Holiday Blues & America’s Mental Health Crisis: Insights from NAMI’s CMO Dr. Ken Duckworth

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Mark Masselli ( 00:04 ):
We're in the full swing of holiday season. It's supposed to be a time of connectedness with our families
and loved ones, but how connected are we right now? The experts say the country's ongoing mental
health crisis deserves more attention and understanding.
Dr. Ken Duckworth ( 00:21 ):
For some people, the increased expectations that we should be happy and living a hallmark life with a
loving multi - generational extended family, presumably with fireplace and nice gifts, that kind of
increased expectation is stressful.
Margaret Flinter ( 00:38 ):
Our guest is Dr. Ken Duckworth, the chief medical officer for NAMI, the National Alliance on Mental
Illness. It's the nation's largest grassroots mental health organization dedicated to building better lives
for the millions of Americans who are affected by mental illness.
Dr. Ken Duckworth ( 00:53 ):
If you know that you get depressed in the wintertime, might be a bad time to try to change your job, or
to end a relationship. You might want to consider not doing those things when you know you're at your
most vulnerable. That would just be an example of how communication around mental health being
open to it can help people.
Margaret Flinter ( 01:13 ):
This is Conversations on Health Care.
Mark Masselli ( 01:24 ):
Well, welcome, Dr. Duckworth, to Conversations on Health Care.
Dr. Ken Duckworth ( 01:29 ):
Thank you for having me.
Mark Masselli ( 01:30 ):
Yeah, it's good to see you. I think everybody knows the song It's the Most Wonderful Time of the Year,
and we hope that's true for everyone. Yet, the American Psychological Association survey showed that
people in their mid - 30s to mid - 40s reported the biggest increase in mental health illness out of all the
groups, and nearly half of them reported that they experienced issues this year. Anxiety and depression
were top conditions that people self - reported. I'm wondering, do the holidays worsen mental health
issues?
Dr. Ken Duckworth ( 02:06 ):
For some people, the increased expectations that we should be happy and living a hallmark life with a
loving multi - generational extended family, presumably with fireplace and nice gifts, that kind of
increased expectation. It is stressful because a lot of us, our lives look a bit different than that, and some
people have lost their elders, they're not at the table, some people have suffered other life events like
divorce or challenges in college or work. And so, I would say real life doesn't really match up to

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Hollywood, that should not be a surprise, but I think the holidays do for many of us have the risk of
increasing our expectations for a connected loving life. And I think if you can bear in mind that this is a
desire to sell trucks, or whatever it might be, the holidays are an opportunity to see what you can make
the best of is my experience.

Margaret Flinter ( 03:08 ):
Well, Dr. Duckworth, you've written a very insightful book called You Are Not Alone, and certainly the
holidays are a time, certainly for many of us, seeing parents, and kids, and our extended family in -
person again, and with COVID, maybe after long absences. So it makes it a good time to check in on how
everyone is doing both mentally and physically. You write about a technique called motivational
interviewing well - known to clinical folks, but I think you're suggesting that it might work and be useful as
we're taking stock of how have our loved ones doing. Tell us about that.

Dr. Ken Duckworth ( 03:42 ):
Yeah. So, the book is based on real people that shared what they learned in their lives, and one of the
people that I interviewed was the man who invented motivational interviewing. So, one strategy is to
meet a person and say, "Ken, you look depressed, you need help." Most people respond to that by
saying, "Thank you. No, thank you, I'm good." So Bill Miller describes this as the writing reflex. It's as if
we all have a committee that has some ambivalence within us. You push on one side of the boat, the
other side of the boat is going to come back. What Dr. Miller said, and this says technique has been
studied in over 200 randomized controlled trials, but if you actually listen to a person and find common
ground on what they want, it's more work and it's harder than telling a person what to do. So if you
listen to them, and they're struggling with their sleep or they're feeling lonely, focus on that.

Dr. Ken Duckworth ( 04:37 ):
So if you think of it as these Venn diagrams, focus on the areas of overlap, things that you see that they
see. People don't tend to like being diagnosed even by a psychiatrist, so just be gentle with that kind of
assertion. And motivational interviewing is about listening to people, and finding common ground to
help them go where they would like to go, but it's not a simple quick fix. And if you say to somebody, "I
think you're depressed and you need help," and they say, "Yes, thank you," that's unusual, so you don't
have to do motivational interview because there's a small percentage of people that will say, "Thank
you, Ken, I appreciate your feedback." So, you have to know a little bit about your relationship. But I
think motivational interviewing, these courses that when you go to clinical meetings, there'll be 500
people in the room trying to learn more about how to get to yes with people, not bringing your own
answers, but rather asking more questions and building upon the strength of your relationship to get
where you want to go.

