO BIG REPORTS COMING OUT. AND I GUESS I JUST... JEFF, I KNOW YOU'VE WRITTEN A LOT ABOUT THIS. I'D LIKE YOU TO JUST WEIGH IN AND TELL US WHAT YOU THINK SOME OF THE I GUESS ONE OR TWO MOST IMPORTANT TAKE-AWAYS FROM THOSE REPORTS WERE THAT WE SHOULD KNOW ABOUT.

The caption changes to "Geoffrey Stevens. Waterloo Region Record."

Geoffrey is in his seventies, clean-shaven, with short gray hair. He's wearing a pale peach shirt.

He says WELL, I GUESS THE MAIN TAKE-AWAY IS THE PROBLEM IN LONG-TERM CARE CANNOT BE ADDRESSED OR RESOLVED AT ALL UNTIL WE PUT A LOT MORE MONEY INTO THE SYSTEM. IT'S GOT TO BE DONE. WE'VE GOT TO I GUESS START WITH LONG-TERM CARE HOMES AND GET RID OF ALL THOSE WARDS. EVERYBODY IN LONG-TERM CARE NEEDS TO BE IN A PRIVATE ROOM WITH A PRIVATE BATH. THAT MEANS REHABILITATING ALL OF THE OLDER MULTI-ROOM... WARD SYSTEMS, ALL OF THE OLDER ONES AND TEARING DOWN A BUNCH OF THEM, WHICH IS GOING TO BE TERRIBLY EXPENSIVE. I THINK WE'VE GOT TO DO SOMETHING ABOUT THE INSPECTION SYSTEM, WHICH HAS BEEN A FARCE, FRANKLY, AND WAS CUT BACK MORE BY THE FORD GOVERNMENT. NO GOVERNMENT HAS PAID A WHOLE LOT OF ATTENTION TO PROPER INSPECTION OF LONG-TERM CARE FOR DECADES. IT'S BEEN WORSE RECENTLY. INSPECTORS DON'T GO OUT FREQUENTLY, WHEN THEY SHOULD. THEY HAVE A SYSTEM OF NOTIFYING THE OWNERS AND OPERATORS OF LONG-TERM CARE BEFORE THEY COME, SO PEOPLE WILL QUICKLY REHIRE TEMPORARY WORKERS SO IT LOOKS LIKE THEY HAVE MORE STAFF THAN THEY HAVE. AND THEY DON'T... THEY FIND THINGS WRONG. THEY DON'T FOLLOW UP AND CHASE IT DOWN. AND IF LONG-TERM CARE FACILITIES ARE CONSTANTLY VIOLATING THE REGULATIONS, NOTHING HAPPENS. SO IF THERE WERE BETTER INSPECTIONS, THAT WOULD HELP A GREAT DEAL. BUT I THINK OVERALL, LONG TERM, STEVE, WHAT YOU'VE REALLY GOT TO LOOK AT IS SHIFTING THE EMPHASIS AWAY FROM INSTITUTIONAL CARE, LIKE LONG-TERM CARE HOMES, AND GETTING MORE AND MORE INTO HOME CARE, TO TAKE CARE OF PEOPLE AT HOME, KEEP AS MANY AS YOU CAN OUT OF LONG-TERM CARE. THEY'LL DO BETTER AT HOME. THE CHANCES OF SURVIVAL ARE BETTER. THEY'LL ENJOY A HAPPIER LIFE. WHAT'S THE AVERAGE? THEY SAY SOMEBODY GOES INTO LONG-TERM CARE, THEY'RE DEAD ON AVERAGE WITHIN TWO YEARS. I THINK THEY'LL SURVIVE A LOT BETTER IF THEY CAN STAY AT HOME CLOSE TO FAMILY WITH REGULAR CARE COMING IN TO LOOK AFTER THEM.

Steve says EVERY POLL I'VE SEEN SAYS PEOPLE WOULD PREFER TO LIVE AND, FRANKLY, TO DIE AT HOME AS OPPOSED TO IN INSTITUTIONAL CARE.

