Getting You to a Better Place Mentally

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Posted January 13, 2026

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ADDITIONAL RESOURCES

• 24/12/365 Phone/Text for mental health assistance: 988 | 801-587-3000
• Huntsman Mental Health Institute (homepage)
• Optimal Again Program, HMHI
• SafeUT.org

TRANSCRIPT

This podcast discusses trauma related to illness, including suicide. If you’re having suicidal thoughts, you can dial or text the Suicide and Crisis Lifeline at 988. That’s 988.

Hi, my name is David Pace, and this is Pace Yourself, a University of Utah College of Science podcast on wellness.

[musical interlude]

Today, our guest is Dr. Amanda McNab, quality improvement and training manager for Crisis Intervention and Support Services at Huntsman Mental Health Institute here at the University of Utah. She is a licensed clinical social worker and has worked in the field for more than 20 years, and, congratulations, Amanda, on just earning recently your doctorate from the University of Kentucky.

 

Amanda McNab

Thank you very much.

David Pace

It’s nice to have you here.

 

Amanda McNab

Thank you for having me.

 

David Pace

Yeah. I was just looking on the Instagram feed of the Huntsman Mental Institute, and I noticed that there was, appropriately enough from the interim director, a message about the holidays and how we are going into this season when mental illness issues might surface for some of us. So, I think it’s timely that maybe we’re talking about this right now, mid-December. And I just wanted to do some backstory in that I met you at Safety Day earlier this year that the College of Science hosts for the University of Utah, and you talked about interventions and de-escalation of mental health issue traumas or dramas that are going on. So, we’re going to talk a little bit about that, but I wanted to just, recognize that we are entering the season and that there’s actually a disorder called season effective disorder, but it’s not necessarily related to the holidays. Is that correct?

 

Amanda McNab

Correct. It’s related more to the time of year, the fact that we have less light during the day, that we’re trapped indoors a lot more often because of the cold and the weather. And some of those factors that are environmental can also impact our biological side. And so it creates an opportunity for some individuals to be more affected at this time of year and maybe experience more things like depression symptoms or maybe increased anxiety.

 

David Pace

So, what are the interventions for that sort of thing?

 

Amanda McNab

For some people, having that extra light. Using UV lights or even if it’s a non-UV kind of sunshine type of light can really help to regulate some of those biological pieces. Definitely, creating connection with individuals, making sure that you’re staying connected, talking to your support systems. Sometimes that means reaching out to third parties like a crisis line or a peer support specialist line. Sometimes it’s just making sure that you’re getting out or talking to somebody that maybe you haven’t talked to in a while. Other people will try to have more time in the environment, out in nature, even though it’s kind of cold. They’ll find ways of being able to experience that as well.

 

David Pace

That’s interesting because you had talked about also on Instagram in one of your videos that, you know, depression, anxiety, psychosis, those were the three examples of mental illness symptoms that we can have. And you also mentioned in that video that we are all likely to have some of those symptoms at some point in our life. Yep. This is not something that is kind of segmented off from the majority of us. This is probably more common than we’re aware of: mental illness. And maybe you could expand a little bit more on that, those three, depression, anxiety, and psychosis. Are those the big three? I mean, psychosis sounds very scary.

 

Amanda McNab

It definitely sounds very scary. And really, all of them are a spectrum. There’s opportunities within all of our lives to have those moments where the stresses, the different things that we’re dealing with just overwhelm us and our ability to maybe function at a level that we feel is appropriate for ourselves. So, with depression and anxiety, we might see those as passing moments. And some of us might experience the more as a longer-term situation that starts to affect our ability to do the things that we need to do to take care of ourselves, to maybe take care of others, to work, to enjoy things.

Things like psychosis, we may see some strange thought patterns, maybe a little bit of a delusional thought where we’re dissociated or disconnected from the reality of others to the point where we are really debilitated and not able to function at a level that really helps us to be able to live the lives we want to.

 

David Pace

So the interventions for that, you’ve already mentioned, medical, or medicines, rather, we call them meds. And then there’s also talk therapy, and there are probably a whole suite of other therapies. I mean, we were just talking about the light therapy that you use for seasonal disorder.

Can you give us a brief overview or 40,000-foot overview of the kind of therapies that are available that the Huntsman Institute offers?

