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How to fix America’s broken mental health care system

how to fix mental health in america

A psychiatrist works with a young patient

(Photo by Loic Venance/AFP via Getty Images)

At age 19, Ryder Dunagan stood on the Brooklyn Bridge and prepared to jump. Instead, he checked himself into a hospital. 

That six-day stay may have saved his life, but it left him with a $30,000 bill. The debt followed him for years and still stains his credit report. 

Like Dunagan, one in five American adults cannot afford the mental health care they need. The situation, dire before COVID-19, has grown worse as anxiety and depression have increased during the pandemic. President Joe Biden campaigned on the promise to prioritize mental health. Now the administration must move quickly to improve access to treatment.

Barriers to care

Dunagan was diagnosed with depression in his early teens. Coming out as transgender had not gone well, triggering his suicidal crisis. He was underinsured on his parents’ catastrophic health plan. The hospital debt and the vagaries of insurance coverage compounded the stress. 

“Changing therapists, doctors, shifting insurance situations — just life — made it difficult to stay on a consistent regimen of mental health medications,” he said. 

When he moved to Los Angeles, Dunagan found affordable insurance through Covered California, the state’s health insurance marketplace. “Now I have mental health support,” he said. “I’m able to get counseling and medication when I need it.” 

His experience illustrates how costs, bureaucracy, and the insurance reimbursement structure put good, consistent mental health care beyond the reach for many people — and how government policy can make a difference.

Nearly 120 million people in the United States live in areas with mental health provider shortages. Closing the gap would require nearly 6,500 additional psychiatrists, but there were just 6,248 psychiatry trainees in 2020, not even enough to outpace retirements.

The Substance Abuse and Mental Health Services Administration projects shortages of almost all kinds of mental health and behavioral health professionals by 2025, including clinical psychologists, school psychologists, and substance abuse counselors. The shortage is especially acute for children.

Financial incentives deter many providers from accepting insurance, effectively limiting provider supply for anyone who can’t pay out-of-pocket. Insurance companies often offer less than half of what a therapist can charge in private practice, according to Rachel Needle , a licensed psychologist in Florida. 

“To make a good living based on our educational level, taking insurance is challenging,” Needle said. Insurance bureaucracy makes low reimbursement rates even less palatable.

Even with health insurance, many patients struggle to stay in high-quality, culturally sensitive care because of deductibles, copayments, and coverage limits, according to Akua K. Boateng , a Philadelphia-based licensed psychotherapist serving mostly young professionals of color. 

“That is probably one of the larger things that I’m dealing with my clients of color, just being able to keep them,” she said. 

The mental health agenda

The Biden administration has a range of policy options to deliver on the promise of accessible, affordable mental health care:

Reimagine tele-mental health. Use of telemedicine for mental health care has spiked during the pandemic, aided by federal policies and fueled by private insurer policies . Blue Cross Blue Shield of Massachusetts, for example, reported 38,000 daily telehealth claims a day in May 2020 — up from 200 before the pandemic. Nearly half of the claims were for mental health.

Some private insurers have committed to continuing to waive consumer costs for these telehealth visits while others have ended those waivers . The new administration should require — or at least strongly encourage — insurers to continue to cover and waive consumer costs for tele-mental health care. 

Telemedicine could also be instrumental in expanding access to appropriate providers through policies that allow providers to practice across state lines. Though provider licensure is governed at the state level, federal policy can encourage reciprocity and ease restrictions on intrastate practice.

“If you can’t find a Black therapist within your city or within your area, you’re just out of luck,” Boateng said. “We need to really reinvigorate (and) re-envision (telemedicine) and join arms across states in order to up the presence and representation that’s required for quality care for people of color and vulnerable populations.”

Cap consumer mental health costs. Out-of-pocket costs deter consumers from using needed services . Especially during the pandemic, policymakers should cap consumer mental health costs such as copayments and apply lower copayments to psychiatric drugs. 

“If people have very high copays or things are not covered by their plan, they’re going to be less likely to seek care,” said Meena Seshamani , a surgeon who managed implementation of the Affordable Care Act (ACA) and now is vice president of clinical care transformation at MedStar Health.

Though the federal government sets overall out-of-pocket maximums through the ACA, those limits are high for most people: $8,550 for 2021. Lower, category-specific limits could  make mental health care much more affordable.

Go beyond mental health parity . The Mental Health Parity and Addiction Equity Act of 2008 requires insurers to provide equivalent mental health and medical coverage, and the Affordable Care Act requires coverage of mental health benefits . 

In reality, these rules have often failed to ensure equal access to mental health care. Where treatment is quantifiable — such as the number of days covered at a skilled nursing or residential treatment facility — insurers tend to strictly adhere to parity rules, explained Lisa Kantor , a Los Angeles-based health care attorney. 

Kantor recommends expanding coverage beyond parity, based on California’s Senate Bill 855 , which requires insurers to cover treatment for the full range of mental illness and substance use disorders identified by the American Psychiatric Association’s most recent “Diagnostic and Statistical Manual.” 

Insurers must determine medical necessity based on accepted clinical standards according to industry experts, not their own internal standards. The law prohibits insurers from using arbitrary or conflicting criteria for what they will cover, and from limiting coverage for short-term or  acute treatment.

Reimburse better for mental health care . Low insurance reimbursement rates keep many providers from accepting insurance. The Biden administration should raise minimum reimbursements, such as through increased Medicare rates, to reflect the expertise and value of mental health professionals.

