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!

Lessons That Go Beyond – Applying Tinnitus Lessons to the Rest of My Life

So, as I said some months ago, I managed to jump in a pool funny and develop Tinnitus in my left ear. Yes, it’s every bit as fun as it sounds. For those of who you are (blessed enough to be) unfamiliar, Tinnitus is a ringing in your ear that is non-stop. And it suuuuuuuuucks, let me just tell you. That was about seven months ago now, and there’s never really been a time that it has gone away. So, with some painful brief exceptions, I haven’t really heard silence since early August. It has certainly gotten better, and there are some days where it is better than others, but yeah…it sucks. And no, there is no cure, although some are being researched and show promise. I’m cautiously optimistic that there may be real, physical remedies in the next few years.

Anyway, no, I am not writing this to whine or get sympathy. Actually, I’m writing to share one of the things I learned from it, in the hope that my experiences can positively affect you.

To be clear, the first few weeks I had it was exceptionally difficult. Anxiety and depression are fairly common for Tinnitus sufferers, and they tend to get worse if you already suffer from these disorders…like me. And tinnitus can be even more emotionally painful if you have something called hyperacusis, which is defined as an extreme sensitivity to sound. Yep. Me again.

The first few weeks I had the tinnitus were particularly bad, and I wound up seeing my therapist for it. Interestingly, although there are no physical cures for tinnitus, there are a variety of behavioral techniques and ways in which counseling can help you deal with tinnitus. My therapist…God bless him…was exceptionally helpful in allowing me to identify these techniques.

One such way, and what I wanted to write about today, was something that I alluded to several months ago: Using my new chronic condition for personal growth. I have tried to parallel my new experience with tinnitus to my experiences with depression and anxiety. While both have obviously been hellish experiences, I wouldn’t trade them. They made me stronger, more empathetic and gave me a sense of purpose as a legislator and writer that I never would have had otherwise. It is so strange to say that depression and anxiety made my life so much more joyful and meaningful.

One of the most useful techniques in terms of tinnitus management basically boils down to this: Acknowledge it and move it. There are periods I can forget about the tinnitus – usually when I am wrapped up in work or something fun. I always laugh about it, but the longest I ever went without hearing the ringing in my ear was the day I ran for House leadership – I didn’t hear it for almost the entire day, as I was so intent on making the phone calls and attending the meetings that I needed to attend to win.

Anyway, those moments and days are few and far between, and there are plenty of moments where I hear the tinnitus and get annoyed distracted, sad, or angry. At those moments, one of the things my therapist taught me was to more or less say, “Oh, yep, you’re there. Hello. Nice to see you. Anyway….” and to move on. That requires a letting go and acceptance that I am just terrible at. But, what I will say is that I am learning and getting better. In turn, my tinnitus is getting better. You acknowledge that it’s there but try to remove the emotional connection with it. Studies have shown that the stress and distress you feel with tinnitus aren’t tied to perceived loudness. This means that your level of stress and how you deal with the tinnitus is much more impactful than its actual frequency or volume!

This brings me to a fascinating experience I had last week. As I said above, I have tried to see my depression and anxiety experiences to make myself a better person. When the tinnitus first started, I pledged to try to do the same with the disorder. Doing so, in my mind, would make the tinnitus worth it. And that brings me to this experience.

So, I see something stupid on Facebook. Someone had said something insulting or ignorant, and I’m annoyed by it. And I just have this very quick, almost automatic thought: “Whatever, I know it’s bothering me, but I’ll just acknowledge it and move on…oh–”

It was my Tinnitus process hitting something more real.

Look, this thing sucks. And I won’t pretend otherwise. BUT, that doesn’t mean that good can’t come from it. It doesn’t mean that you cannot experience something good from something just absolutely terrible. And I hope I will continue to take the lessons I’ve learned from Tinnitus and apply them to the rest of my life.

More importantly: I hope you can keep this motto as well. I hope you can try to find the good in the bad and apply lessons you’ve learned from negative experiences into positive ones. Negative experiences, terrible tragedies, horrible events – I am not stupid enough to say that they are “worth it” or won’t cause you endless hours of pain or torment. But what I will say is that one way of dealing with these experiences is to try to take the lessons learned in order to make them more “worth it.” I have found this to be an excellent coping mechanism, one that has helped me take a real challenge and turn it into something positive. I hope this is something you can do, too.

Don’t Let Your Mental Health Stop You From Voting

I came across this article in Al Jazeera that is arguably an amalgamation of my entire universe. The article deals with the impact that mental health and depression have on voting. As you’d likely expect, people who suffer from mental illness are less likely to vote.