Geoffrey says THAT'S CORRECT.

The caption changes to "The Week in Review. @theagenda. Tvo.org."

Steve says LAURA, AS YOU TALK TO PEOPLE IN THE PROVINCIAL GOVERNMENT, CLEARLY THE LONG-TERM CARE SYSTEM HAS BEEN TREATED AS, IN SOME RESPECTS, LIKE A POOR SECOND COUSIN IN THE HEALTH CARE FAMILY. BASED ON YOUR CONVERSATIONS, BASED ON YOUR REPORTING, DO YOU SEE ANY DETERMINATION IN THE CURRENT GOVERNMENT OF ONTARIO TO DO SOMETHING ABOUT ALL THIS?

The caption changes to "Laura Stone. The Globe and Mail."

Laura is in her thirties, with long blond hair. She's wearing a black blazer and a white blouse.

She says WELL, I THINK WHAT WE'VE SEEN THROUGHOUT THIS PANDEMIC, AND PARTICULARLY WITH THE RELEASE OF THESE REPORTS, IS JUST HOW COMPLETELY SIDELINED THE LONG-TERM CARE SECTOR WAS, HOW UNPREPARED THEY WERE. THEY WERE CAST ASIDE. AND THE STORIES COMING OUT OF THE COMMISSION'S REPORT ARE JUST DEVASTATING, AND FRANKLY, LIKE THEY'RE HARD TO READ. THEY REALLY PULL AT YOUR HEARTSTRINGS. THEY ARE SO SAD, THE WAY THAT THE STAFF WOULD CRY OUTSIDE HOMES. THE WAY THESE PEOPLE DIED ALONE, WITHOUT FAMILY. IT'S SERIOUSLY DISTURBING. I THINK THAT THE FORD GOVERNMENT, YOU KNOW, THROUGHOUT THIS HAS SEEN HOW DAMAGING THIS HAS BEEN FOR THEM AND THEY ARE TRYING TO DO SOMETHING ABOUT IT AND WE'VE SEEN MANY ANNOUNCEMENTS ABOUT HOMES TO BE BUILT AND GOOD NEWS ANNOUNCEMENTS IN THEIR MINDS.

The caption changes to "For more on this story visit: tvo.org/theagenda."

Laura continues I MEAN, THE TROUBLE IS THAT THESE ARE YEARS, IF NOT DECADES AWAY, AND THE FORD GOVERNMENT DOES HAVE TO ANSWER FOR, AS THE PROFESSOR MENTIONED, THE LACK OF COMPREHENSIVE INSPECTIONS, WHY THERE WAS NO PREPARATION BETWEEN THE FIRST AND SECOND WAVE, WHICH I THINK THE PUBLIC VIEWS AS INEXCUSABLE. AND THE MINISTER HAS TO TAKE SOME RESPONSIBILITY FOR THIS, AND WE'VE SEEN A REAL RESISTANCE ON HER PART. SO, YES, I THINK THERE'S CERTAINLY A RECOGNITION THAT THIS NEEDS TO CHANGE AND THERE NEEDS TO BE INFRASTRUCTURE BUILT, BUT ALSO THE COMMISSION TALKS ABOUT, YOU KNOW, A WHOLE-HEARTED CHANGE IN THE WAY THAT THE SECTOR IS RUN. WHILE PROFIT COULD PLAY A PART POTENTIALLY IN BUILDING THESE HOMES, THAT SHOULDN'T BE THE SOLE PURPOSE OF RUNNING A LONG-TERM CARE HOME. SO THERE IS A LOT OF SOUL SEARCHING THAT NEEDS TO BE DONE NOW AND I THINK THIS IS GOING TO BE ONE OF THOSE MAJOR ISSUES THAT DOGS THE GOVERNMENT HEADING INTO THE NEXT ELECTION.

Now music plays as an animated slate reads "The week in review."

A guest appears on screen.