 

Amanda McNab

Sure. When you’re looking at interventions, you’re looking at a wide spectrum. So, things such as outpatient, where you are doing talk therapy or maybe basic medication managements. There are intensive outpatient programs where you go a couple of times a week. Usually, evenings to have group therapy or family therapy, individual therapies based on whatever symptomology. Maybe it’s depression symptoms maybe its anxiety symptoms, substance abuse disorders.

For some individuals, that three times a week isn’t enough. And so there’s a partial day program. For our youth, that looks like part of the day doing school-related activities. And then that group, individual and family therapy for adults, it’s pretty similar. There’s a new program that’s called Optimal Aging. That is for our adults who are moving into another stage of life and could use that extra support. If day treatment is not enough, we have different programs such as our crisis care center that can provide a short-term or brief intervention for crisis support. That would be more of a subacute kind of class.

David Pace

What does that mean?

Amanda McNab

So it means that they don’t need that really intensive environment that an inpatient hospitalization is. Maybe they need something shorter term, less than a 24-hour stay.

 

David Pace

Because it’s subacute symptoms.

 

Amanda McNab 

Exactly. And from that subacute, it might move into an inpatient stay where somebody’s there for four to 10 days or longer, sometimes depending on the symptoms, in a closed environment where they’re working with professionals and a team that are helping them.

With the subacute, it’s very similar, but it’s much shorter term. And they’re still getting the same connection with social work, psych techs, peer support specialists, psychiatry, just depending on kind of their needs at the time. But then be able to return to their environment after a shorter amount of time.

 

David Pace

Something like a detox program is something you offer for substance abuse. And then, but you also have beds that, well, I guess a detox would be an overnight situation for some people.

 

Amanda McNab

Yeah, within the inpatient realm, you’ve got detox for those substance-use disorders where people might stay for a few days just to make sure that they are safe and medically stable before going back to their home or to whatever environment they were in. There are mood disorder. There are some of that delusional or psychotic symptoms units that particularly focus in on those areas.

There are units that are specific to children and youth as well. So, adolescents or younger, depending on what the needs are at the time. Huntsman Mental Health also has other outpatient services like the psychedelic mood disorder clinics, etc. People are using electroconvulsive therapy, which can help those that are dealing with severe depression. Sometimes the delusional or psychotic symptoms, but oftentimes it’s considered for those that are treatment-resistant symptomology.

 

David Pace

So, there’s the whole, we’re talking about a huge suite or cohort of medical professionals, psychiatric professionals that are available. Actually, let me back up a little bit. Tell me how unusual Huntsman Mental Institute is in the country, because it’s kind of its own thing, right? Or it’s a prototype perhaps of what we hope to see more broadly?

 

Amanda McNab

It is. Because we’ve been able to really combine that academic and research side with the actual support and treatment of the community, it is a model that is hopefully at the forefront of finding what is the best practice. What is the treatment option that best fits an individual rather than treating everybody the same. And it allows for the training and support of the next generation of providers. Hopefully, meaning that they are seeing and part of that initial look for what really is going to be effective for people. So, we are one of the, I would say, leading groups in trying to create that connection between research, training, and the actual treatment.

 

David Pace

And then you have, and maybe we’ll talk about, well, I’m sure we’ll talk about this more later, but you have these centers, right, that are very outreach, outward facing, where people can drop in. I think you just opened a new facility in South Salt Lake.

Many of us are concerned about how it impacts society. I’m thinking of the unhoused, people living on the street, and also youth who are finding themselves literally out in the cold. And so these facilities are, obviously, it’s a gathering place, but do you also have, like, people in vehicles that can get a phone call and maybe go out and reach out in that way? Or do you, obviously, you’re going to have to rely on the EMTs and even the police in some cases, is that correct?

 

Amanda McNab

In some cases. So, again, within the crisis world, it’s a big continuum, just like with treatment. So, we can have individuals over the phone providing that level of support and care. We have individuals that are part of our mobile crisis outreach teams. We refer to them as MCOT, just because mobile crisis outreach can be a pretty long way of describing something.