That’s a problem under the best of circumstances, but it’s an even more acute one in the pandemic, when rates of mental illness have shot through the roof, potentially being enough to keep thousands of voters at home. In an election like this one, it’s possible that this could make a difference in some key states.

According to the article, studies have directly correlated depression and not voting. The research that was done indicated that this may be the case for many reasons, including:

  • A depressed person may not have the energy to engage in voting or the prep work that goes into voting.
  • They may not have the mental/emotional energy to participate in the political process in general.
  • There is a correlation between financial distress and depression, and this often leads to not voting.
  • Feelings of depression lead to apathy, which leads to feelings that voting is an utterly irrelevant activity.

Interestingly enough, anxiety seems to actually motivate people to get involved in the political process, because people view the political process as a way to reduce anxiety. It gives them some measure of control over their anxiety.

I want to spin that message back to depression. I get it – better than most – that depressions leads to feelings of hopelessness, and this ultimately ties back to the idea that voting is a pointless, useless activity. However, I am begging you, don’t let that be you. There is too much at stake.

Some personal thoughts, too. One of the things that really has damaged my mental health – and lead to quite a bit of anxiety and depression – is when I am experiencing something that I have no control over. I can’t control whether or not I win my reelection. I can’t control if something will happen to my wife or my kids tomorrow. Yes, there are measures I can take, there are things I could do, but I can’t control everything. None of us can.

All we can do to feel better is accept that, but also take prudent measures to positively influence an outcome. Remember: Voting is all about control. For all the challenges, for all the roadblocks, we can still change the outcome of our government. We can still make it ours again – yours again. Voting is the ultimate measure of control over what the government can and should do. Seize it back.

Please, go vote!

Telling Your Story – The Courage of Brayden Harrington

When we all grow up, we should wish for the courage of this 13-year-old boy.

As many of you likely know, the Democratic National Convention was this past week. Thursday saw the formal acceptance speech of Joe Biden to become the Democratic Nominee, but many people don’t remember that speech compared to Brayden Harrington’s.

Brayden Harrington is a 13-year-old boy with a severe stutter. Apparently, he met Joe Biden at a rally. The former Vice President has struggled all his life with a stutter and has always connected deeply with them.

Here’s the first time Biden & Harrington met:

Then, on Thursday, just before Biden’s speech, Harrington addressed the nation:

It’s an astonishing display of courage and strength. As a 13-year-old, I didn’t want to be seen in public on my best day – let alone with my deepest struggles and insecurities displayed FOR THE ENTIRE COUNTRY. This young man and his family knew – had to know – that they were exposing themselves to millions of horrendous people, people who would mock this kid. They had to know he was changing his life forever.

He spoke anyway.

And he inspired others. I caught this tweet:

This brave man was inspired by a 13-year-old boy. It’s unreal.

Brayden Harrington’s bravery inspired others. It had millions of people looking at television and thinking, “If he can do it, why can’t I?”

Forgive me for a moment as I veer into my story. When I first spoke about my own depression & anxiety issues, I did it to try to destigmatize mental health. What I didn’t calculate was the inspirational effect. That by telling my story, I’d encourage others to tell there’s.

That’s what Brayden Harrington did.

To be clear, what this kid did, given his young age and the literal national audience, was astonishing. I just have no other words for it. But I would hope that all of us out there could look at Harrington’s bravery – and the incredibly warm response it has received – and see ourselves in it. Whatever you shame, your struggle, if you think you are the only one…you are incorrect. Millions upon millions of people suffer from stuttering, and Harrington gave them all a confident and commanding voice.

My point? Share your story. It doesn’t have to be on national television or in an op-ed in your paper. It doesn’t have to be a big Facebook status.

Tell a friend. Tell a stranger. Say the words out loud, and find comfort and strength in finding your voice and using it. There is a power in sharing what you think is a shameful secret…you show it you aren’t afraid. You find support in areas you didn’t know existed. And you inspire others to do the same. It helps you take command of your secret, whatever it is.

Trust me on that.

Trying To Flip It: Using Pain For Growth

So, last week, I did a stupid. I went swimming with the kids and jumped into the pool. The second a did, I felt water just shoot RIGHT UP into both of my ears. Ow. Ow, ow, ow. I hopped around, I stick my finger in there, nothing. A few home remedies later, and I got the water out. And I also got tinnitus pretty bad in my left ear.

A visit to the ENT and a nice dose of steroids later, and I hope I am on the mend. Tinnitus sucks. And, not gonna lie, it’s been upsetting. Like…is this ever going to go away? How can I get past it? How can you ignore something THAT IS CONSTANT?

