Disability, Equity, and Mental Health Research Webinar Series: Transforming Mental Health Disability Research Through Lived Experience Leadership and Co-Production

Transcript

BESHAUN DAVIS:  Thank you all for attending.  Good afternoon, good morning, good whatever time it is where you are.  I know we're all in very different time zones perhaps.  I wanted to go ahead and kick this off by welcoming you all to our first webinar in our inaugural Disability, Equity, and Mental Health Research Webinar Series hosted by the Office for Disparities Research and Workforce Diversity at the National Institute of Mental Health. 

The main goal of this webinar series is to explore disparities in mental health outcomes for people living with disabilities, and our main goal with this series was to bring together a diverse panel of researchers, advocates, and people with lived experience to discuss the intersection of disability, mental health, and race and the role of pervasive ableism on the mental health of individuals with disabilities. 

To kick off today, we'll have a webinar hosted by Dr. Nev Jones, which will focus on understanding frameworks ‑‑ it says that someone can't hear me.  Can folks hear me?  Okay.  People can hear me.  Just wanted to make sure. 

To start, today's webinar will focus on understanding frameworks and methods for meaningful inclusion of people with lived experience ‑‑ meaningful inclusion and leadership of people with lived experience in the research process. 

My name is Dr. Beshaun Davis, and I'm the program director for Minoritized Populations Mental Health Research in the Office for Disparities Research and Workforce Diversity.  So on behalf of NIMH and ODWD, we're very pleased to welcome Dr. Jones to kick off our webinar series. 

Dr. Jones is a rising associate professor in the Department of Social Work at the University of Pittsburgh.  Her work is grounded in her personal and family experiences of schizophrenia and associated experiences with mental health services.  Dr. Jones is a thought leader and champion of participatory methods in the integration of co‑leadership of individuals and families directly impacted by psychiatric disability and the research, policy, and implementation of mental health services. 

She currently leads studies focused on early psychosis, community‑based SMI services, poverty and unemployment.  A really strong example is her NIMH R01 focused on understanding factors influencing decisions to apply for social security and disability benefits in young people with early psychosis and the impact of these benefits on career development. 

I'm very delighted to welcome Dr. Jones and to hear her presentation today. 

Before we kick off Dr. Jones' presentation, I just want to note this is the first in our webinar series.  Our next one will be on ‑‑ excuse me.  Our next one will be on September the 9th at 2:00 p.m., and that will be by Dielle Lundberg and Dr. Jessica Chen on the Framework for Understanding Structural Ableism in Health Care. 

So I'm going to be quiet, and I'm also going to put a link to the next webinar in the chat.  Without further ado, I'll hand it over to Dr. Jones. 

NEV JONES:  Thank you so much, Dr. Davis.  It's really a joy to be here, and I really want to thank the Office of Disparities for their incredible work and obviously Dr. Davis' leadership in putting together what looks to be a really incredible webinar series.  I hope folks keep coming back to see these and engage. 

I will go ahead and share now.  I have left a fair amount of time, a good chunk of time for Q&A.  So please definitely kind of, as I'm going through, put your questions using the Q&A function. 

Always slower to share PowerPoints than it should be.  Just diving in, I'm going to say a few words about myself, intro, but then kind of divided this up into three parts. 

Part I, I'm going to provide brief definitions, discussion of kind of key terms in this area, and then try to provide a bit of philosophical grounding for why lived experience and disability involvement and leadership in research matters, and philosophical grounding with a bit more kind of teeth than just sort of it's nice to add people on and to include some level of consultation.  Kind of really that speaks more to if we actually care about science in the deepest sense, we have to be doing this, and we have to be engaging actually with knowledge generated through lived experience in a deeper way. 

Part II briefly then I just want to talk about the landscape of participatory approaches and also how we might think about leadership development, barriers, and solutions ‑‑ again, kind of briefly ‑‑ to some of the more common problems that we see in the participatory research space. 

A little bit of international context, and I know there are probably some folks on this webinar who are based outside of the U.S.  My audience is kind of primarily U.S.‑based researchers in terms of who I'm speaking to, but I think there's a lot that we can learn from some of what's happened in other countries, and also it's not always a matter of it's perfect elsewhere and problematic here.  As things kind of advance, grow, and expand anywhere, there are also often problems and challenges associated with that growth.  So I'll talk about that a little bit. 

Then kind of back to the U.S., here we are, this is NIMH kind of leading the way in 2024, which is incredibly exciting.  So just sort of some select kind of resources, ways that folks can connect in more, and I think actually a pretty optimistic message at the end about there's a lot we have going for us, there's a lot we can kind of start to build on in a more systematic way. 

Here's me with a few of my doctoral students and in my office.  I really kind of got my start in this space through kind of lived and family experience and sort of kind of deep immersion in the system, in the context specifically of diagnosis of schizophrenia and sort of all that goes along with that or can go along with that in terms of the level of intensity of treatment, involuntary and voluntary hospitalization, et cetera. 

I also, because I was in an early, early psychosis, or what we call a coordinated specialty care program, got funneled into some research projects very early on, and that was at least part of what lit a fire under me in terms of the research component of all of this. 

Then I went back to school and have been kind of working in this space, in the mental health services research space ever since.  I have also done a lot of things on the side or sort of forays into adjunct spaces.  I work for the State of California in a policy leadership role.  I worked at a mental health agency in the San Francisco Bay area as a director of valuation and kind of quality improvement. 

Then I have co‑founded, co‑led two different regional Hearing Voices networks and also have done a tremendous amount of direct peer support and family support work focused on experiences labeled as psychosis specifically. 

As a researcher, mixed methods, so always that qualitative component as well as kind of participatory aspects of integration of a much broader set of folks and perspectives than I myself could possibly hold, have learned and continue to learn and learn and learn about what is happening in the United States in these spaces and what it might really take to really kind of change some of the areas of really deep inequality, injustice academically, what we call poor outcomes or really unacceptable outcomes, unacceptably bad outcomes in terms of people's lives. 

Then with that, with those kind of intro words in place, moving on to some definitions and then the kind of more conceptual grounding. 

Lived experience is a term that we see being used more and more widely, and it's certainly not only used in the mental health space.  Various minoritized communities have kind of taken up the language of lived experience.  Even when we are talking specifically about mental health, in a sense, when we just use the word lived experience in general, we're talking about a very broad umbrella or invoking a very broad umbrella. 