A caption on screen reads "Is virtual care here to stay?

Steve says TO THAT END, DR. COLLINS, DO YOU THINK THERE IS A CONCERN OF VIRTUAL CARE BEING SEEN AS SOMEHOW THE DEFAULT KIND OF CARE THAT IS PROVIDED AND DOCTORS IN THE FUTURE MIGHT ONLY ACTUALLY SEE THEIR PATIENTS IN PERSON ON RARER OCCASIONS?

The caption changes to "Ann Collins. Canadian Medical Association. @DrAnnCollins."

Ann is in her fifties, with chin-length blond hair and bangs. She's wearing a black blazer and a white blouse.

She says WELL, CERTAINLY, STEVE, CMA'S VIEW ON THAT IS THAT IT WAS NEVER... VIRTUAL CARE WAS NEVER MEANT TO REPLACE IN-PERSON CARE. IT'S MEANT TO BE COMPLEMENTARY. AND IDEALLY, IT SHOULD BE USED WHERE THERE IS AN ESTABLISHED DOCTOR-PATIENT RELATIONSHIP. CERTAINLY I THINK THAT YOU MAKE A GOOD POINT, AND WE ARE ONLY GOING TO SEE AN EXPLOSION OF FURTHER DEVICES, ARTIFICIAL INTELLIGENCE, OTHER ADJUNCTS TO VIRTUAL CARE THAT WILL BE ABLE TO EXPAND ITS USE. BUT, NO, AT THE END OF THE DAY WHEN A PERSON PRESENTS WITH A PROBLEM AND YOU CAN MANAGE IT SO FAR PERHAPS WITH VIRTUAL CARE, THERE SHOULD BE SOMEONE AT THE END OF THAT CARE RELATIONSHIP THAT CAN ACTUALLY SEE THE PATIENT. THERE ARE TIMES WHEN YOU KNOW THAT YOU'RE NOT MAKING... YOU'RE NOT HITTING THE MARK. YOU'RE NOT KNOWING WHAT'S WRONG WITH THIS PATIENT. YOU HAVE TO SEE THEM. YOU HAVE TO BRING THEM IN. YOU HAVE TO TOUCH THEM. YOU HAVE TO LAY YOUR HANDS ON. AND OF COURSE THERE ARE MANY OTHER THINGS THAT WE CURRENTLY PROVIDE AS SERVICES IN PRIMARY CARE, LIKE IMMUNIZATIONS AND OTHER SCREENING PROCEDURES THAT NEED TO BE DONE IN PERSON, WITH CONTACT.

Steve says DR. AFFLECK, LET ME TRY THIS WITH YOU. ARE THERE SAFETY CONCERNS AROUND THE USE OF VIRTUAL CARE?

The caption changes to "Ewan Affleck. College of Physicians and Surgeons of Alberta."

Ewan is in his fifties, clean-shaven and balding. He's wearing a gray sweater.