There is a way. Actually, the more I relax, the less I concentrate on it and the more I can just…you know, do life…I’m okay. I’ve also been trying to take some of the lessons I’ve learned in the course of my long history with mental illness and apply it to this, including, hopefully, looking at this from a growth perspective.

Okay, first. As a stereotypical male, I do not do well with physical discomfort. My wife makes fun of me cause all of my clothing is usually pretty baggy. But seriously, even the slightest physical discomfort and I have big problems. Kind of funny, considering I’ve done okay in the mental resiliency front, but I digress.

Anyway, this has been a struggle. I can’t lie. I’ve been having a lot of anxiety about the ringing, a lot of guilt that I basically accidented and then stupided myself into this, and just a lot of stress.

I’ve tried to deal with that in a couple of ways. First and foremost: In a sense, this bit about tinnitus is very similar to fighting anxiety. Yes, that’s an accurate statement. Tinnitus is aggravated by stress and anxiety. If you can ignore it – which is HARD – it gets less or goes away. I’m lucky, the form I have is relatively mild, so ignoring it is not the hardest challenge in the world. But I am trying to ask myself some questions that I think are pretty important. How can I take the lessons I have learned from this stupid battle and apply them to the rest of my life? How can I learn to be more comfortable and more relaxed with physical discomfort? How can I teach myself to be okay with a silly mistake that anyone could have made?

My point, from a mental health perspective, is obvious. When you do something dumb, you are allowed to wallow in self-pity for a bit. Go ahead. Flush that stuff right out of your system. And, when you ready, start to ask yourself some questions – not just about how to deal with the immediate situation, but how to grow from it. How to take whatever mistakes you have made and transform them into lessons you can learn. I’ve tried to apply this model of post-traumatic growth to my own life, and I know I have written about it in the past as well.

Anyway, I’m trying to take this model and applying it to my own life. I’m not being as successful as I want, but I’m trying. I hope you can too.

So…do you want to be a Beta reader for my next book?

This one is personal, and it is exciting: I have a Beta version of my next book ready to go, and I’d like your help.

The book – tentatively titled Almost The End Of The World – is about a college student who has to return to life after the very, very near-miss of a world-ending asteroid. Here are the first three sentences of the description:

On January 3, the world was supposed to end when an asteroid collides with Earth.

It missed.

Now, everyone left alive must deal with the consequences.

This one asks questions about our shared obligation to each other. When we’re in a crisis, do we pull closer? Or further apart?

For the record, I started writing this before COVID!

So…want to read it? Or want the full description?

I’m looking for someone to read the Beta version of my book and give me feedback. This isn’t an editing role – I don’t want someone to look this guy over and read it with a fine-tooth comb. What I do want is for someone to read the book and tell me if I hit the main beats. Do you like the characters? Is the story relatable? What do you think I need to make it more clear? Looking for readers with the ability to make brutally honest judgments and the time to give me their unvarnished assessments.

If you’re interested, comment here, or Email me at MichaelSchlossberg@gmail.com.

 

John Lewis & Joy

As most of you are probably aware, Congressman and Civil Rights legend John Lewis died this weekend as a result of cancer. Lewis was 80. He was one of the original speakers at the March on Washington and until this weekend was the last speaker who was alive from that famous day. Congressman Lewis was commonly referred to as the “conscience of Congress” and one of the most powerful voices of the modern era on issues relating to race relations and civil rights. His absence, at this moment, leaves a hole in this country, but at least he died knowing that this country was a better place for his work.

My social media feed was replete with tributes to him – I suspect yours was as well. However, one clip, more than any other, really caught my eye:

To be clear, in this clip, John Lewis – then 76 – is crowd surfing. WEEEEEEE!!

“I just wanted people to keep me up….” That just clipped me in a big way.

I have absolutely zero idea what made Colbert or his producers go, “HEY, I have a great idea…but rock on!” It’s amazing and heartening to watch. And I’ll add this: As you can see in this clip, most of the audience is white. I would have killed to be in that audience and touch John Lewis – to, in his words, make sure that I kept him up. There had to be something so special about that. But there’s a deep sense of poetry there. John Lewis – a man who was beaten on the Edmund Pettus Bridge while fighting for civil rights – being held up by men and women of the same skin color as the men who beat him. It says something about how far we have come.

Of course, as you may suspect, this wasn’t the only clip of John Lewis expressing a deep sense of joy & silliness. Here he is in 2018, dancing away:

Again, the internet is filled with stories of Lewis’s kindness, selflessness, and a sense of caring for other people. Numerous members of Congress spent time discussing the way Congressman Lewis went out of his way to say hello or drop them a kind word.

