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“Noomifying” – and thus “Gamifying” – Depression & Anxiety

A dear friend was telling me about her very positive experience – thus far – with Noom. Just in case you’ve missed the ads (they are all over my YouTube feed, so I must be in their target demographic), here’s the basic gist: Noom is a weight loss website/app/program. There is a charge associated with it (I think it’s $40 a month), but it gives you access to a slew of resources, including weight loss trackers, recipes, fitness goals, articles, and more. The app then gives you “points” for completing tasks, like reading articles or tracking your food.

This buddy of mine is an achievement lover – she’s was laughing as she told me that she has actually done Duolingo for over 1,000 days, even though she doesn’t care that much anymore – simply because she doesn’t want to lose her streak. This fascinated me. Noom apparently gives you little tasks – walk 3,000 steps, for example – and then slowly ups the ante. It thus creates a runway of small, achievable goals. It’s also largely psychology-based, giving users the opportunity to learn more about the mindset behind weight loss and encouraging them to identify flaws in their thinking that lead to more weight gain, or at least less weight loss.

Noom also divides food into three categories – green, yellow, and red. You limit your intake of yellow and red but are free to enjoy green.

This fascinated me. The problem with many of these diets is that you have to stay on them forever or they stop working, like Atkins. But as I understand Noom, it seems to be based on changing the way people think and their lifestyle. This strikes me as having the potential for more success.

Does it work? Yeah, maybe. Noom has an array of research on their website, but it’s unquestionably worth doing a bit of digging on your own. From what I could find, yes. It does seem to work.

All of this being said, I wasn’t trying to write about Noom and weight loss. As my friend was explaining this to me, it made me think: How can we gamify depression the same way?

What would that look like? Hard to say. After all, weight loss isn’t like depression, and depression can often be harder to shake free than weight loss is to lose. However, the lifestyle-centric nature of Noom is what strikes me as having the highest possibility to work, and a lifestyle change with an app – replete with professional resources, access to counselors, tasks you can complete that provide you a sense of accomplishment – that is interesting to me.

Aspects of the Noom app are gamification. You complete certain tasks, you get achievements or rewards. It steers your brain in a certain direction by creating artificial awards that reward desired behavior. Could you do that for depression? Again, hard. But not impossible.

I’m not the only one to come up with this idea, of course, and people smarter than me have written about, researched, and studied this concept. That research has been positive: It appears that a well-design app can actually improve mood and rates of depression.

This begs the question: What more can we do to gamify depression and anxiety treatment? What controls are needed to ensure that these apps go well and that users don’t experience a crisis – or become worse – while using an app? I don’t have answers, but I do believe that the potential is clearly there.

Suicide attempts among teen girls rise – but suicides fell….

There is a strange disconnect among findings that came out a few weeks ago from the Centers for Disease Control, and I think it is one worth examining.

First, from the Centers for Disease Control:

In the early months of 2021, visits to emergency departments for suspected suicide attempts increased roughly 50 percent for adolescent girls compared with the same period in 2019, according to a report released Friday by the Centers for Disease Control and Prevention.

The same article makes a few other very salient points:

  • Suicide attempts began to rise in May 2020.
  • Suicide attempts among girls rose 50.6% compared to the prior year, but a mere 3.7% among boys.
  • Similar increases were NOT observed amongst men and women, aged 18-25.

There’s a lot of places to look at this, and the gender differentiation is genuinely fascinating. What on earth could cause such a difference in terms of the differences between men and women?

That being said, there’s a different question I want to ask: How is it possible that ATTEMPTS rose so much, but suicide deaths declined? As I wrote about previously – and has been written about by people much smarter than me – preliminary data indicates that suicides declined by 5.6% during the same time period that suicide visits among this demographic increased so dramatically. How can this be?

There are, of course, many possible answers.

First, the data released by the CDC is preliminary. There isn’t a breakdown of completed suicides by demographics. This means that it is very possible that suicide attempts – and completed suicides – rose among the demographic we are discussing, but that they declined enough in other demographics to offset this rise. It’s also possible that the suicide attempts were less serious attempts that were less likely to result in death. Typically, women are more likely to survive a suicide attempt, as they tend to use less lethal means. It is also worth noting that women are three times more likely to attempt suicide than men, but men are 3-5 times more likely to die of suicide than women.