Mark Masselli ( 05:44 ):
I really like that. Margaret, we often talk about just in dealing with other organizations how do we find
the seam of opportunity where we can find common ground with somebody. So finding it with other
human beings really makes a lot of sense. I do want to get back to that APA poll that we mentioned
earlier, which found people between 18 and 34 had the highest rate of mental illness, and half of all
people in this age group reported a mental health issue. I'm wondering, from your professional vantage
point, what's the best guidance for people dealing with issues at such a relatively young age? I know you
write about Wellness Recovery Action Plan, and that sounds very powerful.

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Dr. Ken Duckworth ( 06:31 ):
Yeah, a couple of things about that. First is to be gentle with yourself. The generation that had to do
schooling through COVID, Zoom school, that generation lost a lot of opportunities. So I'm now talking
about the youngest part of the 18 to 34 group mark. You are supposed to be out in the world trying
things, trying out for sports, being in the theater group, asking someone out, getting rejected, having
successes, you're experimenting with the world. So this is one of the reasons I think a lot of people in
their 50s who have solved most of these developmental challenges, what you're going to do
professionally, who you're going to love, what kind of life you're going to design for yourself. The people
in their 16 to 25 years are really trying to sort that. And I think the lack of opportunities to experiment in
the world cuts directly into that demographic developmental need to try things out in the world.

Dr. Ken Duckworth ( 07:30 ):
And so of course, parents who are trying to do Zoom school for their elementary school kids, they
deserve a special spot in heaven because I don't know how you can sustain attention. And I've talked to
people in education who said the kids feel that they have lost some of their both social skills and some
of their capacity for attention span. Multiple educator, people have told me this, whether in elementary
school or in graduate school. So, I also think this generation is more willing to acknowledge mental
health, I don't think it's as much of a secret as it is for those of us with a few gray hairs.

Dr. Ken Duckworth ( 08:09 ):
I think it's more accepted, it's more integrated into a parlance of this is part of life. So I think it's both
things, I think it's additional challenges, and I think the economy hasn't been easy to buy a house, this is
something people like to do at the end of their 20s if they're lucky and early 30s. It hasn't been easy to
buy a house, for example, to pick one economic metric. And I think that people are also more willing to
acknowledge anxiety and depression. So the rise we've seen is anxiety and depression. We haven't really
seen much higher rates of any other conditions. More people self - report trauma, and some people in
some of these surveys have shown a more of a relapse in the substance abuse space.

Margaret Flinter ( 08:50 ):
Well, it certainly has been a difficult several years and mental illness was with us before COVID, during
COVID, after COVID, but maybe there's a greater tendency for families to reach out and try and get help
for themselves, and the person with the mental illness. And I wonder if you could share with us why is it
helpful for a family member to get involved with NAMI, is there a vocal chapter? What do participants
get out of the experience? How do they come to grips with what some people still think of as stigma and
shame of a family member who's coping with mental illness?

Dr. Ken Duckworth ( 09:26 ):
It's a great question, Margaret. One of the reasons I called NAMI's first book, You Are Not Alone, people
want to feel that they're part of something. So when this happens in your life, you have a child who
develops bipolar disorder with psychotic features, for example, you can feel very alone and may even
blame yourself. Once you join 100 or 1,000 or 10,000 other people who are just doing their best to make
sense of what the science says, what the best techniques are for communication, I think it really helps
people to not be alone.

Dr. Ken Duckworth ( 10:00 ):

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And when in this book, I interviewed a number of people who found it was actually helpful to run those
groups, to help other people, to make purpose of their pain. And so NAMI is a great organization, all
these programs are free. They're all over the country, there's just under 700 affiliates. So wherever you
are, there is a NAMI group that provides free support, free education, and is advocating for better
services because of any of you have tried to get help in the mental health system, we have a lot of work
to do. So the local NAMIs and the state NAMIs fight for better services.

Mark Masselli ( 10:38 ):
I just watched your new ad campaign, which I really love, and it's so powerful.

Video ( 10:45 ):
I wonder if you know that we can get help. I wonder why we waited so long. Not wondering anymore.
Love, Your Mind. Let's see how far we can go.