What does this have to do with mental health? Honestly, quite a bit. We live in very serious times and face seemingly insurmountable issues. Racism. COVID. Climate change. Inequity and more. Every day, brave men and women fight and die facing these issues, willingly or otherwise. John Lewis was one such man.

Lewis could have become an embittered man. Instead, he chose to spend the rest of his life fighting for a cause he believed in, making new friends and allies, new enemies, and more. If a man who almost died on a bridge named after a soldier to the Confederacy could become a public servant and fight the ghost of that Confederacy…what choice do the rest of us have? How can any of us look at the world and decide we must retreat into its shadows when legends like John Lewis fought on?

This doesn’t mean we must always be serious. It doesn’t mean that we forego self-care, reflection, and our own lives. But it does mean that we must use our down moments to lift ourselves back up again.

To paraphrase the life of John Lewis: You have to walk across that bridge to be able to crowd surf.

Find your joy while fighting your fight.

Are suicides increasing during COVID-19?

It was a frequently used argument during the pandemic, one often used against lockdowns: Suicide rates would increase as a result of social isolation, financial hardships, and more limited access to proper medical care. This fear was repeated by medical professionals and medical health care experts. Even Donald Trump repeated the line at one point, arguing that extensive lockdowns would lead to “thousands” of suicides. So great that he and so many others suddenly care about mental health when they spent years defunding services that would prevent suicide and trying to rip health care away from millions, but that’s a completely different story, so let’s move on, let’s move on.

We’re about four months into some of the various lock-downs and quarantines. The question is obvious: What does the data say? Are suicide rates on the rise?

It seems like its too early to tell. We will only be able to more definitively tell the numbers when the annual suicide numbers come out at the beginning of the year, and even then, it will be extremely difficult to determine the cause of the suicide. However, there is some evidence to indicate that things are not as bad as many of us feared they would be – though that could very, very easily change.

First, let’s look at what data is available and what data has been misleading. At the beginning of the pandemic, a doctor said that his California hospital had seen “a year’s worth of suicide attempts” during a four-week period. That report was utterly debunked: Numbers had barely increased at the hospital in question, and locals reported that they believed the local rate had remained stable in the area.

Apparently, calls to some suicide hotlines have increased. Outreach to suicide prevention text lines has increased as well. However, this may not be a bad thing, as it may be a reflection of people turning to the closest support line to get help. Indeed, if these hotlines are working, the increase in calls may be a good thing. Again, unfortunately, there’s no evidence to say one way or the other.

I couldn’t find any hard data discussing whether or not there was any evidence of suicide rate increases in the United States – if someone has that, please correct me. However, I did find evidence that suicide rates have actually dropped 20% in Germany. This is a preliminary finding, so it is likely too early to draw hard conclusions from it.

There is no question that COVID-19 will cause a massive spike in a wide array of social problems, and suicide would certainly seem to be one of these problems. However, as noted by many articles on the subject, it’s more nuanced than simply saying that “The lockdowns led to more deaths.” The pandemic also ripped apart the economy, threw us into a recession, and maybe a depression. There is clear evidence that down economies lead to higher rates of mental illness and suicide. As such, it is difficult to say that lockdowns lead to suicides. It is much more complex than that.

So, what’s the conclusion? There’s no conclusion. Not yet. Time will tell. But, more importantly, policymakers and the community at large must continue to work to mitigate the economic and social impacts of COVID – particularly on the mentally ill. I’m hoping to be able to work on that one over the summer.

Doom Scrolling: What It Is and Why It’s So Dangerous

I think it was at the height of the George Floyd riots (not protests, riots, and I do mean those two differently) that it really hit me. Dozens of cities were burning across the nation, the fire started by the murder of George Floyd. The kids were in bed, and I could not stop looking at Twitter, loading new tweets, reporting whatever horrendously depressing piece of information I learned to my wife, and then letting the cycle repeat itself over and over and over again.

I slept like crap that night. And for the next three.

Finally, at some point, it hit me: What the hell was I doing? Yes, staying informed is important, but this was insane. No good came of me cycling over and over through the battlefield that our news had become. Twitter was horrendous. Facebook was toxic. I needed to put down the damn phone.

I was Doom Scrolling.

Doom Scrolling is when you are staring at your phone, refreshing a social media feed, consciously or subconsciously looking for more bad news. It usually happens late at night, when you turn on your phone to unwind and relax…and instead become convinced that the world is on fire and that you will never get a peaceful night’s sleep again.