He says IN SHORT, YES, STEVE, THERE ARE SAFETY CONCERNS. AND THERE ARE SAFETY CONCERNS WITH ANY USE OF TECHNOLOGY IN HEALTH CARE. SO WE HAVE TO BE VERY PRUDENT WITH THAT. A VERY SIMPLE WAY TO LOOK AT IT IS THAT A LOT OF ISSUES HAPPEN BETWEEN THE INTERFACE IN CARE. SO IF YOU SEE YOUR FAMILY DOCTOR AND THEY REFER YOU TO A SPECIALIST OR IF YOU'RE SEEING A REHAB PERSON OR YOU'RE GOING FOR SURGERY, THE INTERFACE BETWEEN THOSE SERVICES, IF INFORMATION IS LOST, IF LAB RESULTS ARE LOST, X-RAYS, WHATEVER, COMMUNICATION OF ANY SORT IS LOST, THEN THE INDIVIDUAL CARING FOR YOU WILL HAVE LESS INFORMATION ON WHICH TO ADJUDICATE YOUR CARE AND POTENTIALLY ERRORS CAN BE MADE OR YOUR CARE MAY JUST BE... YOU WILL NOT GET THE FOLLOW-UP YOU REQUIRE, RIGHT, FOR SOMETHING THAT IS TIME-SENSITIVE. SO VIRTUAL CARE BY DEFINITION INVOLVES THE USE OF INFORMATION OR THE TRANSMISSION, EXCHANGE OF INFORMATION BETWEEN SERVICES AND INDIVIDUALS, AND SO WE HAVE TO ENSURE THAT THAT OCCURS IN A WAY THAT ASSURES THE INTEGRITY OF THE INFORMATION. OTHERWISE, IT CAN BE UNSAFE. AND I WILL JUST FINISH THE STATEMENT BY SAYING, THERE'S NOT A LONG TRADITION OF EVALUATING THE SAFETY OF THESE TECHNOLOGIES. WE EVALUATE THEM WITH RESPECT TO PRIVACY AND SECURITY, BUT NOT SAFETY. SO THIS IS SOMETHING AS A COLLECTIVE IN CANADA WE NEED TO BEGIN ADDRESSING.

The caption changes to "The Week in Review. @theagenda. Tvo.org."

Steve says LET ME FOLLOW-UP WITH DR. THOMPSON ON THAT. ARE YOU CONCERNED THAT VIRTUAL CARE OPENS THE DOOR FOR MORE EXAMPLES OF MISDIAGNOSIS?

The caption changes to "Keith Thompson. Western University."

Keith is in his late forties, clean-shaven and bald. He's wearing a blue sweater and a white shirt.

He says I THINK THERE IS THAT POTENTIAL. I THINK PART OF WHAT'S BEING DISCUSSED HERE AND CERTAINLY IN ANN HAS SAID AND EWAN AS WELL, THESE WORK BEST WITH EXISTING RELATIONSHIPS. WE HAVE THE ADVANTAGE OF KNOWING OUR PATIENTS WELL. BUT CERTAINLY WE NEED THE WHOLE STORY, AND SO ONE OF THE DANGERS IS, IF THERE'S EPISODIC CARE, WHETHER IT'S VIRTUAL OR FACE-TO-FACE, FOR THAT MATTER, IN A WALK-IN CLINIC, NOT HAVING THE FULL BACKGROUND ON THE PATIENT CAN REALLY POSE SOME SERIOUS ISSUES. SO, YOU KNOW, THIS WILL BE THE CHALLENGE GOING FORWARD, IS THE TYPES OF CLINICAL ENCOUNTERS WE HAVE AND THE TYPES OF PROBLEMS... FOR EXAMPLE, YOU KNOW, ACUTE CHEST PAIN. NOT APPROPRIATE, RIGHT? IT MIGHT BE A TRIAGE ENCOUNTER THAT YOU HAVE, BUT REALLY THAT PERSON NEEDS TO BE SEEN URGENTLY AT HOSPITAL. I DO KNOW OF ONE CASE APPARENTLY THAT WENT OFF THE RAILS. IT WAS APPARENTLY PANCREATITIS. PATIENT PRESENTED WITH ABDOMINAL PAIN. IT WAS A VIRTUAL ENCOUNTER. AND THE PHYSICIAN WAS FOUND, UNFORTUNATELY, TO BE RESPONSIBLE FOR NOT MANAGING THAT APPROPRIATELY. THERE WAS DISCIPLINE. IT SHOULD HAVE BEEN TRIAGED TO THE HOSPITAL...

The caption changes to "For more on this story visit: tvo.org/theagenda."