But it’s a team of two individuals. One is a master’s level mental health professional. One is a peer support specialist that go to the individual to talk to them about what’s going on, what may have happened that caused them to become in a situation that they feel like they’re in crisis. And what we can do to help support them and reconnect them with their resources, their strengths to feel like they’re able to hopefully return back to a level of function that would keep them going within their current environment. Rather than having to go someplace like a crisis center.

 

David Pace

Some of the common factors I wanted to go over, because I think in general, all of us, I mean, if this is in fact as ubiquitous as we’re suggesting, it might be wise to go over some of the causes of mental illness. The ones that I know that you brought up in your safety day demonstration, 42% of those common factors were embedded in relationships.

 

Amanda McNab

Absolutely.

 

David Pace

28% problematic substance abuse. I think I’m going down in terms of how much. Well, no, I’m not. 15% are financial. And correct me if any of these stats are wrong, because I’m sure they’re in flux a lot. 4% are loss of housing, which is becoming more of a problem as housing becomes more expensive. 22% physical health problems. By that, you mean like disabilites, the ability to move around?

 

Amanda McNab

It could be disability, it could be pain, chronic pain issues, or possibility of things such as organ failure, having to be on transplant or dialysis, other areas of really the body not functioning the way that that individual needs it to at the time.

 

David Pace

And then continuing on, 9% criminal legal problems. These are people that have gotten in trouble with the law or have a felony or even not a felony, just anything that they’re now in the system. 29% are in crisis in the past or upcoming in the next two weeks.

What do you mean by that?

 

Amanda McNab

So, with the research, what they found is when people are anticipating something is going to go wrong, maybe having that anxiety that something really, really bad is going to happen. They’re anticipating something is going to affect their ability to function in the way that they currently are or maybe in the way that they want to be able to function. And so, the anxiety, the emotions that get connected to that can help create a sense of not having options. And that can push somebody into a crisis state.

 

David Pace

That’s interesting. So it’s connected to anxiety then.

Amanda McNab

It can be, yep.

David Pace

I mean, those are a lot of common factors. And I guess anything else, I mean, it’s probably endless. People respond or react to different situations, life situations. And then, of course, there’s the whole side of genetics. Yes. You want to talk about that a little bit? I mean, there was recently a report that I sent you, some research that’s being done here at the University of Utah, about how we are not able, in the case of suicide, to predict it. Our predictors are off . . . are possibly off. And that we have to look at that now as being a real mystery, a real puzzle as to how do we predict those that are suffering from suicidal ideation.

Is that correct? Did you read that article by chance?

 

Amanda McNab

I thought it was very interesting to learn more about the comparison of genetics between individuals who have died by suicide, who had a history of depression or anxiety symptoms, and those that died by suicide that nobody knew anything about depression or anxiety symptoms. They weren’t diagnosed according to their loved ones, to probably interviews and things like that. And they didn’t show any symptoms that people could visualize and say, oh, yes, they were dealing with depression or something like that ahead of time.

Which really can tell us how impulsive suicidal ideation and suicide attempts can be because it’s not necessarily always connected to the mood or to the different components that we’ve thought that it’s been connected to.

 

David Pace

So it really raises more questions than it answers at this point in a particular study.

 

Amanda McNab

I think it helps us to see that what we’re looking for can be red flags. It can be information that is helpful to identify somebody who’s at higher risk, but that there’s still a lot of pieces that are missing.

We’re still missing out on how other areas like genetics, like our socioeconomic status, the other areas of social determinants of health that aren’t really related to the medical side, but to our environmental side are connected. And how do we use those as red flags to be able to identify and support somebody who is at higher risk?

 

David Pace

What would you say to someone who is worried about their loved one? You just said it, right? We don’t know what all the red flags are. So, what would you say if someone suspects that someone might be considering ending their life? How do you approach the support system that you’re talking about, like parents, spouses, even coworkers? What would you say to them?

 

Amanda McNab

I would say if you have that feeling, maybe there’s something in your gut or there’s something that you’re seeing that just isn’t adding up, ask the question. A lot of people have been told, well, if you ask about suicide or you say the word suicide, that it’s going to implant the idea in somebody’s head. But that’s actually not how it works.

 

David Pace

That’s interesting. That’s good to hear.

 

Amanda McNab

A lot of individuals, if you’re asking them straight up, have you had thoughts about suicide? Have you had thoughts about ending your life? They may actually answer you with a true answer and say, yes, I have. And you’re the first person who’s asked me. And that opens up a conversation.