Certainly all kinds of people experience mental health challenges of one kind or another, especially maybe more transient mental health challenges.  We know from some of the epidata just on teenagers, on adolescents, that the majority, some estimates are as high as 60 percent to 70 percent of adolescents experience what gets referred to as clinically relevant depression. 

In some sense, lived experience of mental health challenges is more the norm than not.  Simultaneously, of course, there are many kind of conditions, experiences, and intersections that are seriously, seriously underrepresented in the research and policy workforce and that are insufficiently present in a way that could really kind of reshape research and policy agendas more meaningfully. 

These are just some examples:  Long term serious psychiatric disabilities, highly stigmatized diagnoses like schizophrenia.  The research is sort of replete with evidence of how stigma against schizophrenia has actually been worsening decade on decade, and there are very, very high levels of experienced discrimination in educational and work settings, among others. 

Intersecting experiences of what I think kind of goes by the hashtag disability poverty and structural racism and various forms of system involvement.  So folks who are really experiencing these intersections end up incredibly underrepresented, and I think often the priorities that stem from really experiencing these intersections of systems and kind of social attitudes are really underrepresented. 

Experiences of the loss of rights due to disability or mental illness.  So some of the more severe and frankly more carceral consequences of mental health or psychiatric diagnoses are underrepresented, I think, among folks who are making decisions about what research matters and what to prioritize. 

Then, again, going along with kind of long term psychiatric disabilities, experiences of long term and/or intensive service use.  So examples of that could be experiencing high doses of anti‑psychotics for very long periods of time, actually experiencing LAIs, or long acting injectables, the injectable form of anti‑psychotics, intensive case management, assertive community treatment.  So a lot of stuff that especially in public sector mental health services research gets studied, but we don't have folks in the research workforce who have actually experienced those same interventions, or we have very few. 

So lived experience, it is a big umbrella, but that doesn't mean that it isn't really critically important to think about the particular areas in which we see sort of the most significant underrepresentation, sort of decentering, marginalization of perspectives that stem from certain experiences, and it's not just kind of all the same. 

Lived expertise is a term that I think we've been seeing a lot more of in the last couple of years.  So the idea behind lived expertise is that you're taking kind of lived and living experience in combination with other areas of experience and work that are not disconnected from the lived experience.  So that could be advocacy and activism.  So is somebody who maybe originally on the basis of their personal experience but has accrued a wealth of experience actually organizing communities, organizing for change, learning policy, et cetera.  Also, work experience that could be in a more formal, less grassroots kind of setting, but as policy, as research, program development, whatever it might be. 

The education in question here might be formal or informal or a combination of both, but sort of the point is that lived experience is a critical piece, and it's then that lived experience infusing and becoming integrated with experiential knowledge and skills in areas relevant to really kind of advancing social change. 

Psychiatric disability then, and this webinar series has an explicit sort of not just psychiatric disability, but spectrum of disability, cross‑disability kind of frame.  So I wanted to kind of pull out psychiatric disability specifically because there has historically been some degree of tension between the mental health side of kind of organizing grassroots activism and other aspects of kind of cross‑disability advocacy, which historically, like the independent living movement, started really more around physical disabilities, and you have a lot of work that's developed in the intellectual and developmental disabilities space, and not everyone on the mental health side has embraced the language of disability.  I think we see more of that in sort of younger generations, but there's a range of views. 

At the same time, I think in the U.S. certainly, social welfare and civil rights legislation protects any of us, protects individuals on the basis of disability.  That is the legal ‑‑ right?  That's the legal frame for the sort of rights and protections that we experience as a result.  And that includes the Rehabilitation Act, the Americans With Disabilities Act, the Social Security Act, so people's claim to SSI or SSDI in the United States.  It means that de facto in some way a very large number of people, very large number of people with mental health challenges meeting criteria for disability are being served by and encompassed under disability‑based and disability‑driven systems. 

And I say this also in part to really emphasize the importance of NIH's recognition of disability conditions as inclusive of psychiatric disabilities and disabled individuals as a health disparity population.  As many of you probably know, this is new.  This just has happened within the last year in terms of NIH actually formally designating disability or disabled individuals as a health disparity population. 

So really, really important to also kind of think about this disability frame explicitly when it comes to mental health. 

So now I'm just kind of segueing from those kind of key terms to more of the philosophical grounding.  One of the places I think that kind of participatory researchers, methodologists working in the participatory space, go is to a body of work that is called standpoint epistemology.  So in Bowell's kind of summary version of standpoint epistemology, there's three core claims that I modified a little bit here.  One that knowledge is socially situated:  Knowledge about relationships, knowledge about power relations, knowledge about systems like SSI or the criminal legal system, et cetera, that knowledge is socially situated.  We see things differently depending on our own vantage point, depending on how we have come to experience and know things. 

Marginalized groups simultaneously tend to be socially situated in ways that do not guarantee, right?  So there's no just guarantee, but as a general rule, make it more possible for them to be aware of things impacting their group and asking questions than it is for the dominant group.  So when you are on the sort of receiving end of oppression, marginalization, on the receiving end of services maybe in a more benign way, you are experiencing things in a different way that raise different questions that can be, of course, formalized as different research questions that may highlight structures and relationalities involved that are really, really critical that may complicate, as the case might be ‑‑ and I'll kind of talk more about this later on ‑‑ but that may complicate the sort of status quo, dominant narrative about a given set of experiences or social conditions. 

Then standpoint epistemology argues that research, particularly that focused on or that implicitly or explicitly involves power relations, should begin with the lives and lived experiences of the marginalized, of those belonging to the marginalized groups in question. 

You can kind of see how this gives us one important potential kind of foundation for making the claim that participatory methods and bringing in folks with lived experience of mental health challenges and/or disability is so critical. 

In the standpoint epistemology literature, theorists and philosophers working in this space have also talked about and elaborated on this term epistemic advantage.  So this is an advantage pertaining to knowledge about a particular topic, experience, set of social relations, et cetera, meaning you have been attuned to certain kinds of experiences or simply directly impacted by them in a way that actually opens up areas of knowledge, direct insight, and understanding that are not available to somebody who hasn't had those experiences or that may be less available to someone who has never actually experienced those things. 