Keith continues THAT BEING SAID, THAT IS A DIAGNOSIS YOU COULD MISS IN YOUR OFFICE AND PUTTING HANDS ON THE ABDOMEN AND FEELING. SO PART OF THIS IS INVOLVES WHAT SORT OF RELATIONSHIP WE HAVE WITH A PATIENT. THEY HAVE TO TRUST US, THAT WE'RE DOING THE BEST FOR THEM. ABOUT YOU WE ALSO HAVE TO MAKE SURE THAT IF WE'RE THINKING OF A MORE SERIOUS DIAGNOSIS, WHAT'S THE BEST WAY TO TRIAGE AND DEAL WITH THIS, RIGHT? IT MAY MEAN DISENGAGING FROM THE VIRTUAL AND GOING TO A DEEPER ENCOUNTER THAT'S GOING TO BE A FACE-TO-FACE, IN HOSPITAL, OR IN CLINIC.

Now music plays as an animated slate reads "The week in review."

Three guests appear on split screens.

A caption on screen reads "The male fertility crisis."

Steve says HERE ARE SOME NUMBERS AND A QUOTE FROM YOUR BOOK TO GET US STARTED. YOU HAD 185 STUDIES INVOLVING NEARLY 40,000 MEN THAT HAD BEEN INVOLVED OVER A 38-YEAR SPAN. YOU FOUND...

A slate appears on screen, with the title "A four decade long drop."

Steve reads data from the slate and says BETWEEN THE YEARS 1973 AND 2011, SPERM CONCENTRATION... IN OTHER WORDS, THE NUMBER OF SPERM PER MILLILITRE OF SEMEN... DROPPED MORE THAN 52 percent AMONG RANDOM MEN IN WESTERN COUNTRIES. MEANWHILE, THE TOTAL SPERM COUNT FELL BY MORE THAN 59 percent, AND YOU WRITE...

A quote appears on screen. The quote reads "The current state of reproductive affairs can't continue much longer without threatening human survival."
Quoted from Shanna Swan, "Count down." 2021.

Steve says NOW, THAT ALL SOUNDS EXTREMELY ALARMING, BUT GENUINELY, HOW CONCERNED DO YOU THINK WE OUGHT TO BE?

The caption changes to "Shanna Swan. Author, 'Count down.' ICANN School of Medicine at Mount Sinai."

Shanna is in her late fifties, with short brown hair. She's wearing glasses, a red blouse and a chain necklace.

She says WELL, OBVIOUSLY I'M CONCERNED BECAUSE I WROTE THAT (LAUGHING) AND I FEEL THAT THE CURRENT STATE OF REPRODUCTIVE HEALTH IS REALLY PRETTY SERIOUS, AND THE NUMBER... WHEN WE LAST LOOKED AT THE SPERM CONCENTRATION, THERE WERE 47 MILLION SPERM PER MILLILITRE MEDIAN WORLDWIDE. SO THAT NUMBER, DROPPING FROM 99 IN 1973, THAT'S A HUGE DECLINE. AND WHAT THAT MEANS IS AT 47, WE'RE VERY CLOSE TO 40. SO 40 MILLION SPERM PER MILLILITRE SOUNDS LIKE A LOT OF SPERM... IT IS A LOT OF SPERM. BUT IT TURNS OUT THAT WHEN A MAN'S CONCENTRATION DROPS BELOW 40, THEN A LOT OF THINGS KICK IN. HIS PROBABILITY OF CONCEIVING GOES DOWN. THE PER CYCLE PREGNANCY RATE GOES DOWN. AND ACTUALLY HE HIMSELF EXPERIENCES AN EARLIER AGE OF DEATH BECAUSE THERE'S A LIFETIME CONSEQUENCE OF THIS POOR SPERM COUNT. SO NOW THAT WE ARE ARGUABLY AT AROUND 40, BECAUSE, YOU KNOW, IF THE DECLINE CONTINUES, WHICH WE DON'T KNOW YET, THEN WE WOULD CERTAINLY BE BELOW 40 MILLION PER MILLILITRE. AND IN THAT AREA OF IMPAIRED FERTILITY. AND SO WITH A LOT OF THE WORLD IN THAT PLACE AND SEEING THE INCREASE IN ASSISTED REPRODUCTION, DECREASES IN TOTAL FERTILITY RATE, I BELIEVE THAT WE'RE IN A SERIOUS PROBLEM.