The one thing that the report does make clear – and that is unquestionably true – is that this could have major public health implications and implications for parents. Young women seem to be in a more fragile state of mental health than their male counterparts, and it is incumbent upon us to ensure that we are taking the steps necessary to protect their mental health.

I’d also go one step further: What are the health implications for the poor young women who wound up in a hospital? What health risks do they face? What ongoing care do they need at home, and at school? What questions do we need to answer?

Regardless, this is something that is unquestionably worth monitoring in the future.

Good public policy can improve mental health, part 9,645,856

There’s a new study available that shows that, for the gazillionth time, public policy can truly make a positive impact on mental health.

First, the study itself. It specifically pertains to the most recent rounds of stimulus checks. Specifically:

A new analysis of Census Bureau surveys argues that the two latest rounds of aid significantly improved Americans’ ability to buy food and pay household bills and reduced anxiety and depression, with the largest benefits going to the poorest households and those with children. The analysis offers the fullest look at hardship reduction under the stimulus aid…Among all households, frequent anxiety and depression fell by more than 20 percent.

This is a remarkable number. Direct financial aid helped to improve rates of depression and anxiety.

It’s also unsurprising. Generally speaking, wealth is not directly related to suicide rates, but subjects related to wealth are. For example, living near people who are wealthier than you may lead to increased rates of suicide. A decline in income – often one that leads to homelessness, housing insecurity, or unemployment – is correlated with higher suicide rates. Furthermore, a landmark study from a couple of years ago showed that raising the minimum wage can directly reduce suicide.

We also know that expanding access to health care can make a positive impact on suicide rates. Of course, you don’t need an advanced degree in public policy to figure out why: When you make health care easier to obtain, this usually involves mental health care, and this means people can be treated for their mental illnesses. This, in turn, can help to attack these illnesses and make someone feel better.

There are ancillary reasons why this is true, as well. One of the less-discussed causes of suicide is pain and chronic pain – I actually had a dear friend lose someone very close to her because of her partner’s pain. Medical care, of course, can treat or mitigate the impacts of countless diseases. This, in turn, can improve someone’s quality of life – and help prevent suicide.

Last, the third rail of politics: Gun control. Like it or not, means reduction policies – policies that make it harder for someone who is suicidal to get a gun – can help to reduce suicide rates. For example, there is a well-established link between gun ownership and suicide. Furthermore, states with stricter gun laws tend to have lower suicide rates. In other words, we CAN do something about suicide rates in government, we already have done quite a bit, and we can do a lot more.

Suicide is not something that just happens. It is not some magical, mystical thing that we have no control over. Yes, there are factors that are well beyond governmental control…but there are also plenty of things we can do to reduce suicide. Things we must have the courage and fortitude to do. I’ve always found mental health to be an under-tapped political issue. Many people know its pain – more than we are willing to admit. And I wish more people spoke about this issue for both the sake of politics and policy.

Okay, seriously…how is it possible that suicide numbers dropped during the pandemic?

We may be close to the end of the COVID-19 pandemic, but the scars of this battle will remain with society for a long, long time. Among the more devastating damages of COVID-19 have been the toll on mental health, with increasing signs of mental illness, greater addiction rates, increased use of mental health resources

…and a decline in suicides…

Wait, what?

Yeah. I don’t get it either. But, according to preliminary data, suicides went down in 2020:

 From 2019 to 2020, deaths by suicide declined by 5.6%, from 47,511 to 44,834, per the CDC. It was the third consecutive year of decline. Suicides [also] went down in April and May of last year, a different trend than in years past, Farida Ahmad, health scientist at the National Center for Health Statistics, tells Axios.

This is astonishing. And it defies expectations, with many predicting that COVID and the economic shutdowns would lead to a massive spike in suicide. And yet, that hasn’t been the case, despite the increase in every other category that would be a predictive factor for an increase in suicides, including mental illness, unemployment, and suicide.