There are some people that are going to say, no, why would I ever do that? And maybe not actually believe that. They may actually have been thinking about it because we’re protective. We protect ourselves. We protect others. We think that we’re going to create a burden by answering in the affirmative.

And at least somebody has asked, maybe planted a seed that somebody is actually caring or putting that information out there for somebody else to maybe check back in with them later and see if they’re ready to talk about what’s going on.

But the biggest thing that family members, friends, anybody can do is just say, if you are, know that I’m a safe person to come talk to. Maybe if that individual doesn’t feel comfortable saying that they don’t feel like they can support somebody, letting that individual that they’re worried about know there are other supports, other resources. Like you put in the introduction, calling 988, being able to say, I’m having a bad day. Or the third party calling and saying, I’m really worried about this particular individual. What do I do? And then 988 and their crisis workers can help support them and maybe brainstorm some ways to address that individual.

And really in our society right now we are facing so many stressors and so many things that are going so it can be really hard to talk about just how bad it really is

You know, I think when we’re talking about supporting others, as human beings, we have, I don’t know if I would call it an ethical duty, but we need each other. We need that connection. We need to be able to support each other and say, something seems off. Can I check in with you? You know, there’s relationships, whether it’s personal, professional relationships with just seeing some stranger on the street and saying something just isn’t sitting right.

You know, if we’re not the ones to be able to respond, there are other people that can. Maybe if it’s a co-worker and you’re really worried about them, finding somebody else, another mutual acquaintance, maybe going to a supervisor and just saying, hey, I don’t know the circumstances. I don’t know what’s going on, but I’m really worried about this person. Do you have any suggestions or would you be willing to check in with them because I’m not the right person to do it?

Sometimes just walking up to the individual and saying, hey, something seems like you’re really stressed right now. Or I noticed that something has changed. Can I help you with anything? That individual may be like, no, no. You know, I don’t know you. You’re my co-worker. We’re not friends. Whatever it may be.

But you’re planting the seed of, oh, something about me is showing the stress that I’m under. Maybe I need to check in with myself, be more self-aware, and reach out to somebody else, if need be, to just make sure that I am doing okay. Especially at this time of year, when we’ve got so many stressors from our professional lives, our personal lives, just stress in general.

David Pace

We’re not just talking about something that we see in movies. And that we see in our histories and things like that. It’s all around us right now. Some of the statistics that you gave is that suicide is the second leading cause of death for age groups, 10 to 17, this is age groups, 18 to 24, 25 to 44, and the fifth leading cause of death for ages 45 through 64. To me, reading numbers make me gloss over. That sounds like everybody.

 

Amanda McNab

It’s quite a bit. It is quite a bit.

 

David Pace

And there’s one suicide every 11 minutes in this country. Is that correct? This is perhaps of interest for political reasons. 50% of suicides are by firearms. 54% who died from suicide had no prior reported mental health diagnosis, which goes back to the study that we were just referring to.

So, there’s different ways to respond to mental health issues that come up. Everything from somebody that you see on the street to a co-worker to a family member. And some of the things that you listed in your presentation was you discussed with us when emotions are high, what do you do? Can you unpack that a little bit? What do you do when emotions are high? Because I think we all have an intuitive sense of when somebody is just being enthusiastic or demonstrative and when there’s danger in the air.

 

Amanda McNab

Absolutely. That’s part of our primal selves. We have those mechanisms of fight, flight or freeze. When there is danger around us, our body automatically responds in a lot of ways. There is some research that there might really be a fourth, which is called flock, where people go to somebody during danger.

 

David Pace

So, wait a minute. Fight, flight, freeze, or flock? Okay. Talk to us about flock. We’re not talking about Christmas trees.

Amanda McNab

Nope. Definitely not Christmas trees. But with fight, you know, a bear breaks into the room and you’re getting ready to punch it in the nose.

Flight, you’re running out the back end, out the window.

 

David Pace

That would be me.