Just to give you some examples, which kind of hopefully maybe bring this to life a little bit more, what it's like to actually experience, let's say, intense psychosis as opposed to seeing it from the outside.  A different kind of example, what it is like to experience the chronic and ongoing dismissal of experiences of psychosis, meaning they're dismissed as, well, that's mere psychopathology, that's just symptoms, we're not going to take it seriously, we're not going to have a conversation, we're not going to kind of dive into that.  Right?  So in a way that is very unlike how other kinds of experiences are responded to in a social context, where we would ask questions and discuss things and take what people are experiencing seriously. 

So what is it like?  What does it do to a person to experience this chronically, repeatedly, over time potentially in all of their interactions with the mental health system?  What if we add on the layer of kind of social exclusion, social abandonment, so that somebody is no longer even able to have normal conversations at all because they have become really socially isolated, are only interacting with clinicians, and the terms of those engagements are along these lines?  What does that do to somebody, right?  And how can we rethink that from the inside out? 

Continuously being labeled as paranoid and threatening ‑‑ and I think here if we think particularly about somebody who identifies as black experiencing psychosis in the United States, where we have this rather horrific convergence of stereotypes that bring schizophrenia, blackness in our society together ‑‑ so paranoia, threat, fear‑based responses.  Then what happens when somebody ‑‑ there's not only this backdrop, but their experience of the system is being repeatedly handcuffed, secluded, or restrained in the context of crisis intervention or acute services and hospitalization. 

What does this really do to a person?  And again, as with the prior example, again what does it mean to be able to think ourselves out of this from those experiences where those experiences are the center, and what complications do they raise in terms of the magnitude in a sense of what really needs to change?  So that is sort of the potential for epistemic advantage. 

Epistemic oppression is another key term that again gets used in the standpoint epistemology literature, but not just there.  Epistemic depression ‑‑ and I'm using Kristie Dotson's definition here ‑‑ it refers to persistent epistemic exclusion that hinders a group's contribution to knowledge production.  And again, epistemic just meaning pertaining to knowledge.  So persistent inclusion in areas relevant to or inclusive of knowledge and knowledge production that hinders a group's ability to contribute to that knowledge.

So what we've come to think that we know as scientists, as researchers, as a society about particular groups, to what extent are those groups, are those who we are writing about, those who we are studying actually influencing the production of knowledge about their own group, about their own lives, about themselves? 

This becomes oppression when systematically we are minimizing people's ability to influence knowledge production.  Dotson talks about some different kind of forms this can take, and this is not comprehensive.  I encourage people to read her work directly for a more detailed version, but I think some of the key areas I wanted to pull out is dominant shared language and instituted social imaginaries, so how we come to think about society and social relationships, that have been formed largely to reflect the experiences of the dominant group. 

The fact that experiences which are unique or more unique to the minoritized group can be left obscured by the way in which collective epistemic resources have been formed.  And there's many examples of this that folks writing in the epistemic oppression space draw on, but we can think about any number of different experiences of oppression, marital rape is one example that a term to describe this phenomenon didn't even exist if we go far enough back in history, and that is because of kind of gender dynamics and hierarchies and oppression, right? 

Then I think kind of taking it one step even further, the fact that even when a marginalized group may come forward with testimony, with claims, with concerns, that that in the context of epistemic oppression may not afford a momentous enough occasion to catalyze the appropriate alterations within shared epistemic resources ‑‑ coming up with new language, accepting new language, accepting the concerns that are being brought forward not only as valid concerns, but concerns that push us towards action or require us to take action to address them. 

So it's really we're taking it seriously enough to take action in response, to change things in response, and she's saying sort of, again, sure sign of epistemic oppression when even though people are coming forward with the concerns, they're not taken seriously enough that society or policymakers or kind of whoever the powers that be are actually take action. 

I wanted to give an example specifically tied to the phenomenology or the experience of psychosis.  This is honestly, in terms of my own research trajectory, where I started my dissertation focused on the phenomenology of psychosis, and that was because by the time I got to my Ph.D., I had so much pent up frustration and anger about the degree of oversimplification, reductionism, outright invisibilization in and through the use of standard diagnostic tools, like the SKID, standard measures of, quote, unquote, psychopathology, and how that goes to shape the questions that physicians ask even when they're not following or using a formal instrument, right?  It's very frustrating and felt like this was an incredible source of gaslighting, invisibilization. 

So we have ‑‑ again, just to kind of speak now in more general terms, we have conceptualizations of psychopathology in the area of schizophrenia, or what gets labeled schizophrenia, that overwhelmingly have come to focus on observable symptoms, observable from the outside by second party or third party observers, and then those that are easy for providers to agree on or that are easy to procure some form of endorsement through self‑report. 

This means that dominant language and conceptualizations have tended to fixate on things like hallucination, and hallucination understood ‑‑ this comes straight from the DSM ‑‑ perception in the absence of a stimulus.  Delusion ‑‑ definition straight from the DSM ‑‑ a fixed belief that persists despite evidence to the contrary.  And this kind of language and thinking in some sense profoundly fails to capture, if one does careful qualitative work in this area, if one is regularly engaged in peer support driven work with folks experiencing psychosis, the very common experiences of extreme ineffability, that the changes are so profound and so complex that they do not in any way just neatly map into these areas of hallucination or delusion, and whether they even fit is a whole nother question. 

So many experiences that I think for many people fundamentally defy the separation between perception, thought, selfhood, consciousness, right?  And yet we don't ‑‑ that's what we're ‑‑ we're not paying attention to that. 

For many ‑‑ so here's the internalized form of kind of epistemic oppression here ‑‑ over time the shared dominance of these clinical conventions can come to obscure or even erase these experiences for people themselves, and there is no language that really kind of captures them.  So even people with direct experience are going to kind of fall into, well, the only word I have is hallucination or voice.  The only word I have is paranoia or delusion. 

Of course this also impacts researcher and clinical conceptualizations, and it becomes these reinforcing feedback loops where then we kind of focus our research in particular ways around these constructs and over time can get ever further from the actual experience and what might matter to people who are actually kind of experiencing these changes. 

Even when attempts are made to correct, to push back, the status quo persists.  So I have an example of this.  Again, a number of these are my papers, but also want to call out Clara Humpston in the UK who has done incredible work in this space.  I don't have any papers up here from folks on the Hearing Voices side, but there's been amazing work happening from voice‑hearer researchers in many countries.  One of my students Shannon Pagdon has been doing a tremendous amount of work around this.

So you have kind of researchers with lived experience of schizophrenia, psychosis, hearing voices, saying this is just a dramatic oversimplification.  You are not describing what people are experiencing, and we're losing sight actually of what people are actually experiencing, and that influences clinical practice, and that influences research. 