This begs the question…why? What’s going on here? I’ve read a few articles on the subject, and they offer some different thoughts:

  • Telehealth played a big role. In many states, it became easier than ever to access mental health resources, as regulations were waved that enabled people to get access to telehealth. As a result, more people may have been able to seek mental health resources, thus saving their life.
  • There were huge, concentrated efforts to encourage people to get mental health help – maybe more so than ever before. Governor’s across the country spoke about it. People still do to this day. As a result, it seems possible that stigma – once a formidable barrier – was shattered. This may have put more people into mental health help.
  • Some noted that it seemed possible that a “heroism effect” was in place – similar to that which occurs at the start of a war or another catastrophe – where a sense of “we’re all in this together” kept more alive. If this is truly the case, then we need to be cautious, as it seems like that such an impact would fade over time.
  • The pandemic forced a massive reevaluation of the way we look at our lives, as more people found that they could live without certain things, and are thus able to live better lives. This is an interesting philosophical argument, one that may also be playing a role in the decline of workers across the economy.

It is also worth noting that a more advanced look at the data is needed: For example, did suicide decrease more in some groups? Did it particularly spike among teenagers and young adults, groups that were believed to be facing particular difficulties during this pandemic? Furthermore, what about differences among racial and economic demographics? What about people who could work at home versus those who could not?

My opinion? All of the above, and then some. I’d also offer this caution…there is no way, no way, that this is it, that we are now on a glide path towards a permanent reduction of suicide. I am absolutely concerned about the long-term impacts this will have on mental health, as well as how this may drive up suicide rates. There is so much more to this story that we absolutely do not understand, and I really hope that others have more insight than me!

Anything to add? Any thoughts about why suicide may have dropped as it did? Let us know in the comments below!

The Potential – And Frustration – of Mental Health Awareness Month

For decades, May has been “Mental Health Awareness Month,” an event formally observed by governmental actors and non-profit stakeholders alike. As a governmental official, I have seen my share of “awareness” days, weeks, and months, and taken the opportunity to deliver quite a few proclamations. Some of them get absurd. My all-time favorite was “Lake Awareness Month.” Different story.

Anyway, these events are important. They give people the chance to highlight timely and relevant societal ills and issues. They give advocates a platform to speak their mind and discuss what important things are occurring within their universe. For mental health advocates, it gives us a chance to talk about the signs of mental illness, suicide prevention, and talk about our issues in front of broader forms. At their core “awareness” events are useful tools for generating media attention and making sure that the public has an idea of what you are up to.

For issues like mental illness – issues that remain highly stigmatized or self-stigmatized – this is very, very important. These events can seem trite sometimes, but they do have meaning, as they can help steer people towards resources or make them become aware of problems from which they or a loved one suffers.

There’s a heck of a “but” here, though. It’s as simple as this: Awareness shouldn’t be confused for action.

What do I mean? Alright, I can’t tell you how many times I’ve been to an event on some important issue or other and listened to other elected officials talk about why this issue was so important. Here’s the thing: I KNOW that the elected official who is there wouldn’t do a thing to lift up the issue. We all show up at events – that’s good, and to be expected. But showing up at an event and collecting kudos for being present somewhere is a cheap way of scoring points. To quote an expression that President Biden attributes to his Dad, “Don’t tell me what you value. Show me your budget, and I’ll tell you what you value.”

This is huge. I’m tired of hearing nice words. Match it with funding, and tell me how you’d get the money to make it happen. Presentations, citations, awareness, it’s not enough. Give me the cold, hard cash to fund the programs necessary to help people.

So, what does this mean for a normal person? Well, simply. First, if someone shows up with a proclamation or a card, that’s great. It’s important. I never want to take away from the action of bringing attention to an important and relevant topic. However, that’s not enough, and don’t let any politician get away with it. Instead of saying thank you and posting for pictures, ask your elected official what they are doing on mental health. What issues are they involved with, specifically? What funding increases are they examining? Are the open for a meeting when you can talk to them more?

Oh, and let me add: This strategy and these comments don’t just apply to mental health and mental illness. They can work across the board on any number of issues.

At the end of the day, awareness is great. For some issues – particularly ones that are under-discussed, they are huge. But it’s not enough. Don’t let any politician tell you that it is.

Depression as a Roguelike

Okay, let me say right off the bat that this entry is going to be nerdy. I mean, SUPER nerdy. Video game genre level of nerdy. That being said, even if you aren’t that level of nerd, I think this entry may have something to offer you that you can connect with.

My favorite type of genre of video games, I have finally come to realize, is a type of game called “roguelikes.” Hear me out. Stop rolling your eyes. I promise this will get to depression and mental health.