Forgive student debt. According to Mark Kantrowitz, publisher of PrivateStudentLoans.guru , a typical social worker with a master’s degree might owe $75,000 in graduate school debt, and Ph.D. and M.D. graduates can owe into the six figures. But many mental health providers, especially those working in some nonprofit agencies or regions , can earn less in a year than they owe. Though some working in public or nonprofit agencies may qualify for public service loan forgiveness, private practice incomes, commonly over six figures , are enticing. 

The new administration should expand on legislative attempts by then-Senator Kamala Harris to create a federal student loan repayment program of up to $250,000 for mental health professionals who practice in shortage areas. 

Destigmatize mental illness. Destigmatization is the key to all other improvements, Boateng says. 

She stresses the need for “creating an environment where there’s safety around pursuing mental health (and) there is a culture of supporting the pursuers of mental health.” 

The Biden administration must make a strong statement recognizing the serious mental health toll the pandemic has taken.

Despite including mental health in the administration’s COVID-19 strategy and response plan , the President has not announced high-level appointees with mental health expertise. The COVID-19 task force , which disbanded upon Biden’s inauguration, included just one mental health nurse and, some experts argued , lacked sufficient focus on mental health. Appointing mental health experts to high-level posts is essential to addressing urgent needs and psychological and behavioral problems that will persist even after the pandemic has abated. 

Improve overall economic well-being . According to Seshamani of MedStar Health, policies that hasten economic recovery can improve mental health as well. 

“People need to feel valued and … like they are accomplishing something or having an impact,” she said. Improving job opportunities and job training become mental health policy levers, but should be paired with workplace protections and accommodations for people suffering from mental illness.

Improving access to mental health care isn’t the sole purview of the federal government. Private insurers can invest in access to mental health care. The provider community can encourage people to enter the health field and support them through the long years of training. But the Biden administration has the opportunity to set a new tone for mental health care in America and lead in creating a system that works.

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How to Fix the American Mental Healthcare System for Good

It’s January in Colorado and a short man in his fifties is dancing under a streetlight outside a homeless shelter, yelling expletives to the sky, a backpack tossed in the snow next to him. I watch him through the glass door of the shelter from which he has just been ejected. He wasn’t able to follow the code of conduct tonight, and he’s overwhelmed and losing control. He drains the last of a fifth of vodka and gleefully throws the bottle as he dances. It shatters on the icy pavement in front of him, as the shelter manager calls the police.

Meet Paul. He is one of approximately 30 percent of individuals experiencing homelessness who live with serious mental illness. He will be spending the night in jail, even though the shelter manager recognizes that he needs treatment, not punishment. His story is not unique. In four years doing homeless outreach in Denver, I met countless people who live with severe mental illness and struggle every day to meet their basic needs and stay safe on the streets.

How did we get here?

Mental illness used to be treated in institutions, closed inpatient facilities that inspired films like One Flew Over the Cuckoo’s Nest . But in the '50s and '60s, Americans lobbied for the closure of these facilities, which were both ineffective and inhumane. Instead, experts proposed a system of “community-based care,” where individuals with mental illness could live with their families or in group homes while receiving outpatient treatment and participating in day programs.

The thing is, this was a two-step process where the second step was forgotten. The institutions closed, but the replacement system was never built. Instead, many of the people living in these facilities ended up homeless.

The intervening decades have shown that mental health care is not a problem that can be solved by ignoring it and hoping it will go away. When we don’t provide services and housing for those who live with mental illness, those people don’t disappear. They end up on the streets, and increasingly, in jails and prisons, which are some of the largest providers of mental health care in the country.

That’s a big problem. In seeking to liberate people with severe mental illness from institutions, we created a new system of institutionalization with a different name.

The good news is, we can fix this. We can start by building the promised system of community-based care. This begins with creating small group homes in communities across the country where individuals with mental illness can live indefinitely for an affordable price. Unlike the institutions of the past, group homes house only around a dozen people each and are staffed with social workers who run them like family homes, not hospitals. We also must ensure that there are a sufficient number of outpatient clinics that are geographically and financially accessible, as well as hospitals equipped to deal with psychiatric emergencies in each community.

But this solution is not just about high-level policy decisions; it involves all Americans. We need communities across the country to step up and say “Yes, we will host a group home for people living with mental illness in our community.” There is no room for Not In My Backyard rhetoric here. The man sleeping on the sidewalk over whom you step on your way to the subway is already in your hypothetical backyard.

Some will say that a plan like this is too expensive. But what they do not see is how expensive it is to maintain the mangled system we already have.

The cost of doing nothing is huge: it’s the $2 billion  of annual federal funding to community nonprofits helping the homeless across the nation, and it’s the $168,000 a year per person that it costs the state of New York to keep someone imprisoned. It’s also the untraceable millions that individual citizens and churches give to people who ask for help and the cost of treating an uninsured person who turns up in the emergency room having a mental health crisis. By redistributing these funds wasted on maintaining the status quo, we will spend no more and the results will be substantially more sensible and humane.

There is no reason to keep waiting, watching the so-called “revolving door” of people with mental illness cycling through homelessness, jails, and hospitals. With an initial investment in housing and a commitment from communities to finally provide the community-based care we promised 70 years ago, we can create real change in the lives of the 9.8 million Americans who experience severe mental illness. It should be an easy decision: continue throwing away billions of dollars on a broken system or use those funds to create a lasting solution to take care of vulnerable Americans. Which would you choose?

Christina Kay is a first-year MPH student in Population and Family Health.

If you would like to contribute to  Columbia Mailman Student Voices , please send a three to five sentence pitch to  [email protected] .