Amanda McNab

Absolutely. It’s a very common thing that most of us are going to do because of that instinct to keep ourselves safe. Some of us are going to freeze. We’re going to just stand there and go, I hope he doesn’t see me. And that’s okay, too. Other people are going to maybe run to the individuals that are in the room with them and try to help, try to protect, maybe even ask, like, are you okay? And the bear is still sitting there. It’s like, let’s go. But we’re going to move towards each other. That would be the flocking. We’re coming together as a group. And a lot of times we see that with individuals in the helping professions. Within our medical and mental health worlds, we see people that have more of that tendency towards flock.

But when we’re looking at those primal aspects, when we see somebody who’s in crisis, a lot of times we start to move towards a crisis point ourselves. So it’s a trigger. It can be. Absolutely. And so when we’re responding, the first thing we need to do is pull ourselves back from a crisis point. In my presentations, I always say, take a deep breath. That is step one. Being able to pull yourself back to a point where you can say, okay, what are the next best steps? This individual is obviously experiencing a lot that right now there’s something going on. Maybe it’s a physical threat. Maybe it’s a mental threat or emotional threat. What can I do next? Usually the next step is to find out what’s going on. Ask the questions. What’s happening right now? What is it that maybe you identify that you need assistance with? Most people in crisis aren’t going to be able to really give an answer, or they’re going to give an answer that is something somewhat connected, but not quite the base of the crisis. Maybe it’s part of the straw that broke the camel’s back at that moment. But finding out more information, giving them an opportunity to tell their story. Because individuals don’t always have the moment to let somebody know, here’s what’s really happening for me right now. This is my reality.

 

David Pace

Can you give me an example, without using any names, about maybe something you’ve experienced or that you’ve heard about that kind of illustrates this?

 

Amanda McNab

Absolutely.

 

David Pace

This moment where you’re trying to do some triage, it sounds like, almost.

 

Amanda McNab

So we had a situation within our family where my brother found out that he had some significant medical concerns that needed to be treated pretty quickly.

 

David Pace

So some diagnoses that came in.

 

Amanda McNab

Some diagnoses that came in. He, you know, I’m pretty a transparent person, but he’s the youngest of us four kids. And he was in a car accident. They had done an MRI. They saw something on his brain. Weren’t sure if it was from the car accident, what was going on. So they monitored it. And they found that it had grown a little bit, which is going to potentially lead to other diagnoses than just a slight brain injury. Turns out it was actually a tumor. So because of this car accident, we found out that he had brain cancer.

And so the family, of course, went into survival mode. You know, this is the baby of the family. Yep. We flocked together, you know, baby of the family. How are we going to protect him? How are we going to take care of him? What do we need to do? And started thinking through, okay, he obviously needs to get connected to doctors to have appointments. Who can take off a work to go with him for the emotional support? Who is going to be there when they decided that he was going to have open brain surgery? Who was going to be the one to sit with him overnight as he’s trying to wake up from anesthesia and kind of reconnect after having brain surgery with what his capabilities were going to be.

Thankfully, he is 100% fine. He has a little bit of word loss or some weird things with his writing that I’ve been helping him along the way because he’s working on a degree. And so I get to read all of his papers and edit for him. But that initial crisis point of being able to say, I’m in shock. And having my coworkers, our family friends, just say, what is going on? You seem really distracted. What’s happening? And me feeling safe enough to say to them, you know, my younger brother, he just got this diagnosis. We’re really worried. And them just sitting with me and saying, that’s scary. You know, what can I do to help support? What can I do to help? And often my response was, I have no idea. And I work in this field.

 

David Pace

What’s the line, Amanda, between what you would think is just biological or situational? And when does it, anxiety in this case, and when does it become a mental issue? Is that a fair question?

 

Amanda McNab

Absolutely. Again, we all are going to experience some form of anxiety, maybe low mood, stress, whatever it may be. And what it looks like for each of us individually at some point in our lives. But it’s when it starts to get in the way of us being able to do the things we need to do to function. So, with anxiety, it’s keeping us up at night, so we can’t sleep. Or it’s preventing us from being able to walk out the front door and go to work.

 

David Pace

So that’s when it becomes a disorder.

 

Amanda McNab

That is where it will become a disorder or at least meet the criteria for a diagnosis, potentially. It also has to deal with duration. You know, if you’re having anxiety, like with my little brother, having anxiety about the next MRI. It’s going to happen, right? The next time, did it come back? What’s it look like? What’s happening? That’s a temporary anxiety. You know, maybe it lasts a few days.