So, Roguelikes. They’re games in which you have to get to the end. My favorite all-time Roguelike – maybe my favorite all-time game at this point – is one called Enter the Gungeon. I cannot understate how obsessed I am with this one.

Games like this are designed for you to die. Like, a lot. A lot, a lot, a lot. They are typically very, very difficult games. What makes them a little extra special – and extra difficult – is that they’re never the same. The games often use a randomization procedure known as “procedural generation.” In these games, levels and bad guys will change. Layouts change. And while the game will follow the same certain pattern, it’s never the same run through the dungeon.

So, what does this Sisyphean-like task have to do with depression? Well…a lot, actually. Take Enter the Gungeon. You will die a gazillion times in this game before you make it to the final boss – and then all the secret final bosses – which is a different story. But, every time you beat a level boss, you gain these extra tokens. You use those tokens to buy better weapons for your next run. Then, you’re next time, you do a little bit better. You get a little further.

Even more importantly: The more you play, the more you learn the patterns. Like, this little bastard, who my kids call the Pinky Malinky enemy:

 

He’s blurry, but deadly

Pinky Malinky up there will fire a shotgun spread at you as you walked. The first time I ever saw him, I was totally taken aback. The second time, same. By the third time, I had it, and I rolled out of the way. 

Of course, that’s not to say that the knowledge of what he does makes me immune from screwing up. Every now and then, I’ll get distracting by dealing with another one of the little guys that shoot at me, and I’ll take a hit. But I learn. I always learn.

See where I’m going with this?

It’s kind of a weird metaphor, but it does hold. My favorite type of video game genre, Roguelikes, is very, very similar to how all of us battle mental illness. Consider the similarities:

  • No two days are ever really, truly the same – but you recognize the patterns.
  • Recognizing the patterns of a Roguelike level means you can learn how to better cope with an attack.
  • Once you learn the patterns, you have a better shot at defeating your enemies.
  • The bad guys appear in different orders, at different times, and in combination with different things, but it doesn’t mean that they aren’t different.
  • Just because you know how to kill them doesn’t mean you always will. Sometimes you have a terrible day and get a Game Over at level one. Other times, you make it to the final boss without batting an eye.
  • Randomness plays an important role – but your skill often is what makes the difference.

Look, video games are an important part of my life. They’ve given me a virtually endless source of joy or entertainment, inspired the names of my kids, and taught me some exceptionally valuable life lessons about persistence and creativity. But I do really, truly believe that there are parallels between how we fight depression and how we play some types of games. I hope this helped to provide you with a valuable metaphor, and please let us know in the comments your thoughts.

Now, please listen to this kick-ass soundtrack:

Rural America and Mental Health

This is something I’d been working on in the real job, and it occurred to me that it might be an interesting topic to explore here.

So, my legislative district is urban and suburban. This comes with the usual struggles: Poverty, educational access, economic attainment, health care access, and more. To be clear, the challenges facing urban America are massive and monstrous. I deal with them every day, and that unquestionably applies to the area of mental health, where the impacts of poverty, crime, trauma, and addiction are deleritous towards the impacts of the lives of urban residents.

That being said, I don’t think we do a good enough job of flipping this topic and talking about the challenges that rural America faces when it comes to mental health. I’ve written about this topic before, but with a specific focus on suicide. I want to broaden that a bit.

First, let’s be clear: In a lot of ways, the challenges facing rural America from a mental health perspective are worse than that of their urban counterparts. This is for many reasons, including:

  • More depressed economies: In total, urban and suburban areas are growing, while rural areas are stagnating or shrinking. Economics do not necessarily predict mental health, but they can predict access to health care. Furthermore, negative changes in economic status are a predictive factor of people developing mental health issues.
  • Less access to health care: Rural America is more likely to have health care access challenges than their urban or suburban counterparts. There are fewer hospitals, and doctors/other health care professionals are less likely to go to rural areas. As a result, a rural resident may miss that they have a mental health challenge, and even if they are aware of their problems, they may not be able to find a doctor they can easily get to – particularly given the transportation problems in rural America and the lack of access to mass transit. Telehealth can help address some of these issues, but again, much of rural America doesn’t have the broadband access they need to make this work.
  • Higher rates of addiction: Rural America tends to have higher levels of addiction than their urban or suburban counterparts.
  • Higher rates of firearms ownership: Unfortunately, this pertains directly to suicide – more guns means more suicide. This is why there are more suicides per capita in rural America than elsewhere.