Health Care Access & Coverage

Strategies to Repair a Broken System: Mental Health Care

A penn ldi virtual conference explores latest research and innovations with ten of the field’s top minds.

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The call for integrating physical and mental health care is not new, but in a half-hour keynote address to the October 29 Penn LDI virtual conference, Benjamin Miller , PsyD, provided one of recent memory’s most cogent and eloquent explanations of why and how that might be accomplished. The University of Pennsylvania event was titled “ Mental Health Care in Flux: Exploring New Ways to Deliver Care .”

Miller’s Paul Starr-esque historic overview of how we arrived at the current ineffective policies opened an afternoon gathering in which nine other top experts detailed the research and innovative programs now seeking to address the mental health care system’s documented shortcomings. All concurred that the COVID-19 pandemic has spawned broad waves of stress, anxiety and need for mental health care that have drawn increased attention in policymaking circles. The conference was co-hosted by Penn LDI and the Penn Center for Mental Health .

Conference participants agreed that the primary keystone of the issue is that mental health care has long been tightly segregated from the rest of the health care system and, in its isolation, starved of resources and critical synergistic connections.

how to fix mental health in america

“We have decades of thinking of mental health as something that’s separate and distinct,” said Miller, who is President of the Well Being Trust Foundation , a non-profit founded by Providence St. Joseph Health five years ago to focus on clinical transformation, policy, and advocacy related to the mental health and social well being of the U.S. population.

“Despite some of the great work and great papers that many scientists have published,” Miller continued, “we still have this tangled mess of a mental health care system with fragmented parts that perpetuates this false divide between mind and body, mental and physical. We limit where a person can get access to care. We’ve got different rules for mental health coverage, financing, delivery, training and so on. And yet, despite year after year of data showing people are not getting care, we continue to build programs on top of programs which all use these ineffective policies.”

The Penn LDI conference in which Miller spoke occurred simultaneously with the publication of an op-ed article in The Hill  by a team of researchers at Penn’s Center for Mental Health. Titled “It’s Time to Pay for Mental Health Care in America,” it was written by Emily Becker-Haimes and LDI Senior Fellows David Mandell , ScD, and Rebecca Stewart , PhD. The piece echoed Miller’s assessments:

“The mental health care system in this country is broken — if something can be broken that was never built properly in the first place. The United States has never invested in its mental health care systems the way that we have for physical health. Pitifully low reimbursement rates and chronic, systemic underfunding have led to a largely fractured, overworked, poorly-trained and poorly-paid workforce, leading to a significant shortage of mental health care providers. There are not enough providers at any level of training. Many mental health facilities are rundown and overcrowded, with long waitlists and poor access to care.”

how to fix mental health in america

Miller noted that one prism through which he analyzes the current mental health system is an admonition from Well Being Trust board member Maureen Bisognano that “once we realize something is not working, it’s unethical to proceed as if it is.”

The second half of Miller’s presentation focused on potential elements of restructuring in three mental health-related areas. They are:

1. Robust integration of mental health care and physical health care

“When we ignore mental health within our larger system, it’s less effective for our overall care,” Miller said. “I’d like to propose that we break our specialty mindset around mental health, a mindset that’s gripped us for too long, and really begin to shift from clinical settings to community-based settings like schools and other community venues. We’re always going to need specialty care, but our overreliance on specialty care has meant these longer wait times, increased costs to the person and to the system, as well as a dissatisfying experience. We must reassess our structures and begin to ask ourselves basic questions like ‘Are there policies or programs that limit where a person can get access to mental health care?’ If the answer to that is yes, it needs to be reconsidered. And I actually think by doing this exercise, we begin to unpack our structures and see how we manage, deliver, and pay for care. Only about one in 10 people with a substance use disorder receives treatment. And, according to another study by the Kaiser Family Foundation, about 40 percent of American adults continue to delay accessing health care because of concerns about cost, and four in 10 of those adults report having trouble even paying their deductible.”

2. Rethinking workforce policies and practices to better meet real need

“Let’s rethink our workforce with an eye to who does what, where and for whom,” Miller said. “ Our current assumptions about where care is delivered might be wrong. Half of the country’s counties have no psychiatrist. Thirty-three percent of individuals who seek care wait more than a week to access clinicians. Some wait upwards of six weeks or longer. Fifty percent drive more than a one-hour trip to treatment locations, and the longer you have to drive, the larger the disparities are. What if the community, leveraging its relationships with clinicians, wants those clinicians in the places where that community’s members are — like in their homes or schools, libraries, barbershops, YMCAs and the like. It seems a major opportunity for us to both reimagine our workforce and what happens if each of us who are non-clinicians are equipped to handle issues of mental health? I’m convinced that this is a moment that allows us to be a bit more radical in how we think about workforce that’s really in community, by community, and for community.”

Miller called for the creation of “task shifting” policies that support the establishment of a corps of local community health worker-like lay personnel trained in low-level psychological interventions. The concept is already being successfully used as part of HIV and COVID-19 public health responses in other parts of the world.

“We need to look at places relevant to critical community conditions or social factors like housing, transportation, and racism that are driving underlying issues of mental health,” Miller said. “We need to democratize this knowledge and empower community members to have the skills to intervene with each other. This is a truly disruptive approach, but one that has been embraced by other countries and should be embraced here.”