 

David Pace

That’s probably good to say. This is completely normal. What you’re going through.

Amanda McNab

Yep, that normalization, that validation, that this is a common experience for people. But it’s when that anxiety stays for months at a time and is preventing you from being able to really connect with others or go to work. Maybe you’re avoiding even your medical appointments because you just don’t want to hear bad news. That’s where it starts to lead into something that maybe needs a higher level of treatment or intervention.

David Pace

Let’s talk a little bit about the resources of the Huntsman Mental Health Institute. You had talked about 115,000 calls received by the crisis line in the last fiscal year. What are those calls? Is it texting? Is it a website you have to go to? Is it a, can you pick up the phone? Can you, you know?

 

Amanda McNab

It really is all of the above. We have the capability of taking phone calls. So people calling 988. We have our legacy crisis number, which is 801-587-3000 that people can call anywhere within the state of Utah or within the nation, really, and get connected with a crisis worker. Or somebody who can walk them through next steps, listen to the story, and employ resources to support over the phone.

There’s also different texting services. So again, you could text 988, just like you would text any other number.

We have the SafeUT app, which is something that can be downloaded on an Android or an Apple phone, and you can text basically back and forth with a crisis worker.

David Pace

What’s the name of the app?

Amanda McNab

It’s SafeUT. There’s also the websites for both 988 and for SafeUT where you can actually send chat messages back and forth. All of those are 24/7/365. They’re available all the time, all day long, all night long for individuals that maybe can’t sleep.

A lot of people think they have to be suicidal or feeling like they’re going to end their lives in order to reach out to crisis services. But crisis is defined by the individual. And so, really, we’re supporting people through a lot of other things. Bad breakups where they’re just struggling. Or a crisis where they’re going to be late for work. They feel like their boss is going to be mad at them. They might get fired. Now they’re having panic.

David Pace

There is a thing called layoff anxiety. It’s a diagnosable term.

 

Amanda McNab

There are a lot of different levels of anxiety that are going on. I don’t know that that one has made it quite to the DSM yet.

 

David Pace

Maybe I’m just projecting there.

 

Amanda McNab 

But it would definitely wrap in to the world of anxiety because it’s real.

David Pace

So we’ve talked about phone calls, texts. We also have drop-in centers.

 

Amanda McNab

Yep. So we have individuals that can go out to the individual who is in the mobile units. And those mobile crisis units are available throughout the entire state, every single county. And then we have the crisis care centers or receiving centers. Some people call them access centers.

We’ve got four here in Salt Lake County, two for adults, two for youth, that people could just show up at and say, I’m struggling. I need help. And they will work to connect them with resources, provide them that safe space for a little while to just be away from whatever it is in the environment. That’s triggering or really creating a lack of safety for themselves.

 

David Pace

Right. Well, this has been really helpful, Amanda. And I just want to reiterate that mental illness is ubiquitous. Even if you are not hospitalized, even if you’re not… At some point, I think the point here is that at some point in our lives, we’re all going to experience something that’s actually disabling. And it is considered mental illness.

And just to bring home the point yet again, you know, we’re talking about a real problem here. The CDC has indicated that Utah has the seventh overall suicide rate of 28.89 per 100,000, age-adjusted. That’s no small thing.

 

Amanda McNab

No.

 

David Pace 

So it’s very sobering. And overall, suicide is the ninth leading cause of death for all Utahns.

 

Amanda McNab

It is. And it’s a pretty scary statistic when we look at it because of the number of individuals that are no longer with us or the number of individuals who are thinking about the fact that they have no other choices.

So, the biggest thing that we want to do is be able to remind them that there are other options out there. And that they need to be explored first. Maybe have an opportunity to check in with that third party or allow somebody to step in and assist for the time being until they feel like they can take control again of the situation.

 

David Pace

Thank you. So again, the suicide and crisis lifeline is at 988. You can ttext or call 988. Today, our guest has been Dr. Amanda McNabb, Quality Improvement and Training Manager for Community Crisis Intervention and Support Services at Huntsman Mental Health Institute here at the U. Licensed clinical social work and just completed your PhD so mazel tov on that. And thank you so much for being here.

 

Amanda McNab

Thank you for having me.