In spite of that, and even when things start to take the form of kind of very credible scientific peer‑reviewed publications, it's like the field can't reabsorb this more fundamental challenge to the way that it has come to conceptualize what people are experiencing.  Examples are the relatively recent NIMH EPINET initiative, very absolutely conventional kind of measures that are being used and are being deployed in realtime all across early psychosis programs in the United States. 

The DSM has not appreciably changed in any way in terms of its conceptualization of schizophrenia.  I don't want to say no matter how much pushback there is, but there's a lot of pushback from people who actually have the experience themselves, and yet the field doesn't change.  That's this third layer, to go back to Dotson, of kind of epistemic oppression. 

These are the changes that we really need to overcome if we really want to do different forms of participatory research, if our goal in doing participatory research is real change, is really to be open to significant rethinking with the prospect that then we really would make leaps in knowledge and really advance and really kind of address seemingly persistent sources of inequality and exclusion.  I think this is what we have to be open to is sort of challenges of this potential magnitude. 

Just a summary for this section, lived experience in the broadest sense is ‑‑ in the broadest sense is universal.  Even lived experience of mental health challenges is close to universal.  But that leaves many disability groups seriously underrepresented in the research workforce and in knowledge production, and we need to take that very, very seriously.  And these perspectives and knowledges, often even when there's academic credentials appended to somebody's name, continue to be marginalized. 

These knowledges are anything but ancillary to the work of mental health research.  They're not just a nice extra.  It's not just for kind of virtual signaling purposes that we would do it.  I'm trying to argue that they are fundamental sources of insight and attunement that we would otherwise lack.  In many cases will pose or will lead to people posing fundamental challenges to the status quo because those experiences lead them to understand, see, conceptualize the same issues very differently. 

And at the end of the day, again, the deeper work of equity and diversity is far from easy.  It's easy when we're thinking about a very superficial form of, well, we can have an advisory committee, and that will improve our recruitment fliers.  That's easy.  These deeper forms of really bringing people into the knowledge production are anything but easy. 

So then this is a little bit of a seg now.  Zooming back to what do we mean by participatory approaches?  What does this look like?  What I use here is the Stakeholder Engagement Framework, and there are a number of such frameworks.  I think this is one of the more influential and widely cited overall.  There's a lot of similarities if you look at different kind of spectrum or continuum or sometimes they are kind of visualized as a ladder. 

So we start kind of on the ‑‑ can't tell whether this will be the left or the right side for you guys, I guess the left side still ‑‑ informing.  This is where researchers are just bringing back their findings kind of to people who are impacted. 

Consultation, the next level up, is actually where we probably most commonly see under the rubric of participatory methods.  So the most common thing to see here is some kind of community advisory group, stakeholder advisory group, service user advisory group.  Those are probably the most commonly used terms in the U.S., and researchers are obtaining feedback on the research.  But those who are in consultant roles, especially at this level, generally have no actual say over what's being done.  They're giving their two cents.  The research team can just take it or leave it. 

Involvement then, the next level up, researchers work directly with stakeholders to ensure that stakeholder concerns and aspirations are consistently understood and considered in the research.  It's sort of like a more thoughtful version of consultation where it's not just sort of take it or leave it feedback to quite the same degree, but there is a level of kind of commitment to making changes that would reflect kind of stakeholder concerns. 

Do want to flag here that I know there are lots of critiques of the language of Stakeholder in the U.S. and other countries right now, but this is not my framework.  This is just a pre‑existing widely cited framework, hence the language. 

We will work with you to ensure your concerns and aspirations are directly reflected in the research, and we will provide feedback on how your input influenced the research, so some level of accountability.  We're going to tell you if we decided to just not make the changes you suggested, and I guess explain why, or we're going to show you where we actually made those changes. 

Collaboration is a higher level up.  Researchers develop equal partnerships for stakeholders for undertaking the research.  So this is maybe more a co‑production, co‑design kind of model, or kind of co‑production/co‑design would arguably fit here.  We have a much more robust, mutual relationship between folks who have been directly impacted by whatever it is that is being studied and researchers who don't have that experience.  Of course this could include researchers within/without lived experience working together. 

Then kind of support is the next level up where really the research is led by the impacted communities, the research is led by the individuals who have the experiences or identities in question, and non‑lived experience researchers are there to support, there to support an agenda that in its most fundamental sense is being set by those most impacted. 

I'm sure that people will have those kind of questions so we can kind of come back to this.  Just to lay out, there's a range of options.  People might use language of CDPR or participatory research.  Really the devil is in the details, and those details can run the gamut of what we see here.  I think that more often falling on the more kind of superficial, limited consultation side. 

What are the problems there?  Because there is a lot, or relatively speaking there's a lot more of this consultative involvement, there has been a lot of critique.  Especially in countries that are in some sense farther ahead, people are really kind of seeing the ways that kind of claims of involvement can, in fact, go awry or amount to something that's very superficial.  So some of the language taken up in this space is of cooptation.  So this is just a classic older definition of cooptation I have here, the process of absorbing new elements into the leadership or policy‑determining structure of an organization as a means of averting threats to its stability or existence. 

So we might integrate lived experience involvement that is very limited that is very superficial in order to defuse deeper concerns or criticisms for more fundamental second order change.  We really need to change things kind of push.  Instead, well, we have this clinical trial that focuses on this pretty status quo intervention.  Let's bring in people with lived experience to see if they have any suggestions that would make it just a little bit better. 

So that is one of the forms that sort of cooptation potentially takes.  Some people would consider tokenization to be a form or variation of cooptation, but tokenization is where we have the involvement of a very small number of individuals, and they are treated and deployed sort of as if they represented the views of a larger and generally much more kind of heterogeneous and diverse community or population.  Often people have made the accusation that research teams will find a few people with lived experience who already agree with the particular line of work they're doing, bring them on.  Sure enough, they agree, and it becomes a form of kind of rubber stamping, whereas other members of the broader population may have very strong concerns about that same intervention or target area or way of doing things. 

Extractive involvement is another source of concern.  So this is sort of using ‑‑ or one form is using lived experience consultants to generate exciting new ideas, but those individuals are not really credited.  Instead the researchers may emerge, look at the brilliant new insights we have, and it's really bolstering the careers and the standing of the academic researchers involved or extractive involvement that's more about sort of, which is related to virtual signaling below, putting people as deep middle authors, as I put it, on a paper so that you can say, look, we involved people with lived experience.  Whereas in reality those folks had very little say over the research, sometimes very superficial roles in the writing and conceptualization of the manuscript or even of the project as a whole. 