Mark Masselli ( 11:08 ):
The campaign is called Love, Your Mind, and we understand NAMI is a campaign resource. It says that
people should be more open accepting and proactive when it comes to taking care of their mental
health. Wondering, what does proactive mean? If someone knows they get depressed around holidays,
is there something they can do before sadness immobilizes them?

Dr. Ken Duckworth ( 11:33 ):
Well, Mark, it's a great question as well. Pattern recognition is a critical thing, but if you can't talk about
it in your family system, in your relationships, or to yourself, your ability to do pattern recognition is
going to be impaired. My dad had very bad bipolar disorder. I became a psychiatrist to help him. I was
not a stem whiz, I went to the medical schools that did not require calculus. There were 11 of them in
America, and I got into 9 of them. I just wanted to help my dad and make sense of all this. So to me, our
inability to communicate as a family meant that we couldn't do the kind of pattern recognition and
problem solving that is happening now in households all across America, not every household, but to
understand your own pattern, so my dad would get manic in the summertime. It would've been very
advantageous for us as a family to take the spring and say, "Hey, wait a second. This would not be a
good time to change things, this would be a good time to make sure he's seeing his doctor."

Dr. Ken Duckworth ( 12:29 ):
We might want to get his medication level checked, can we do that with him? Not to him, collaborative.
Same thing for seasonal depression. A lot of people know about themselves that there are certain
periods of time that they have troubles with depression, particularly true in northern latitudes with
seasonal affective disorder. People who live in Key West are less likely to have seasonal affective
disorder than people who live in Bangor in Maine. But learn from your prior experience, whether it's
lights. There's a very special kind of lights, this is not turning your lights on in your kitchen. Whether it's
psychotherapy medication lights, whatever it is, learn from your prior experiences of the seasonality of
your vulnerabilities, particularly in the mood disorder space, there does seem to be seasonality as a real
phenomena.

Dr. Ken Duckworth ( 13:21 ):

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The ability to talk about it, back to Margaret's point, communicate about it, problem solve about it,
helps with pattern recognition, and helps you get ahead of things. So if you know that you get depressed
in the winter time, might be a bad time to try to change your job, or to end a relationship. You might
want to consider not doing those things when you know you're at your most vulnerable. That would just
be an example of how communication around mental health and being open to it can help people.

Margaret Flinter ( 13:52 ):
Well, thank you so much, Dr. Duckworth, for sharing your personal story with your father, your own
family member. And I wonder if I can maybe jump off that to think about where people get most of their
healthcare in primary care to begin with, how do you think the primary care system in the United States
is doing in terms of all the focus on screening and screening for depression and anxiety? Not sure we do
screening beyond that, but certainly substance use disorder -

Dr. Ken Duckworth ( 14:18 ):
Whenever I see a pediatrician or a primary care doc, a family doc, I meet them at a party, I thank them
for all they're doing. Primary care is one of the backbones of the American mental health system.
Because we don't really have a coherent organized system, people do tend to trust their doctors if they
have one, everybody trusts their pediatricians. Pediatricians are literally the nicest people in medicine.
It's universally true, it happens every single year, the nicest people going to pediatrics. So if your child is
having behavioral vulnerabilities, or showing things that are concerning you, most pediatricians consider
this part of their portfolio, not psychotherapy, they're not allowed to do psychotherapy, but they can
recognize, and some practices have referrals, "Well, here's a person that works with kids who have panic
disorder. Here's a practice that works with kids who need organizational tutoring, and you might want
to consider getting tested through a neuropsychologist."

Dr. Ken Duckworth ( 15:18 ):
So I happen to love primary care doctors, pediatricians, we ask an awful lot of them. So if you know a
primary care doctor or a pediatrician, thank them for what they're doing because America tends to
value specialists in terms of how we pay for things. And primary care and pediatricians are not at the top
of the pay scale, they're not driving BMWs. So, it's just important to recognize that mental health is a big
part of their job because people feel safe with them, they know them, they have relationships with
them. And you talk to them, they'd say a third to half to more of their job is directly related to mental
health.

Mark Masselli ( 16:04 ):
Well, I want to make two points here. One, we're a big advocate of promoting primary care and access
to primary care because not everybody has access to primary care. And so, the community health center
movement around the country is very committed to that, but also a different model of delivery, an
integrated model where next to the pediatrician is a behavioral health specialist, a licensed clinical social
worker, or a psychologist, a psychiatrist, really this team - based care because the pediatrician alone can't
do it, we need more integrated delivery teams. But we couldn't agree with you more, special praise to
all those primary care providers.