Steve says THIS IS A PROBLEM IN THE DEVELOPED WORLD. IS IT ALSO A PROBLEM IN THE DEVELOPING WORLD?

Shanna says WE HAVE MUCH LESS DATA, MUCH FEWER STUDIES FROM DEVELOPING COUNTRIES. THAT'S BECAUSE THESE SPERM COUNT STUDIES TAKE A CERTAIN LEVEL OF TECHNOLOGY AND SOPHISTICATION. BUT WE'RE GETTING MORE OF THEM. AND WE'RE HOPING IN AN UPDATE THAT WE'RE DOING WE'LL GET MORE INFORMATION. BUT THE FERTILITY DECLINE, WHICH IS THE NUMBER OF CHILDREN BORN PER WOMAN, THAT HAS BEEN WORLDWIDE AT ABOUT THE SAME RATE. SO THE TOTAL NUMBER OF CHILDREN BORN IN 1960 WAS FIVE PER WOMAN OR COUPLE WORLDWIDE, AND THAT HAS DROPPED TO 2.4 WORLDWIDE IN 2019. SO THAT'S THE SAME ROUGHLY RATE OF DECLINE IN FERTILITY AND SPERM COUNT, AND IT IS WORLDWIDE FOR FERTILITY. IT'S GOING ON IN EVERY COUNTRY. AND MANY COUNTRIES, PARTICULARLY WESTERN COUNTRIES, ARE NOW BELOW REPLACEMENT. SO THIS IS NOT JUST A WESTERN PROBLEM.

Steve says THE THESIS OF THIS CONVERSATION NOW HAVING BEEN ESTABLISHED, LET'S BRING OUR OTHER TWO GUESTS IN HERE AND GET SOME REACTION FROM THEM AS TO THIS INFORMATION WE'VE JUST RECEIVED. LINDA, WHY DON'T YOU START US OFF HERE? SHANNA HAS WRITTEN THAT THIS IS A GROWING EXISTENTIAL CRISIS. WHAT DO YOU THINK... GLOBAL?

The caption changes to "Linda Birnbaum. Duke University."

Linda is in her sixties, with short curly gray hair. She's wearing a pink blouse and golden hoop earrings.

She says I TEND TO AGREE WITH SHANNA. ABOUT 15 YEARS AGO I ACTUALLY... THERE WAS A MOVIE SOME PEOPLE MAY REMEMBER CALLED "CHILDREN OF MEN," WHICH POSITED THAT THERE WAS EXTREMELY LOW FERTILITY AND IT WAS A HUGE PROBLEM. I THINK THAT THAT IS... YOU KNOW, FOR THE WORLD, I'M NOT SURE OVERALL, WITH WELL OVER 7 BILLION TO 8 BILLION PEOPLE ON OUR PLANET, I'M NOT SURE THAT FERTILITY IS A PROBLEM WHEN YOU LOOK AT IT THAT WAY. BUT WHEN YOU LOOK CERTAINLY AT AN INDIVIDUAL COUPLE OR INDIVIDUAL PEOPLE, IT IS A PROBLEM, AND I THINK THAT THE DATA IS GROWING AND EXTENSIVE THAT IT'S NOT ONLY MALE FERTILITY WHICH HAS DECREASED BUT ALSO FEMALE FERTILITY AS WELL.

Steve says RICHARD, WHAT SAY YOU?

The caption changes to "Richard Sharpe. University of Edinburgh."

Richard is in his sixties, clean-shaven, with short gray hair. He's wearing glasses and a checkered shirt.