3. Organizing and mobilizing a new constituency for mental health advocacy

“As scientists,” said Miller, “we should know that too much of our research, practice, and policy work is really only noticed by those people who diligently read the latest Health Affairs like myself. But that’s not enough. Our challenge is to better organize a new constituency for mental health bound by a common vision framework for advocating for a significant redesign of health care. My hypothesis is that the reason we don’t see our policy work being as transformative as we might like is that not enough phones are ringing in senators’ offices. We have to find those people who can make the calls, and who know folks who aren’t showing up at the meetings, the hearings, and the other places where advocates need to be. You may say, well, that’s not my job. That’s what the advocacy organizations do. Well, sure, they mobilize quite well, but there’s a fundamental difference between mobilizing and organizing. Organizing is knocking on the doors of the people who don’t know mental health is their issue and getting them on your team. Mobilizing is taking those people who have bought into the issue and directing them to do something different. Most mental health advocacy organizations mobilize quite well — the Capitol Hill visits, the action alerts, et cetera. But have we convinced enough people to organize? I believe this is where we have to adopt the vision and framing principles of social movements. This is really about what mental health advocacy can do to change hearts and minds. You have to have a constituency, you’ve got to have people, and you have to have a long-term commitment. We know that social movements are not episodic. They’re about long-term perspective and really investing in building relationships over time, including the next generation who can continue the work.”

“In closing,” said Miller, “I want you to think about your own life for a second — your loved ones, your family, your friends. What would you do if they asked you for help with a mental health situation? Would you know where to turn? Who to call, what to say? For most Americans, the answer is ‘no’ and we need to change that.”

how to fix mental health in america

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Reducing the Economic Burden of Unmet Mental Health   Needs

It is vital to understand the full costs of the mental health crisis affecting our nation. Left untreated, mental health disorders affect the well-being of children, adults, families, and communities—both because of the emotional costs as well as the economic ramifications.  These disorders were already too common before the COVID-19 pandemic, and the pandemic magnified the crisis by simultaneously increasing the need for care and diminishing access to it.  As part of his Unity Agenda, President Biden has put forward a national strategy to transform how our country understands, accesses, and treats mental health. This strategy recognizes that policies that improve the affordability of mental health treatment, expand access to behavioral health providers, invest in prevention, and increase the take-up of mental health services, can reduce the economic, emotional, and physical burdens that mental health disorders can create.

The state of mental health disorders in America

The pandemic has led to profound changes that have accompanied an overall decline in mental health. About half of women and a third of men have reported worsening mental health since the beginning of the pandemic, with about a fifth saying the pandemic has had a major impact. The problem has been particularly acute for young adults, with about 50 percent  reporting symptoms of depression. The problem is also magnified among those disproportionately affected by the pandemic. Women with children, Hispanic and Black people, the unemployed, and essential workers have been more likely to report mental health issues during the pandemic than the general population.

Mental health disorders cover a broad range of diagnoses, including but not limited to developmental disorders such as Attention Deficit Hyperactivity Disorder (ADHD), substance use disorders such as alcohol dependence, depressive and anxiety disorders, and schizophrenia and other psychotic disorders. Mental illnesses also range in severity, from the mild and self-limited to chronic and functionally-debilitating disorders. Effective treatments are available for many mental health disorders, and if implemented with fidelity, treatment can decrease or eliminate symptoms, promote recovery, and reduce morbidity and mortality.

There are several indications that Americans were experiencing a mental health crisis prior to the pandemic. Between 2008 and 2019, the percentage of adolescents (ages 12 to 17) that reported having experienced at least one major depressive episode in the past year increased nearly 90 percent , from 8.3 percent in 2008 to 15.7 percent in 2019, while the percentage of young adults (ages 18 to 25) reporting at least one major depressive episode in the past year increased a similar 81 percent from 8.4 percent in 2008 to 15.2 percent in 2019 (Figure 1). Over roughly the same period, suicide death rates among individuals 10 to 24 years of age increased 47 percent . Although rates of depression were highest among adolescents and young adults, more broadly in 2019, over one in five adults age 18 or older were classified as having a mental illness, and more than 13.1 million (or 5 percent) of adults had disorders that were classified as serious because they substantially interfered with or limited one or more major life activities. Rates of mental illness were highest among those age 18 to 25, females, and those reporting their race as other, as shown in Figure 2.

how to fix mental health in america

Among children age 3-17, the most commonly diagnosed mental disorders from 2013 to 2019 were ADHD (9.8 percent), anxiety (9.4 percent), behavioral problems (8.9 percent), and depression (4.4 percent). These disorders often begin in early childhood: approximately one in six U.S. children age 2-8 had a diagnosed mental, behavioral or developmental disorder. 

The social and economic consequences of mental health disorders

Mental health disorders result in large economic costs to those afflicted, their families, and society as a whole. As discussed in this year’s Economic Report of the President , good physical and mental health are essential inputs into a productive economy, helping create educated, productive workers. Poor mental health is associated with worse educational outcomes. Mental health diagnoses such as ADHD are associated with lower school attendance , lower test scores , and higher dropout rates .  Research also shows teens and adults with mental illness and substance use disorders are less likely to be in the labor force. Data from Denmark shows that mental health disorders such as depression, schizophrenia, and bipolar disorder carry significant earnings losses. These negative outcomes, among others, may further lead to what Case and Deaton have termed “ deaths of despair .” These deaths from drugs, alcohol, and suicide—caused by pain, economic distress, and mental health difficulties— more than doubled between the 1960s and 2017 and have continued to rise.

