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#15: Jonathan Purtle, Associate Professor at Drexel University School of Public Health

Jon and I met while studying in Amsterdam, where he infamously cycled through the IJ-tunnel following a Ghostface Killah concert with an accomplice that shall remain unnamed. We’ve met up a few times since in various European cities, including during one strange weekend in a summer empty Lyon. He also guided me to one of my favourite public art pieces, the Kurt Vile mural, in his hometown of Philadelphia when I visited a few years back. We spoke in early September.

Jon works in the Department of Health Management and Policy where he focuses on something called ‘implementation science’.

“It’s the science of translating things we know work, or don’t work, and scaling up and improving things that work and de-implementing things that don’t. A lot of implementation science is focused on things like clinical healthcare, so it could look at whether or not a primary care physician screens someone over 65 for depression for example. Something where there is a strong evidence base showing that it yields positive outcomes, yet is often not done. I work in the arena that focuses on mental health and public policy.”

Jon’s focus is on researching mental health issues and policies and communicating his findings to policy makers. It sounds like an area that might have been directly impacted by Covid-19.

“To a degree. I had a lot of projects going on before Covid, and even though they might not necessarily be interrupted by Covid, it changes the context. I haven’t dropped everything to chase Covid things, but we did a survey of state policy makers, and the people who work for them, who are in charge of children’s mental health systems. We’re going back and surveying them again to understand if states can continue to provide services to kids during Covid, and what their needs are going forward.”

Jon also wrote an article about mental health disparities from a Covid perspective. This follows the fact that racial disparities in mortality and infection rates have received a lot of media coverage in the US -- Jon sees this coverage as something positive.

“Covid definitely elevated that, which is great. There has been a lot of talk about how it translates into mental health. Communities of colour and low-income communities are more exposed to the stressors related to Covid, both social and economic, and potentially have fewer buffering resources.”

Black Life Matters is of course another movement that has highlighted racial inequality in the US. John thinks it’s been great that all US institutions have been forced to look at their practices with regards to race.

“Even the smallest community-based organisations, the marketing firm, the law firm, the University. Pretty much all institutions, at least in the North East, were asked what they are doing to promote racial equity. Leaders of all organisations had to do something and move forward with some kind of plan. At Drexel each level of the University has had anti-racism reviews of curriculums and policies, we’re looking through all of our classes to see how we can improve the courses we offer.”

I’m interested to understand how Jon goes about communicating his research findings and who he is trying to influence in the process. He makes the point that academia often doesn’t care about or value the impact of research, instead the focus is on publishing peer-reviewed articles and securing grants. This means that a researcher needs to go above and beyond to communicate findings outside the academic community.

“I’m generating knowledge and evidence about how to better communicate with policy makers, but that’s not to say that Universities and other researchers are best positioned to do that. We have these trusted intermediary organisations, so for the state policy makers I mentioned it’s an association called The National Association of State Mental Health Programme Directors. They communicate directly with policy makers about a range of issues, and they trust them. So that organisation is my audience; different professional societies that policy makers turn to and trust.”

One of the things I’ve noticed when following the US response to Covid-19 is the fact that the virus seems to have been politicised to a degree I haven’t seen in most European countries. While this hasn’t directly impacted Jon’s work, he admits that he finds it hard to imagine Covid without a political angle.

“Everything has a political dimension here, everything, and it’s so incredibly tribal. Your personal behaviours related to Covid are so political. Wearing a mask is a more political statement than a risk reduction practice in so many ways. Science is playing less and less of a role in policy making in the US and there is a recognised need to address that problem in some way.”

A big part of Jon’s job is surveying elected officials and he mentions that no matter the question, if you look at the mean for Democrats and Republicans the difference is always significant.

“A lot of my research is implicitly about how to convince conservatives to embrace policies that are more aligned with evidence because liberals are often more on-board to begin with. For a lot of conservatives it’s a total non-starter, so it’s about identifying people who could be swayed and framing the issue so it resonates with their values and what they care about. For example, an equity frame for a Democrat is probably effective but for a deeply conservative Republican that would probably lead to a backlash. Conservatives care about frames relating to money and opportunity so you can make a case around different opportunity points.”

Mental health has become an increasingly visible topic in many countries in the past few years. With such a high level of uncertainty across the world, I’m interested to hear what Jon thinks the mental health impact of Covid-19 might mean for society at large?

“A big representative survey of about 6000 US adults looked at the prevalence of various mental health conditions and symptoms directly related to Covid and right now there is far more mental health distress in the United States. A lot of it is directly related to Covid and there are these disparities by race, by ethnicity and by essential worker status. We don’t know how long it's going to persist; it could be transient and when Covid goes away we’re ok, but all of it probably won’t go away.

Another big question is suicide rates because they have been going up precipitously for a while. With Covid, gun ownership increased a lot in the US and having a firearm in the house is by far the biggest risk factor for committing suicide. So there are more people with all this stress and more of them have guns in their house.”

As a mental health expert, I’m interested in understanding how Jon has managed to protect his own mental health.

“We have two young kids so I just play with them, they are the most fun. They can also be very stressful, but playing with them in childlike ways is a constant stress reliever. Going outside as much as possible, we cycle around a ton. We bought a car this summer so we’ve been going to different woods and nature reserves and walking around as much as possible.”

The University sector had been heavily impacted by Covid-19, with remote teaching and fewer international students in most countries. Jon thinks it’s too soon to say what the longer-term impact will be on the University sector, but it’s clear that many institutions are losing a lot of money at the moment.

“There is talk that some of the newer and less stable Universities might go out of business. The bigger older ones will be more resilient, but it really remains to be seen. I’m glad I’m tenured and have a job, I feel bad for people entering the field now. All Universities have these hiring freezes and if someone leaves they’re generally not replacing that person. They’re doing everything they can to save money.”

So with all this uncertainty and stress, how does Jon think we might notice the rise in mental health issues in our day to day lives?

“It’s an interesting question, I haven’t really thought about that. I guess in ways you might imagine; people are a little more on edge, which I’ve kind of noticed. Maybe also a bit more withdrawn, but it remains to be seen how social connections and being around other people when Covid is gone is going to fix some of what we see. I think it’s going to be harder for everyone to engage in meaningful social interaction in rewarding ways with new people. And more so for people who have felt the mental health burdens of this. A potential bright side is that there is so much stigma around mental illness, but when everybody undergoes this kind of stress together there is an opportunity to bust down some of that. Because it’s no longer just that weirdo, it’s everybody. Maybe that can be a silver lining of all of this from a mental health perspective.”

So, a year of great upheaval, but also signs that there may be some positive outcomes along the way.

You can find all Jon’s publication via this link at the National Library of Medicine. More details on some of the topic covered in our conversation can be found in Population-Based Approaches to Mental Health: History, Strategies, and Evidence and Audience segmentation to disseminate behavioral health evidence to legislators: an empirical clustering analysis.

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