He says WELL, I THINK THERE'S A MAJOR PROBLEM WITH MALE REPRODUCTIVE HEALTH FOR SURE. I THINK THAT THE GLOBAL REDUCTION IN COUPLE FERTILITY IS AN ISSUE WHERE WE HAVE TWO FACTORS AT PLAY. THE ONE THAT WE'RE CONCERNED ABOUT NOW, WHICH IS ADVERSE CHANGES IN SPERM COUNTS IN MEN, AND THUS IN COUPLE FERTILITY, AND SOCIETAL CHANGES, WHICH HAVE HAD A HUGE IMPACT ON COUPLE FERTILITY WHEN THEY'RE TRYING FOR CHILDREN AND ALSO HOW MANY THEY WANT TO END UP HAVING. SO IT CAN BE DIFFICULT TO DISENTANGLE THOSE TWO. BUT I THINK THE BIGGEST IMPACT OF HAVING LOTS OF MEN WITH LOW SPERM COUNTS IS ANOTHER SOCIETAL CHANGE, AND THAT IS THE DELAY OF COUPLES IN TRYING FOR CHILDREN UNTIL THE FEMALE PARTNER IS IN HER 30S.

The caption changes to "For more on this story visit: tvo.org/theagenda."

Richard continues THAT'S BECOMING NOW ALMOST THE MOST COMMON SITUATION. BECAUSE AT THAT TIME FERTILITY IN THE FEMALE IS MUCH REDUCED COMPARED WITH WHEN SHE IS IN HER EARLY 20S, AND THAT MEANS THAT SPERM COUNT BECOMES A MUCH BIGGER PLAYER.

Now music plays as an animated slate reads "The week in review."

Steve and a guest appear on split screens.

A caption on screen reads "Flattening Ontario's mental health curve."

Steve says LET ME READ SOMETHING THAT WAS RECENTLY PUBLISHED IN THE NEW YORK TIMES, AND THIS WILL HIGHLIGHT ONE WORD IN PARTICULAR, AND THAT WORD IS "LANGUISHING."

The guest says YEAH, YES.

Steve says IT'S A SENSE OF EMPTINESS AND IT MIGHT BE THE DOMINANT EMOTION OF 2001.

A quote appears on screen, under the title "The word of 2021." The quote reads "Languishing is a sense of stagnation and emptiness. And it might be the dominant emotion of 2021.
It is the neglected middle child of mental health. It's the void between depression and flourishing -the absence of well-being. You don't have symptoms of mental illness, but you're not the picture of mental health either. You're not functioning at full capacity. Languishing dulls your motivation, disrupts your ability to focus, and triples the odds that you'll cut back on work. It appears to be more common than major depression -and in some ways it may be a bigger risk factor for mental illness."
Quoted from Adam Grant, The New York Times. April 19, 2021.

Steve says AS SOON AS I SAID THE WORD, YOU SAID, "OH, YEAH." SO I GATHER THIS IS NOT NEWS TO YOU?

The caption changes to "Kwame McKenzie. Wellesley Institute."
Then, it changes again to "For more stories and information: tvo.org/MentalHealthWeek."

Kwame is in his early fifties, bald, with a goatee. He's wearing glasses, a black suit and a pink shirt.

He says NO, THIS IS AN INTERESTING FACT. ONE OF THE THINGS THAT OFTEN HAPPENS IN SORT OF NEW SITUATIONS, PANDEMICS, IS THINGS THAT WE KNOW ABOUT ARE GIVEN NEW LABELS AND THOSE NEW LABELS GET SOME CURRENCY. AND THAT'S NOT TO SAY IT'S WRONG AND THE FACT THAT PEOPLE IDENTIFY WITH THE WORD "LANGUISHING" I THINK IS VERY IMPORTANT. BUT THE DESCRIPTION OF LANGUISHING SEEMS VERY SIMILAR TO THE DESCRIPTION OF MILD DEPRESSION, MILD ANXIETY, AND IT WOULD BE INTERESTING TO KNOW WHETHER YOU CAN DIFFERENTIATE THE TWO. THE IMPORTANT THING ABOUT IT... SOME PEOPLE SAY, "WELL, THIS ISN'T IMPORTANT BECAUSE IT'S NOT A SERIOUS MENTAL HEALTH PROBLEM AND IT DOESN'T NEED MEDICAL INTERVENTION." AND I WOULD SAY, WELL, YOU'RE RIGHT. IT DOESN'T POSSIBLY... POSSIBLY IT DOESN'T NEED MEDICAL INTERVENTION, BUT IT IS AN IMPORTANT PROBLEM. YOU KNOW, IF WE IN A THOUGHT ECONOMY, IN A SERVICE ECONOMY, IN THE ECONOMY WE HAVE, WE NEED PEOPLE TO BE BRIGHT-EYED AND BUSHY-TAILED IN ORDER TO PUSH FORWARD IF WE WANT TO BUILD BACK BETTER, WE ALL NEED TO BE ON OUR A-GAME. AND LANGUISHING... WHICH IS MENTAL DISTRESS, WHICH IS MENTAL UN... I CAN SAY NOT MENTAL... MENTAL ILL HEALTH. I DIDN'T WANT TO SAY THAT BECAUSE IT SOUNDS SO CRUMMY, BUT IT'S CERTAINLY NOT WELL-BEING. IT'S GOING TO BE IMPORTANT THAT WE HAVE TO HAVE A STRATEGY TO DEAL WITH IT.