The COVID-19 pandemic exacerbated secondary effects of substance use disorders. A late 2020 survey found that 15 percent of adults in the United States reported starting or increasing substance use as a way of dealing with the pandemic. The Centers for Disease Control and Prevention (CDC)   estimates that for the 12 months ending in December 2021, overdose deaths were nearly 108,000, the highest count on record and nearly a 50 percent increase from the estimated drug overdose deaths for 12 months ending in December 2019. Domestic partner violence also increased in several countries by about a third in 2020 as compared to 2019.

The effects of mental health disorders can persist into the future, and even extend to the next generation. Depression during adolescence has been linked to longer-term consequences, such as higher engagement in crime . Mothers with inadequately treated mental illness often adopt less effective parenting strategies and struggle to develop close, emotionally healthy relationships with their children. This can result in poor emotional development in young children, lower cognitive scores and academic performance , and higher rates of behavior and mental health problems. The magnitude of intergenerational transmission is substantial, with one study finding that children of parents with mental health problems were twice as likely to develop mental health problems in adulthood.

Society also bears many of the costs of mental health disorders through public disability programs that pay for income support for those who cannot work.  People with psychiatric disabilities were the largest contributor to growth in Social Security Disability Insurance (SSDI) rolls in the early 2000s. As of 2020, 18 percent of SSDI beneficiaries, or 1.4 million individuals in current payment status, suffered from depression, bipolar, or psychotic disorders. Overall, the mental disorder category accounted for 29 percent of beneficiaries in 2020, or 2.4 million people—a share larger than beneficiaries who cannot work due to injuries, cancer, or diseases of the circulatory and nervous system, combined. While these supports are important and necessary, too many people fall through the cracks and do not receive the treatment that could both improve their livelihoods and reduce their reliance on disability insurance.

Additional costs to society of inadequately treated mental illness include increased homelessness and incarceration. The homeless population has significantly higher rates of mental illness than the population as a whole, and lifelong mental illness is associated with higher rates of incarceration . Both homelessness and incarceration are likely to be exacerbated by difficulties maintaining work or close relationships due to mental illness. In addition to the severe economic consequences for those affected, supportive services for the homeless impose large societal costs, and incarceration leads to millions of dollars of direct and indirect costs on society. Other societal costs include increased co-occurring mental health problems, loss of earnings, and premature death.

How can the burden of mental health disorders be reduced?

Given the costs to those suffering from mental health disorders with unmet needs and the costs that spillover to society as a whole, it is important to consider ways that public investments can be made most effectively to improve overall outcomes. 

Many individuals who suffer from mental health disorders do not get the treatment and care that they need.  Among those age 18 and older with serious mental illness in 2020, almost half reported that they did not receive treatment when they needed it at least once over the previous year. This rate was higher for 18- to 25-year-olds, women, and the unemployed or uninsured . With appropriate care and support, many may be able to live happier, healthier, and more productive lives.

A significant share of those with serious mental illness with perceived unmet needs reported not receiving care in the past year due to reasons related to costs (see Figure 3): 46 percent reported that they could not afford the cost of treatment, and 19 percent reported that their health insurance did not pay enough for mental health services. 29 percent reported that they did not know where to go for services, suggesting issues related to access.  Outside of the top five reasons, stigma-related issues were also reported, including concerns regarding confidentiality (12 percent) and that others would have a negative opinion (11 percent).  

how to fix mental health in america

The Federal Government covers some of the costs of treating mental health disorders. Around $280 billion were spent on mental health services in 2020, about a quarter of which came from the U.S. Medicaid program. But more could be done. Expanding health insurance coverage is an important component of addressing cost-based barriers to adequate treatment, and there is a growing body of evidence that health insurance coverage directly leads to increased take-up of effective mental health services and reduces stressors that could negatively impact mental health.  For instance, Medicaid expansions have been shown to increase utilization of mental health services. Causal evidence from randomized access to Medicaid coverage through a lottery in Oregon finds that Medicaid coverage resulted in better self-reported mental health overall, reduced the prevalence of undiagnosed depression by almost 50 percent, and reduced untreated depression by more than 60 percent. These reductions were accompanied by increased use of medications frequently prescribed to treat depression and substantial improvement in the symptoms of depression. In addition to improving access to treatment, Medicaid coverage decreased financial strain by reducing the probability of having to borrow money or skip paying other bills due to medical expenses by more than 50 percent—virtually eliminating out-of-pocket catastrophic medical expenditures. This reduction in financial hardship likely also contributed to improved mental health. 

However, having health insurance does not mean that costs do not present barriers to care. While Federal and State laws require parity in coverage between mental and physical health services, mental health services are more than 5 times as likely to be charged out-of-network, and in-network provider reimbursement rates are 20 percent higher for primary care than mental health visits. Those differences create barriers to accessing care, with one survey finding that only about half of insured adults find their plans to have adequate mental health coverage. While the evidence is mixed, parity has been shown to decrease out of pocket costs and increase certain types of care utilization, such as admissions for substance use disorders.

Even if treatment is affordable, treating mental health disorders requires adequate capacity of the behavioral health workforce so that access to mental health providers is widely available. As of 2021, 37 percent of the population live in areas with mental health practitioner-shortages. Two-thirds of the shortages are in rural areas, but other groups , such as ethnic minorities and those in under-resourced urban areas, also lack access. In total, over 6,000 mental health professionals are needed to fill the gap. Proposed policies that can help address this gap include: expanding programs like the National Health Service Corps , which provides loan repayment and scholarships for those providing health care services in underserved communities; and scaling training programs that prepare people for jobs in behavioral health. In addition, increasing Medicaid and Medicare provider payment rates, and policies to reduce provider burnout, could help expand the supply of mental health professionals.