Mark Masselli ( 16:46 ):
But I want to touch on public policy issues, and we know NAMI has long fought for reality. And again,
back to the mental health care, and also physical care. And Margaret, we've had a number of leaders in

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the mental health world on advocating for this parity, and it's been a long hard fought. NAMI has
certainly been a leader in this area as well. The Biden administration proposed rules to strengthen
enforcement of mental health parity laws that would improve access to care. Not surprising, the
insurance industry is really pushing back, and executives has said the proposed rules are "so
burdensome" that many of our members will have no other choice but to rethink the type and level of
their plans' coverage of mental health benefits. I'm wondering if you'd respond to that.

Dr. Ken Duckworth ( 17:38 ):
Mental health is part of health. It's just that simple. And we have yet to have a cardiologist who doesn't
accept insurance because the payments are too low. No cardiologist is charging $28,000 for a private
pay bypass. That's never happened. So, the medical field participates in a payment structure because
the payments are worthwhile. The mental health field has been historically underfunded and
discriminated against. So NAMI is very in favor of the idea of the Biden's proposal to promote another
level, kind of version 2.0 of mental health parity. My colleague, Rochelle Keys from NAMI was on the
stage with President Biden as an example of someone who in her family had run into these problems.
And this is a great example of how NAMI engages in sort of public policy discussions.

Margaret Flinter ( 18:39 ):
Well, I wonder if we could get your opinion on something else, Dr. Duckworth. It's been just a little over
a year, I think, since 988, the National Suicide & Crisis Lifeline was opened. The Pew Charitable Trusts
has raised some challenges that the service still faces, including workforce shortages, which of course
are everywhere, language access issues, and also what happens next, the access to ongoing care. We'd
really welcome your thought on the need for this 988 line and what you think of its effectiveness or
success in this first year, and opportunities for improvement.

Dr. Ken Duckworth ( 19:16 ):
The basic idea of 988, which NAMI helped to lead our policy team, I, Ken, was writing the book, I get no
credit for the 988 work. The policy team led a whole collection of people who thought calling 911 for
mental health crises promotes worse outcomes per square inch. That is to say a police response is rarely
required for a mental health crisis. And the idea was to take that very long number for the National
Suicide Prevention Lifeline, and it turned it into a three digit number. So I would say there's a couple
dimensions to this. Most of the calls are answered quickly, there's a very low call rate, they added
Spanish language one year later, and they just added American sign language for the deaf and hard of
hearing. That has done a good job of reducing the number of calls that end up going to police
departments, so that's only one piece of the puzzle.

Dr. Ken Duckworth ( 20:17 ):
I think what the Pew Trusts is talking about is the idea of mobile crisis teams. And that's not something
you can pay 20 cents on your Verizon bill, 988 is funded right across the country by a contribution like
911 is by people on their bills and by Federal money. Local services, like when you call 988, and you
need someone to come to your house and assess you, that's going to vary greatly on your local
resources. Now we're back to NAMI and advocacy. So if you live in Tucson, Arizona, Eugene, Oregon,
Denver, Colorado, there are exceptionally good mobile crisis teams that are culturally thoughtful, have
peers. The state of Georgia, every mobile crisis team has a person with a mental health condition travel
along, so that the compassionate experience of being with someone. But that's not universal, and that's
because our patchwork mental health system is largely state funded.

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Dr. Ken Duckworth ( 21:22 ):
So this is another advocacy dimension. We have to work the problem so that more people can have the
services that they have in Georgia, that they have in Arizona, that they have in Colorado. So to me, this is
an endeavor that is well worth doing, and part one has been a success, we need a part two.

Mark Masselli ( 21:42 ):
I want to pull the thread a little more on the 988, and I think it's been identified there's a shortage of
mental health providers in the country. I'm wondering if you can give some dimension to the problems
in terms of developing enough, or cultivating enough, or educating enough mental health providers who
are so important. It's kind of interesting, you were talking earlier that mental health really part of the
pandemic, one of the maybe silver linings is that people starting to access mental health more. And I
think people a little like we also experienced the word public health, people got into focus during the
pandemic.

Dr. Ken Duckworth ( 22:25 ):
Yes.