So, what’s the answer? Okay. Some of these are above my paygrade. I am not capable of reviving the economy of rural America. I cannot relieve their economic pressures, though I will say that I do believe that the progressive policies I support can help address these issues.

That being said, yes. Progressive policies, in my opinion, can help. Dealing with health care access, a lack of broadband internet, rates of addiction…guys, this requires investing money. Increased reimbursement rates for physicians, psychiatrists, and psychologists to encourage more people to enroll in mental health specialties. Grants for construction and increased funding for operations for hospitals. Increased investment to open drug treatment centers. A minimum wage that isn’t a catastrophe. Targeted tax incentives to alleviate the pain faced by rural farmers. It’s funny because typically, rural Americans vote for more conservative politicians and policy outcomes. I would argue they are voting against their own interests here.

That being said, an honest answer acknowledges that this is more than just politics or policy. Rural America faces unique challenges that cannot be solved with the drop of a hat or the wave of the magic money wand, and these challenges require long-term investment, comprehensive solutions, and answers more than whatever I have thought of.

Still, as a long-time elected official for a depressed urban area, I have nothing but sympathy for my rural friends. They deserve real answers and real investment. I hope we can figure out comprehensive solutions to their problems and pain.

The Mental Health Benefits of Doggos and Other Animal Friends

According to my Facebook memories, one year ago today, I wrote, “The only true winners of the pandemic are the pets.”

The picture above is the pet, Lexi. We got her in August 2019, and she has been our bestie ever since. She is sweet, lovable, patient, insane, and a wonderful addition to our family. We got her about six months after we lost Molly and a few weeks after we tried – and failed – to foster Mack.

I said it to my wife a thousand times, and it’s true: Lexi made the pandemic so, so much easier. She was a constant companion, a source of amusement, and basically just seemed…pretty glad to have us around. She seemed to just make us happier.

I just wanted to point this out – that’s a very, very real feeling. Doggos help, big time. From a mental health perspective, they:

  • Reduce depression
  • Ease the symptoms of a variety of mental illnesses, including anxiety, depression, and PTSD
  • Lower stress hormones
  • Reduce anxiety felt in children
  • Fill us with love and affection

There are a variety of physical benefits as well, including an increase in exercise, lower cholesterol, and improved heart disease. 

Oh…cats. Fine. I’m a dog person – and, unless I’m mistaken, I’ve found more articles about dogs than cats. However, cats do have real benefits on our physical and mental health, with some studies indicating that they lower blood pressure.

Actually, let me add one more thing. For years, Auron has wanted a fish. I mean, years. We told him – years ago – we’d do it when he was ten. To my disbelief, he actually remembered! Well, Auron turned ten the other day, and his Pappy got him a fish. We were all actually really clear with him: This is yours, buddy. You will be responsible for cleaning and feeding it – yes, we are supervising, I don’t want the damn thing to die.

To be clear, don’t get a dog to cure your depression. That’s not fair to the dog. They are living, breathing things. They are real, intense, and expensive responsibilities. But, if you have the time and the money, they are so, so worth it. If you are on the fence, keep that in mind. They are utter joys. And they can make us feel good.

Go Outside: It’s Good for Your Depression – and a Whole Lot More

Let me start by acknowledging that I’m really lucky that I can actually type this up. I have a nice house with a big backyard. Not everyone is able to do this. However, if you can, if it’s nice enough, you have the means to do so, and you have the space to do so – please go outside.

When I was younger, I went outside more often. That slowed as I got older, and I couldn’t even really tell you why. I was never a backyard kind of guy. Then we spent ten years in a home with a relatively small backyard (albeit a nice porch) and I didn’t see much of a point of going out. That changed as I did more research. One book in particular sticks with me – I’ve written about it before – The Depression Cure by Dr. Stephen Ilardi. The book argues that depression came from the way we have crafted civilization and that more time outdoors is necessary to address depression. I had other issues with the book, but on this point, I think is absolutely right.