Temporary regulatory changes enabling reimbursement for telehealth visits during the COVID-19 pandemic led to a rapid increase in the use of telehealth for outpatient visits, accounting for 13 percent of visits between March and August 2020.  While telehealth use declined to about 8 percent of visits one year later, this is still significantly higher than its rate of less than 1 percent prior to the pandemic. The share of mental health and substance use disorder visits via telehealth remains elevated, and telehealth represented over 35 percent of these visits between March and August 2021.  Fifty-five percent of rural residents relied on telehealth for behavioral health services during this period compared with only 35 percent of urban residents, suggesting that telehealth offers potential to increase access in areas that are experiencing provider shortages and is a promising way to meet mental health needs in underserved areas. However, more permanent regulatory changes at the Federal and State levels will need to be in place for providers to continue to offer telehealth services after the COVID-19 public health emergency eventually ends. 

Because one-half of all lifetime cases of mental disorders are estimated to start before age 14, school-based mental health programming is one promising strategy for increasing early detection of mental health disorders while also improving access to treatment. Indeed, in a recent National Academies report on addressing mental health and well-being challenges of youth that arose from or were exacerbated by the pandemic, experts identified several school-based strategies. These include school-wide screenings for mental health needs; school-based health centers or partnerships with health and mental health providers in the community; balancing academic learning opportunities with social, emotional, and behavioral support; and promoting and building resilience. Relatedly, interest in social and emotional learning (SEL) has increased because strong SEL skills in childhood are associated with positive academic, social, and mental health outcomes. If schools can help children master these non-academic skills, then perhaps they can prevent future mental health problems in adults. A 2017 review of randomized control trials evaluating popular school-based SEL programs reported positive effects on reducing depression and anxiety. 

Expanding access to behavioral health services may not address unmet needs if help-seeking remains inconvenient or stigmatized. Thus, moving beyond traditional healthcare relationships and expanding community-based mental health services can improve the uptake of mental health treatment. This could include building a peer mental health workforce and expanding the availability of Certified Community Behavioral Health Clinics (CCBHCs), which have been shown to improve health outcomes by delivering care for mental health and substance use disorders regardless of ability to pay. In addition, programs that expand the availability of school-based mental health professionals and embed mental health services into settings such as libraries, community centers, correctional facilities, and homeless shelters can reduce barriers to care.

Access to mental health treatment can mitigate economic losses, with one study finding that the approval of treatment for bipolar disease in Denmark eliminated one third of earnings losses and half of the disability risk associated with bipolar disorder. However, current treatments are not effective for all people, and treatment nonadherence is higher among patients with psychiatric disorders than other chronic conditions. As a result, continued investment in research is needed to develop and improve treatment efficacy and adherence.

The mental health crisis facing Americans imposes significant costs to the well-being of affected individuals, their loved ones, and society as a whole. This crisis took hold long before the onset of the COVID-19 pandemic, but its effects were amplified as the pandemic resulted in the loss of lives and livelihoods and unprecedented social isolation. Increasing the productive capacity of the economy going forward requires improving people’s mental health, which can be done by improving the affordability of mental health treatment, expanding the behavioral health workforce, and removing barriers to seeking care. 

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how to fix mental health in america

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What will it take to fix the U.S. mental health crisis? ‘A social movement’

What will it take to fix the U.S. mental health crisis? ‘A social movement’

how to fix mental health in america

Now, Insel has written a new book, Healing: Our path from mental illness to mental health , that draws on that experience as well as his subsequent role at Google. Healing follows Insel’s previous books, The neurobiology of parental behavior and The psychobiology of obsessive-compulsive disorder .

Read all of our 2022 Summit articles

Leading up to the 2022 Summit, where Insel will be among the Main Stage discussion leaders, Health Evolution Editor-in-Chief Tom Sullivan spoke with Insel about the book, trying to accomplish something similar for mental health to what former Vice President Al Gore did for climate change, why it will take a social movement to fix U.S. mental health, and more.   

What inspired you to write Healing ?   Insel: It wasn’t inspiration. It was confusion. I wrote it because I couldn’t figure out something that was really nagging at me. Fundamentally, I had been in the world of academic research, at the National Institute of Mental Health as Director, and I loved it. I was blown away by the progress we were making in so many areas, genomics, neuroscience, cognitive science especially. The world was being transformed by science. I was there from 2002 to 2015. During that period, I had a chance to see what seemed like the Golden Era for science and mental health research. At the same time, the suicide rate went up 33 percent, the homelessness rate went up probably two- or three-fold, overdose deaths went up in those years by 300 percent. What really struck me was the conundrum that with so much progress on the scientific side and the fact that we were learning so much and doing so much better — and we had at this point, pretty good diagnostic tests and really good therapies — yet on the public health side the numbers were going in all the wrong directions. Morbidity and mortality were getting worse, not better, more people were incarcerated, more people were homeless. The conundrum for me was: Why in the real world of care are we failing when in the world that I was living in we were succeeding brilliantly? And how do we square that? How do we connect those dots? That’s what got me started. I had to figure this out because I don’t want to continue doing what’s not working.  