Mark Masselli ( 22:25 ):
What's your prescription as a clinician for how we might develop, cultivate a larger workforce in this
area? Because it's pretty clear -

Dr. Ken Duckworth ( 22:35 ):
Yeah. I think we need major student loan relief if you choose a career in mental health. And part of the
book, You Are Not Alone, is the idea that peers also have something to offer. So essentially when mental
health became a we thing through the pandemic instead of a you thing or a they thing, more people
wanted to access mental health. So the demand went up 5X, 3X, supply is unchanged. So I'm not an
economist, but you see the supply demand mismatch and access problems that immediately followed.
So to me, I have two daughters in medical school. Psychiatry is cool now, it's interesting. When I went
into psychiatry, it was not cool, cardiology was cool. And both of my daughters recognized that
psychiatry is cool, I can't promise either of them are going to go into psychiatry, they have their own
minds and their own choices.

Dr. Ken Duckworth ( 23:27 ):
But it's interesting to me, this is now seen as a worthwhile destination, but that doesn't mean we're
developing hundreds of new spots for psychiatrists, same for psychologists, same for social workers. So
mental health now has cache, it's considered interesting, and compelling, and important. So we've
crossed that hurdle. But to me, we have to create more new residency slots, more psychology
internships, they're extremely competitive to get a psychology internship, you can get 300 people
applying for one spot.

Dr. Ken Duckworth ( 23:59 ):
But also I think looking at what Georgia did, hire peers, they don't replace clinicians, but a person who's
lived with something, let's take severe depression, and has gone through a training to be a certified peer
specialist, can augment the workforce, can make the professional workforce go farther because now
you have somebody who's traveled in those waters along with you. So that's one of my prescriptions is

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that more states should be alike Georgia to create an alternative additional set of players on the field.
But psychiatry is cool now, and that's hopeful. So we're not going to have empty residency spots, we're
not going to have them anymore, we had them. When I was young, not every position would fill, and I'd
be like, "Psychiatry is the most interesting thing going," but almost no one agreed with me back in the
day.

Margaret Flinter ( 24:56 ):
Well, Dr. Duckworth, we could do an entire part two of the show with our thoughts on workforce
training and -

Dr. Ken Duckworth ( 25:01 ):
Oh my, that's a big one. Yeah.

Margaret Flinter ( 25:04 ):
... into the National Community Health Center system, the way [inaudible 00:25:07] has done, but we
need another show for that. I would like to maybe give you a chance to share your thoughts with our
audience about any latest research, about what still seems to be a bit of an ongoing debate, about talk
therapy, psychotherapy alone versus medication treatment. Is it still a combination of the two that's
best, or anything new from the research in this area?

Dr. Ken Duckworth ( 25:31 ):
The most important thing is to respect people's wishes, some people don't like meds. Psychotherapy has
been shown to be effective for most mental health conditions, particularly if you have a relationship
with someone, like if you have a trusting relationship, or you use a technique that is well - validated for
your condition. Some people don't have time for psychotherapy. Medications are effective for most
conditions most of the time. Even though we don't understand how they work, you have to accept that,
must accept.

Dr. Ken Duckworth ( 25:58 ):
One of the interesting things in research is now looking at the potential for a psychedelic compound
called MDMA, which is in fast track for phase 3, it's guided psychotherapy for PTSD. And so, this is the
idea of taking a psychedelic with a person who's trained in psychotherapy together. So this is the first
FDA effort to integrate the two. But if you were to ask me, I have a severe depression, what's the best
way to get better? The best way is to probably do both, psychotherapy and medications. I think there's a
pretty good literature, and that literature has been around for a long time. Myrna Weissman came out
with a study in the '80s that showed that that was well before the SSRIs were developed, before TMS,
before ketamine, before all of it. So I think there's a psychological and a biological dimension to many
mental health conditions, and the idea of when you can access both, back to access, that's probably the
most efficient strategy.

Mark Masselli ( 27:00 ):
Well, that's so exciting. I know Dan Bryan and our own staff has been working on the ketamine issue,
and obviously we're focused on the policy side of reimbursement of how that works to make sure that
Medicaid allows for this to happen. But we know the Veterans Administration has played a key role in
this area, we're very excited about it. I want to get back to seasonal disorders. I think the NIH has came

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out and identified that light therapy may be a effective intervention. Any additional thoughts, I know
you touched on that earlier, but anything in the literature that you want to point our listeners too?