Then in a more limited sense, just virtuous signaling would be any amount of kind of involvement that is really more there to make it appear that research teams or initiatives are acting in more kind of community engaged ways while they're not really kind of fundamentally shifting practices, they're not fundamentally rethinking what they may or may not be prioritizing. 

This is brief.  There's a lot too.  There may later on in this series be dedicated webinars that just sort of dive more into the methodology.  I'm trying to keep this relatively high level because there just isn't enough time to really go in depth. 

How can we then ‑‑ so if we sort of acknowledge there's this spectrum of involvement, there's lots of problems, there's lots of concerns, especially in countries where more of this is ostensibly happening, so there's more opportunity to see how it's going awry, how do we ensure that involvement really matters and matters in this deeper way? 

So I wanted to start here by really emphasizing the values piece, right?  So we can't just kind of follow a manual in order to get this right.  It's really about a shift in the way that researchers and trainees think about the kind of project that we're engaged in.  I literally mean this at the highest level in the sense of what is the scientific enterprise really about, right?  It's not about career advancement or personal power, personal prestige.  It is in sort of more formal conceptualizations, in fact, about really advancing knowledge and changing outcomes, changing outcomes that are unacceptable or suboptimal. 

If that's what we're committed to, then we will embrace challenges to the status quo.  If the status quo is not working and there are underrepresented groups who have hard questions to ask, who have new ideas, who have innovative ways of thinking about how we might change and restructure things, those will be incredibly welcome to us, right? 

And they, we will recognize them as having the power to push us all as individuals to be otherwise than we are, as a field to be otherwise than we are, to think differently, and to achieve things that we have not. 

I think in many areas of public mental health services there is very little controversy about the level of sort of brokenness, dysfunction, unacceptable outcomes of all kinds from kind of premature mortality on the order of 15 to 20 years for folks diagnosed with schizophrenia in this country, unemployment above 75% for people diagnosed with schizophrenia, levels of homelessness and criminalization that are incredibly disproportionately high. 

So I think we can accept that we are not where we want to be.  If this can help us get there and we care about the scientific enterprise, we really need to kind of like embrace this in a deep way. 

Then kind of commensurate with that is humility.  We absolutely need humility.  If we think that we already have it figured out, that we are the source of all the answers, right, and if we don't have the ability to reflect on our own uses or misuses of power, we do not have that openness to change that, again, the scientific enterprise so badly needs. 

There is also some more pragmatic stuff, and there's a lot we could talk about here, but I'm being somewhat selective. 

Meaningful involvement, the relationship building, the trust building, the community engagement, the multi‑layered aspects of it generally does slow down research, right?  Because you have group processes to make decisions rather than a PI in a top‑down way saying, this is what we're going to do.  That slows it down.  That means, if anything, when a project is being pursued in a genuinely authentically participatory way, it requires more money and more resources. 

There's also capacity building involved.  So if you're bringing in kind of folks from non‑academic spaces or who don't have that background and training, it is unfair to think that people can intervene in research without first being empowered to kind of critically digest the research and the methodologies in question.  So there's this training and there's this capacity building in addition to sort of the other ways that the process slows down. 

In my experience almost universally, you bring in a diverse group of folks with direct experiences of the thing in question, and they're going to complicate any possible narrative that you or the research team came in with.  It's going to complicate.  It's going to raise difficult questions.  Again, that makes the work a lot deeper, but also harder and more time‑consuming.  Often really hard questions about ethics and values will also be raised, not just utilitarian goals like NSRT, but deep questions about but is this simultaneously the most ethical way to go?  What about the values that are really in play or enacted here? 

Just to summarize, we really need more funding and resourcing, particularly when it comes to community partners being brought on.  We have all the kind of general criticisms of kind of in reality things are team science but the field doesn't recognize them as such come into play, but in an even more kind of pressing way.  Just the first and senior author counting on publications, all the indirects from a grant going just to the contact PI or the PI depending on how institutions work this out.  So all those kinds of top‑down problems that don't really, truly recognize teams ‑‑ teams as the fundamental unit, rather than individuals or PIs ‑‑ are a problem, are in tension with what we're trying to do. 

More broadly, I think, quality over quantity.  When we're talking about slowing down, asking difficult questions, raising complications, we have to then really kind of care about quality rather than churning out papers or grant applications, et cetera. 

Leadership development.  So a lot of CVPR historically has tended to focus on engagement with like community organizations or, in many cases, geographically identified communities.  In the mental health and disability kind of lived experience and involvement spaces, we're also just as often talking about folks who are being hired to work on research projects, students with lived experience or students with disabilities, and then them moving up the pipeline.  So I think there's a lot of parallels here and sort of what we could think of as the importance of investing in leadership development parallels to training and leadership development initiatives across many other areas of sort of minoritization and under‑representation. 

Lots of parallels.  Disability does involve some unique barriers and challenges that are not always covered well by programs and supports that have been developed for other groups.  Especially when we're talking about mental disability in the context of academic research, there's a fundamental tension between disability of the very thing that historically has just been sort of valorized as the center of the whole kind of project and enterprise of academic research. 

So I think it's important to also really understand that there are some unique challenges here that we have to frontally deal with.  If we can really invest, we have the potential that we're not just talking about a landscape in which there's collaboration between community members on the one hand, researchers on the other, but we're actually now growing the workforce of PIs, or future PIs, who are going to approach the work, their entire body of work, with different priorities, with different attunements, with different ideas when it comes to innovation and change. 

We are potentially in the future supporting entire lines or trajectories of research that otherwise might never exist, either because they wouldn't be prioritized by people without the experiences in question or certainly are less likely to potentially.  So I just want to stress leadership development as well. 

I know I am spending a bit more time talking, so I am going to try to move a little bit more quickly through these last slides. 

I think I mainly want to flag, especially for anyone out there who's less familiar with the international kind of landscape of lived experience involvement and leadership, that there's a lot that we could learn.  I think it's probably a pretty uncontroversial claim to say that overall many other countries are well ahead of the U.S. in terms of how developed lived experience involvement requirements and infrastructure are. 