And what did you determine? For CEOs developing mental health strategies with an eye toward the future, what is the path forward, if you will?   Insel: Because I had moved from government to Google — and the reason I did it was recognizing we had this gap and I thought ‘go where the people are, use the power of big data and deep pockets’ — the first thought I had was that we can actually get this done. But it’s not that simple. So, I spent three or four years trying to figure out how we fix the broken care system. That part of the conundrum was that even though we have good treatments, people don’t get them and they don’t get them for many reasons. But a big reason is that we have a care system that is really a sick care system, not a health care system. It’s incentivizing providers and patients and families in all the wrong ways. What ends up happening is people avoid care, they get into care only when they’re in a crisis. Crisis care often leads them into jail or into prison instead of into our health care system. And when they do get into the health care system, it’s highly fragmented. It doesn’t provide continuity and they don’t have a feeling of agency or of any control over what’s going on. They don’t like what they find. More than half of the people who should be in care are not in care because they don’t want what we have to offer. They don’t buy what we’re selling, basically. In mental health care, the people who need care the most often don’t get it, or are the least likely to engage in it. You don’t see that as much for cancer or heart disease, but in mental health, when you’re really, really sick, you don’t think you’re sick. You end up more likely to be in jail or prison than in the health care system. That’s not a great recipe for good outcomes.  

So that was the beginning. Much of the book was about the broken mental health care system and how to fix it. It took me a long time to begin to understand that we could really do a lot to fix the system and make it much, much better — but we still might not be able to solve the conundrum that started me on this whole journey.   

If we can improve the system but not necessarily solve the conundrum, what’s the solution? Or, at the very least, what’s next?    Insel: When I went to places that did better at mental health care, we still saw a lot of the same problems. In New York and efforts underway in California and many places, we were spending a lot of money, involving a lot of people and training a lot of people but the outcomes weren’t getting that much better. That’s when I began to realize that I had been thinking about the problem in the wrong way and that the problem wasn’t just that we had a broken care system. We did, and we do have to fix that. But if I was really honest with myself and I really wanted to focus on improving mental health in America, it’s not just about us. It’s not just about health care. It’s about a lot of other stuff that isn’t yet part of health care: having what I call the three Ps of recovery: people, place and purpose. That’s really the model. Reducing symptoms in the moment is important, but insufficient. What we really need to do if we want to begin to solve the conundrum and to actually do something about the rates of incarceration, homelessness and chronic disability is to engage those three Ps. Whether we do that in health care, or we do that through the social safety net, it must be what we commit to if we’re going to bend the curve here.   

The author Michael Pollan is quoted as saying that your book should become a call to action for a new social movement. Was igniting such a movement one of the reasons you wrote the book?   Insel: When I started writing this book, it was to figure out the conundrum but by the time I finished the book, I was convinced that what we needed wasn’t just more collaborative care or more precision medicine — all of which are important and we do need those — and what we need is a social movement for the mental health crisis. We need what Al Gore did for the climate crisis and that’s what the book is. It’s really an ‘Inconvenient Truth’ here just to call attention to what is a national problem here in the U.S. We are exceptional in how poorly we are dealing with the mental health crisis. Even before COVID that was true, but it’s doubled down with the effects of COVID. There’s no magic bullet for this. It’s going to require broad engagement. It’s going to require broad understanding of the complex problem and it’s going to require more than just more clinics and more pills and a bigger workforce. It’s going to require understanding that this is a problem that involves all of us. It’s not just the people who are homeless that we’re walking over, stepping over on the street, or the people who are currently incarcerated. They’re sort of the canaries in the coal mine.   

Fundamentally, the point of a social movement is widespread recognition that we are going to have to take a much more comprehensive view of this problem. We’re going to have to think about rebuilding the social safety net that we’ve allowed to become shredded in America. We’re going to have to think about things that we don’t usually think about as health care systems or health care providers, such as family support, parental leave, pre-K support, the fact that kids who do go to college graduate with so much debt that they end up getting buried in that and the amount of stress they feel. We need to be thinking at that scale and at that level.   

One of the pressing challenges that pre-dates the pandemic but has come to the fore is the need to integrate mental and behavioral health with physical health. Is there a point on the horizon where you can envision that integration actually being widespread?   Insel: We’re in this extraordinary moment of real transformation for the way mental health care is provided. One of the silver linings of the pandemic is that mental health care has had to reinvent itself. I don’t think we’re all the way through that. Instead, I like to think of it as a five act play and we’re in act one still. But we do have in place an enormous number of new companies that are providing telehealth that can be convenient and can be done in a way that integrates with primary care. The integration is an act two problem to solve because it’s still often a carve-out for people. Some of this is paid for with insurance, some of it is paid for out-of-pocket, but it’s an improvement from where we were. The integration of specialty mental health care with primary care has been more difficult than it should have been. I’ll add into that the integration of substance use disorder or addiction care. Even integrating that with mental health care has been a challenge because we have this very fragmented system. We have a model for collaborative care and we’ve known for 25 years that it’s highly effective at delivering better outcomes at lower costs yet it’s been very difficult to implement. But that’s a solvable problem because the model does work in figuring out ways to improve the scalability of collaborative care. It’s critical to know that most mental health care today, like most medication for mental illness, is actually prescribed by primary care, not by psychiatrists. About 80 percent of antidepressant and anti-anxiety prescriptions are written through primary care. Increasingly, that specialty mental health sector is for people with serious mental illness who have either very complicated forms of depression or schizophrenia or bipolar illness that require antipsychotics and other interventions. What that means is that a lot of people with depression or anxiety get medicine but they don’t get psychotherapy. And we know for many people, particularly with mild to moderate depression, psychotherapy is as effective or in some cases probably more effective if you look at long-term outcomes. That’s certainly true with some forms of anxiety as well. These are very treatable problems, but I don’t think that primary care doctors are set up to do more than provide the medication. The beauty of collaborative care is it brings in somebody else who can help connect the person to psychological support, psychological care as well. We’ve done that beautifully in the UK, but not yet in the U.S. with the single exception of the VA system, which has done this really well.  