The basic crux is that going outside helps make you feel more relaxed, more at peace, and more connected to others – even if there is no one around. And it’s backed up by some research:

  • One analysis of ten studies found that self-esteem and mood could be improved for people who spent more time outside.
  • People who walked in nature showed lower activity in brain centers associated with rumination, as opposed to those who walked in an urban center.
  • Being close to nature or “greenspace” can reduce stress, symptoms of anxiety, and provide children with ADD or ADHD additional cognitive benefits.
  • Nature is also associated with lower stress levels and higher levels of relaxation.

Alright, fine, going outside is good for your mental health. That probably isn’t really much of a surprise to you. It also helps explain why I’ve spent so much dam money on my backyard of late. But, let’s be clear, there are implications here that go a bit beyond the need to get some fresh air. Let’s go back to my disclaimer at the front of this article: What about people who don’t have a backyard? People who live in a heavily urbanized area and don’t have nearby public parks or nice amenities? People who are physically disabled and thus unable to easily access the benefits of nature?

Well…I mean, let’s be honest, they’re not going to get the benefit that the rest of us will. And that’s deeply unfair.

Of course, the benefits of nature, parks, greenways, and waterways are about more than improving your mood. Studies also show that access to nature can improve your physical health and provide a sense of connection with others. It can also improve your memory, your concentration, and help you lose weight. It’s pretty clear that being able to get outside in a high-quality space is about more than just improving your mood. It can do a lot more, and maybe, if Dr. Ilardi’s theory is to be believed, help people reconnect with something deeply biological within them.

So, if you can, go outside. Also – if you can – let’s all do a better job of advocating for high-quality public spaces that can be accessible to all of us, regardless of our income levels, where we live, or our levels of physical functioning.

The Rise of Telehealth

Telehealth wasn’t new to COVID-19. The concept has been around for decades and applies differently to different areas of medicine. That being said, one of its most positive potential uses has been in the area of mental health, and in that regard, COVID-19 may have pushed us towards telehealth in a big way.

First, check out this USA Today article on the subject. This line stuck with me:

Prior to the pandemic, Blue Cross Blue Shield of Massachusetts received about 200 telehealth claims per day. That number reached up to 40,0000 claims per day from April to May 2020, and the insurer is still receiving about 30,000 claims per day almost a year later, according to spokesperson Amy McHugh.

The article also noted that ” mental health appointments made up about 53% of the 7.5 million telehealth claims processed by Blue Cross Blue Shield of Massachusetts since March 2020.”

This isn’t a surprise, and many of us have had experiences with it. I know I had numerous virtual appointments via telehealth over this pandemic, and I found it every bit as effective as an in-person visit. Maybe even more so – the flexibility that came with it was highly beneficial. I remember having a therapy appointment from my office in Harrisburg!

Of course, it’s not for everyone, but there is unquestionably good news in the area of telehealth. According to a 2020 article from the American Psychological Association, telehealth seems to be working so far. There are even some questions as to whether or not telehealth may be more effective for some groups that are typically less willing to visit a psychiatrists office – like men – as it allows them to get therapy without having to leave their house, thus reducing potential barriers and making it easier for them to overcome self-imposed stigma.

The USA Today article also noted that telehealth can make a therapist more efficient. Said one therapist, “I probably spend somewhere between 2 to 5 minutes per patient moving from one room to another or pausing to document or checking something on their file or handing something off. There are built-in inefficiencies that isn’t time spending with the person… but some of those inefficiencies are taken care of by the fact that everything is electronic.”

Obviously, COVID pushed us more this way as part of all of our efforts to socially distance. However, major challenges remain in terms of full utilization and effectiveness of telehealth services. First, telehealth is predicated on the idea that someone has the broadband infrastructure and necessary equipment. As this pandemic has shown, that is NOT the case for everyone, particularly among rural Americans or the urban poor. Lacking such equipment means that someone will not be able to get the help they need.

Furthermore, there are insurance barriers. Not all insurance companies cover telehealth, and while states of emergency have knocked down many of these barriers, they haven’t destroyed all. As such, insurance regulations need to be updated in many states. However, this presents a problem in and of itself. For example, in Pennsylvania, the issue has been tripped up due to attempts to limit telehealth services and prevent abortion services from being prescribed or conducted via telehealth. Don’t ask.

The point is this: Telehealth is great, but we’ve got a long way to go.

Let me conclude with this: Did you have a telehealth experience with COVID-19? What was it like? Did you find it to be as effective as an in-person visit? We’d love to hear from you – give us your comments below!