So examples of this.  The NIHR in the UK requires service user involvement.  It's not a choice.  It's not a suggestion.  It's mandated.  Components and plans must be submitted, and they're scored and rated as part of grant review.  Same thing is true for the Wellcome Trust, which as folks know is based in London.  Technically funds more international research, but it's a UK‑based entity. 

Dedicated lived experience‑led research centers funded by the national bodies in existing countries.  I'm giving two examples, the Service User Research Enterprise at King's College London, and ALIVE at the University of Melbourne.  ALIVE includes several other universities in different parts of Australia but based at Melbourne.  We don't have anything like that in the U.S.  We have nothing like that.  We have the potential for NIMH ALACRITY centers to be used in that way, but no such thing exists. 

Third sector research involvement coordinating organizations.  The McPin Foundation in the UK functions to link, for example, universities to community members who want to participate in research and provides comprehensive kind of country‑wide listings of where there are research involvement opportunities.  So we don't have anything equivalent to that in the U.S. 

We don't have dedicated service user/consumer academic positions, which now exist, again, in New Zealand, Australia, Canada, and the UK and several Western European countries I'm aware of as well.  This is where kind of institutions are saying this is so important that we need dedicated chairs, dedicated positions.  We need to actually be hiring people at various levels all the way up to kind of full professors. 

Then dedicated scholarships and fellowships for students with lived experience that are really taking into account the impact of disability and the often very significant impact of disability in terms of creating additional kinds of barriers for folks as they try to navigate their way through. 

So there's some really important examples of mechanisms and infrastructure that we don't have here.  We don't have to reinvent the wheel.  We can look to these kind of other countries and other contexts.  But also, as I've mentioned before, there's greater ‑‑ I think the UK term I see the most for this is tick‑box involvement or a tick‑box exercise where, because there's the mandated involvement plan, all the researchers know how to write it, but it is not really, again, meaningfully impacting things.  There's more extractivism once it's kind of incentivized to look like you're involving folks with lived experience more.  There can be an unfortunate tendency to sort of use that in the wrong ways for the wrong reasons. 

And there's still more emphasis on lower level consultation than there is truly investing in leadership development, in the development of PIs with lived experience of psych disabilities. 

This last section I'll do very quickly so we have time for questions.  Again, please keep putting them in the Q&A. 

I wanted to end on a really optimistic note.  Five years ago, if you'd asked me how much hope I had in NIMH helping lead the charge, you would have gotten a very, very cynical response, and I very genuinely feel there is incredible energy and investment from many folks at NIMH right now in equity, in lived experience integration and involvement, in participatory methods. 

Just to call out a few things, the Office for Disparities Research and Workforce Diversity, who's hosting this, so many incredible people, including Dr. Davis, who introduced me.  The whole webinar series that we're seeing here is really a sign of this real investment and commitment we haven't seen historically. 

The whole range of notices of social interest and different kind of calls for proposals or targeted calls around issues that in many ways have long been neglected within the NIMH portfolio, everything from social insurance, systems policy, policy impacts on people's mental health, social and structural determinants, and environment in other ways explicitly calling out ableism, discrimination, and stigma as major determinants that we need to be studying in a focal way.  And I think some really important priorities right now in the areas of crisis response, peer support, and the peer workforce that we haven't historically seen.  So this is really an amazing kind of combination of energy and commitment with substantive opportunities to be applying for funding in really kind of key areas. 

I also wanted to call out the NIMH Common Fund ComPASS Initiative.  This is really kind of path breaking in that funds are actually being awarded to community‑based organizations, and a variety of different NIH institutes are involved, including NIMH. 

We have growing momentum within and across the psych disability user/survivor and cross‑researcher community.  I do want to acknowledge incredible trailblazers in this space who have done so much with so little support.  That includes Jean Campbell, who's no longer retired, Ed Knight, Peggy Swarbrick, Chyrell Bellamy, who will be co‑hosting an NIMH event this fall, which is a big move, and so many others, a lot of people who have kind of paved the path that we can now more easily walk on. 

And there's a lot happening to build community and bring people together.  So the QR code here, we'll try to put it in the chat too, but the QR code will take you to the home page for something called the Transform Mental Health Research Initiative, which I've been involved in.  We have a Listserv, and it creates kind of a meeting and discussion place for folks invested in this space.  That includes students, researchers with and without lived experience, allies.  All are welcome.  Everybody who wants to see this space grow, who wants to support lived experience involvement is welcome. 

I want to shout out to David Mordecai, who's out in the audience, who really did a lot of work in the last few days of getting the website revamped. 

Graduate students, lived experience graduate students who are organizing to support each other and map out mentorship.  Again, I have the QR code here if you just want to scan it.  We'll try to put it in the chat.  I think at least kind of two of the graduate students behind these efforts, Sarah and Jeff, are out in the audience as well.  So they are trying to kind of create more mutual support and organizing between graduate students with lived experience as well as trying to figure out ways to map out the landscape of what's available out there and how to connect folks who are interested in getting Ph.D.s to prospective mentors who would be really kind of interested and invested in hosting them. 

There is a survey up on their website too which specifically kind of asks if you are a mentor, regardless of your own lived experience, if you're a mentor, you're a professor, you're a researcher who is interested in supporting folks, fill it out, and we can kind of start making those connections happen. 

These are just some references, which I'm sure will be posted eventually, and that's it.  Now we can move to questions. 

BESHAUN DAVIS:  All right, Nev.  Thank you so much for such a great presentation.  I feel like, like I said, you were the perfect person to kick off this webinar series.  There was so much in there that we're going to have a lot of rich discussion about. The chat has been blowing up, the Q&As and questions.  I think people have lots of things they would like to see us discuss. 

While I curate some of these questions, I have sort of an opening question for you.  It's really just thinking about this idea that the stakeholder engagement framework that you presented, and I feel like there's a lot that happens when people say that they're integrating people with lived experience into their research, and I think sometimes people mistake where they're at on that continuum, right? 

So I wonder like what questions do you think researchers should be asking themselves to think about if they're meaningfully engaging people with lived experience and leadership in coproduction in a significant way that's not tokenizing or anything on the lower end of that spectrum? 

NEV JONES:  I think that's a really important question.  I think part of the question is kind of the power dynamics that often come into play, and I'm working with some of my mentees on a book chapter right now, and we're also kind of simultaneously working with some interviews that we did with folks that have been involved in research, and I think a consistent theme is like feeling like you actually can't speak up. 