Looking at your iPhone late at night is bad enough for your ability to get some sleep, but Doom Scrolling is pretty much the worst thing you can do with your phone before bed, short of trying to eat the damn thing. But the problem with Doom Scrolling is what it does to your mind: It excites it, it terrifies it, it makes you feel sad and afraid. It also revs up your mind at a time you are trying to slow it down and get some rest.

All of these emotions are obviously not conducive to getting a decent night of sleep, and in turn, you wake up feeling sad, anxious, and depressed. This can turn into a bitter cycle.

Stopping Doom Scrolling is important to your mental health. It is difficult, but we have to find a way to do it.

How? Some thoughts.

  • Physically separate from your phone: Yes, that. It can be hard. It may make you twitch. But put your phone somewhere else. Charge it on the other side of the room. Give it to a supportive partner (who probably hates how much time you spend on it, anyway). Set a hard stop: No more phone use after Xpm. Just…go away from it.
  • Monitor your social media habits otherwise: Doom Scrolling happens because we have developed habits that push us towards using our phones anyway. Doom Scrolling is easier to stop when we monitor our social habits to begin with, then avoid staring at our phones at a moment where our minds are already primed to look for the bad news. We all know what it’s like – disappearing down the Scroll Hole. Looking at your phone for so long that you forgot why you started to begin with. Don’t be that person. Develop the habits to stop looking at your phone so much to begin with.
  • Set a time limit: Say you really do want to look at your phone and watch for the news. Maybe you, like me, enjoy being plugged into society and find value in it. That is a totally understandable reflex, and our phones have been unquestionably helpful at building a more connected world…indeed, many of us never would have become as a way of the problems people of color face at the hands of elements of law enforcement, to begin with, were it not for our phones. So, allow yourself ten minutes. Physically set a timer. Scroll for ten. And when your phone rings, be done.

You’ll notice a theme: Some of the pieces of advice that I give are more physical than psychological. That’s because Doom Scrolling is a reaction to the terror around us. I’ve repeatedly tried to note that individual psychology cannot be separated from the real world, and at moments of terror or anxiety, we all become depressed. Our phones just give that an outlet, hence the Doom Scrolling.

And one more thing. Don’t berate yourself for Doom Scrolling. It happens, and it’s okay. You’re not weak. You’re human and normal. We all want to feel connected, even to a world that feels broken. For better or for worse, our phones give us that opportunity.

How much is Doom Scrolling an issue for you? Have you found any tricks that can help you stop it? Let us know in the comments!

EDIT: More Resources! Here is a great article on the topic from Choosing Therapy.

The Depression & Anxiety of Racism

Last week, I wrote a bit about the Black Lives Matters movement and the incredible stress and strain that racism is causing people of color. This is a topic that I really think demands further exploration.

First, I mentioned it last week, but check this article out in more depth. Rates of anxiety and depression spiked, hard, for African & Asian Americans in the aftermath of George Floyd’s murder. Among African Americans, positive screenings for these disorders rose from 36% to 41%, while they increased from 28% to 34% among Asian Americans. Those are all significant increases.

Interestingly enough, it did not increase for members of the Hispanic population. I’d be curious to better understand why that is the case, but that’s for another day.

Tragically, the reason we have this data is because the federal government was attempting to track the impacts of COVID-19 on minority populations, which, as we know, has been hit particularly hard by this pandemic. One tragedy upon another.

If these findings are accurate and representative of the increasing rates of mental illness among the general public, it means that at least two million more people experienced mental illness as the result of the murder of George Floyd. These are horrifying numbers, but they really aren’t all that surprising.

We know, definitively, that external forces can increase rates of mental illness. Depression, anxiety, and suicide all rise in times of economic turmoil and it makes tragic sense that a group of people who are under perpetual attack at an individual and societal level would experience rising rates of mental illness when a horrific video showed a slow-motion murder.

What does this mean? Again, the good news…such as it is…is that we, as a society, are having a larger conversation about systemic racism. I worry that too much of the conversation has focused on police brutality and criminal justice reform. That is important, no question, and its the primary issue in front of us at the moment. However, we cannot lose sight of the impact that centuries of racism have had on countless other areas of life.

One of those must be mental health.

As a white man, I cannot personally understand the impact of racism on mental health. But the literature and personal experience of countless people of color are clear. Racism means lost opportunities. It means personal pain and lives destroyed. It also means the trauma of watching countless people who look and act like you being gunned down by the men and women who are supposed to protect you.

What’s my point of this entry? The article above proves it: Police brutality and systemic racism mean depression. They mean mental health. And as we have a conversation about what Black Lives Matters means, we cannot forget this vitally important component of addressing and ending systemic racism.