Dr. Ken Duckworth ( 27:38 ):
For seasonal affective disorder, if you have resources, don't go away in the summer, go away when you
are at most risk of being vulnerable. So this is the time to go to Florida when the days are shortest. Also,
I would say there's pretty good evidence that if you have a bipolar vulnerability, you have to also be
careful with light therapy as you would with antidepressants. I think that's been shown in the literature.
And even if you live in Boston, and you only get a few sunny days a year in the dead of winter, get out in
the sun. So it's sunny right now, I'm going to go for a walk with my dog right after this conversation.

Dr. Ken Duckworth ( 28:21 ):
I don't particularly have a vulnerability in this space, I have other vulnerabilities because I'm a human.
But getting light into our little pineal glands is a good idea. Even though it's weak and hard to find in
Boston, I would encourage people to access light. If you have the resources to go south, do it in the dead
of winter when you've recognized your own patterns. So don't take summer vacations. If you have
seasonal affective disorder and you live in the north, take winter vacations.

Mark Masselli ( 28:52 ):
And don't go to Iceland, go south.

Dr. Ken Duckworth ( 28:55 ):
Well, Iceland, again, everybody to their own thing. But one of my daughters lives in Spain, and it's pretty
sunny over there, I got to tell you.

Mark Masselli ( 29:08 ):
That's great.

Margaret Flinter ( 29:08 ):
And certainly going for a walk in the sun sounds like good advice at any time. But, Dr. Duckworth, I
wonder if I can ask you about co - occurring disorders, mental illness, and substance use disorder, and
maybe particularly a little bit about alcohol. We read that the data says young people are drinking less
alcohol, that would be good news. But we also look on the older spectrum and see those midlife deaths
of despair in which alcohol plays a very prominent part. Excuse me. What does NAMI offer to people
who are dealing with co - occurring disorders, and what are your thoughts on most effective treatments
there?

Dr. Ken Duckworth ( 29:50 ):
I would say this is an area that I wanted NAMI to grow more in. And that's why in our first book, You Are
Not Alone, I interviewed people who had both mental health and addiction vulnerabilities. And what
they told me is something that I have seen is these are two cultures that exist on different tracks. And if
you think about it, the addiction community grew up around peer support AA, not a professional
concept, which is why treatments for things like opiate disorders, which are medical, have been harder
to integrate.

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Dr. Ken Duckworth ( 30:23 ):
Mental health starts with a professional model, Freud, MDs, therapists, research, and the idea of
integrating peers has been a bigger challenge on the mental health space. So I've been contacted by
many people just because of one little chapter in our book because I actually shone some light on the
issue. So NAMI likes the work of people like Ken Minkoff who are working at the policy level to have
things like screening for depression in addiction programs, screening for substance use in psychiatric
services, the idea that on the policy level to integrate these two cultures because they are two cultures,
and they don't necessarily think alike.
Dr. Ken Duckworth ( 31:07 ):
So it's an ongoing challenge. But one of the reasons I wanted that to be a prominent part of NAMI's first
book is the joy of being the author is you get to decide what you're going to cover. And I knew that co -
occurring disorders matter to people. Many of the bad outcomes come with co - occurring disorders,
opiates and bipolar disorder, alcoholism and depression, schizophrenia, and other kinds of compounds.
This is what you see in the real world, and many of those people have the highest risk. So I didn't want
to ignore that. NAMI grew up with moms who were blamed for their children's schizophrenia, and that's
still the core educational advocacy angle. But NAMI has expanded to include other mental health
conditions and to integrate things like addiction and trauma to our thinking. Sorry, that's my dog who
knows we're going for a walk. Sorry.
Mark Masselli ( 32:01 ):
Well, Dr. Duckworth, thank you for joining us. Thank you for the book you wrote, for your podcast, and
for NAMI's leadership. And thanks to our audience. Be sure to go online at chcradio.com to sign up for
our email updates. You can also share your thoughts and comments about this program. Thank you
again. Enjoy that walk with your dog.
Dr. Ken Duckworth ( 32:23 ):
Thank you for having me, everyone.
Mark Masselli ( 32:25 ):
All right. Take care.
Margaret Flinter ( 32:25 ):
Thank you, Dr. Duckworth.
Dr. Ken Duckworth ( 32:26 ):
Thank you, Margaret. Thank you, Mark. Take care.
Mark Masselli ( 32:27 ):
Bye - bye.
Margaret Flinter ( 32:32 ):
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