The caption changes to "The Week in Review. @theagenda. Tvo.org."

Kwame continues THAT STRATEGY MAY NOT BE A MEDICAL OR CLINICAL STRATEGY, BUT IT MAY BE ONLINE STRATEGIES, IT MAY BE THAT WE HAVE TO THINK ABOUT EQUIPPING EACH OTHER WITH THE ABILITY TO WORK THROUGH IT, BUT IT IS GOING TO BE IMPORTANT THAT WE DEAL WITH IT. INTERESTINGLY, ONE OF THE THINGS THAT I SAW ON THE STATISTICS CANADA WEBSITE WAS THE IMPACT OF THE CERB ON MENTAL HEALTH AND MENTAL DISTRESS. AND YOU CAN SEE A DECREASE IN MENTAL WELL-BEING IN CANADA AS THE PANDEMIC STARTED TO ROLL OUT. AND THEN... AND YOU CAN SEE THE IMPACTS, PARTICULARLY ON LOW INCOME GROUPS. AND THEN AS THE CERB WAS ROLLED OUT, YOU CAN SEE A SIGNIFICANT UPTICK IN MENTAL WELL-BEING, AND I WOULD IMAGINE ALSO A DECREASE IN THE AMOUNT OF LANGUISHING THAT WAS HAPPENING IN CANADA. SO WHEN WE'RE THINKING ABOUT WHAT WE'RE GOING TO DO ABOUT LANGUISHING, WE POSSIBLY HAVE TO THINK ABOUT HOW WE CAN EQUIP OURSELVES.

The caption changes to "Kwame McKenzie, @kwame_mckenzie."
Then, it changes again to "For more on this story visit: tvo.org/theagenda."

Kwame continues WE POSSIBLY NEED TO THINK ABOUT WHAT ADVICE WE CAN GIVE OURSELVES TO BE MORE MENTALLY HEALTHY. BUT WE ALSO HAVE TO THINK ABOUT THE SITUATIONS WE FIND OURSELVES IN OR WE PUT PEOPLE IN AND THINK ABOUT WHAT WE CAN DO TO DECREASE THE WORRIES AND DECREASE THE STRESS AND GIVE PEOPLE THE OPPORTUNITY TO WORK THROUGH WHAT IS A VERY DIFFICULT AND TRAUMATIC TIME FOR A LOT OF PEOPLE.

The clips end and Nam reappears.

She says THAT'S JUST SOME OF WHAT WE COVERED THIS WEEK ON THE AGENDA. FOR MORE, INCLUDING THE FULL CONVERSATIONS, YOU CAN VISIT OUR WEBSITE, TVO.ORG, OUR YOUTUBE CHANNEL AT YOUTUBE.COM/THEAGENDA OR OUR TWITTER FEED: TWITTER.COM/THEAGENDA.

Watch: Mental Health and Well Being During a Pandemic