It's not necessarily visible to the researchers because they don't know that you're holding back, that you feel afraid, and some of that is that generally people are being brought in in a way that they're in a subordinate position, whether they're students, whether they're being brought in as research assistants or something like that, or they're kind of community members who don't have the same sort of titles, power, clout.  They're usually paid substantially less than sort of the PI of the project.  So there's all kinds of things that influence that. 

I think researchers in leadership positions really asking themselves, if I was in this person's shoes, how comfortable would I feel raising more significant challenges?  Talking about maybe feeling like the wrong decisions have been made, feeling like I can't kind of persist in a line of kind of critique or questioning like one such as, well, no, just push that to the side, just giving up.  So I think that part of it is really important. 

I think, if you're adding people to a paper that they have not been meaningfully involved in, really, really thinking about that.  I think we've talked to a number of people ‑‑ and hopefully we'll be getting papers out on this ‑‑ who actually feel very harmed by that.  It might feel like, oh, but I'm doing the right thing.  I'm putting somebody on this paper.  If they haven't been meaningfully involved, it can send a really harmful message about what does it even ‑‑ what does it mean?  What does any of this mean? 

I think there's maybe a lot more of that happening than people realize.  Even when they're well‑intentioned, they're sort of not grasping, I think, how this is in fact being experienced by folks with a lot less power in the process. 

I think the other thing is like asking oneself is one investing in leadership development?  Is one saying, okay, I'm working with you as an RA or a graduate student who has lived experience?  Am I giving you some funding to lead your own projects?  Or the same thing applies with the community.  Are you coming in because you want to further your own research aims, are you really thinking about how am I building folks up to lead themselves?  And how am I using my money, my funding, my resources to give them those critical first opportunities to really be calling the shots, to say what the priorities are, to do the projects they want to do rather than you're just doing what you want to do? 

And there's intention there with the way funding works, but I absolutely think also most researchers, most professors can certainly get creative, find money, and find ways to really support community leadership.  So we're talking sort of the other side of that spectrum going back to the kind of engagement opportunities framework. 

And that if we honestly, if we honestly ask ourselves if we're doing that, I think most people are smart enough to be able to realize, no, actually, that's not what I'm doing, then the values piece comes in because, if you're not doing it for the right reasons, you might be able to intellectually grasp what you're doing and in a sense it doesn't matter. 

So we have to build academic cultures out in a way that those values are something that is rewarded, that is instilled in trainees as they're kind of going up through the pipeline because, if we don't have those values, we can go through the motions, and there's always going to kind of be versions of these problems, I think, in fact, where things end up much more superficial and not really having the impact they should have. 

BESHAUN DAVIS:  No, it makes a lot of sense.  It seems like there's so many systemic changes that need to be happen to meaningfully integrate people with lived experience.  And also that piece about leadership development and kind of contributing to that idea of lived expertise.  Many people have lived experience, but they don't have these opportunities to develop into this sort of lived expertise sort of space to be able to lead in a meaningful way.  It's kind of like, if people are tokenized, they can't develop and can't lead in the same way, in the ways like academia sort of respects. 

I'm going to try and ‑‑ there's a bunch of questions in the chat.  I've tried to curate some of them.  I apologize because I see there's now 56 Q&A questions.  I'm selecting a few of them that seem really relevant.  I apologize if I can't get to everyone, but I'm doing my best. 

One question that I think kind of ties into this sort of systems‑wide kind of changes that we were just discussing is this idea like do you have any tips for early career trainees who want to engage in coproduction but have limited resources or have to move around because of training experiences and post doc, it's hard to form the long term community partnerships with the training model.  I wonder what you think about like this sort of approach for early career folks or trainees. 

NEV JONES:  I think one thing that its both an additional challenge and kind of an additional set of opportunities that maybe makes this easier is that I don't ‑‑ I think you see a more diversified set of kind of involvement ‑‑ what's the best way to put this?  Like ways to involve that are not just an identified community that's either geographically located or set of people who belong to a local ‑‑ service users as a local community mental health center. 

There's a lot of national groups in the U.S. ‑‑ the Alliance on Rights and Recovery is one example.  So I think if one is just strategic at a trainee stage, if you're connecting, for example, with a national group, it doesn't matter where you then go. 

If we're thinking about getting the skills and experience of bringing people into the team and mentoring them ‑‑ in some sense, this is not different from mentoring any other, anyone else, period, or any other under‑represented group.  You're building up people's skills that are going to continue to benefit them.  So you have an undergrad who you're mentoring and they go on to a doctoral program somewhere else, it's not just that they're working with you continuously, you are kind of contributing to capacity building and kind of pipeline development in a way that actually does continue to bear fruit. 

I think in some sense it's not just sort of geographically, locally kind of situated work.  It doesn't have to be.  Certainly if you're in the midst of a more kind of unstable period, you're in a post doc where you might be in one place for only a year or two, it is a very legitimate and good thing to be thinking about, and there's certainly workarounds where the relationships you're building truly are still relationships for life.  And maybe just COVID in general has also just sort of cracked open the we don't have to be living in the same place to kind of continue working together. 

The deeper the relationship is, the deeper the relationship is, right?  Like you may not have an active project, but if you become friends with someone, you're now ‑‑ it's just an organic part of your friendship is consultation and hearing people's ideas.  So that's like really, really important too.  I think kind of grants come and go.  You might kind of ‑‑ you will both lose and find opportunities to partner and repartner with folks if that is a real relationship. 

BESHAUN DAVIS:  That makes a lot of sense.  It's not just about sort of this academic partnership.  It's really about relationship building long term, and I love this idea of connecting with sort of national organizations rather than ‑‑ I think you can be hyper local and there's a benefit to that, but if the point in your training where you're at is not such that you're going to be in a fixed place for a long time, there's ways to do this and a way that doesn't, you're not prohibited from doing this essentially.  There's opportunities and ways to work around. 

I want to think about ‑‑ there's a couple of comments about epistemic oppression.  I think that was something when you were presenting that I was really fascinated by.  We have a couple of different questions in that area, so I want to focus on those for a moment.  We have one comment from BiraMS, who's a Queer, Trans, Andean peer specialist, who wonders about what do you see as the most viable ways to push larger systemic structures to center indigenous client‑centered and peer‑driven methodologists for activists, both for industry professionals and for peers with less industry background? 

NEV JONES:  Well, the pragmatist in me which this might sound a little like coopted, and probably when I was a beginning graduate student, I probably sounded more radical, but I place a lot of faith in getting people into the pipeline to position folks who are from really, really different, different to the status quo, very under‑represented backgrounds, in leadership positions because I think then you're placing people in positions where they can really kind of disrupt and disrupt in a more significant way.  By mentoring, by then continuing to mentor an even larger number of people below them who are bringing different perspectives, who are bringing a commitment to these kinds of methods and critical approaches, right? 

So I think that's a really, really big piece of this.  I think different versions of that are leaning to kind of change grant review because if you want to do participatory projects in ways that really robustly include communities, those who are impacted, you have to be able to pay them.  We can't just kind of exploit people working as volunteers.  So you need money, you need funding.  So we do need funding mechanisms that are really valuing these methods. 

I think, I was just scanning through, this relates to some of the other questions in the Q&A.  We do need this to be reflected in review processes and in who is selected as reviewers to do reviews.  Some of that becomes chicken and the egg, right?  You have to have funding to review.  But I also think that there are folks at NIMH who are very actively thinking about this.  It's not to say everything is perfect, but I think change has to happen there. 

Universities have to embrace it.  So it's all these different systems coming together.  You can't have them kind of in conflict with each other.  You can't be in an institutional environment that's completely unsupportive either.  Across all these different institutional spaces and journals and through journal publication, we need to just kind of start moving the dial. 

I think allies are critically important.  So you see kind of in the journal space, psych services, community mental health journal, we definitely see examples in the U.S. and even more internationally ‑‑ I'm not even talking about the UK here, just in the U.S. where journal editors are saying this matters, journal editors are trying to get different folks involved in peer‑reviewed manuscripts. 

No one of these things is enough, but I think all of them in concert will really start to kind of turn the wheels and hopefully lead to change over time. 

BESHAUN DAVIS:  To change the system, we have to take a multi‑faceted approach.  I understand that there's a lot of different areas that we can act and coalitions that we can build and ways that we can sort of champion and platform people to really shake up the system in a way.  It sort of sounds like there are a lot of different ways we can do that. 

Being mindful of the time, a question I thought about while you were presenting, and I think that this is something that comes up with lived experience, particularly in the research workforce, there have been a few questions about this idea of we want to center people with lived experience, especially with experiences being like psychiatrized or being involuntarily treated or things like that, but the thing about the research pipeline is that sometimes disclosing those sort of stigmatized experiences can derail your research path.  I think this is a question from Kira M. in the chat.  What do you think about this?  The context about disclosure and how folks can integrate their lived experience into the work that they want to do without being just diverted from this path all together? 

NEV JONES:  Yeah, and again here, it's multiple systems are involved in creating the conditions that then become problematic or erect barriers for folks.  I think the fact that I know probably something on the order of 20 to 30 times as many researchers with lived experience of psychosis or even having been labeled with schizophrenia in the UK, which is a much smaller country in both geographical and population size, than I do in the U.S., as somebody who has been extremely active in this space ‑‑ and I'm even counting undisclosed people but who have at least reached out to me over the years ‑‑ that really tells us that where you have a landscape where there actually are positions based on lived experience, where there are entire research centers dedicated to lived experience, you do have more people, in fact, coming forward, disclosing, or kind of thinking that they can become researchers is probably part of it too because they see visible role models. 

So I think there are indeed a lot of kind of challenges around disclosure and its potential consequences in the U.S., and rather than putting that on the really difficult decision‑making that especially like students and early career folks would have to make, thinking about how do we create the kind of the cultural conditions that it is not ‑‑ you're not taking such huge risks to disclose. 

So I think that's part of it, and then having more visible role models is really important.  I think we often have far too few, especially again around the sort of most traditionally kind of stigmatized diagnoses.  So the more that we can kind of move the dial there, the more that universities can signal pride in folks who have disclosed, all of this kind of starts to help and create more space and more responsibility. 

Then to wrap it up on the flip side, I don't think we should ever pressure people to disclose.  I think that, especially like let's say for NIMH, mechanisms that would be open to people with a disability, that finding ways to allow that to be a completely private, direct disclosure, rather than, let's say, something that has to be attested to by the institution, really important, especially when it's not ‑‑ when we know that there are consequences, when we know it's something that may not otherwise be visible and we're de facto sort of forcing someone to disclose potentially and they may not yet feel comfortable. 

BESHAUN DAVIS:  Thank you for tackling that.  This is a really important question.  I can think about even my own journey, I'm a psychologist, but I trained to interview for grad school, and people would say, don't say anything that would suggest you have any sort of lived experience.  I think the culture is changing around that, but some of these methods that you just talked about can change that culture hopefully in the long term. 

We're coming up on the end of the webinar and everything.  There's a lot more questions in the chat.  I feel like we could probably talk for a whole hour about just some of the questions that are here.  I guess, are there any things that you would want to say that you maybe didn't get a chance to put in your slides or just things that are coming up as we're discussing these questions?  Any closing remarks that you'd want to add, anything that you want people to know before we finish up? 

NEV JONES:  I was just responding to one.  For the two initiatives in question, because there's a lot of kind of questions about resources and how to connect, and I see that there's some maybe like errors with different functions of the websites I put up, both of which I'm involved with.  So if you e‑mail me because my name is ‑‑ my e‑mail is already up here, or anyone else already involved, if you know anyone else involved, if you e‑mail me, I can help troubleshoot that. 

I think that the fundamental thing is getting people connected to each other.  We can accomplish so much more.  We can support each other.  And also allies can kind of come in and really help, especially allies who already have more kind of senior positions. 

So please get involved in these kind of emerging coalitional efforts and don't hesitate to reach out to me directly.  If I'm not the right person, I can maybe just, because I've been very active in this space, maybe connect you with somebody who has similar experiences to you or who is working in a more similar area.  Again, the more we come together, the more that we can all accomplish and the more we can kind of help change the field. 

BESHAUN DAVIS:  Thank you so much for that, Nev.  One of my colleagues here says many hands make light work, and that's kind of what we're saying right now.  All of us come together, and we can tackle these key issues. 

I just want to thank you again for kicking off this webinar series.  I want to thank everyone for attending.  I think this was a great discussion, and we all learned so much from Dr. Jones' presentation.  Hopefully I'll see some of you all at our next webinar, which is on September the 9th at 2:00 p.m., and that link was also in the chat. 

Thank you all for attending.  Thank you, Dr. Jones, for presenting.  I guess have a good rest of your afternoon.