For CEOs looking toward the future — whether mental health becomes a social movement, strategic imperative, or both — what should they be thinking about now to drive impactful change?   Insel: All of us have a role. There are two kinds of families in America: families that are struggling because a loved one has mental illness and families who aren’t struggling … yet. All of us will. We’re kind of becoming involuntary experts as we learn about it through our personal experience. Health care CEOs can start to make a difference by understanding that we cannot fix this ourselves. It’s like climate change in that we didn’t cause it and it’s not within our domain to do everything. But we can do something. Part of that is building out capacity so that when there are no beds, people don’t have to go to jail, they can actually come into health care. That requires thinking beyond our narrow idea of what health care looks like to consider more broadly those three Ps. That’s the bottom line: the problems are medical, but the solutions are social, they’re environmental, they’re political.   

Tom Sullivan

Tom Sullivan

Tom Sullivan brings more than two decades in editing and journalism experience to Health Evolution. Sullivan most recently served as Editor-in-Chief at HIMSS, leading Healthcare IT News, Health Finance, MobiHealthNews. Prior to HIMSS Media, Sullivan was News Editor of IDG’s InfoWorld, directing a dozen reporters’ coverage for the weekly print publication and daily website.

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The US Mental Health System Is So Broken That Even Money Can’t Fix It

  • 1 Indiana University, Bloomington
  • 2 Center for Pediatric and Adolescent Comparative Effectiveness Research, Indiana University School of Medicine, Indianapolis
  • 3 Web and Social Media Editor, JAMA Pediatrics
  • 4 Denise Hayes & Associates Counseling and Consulting, LLC, Indianapolis, Indiana
  • 5 Indiana University School of Public Health, Bloomington
  • Original Investigation Association of Youth Suicides and County-Level Mental Health Professional Shortage Areas in the US Jennifer A. Hoffmann, MD, MS; Megan M. Attridge, MD; Michael S. Carroll, PhD; Norma-Jean E. Simon, MPH, MPA; Andrew F. Beck, MD, MPH; Elizabeth R. Alpern, MD, MSCE JAMA Pediatrics
  • Correction Error in the Text JAMA Pediatrics
  • Comment & Response Attention to Co-occurring Disorders, Crisis Care, and Adequate Funding and Pediatric Access to Behavioral Health Care Mitchell Berger, MPH JAMA Pediatrics

Mental health was a major issue before the COVID-19 pandemic, and it has only worsened since. Suicide is the second leading cause of death for teens in the US, and rates are rising in children of most ages. Countless youth need help. 1

Unfortunately, help is often in short supply. Most counties in the US have few, if any, practicing child psychiatrists and small numbers of mental health care professionals in general. 2 Of course, it is possible that such professionals are living and working where there is greater need. It is important to understand if health care professionals are practicing where they are needed or if relative shortages are impacting outcomes.

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Carroll AE , Hayes D. The US Mental Health System Is So Broken That Even Money Can’t Fix It. JAMA Pediatr. 2023;177(1):8–10. doi:10.1001/jamapediatrics.2022.4416

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how to fix mental health in america

Opinion The Editorial Board

The Solution to America’s Mental Health Crisis Already Exists

Credit... By Xander Opiyo

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By The Editorial Board

The editorial board is a group of opinion journalists whose views are informed by expertise, research, debate and certain longstanding values . It is separate from the newsroom.

  • Oct. 4, 2022

Across the country hundreds of thousands of Americans with serious mental illnesses, such as schizophrenia and bipolar disorder, have been consigned to lives of profound instability. Instead of therapists to help them manage their illnesses or doctors to oversee their medication regimens or evidence-based treatment for their substance use disorders, they cycle through homeless shelters and the jails and prisons that have become the nation’s largest mental health providers. Or they make their homes on the streets. They are victims of a mental health system that is not designed to meet their needs — and of a society that has proved mostly indifferent to their plight.

Few Americans are receiving adequate psychiatric care or psychological support these days — either because their health insurance doesn’t cover it, or because they don’t have insurance to begin with, or because wait lists run far too long. But even amid such pervasive insufficiency, society’s neglect of the most severely mentally ill stands out. Of the 14 million or so people who experience the most debilitating mental health conditions, roughly one-third don’t receive treatment. The reasons are manifold — some forgo that treatment by choice — but far too many simply cannot connect with the services they want and need.

The most obvious reason is money. Community-based mental health clinics serve the vast majority of Americans with serious mental illnesses. These patients tend to be low-income, to be disabled and to rely on Medicaid, whose reimbursement rates are so abysmal that clinics lose money on nearly every service their doctors provide. “They get 60 to 70 cents on the dollar,” says Chuck Ingoglia, president of the National Council for Mental Wellbeing, a nonprofit representing thousands of U.S. community mental health centers. “I don’t know any other part of health care where your physician is your loss leader.” As a result, staff vacancies can run upward of 30 percent in public mental health clinics and waiting lists can stretch for months, even for people in crisis.

In many ways, the criminal justice system has become the only reprieve: Because court-ordered patients are granted priority, pressing charges against loved ones is a common way to get them psychiatric attention in a crisis. Jails and prisons also serve as final landings for those who fall through the cracks: They make up the three largest psychiatric facilities in the country, and more than 40 percent of the nation’s inmates have been diagnosed with mental disorders.

Americans have long accepted that, tragic though it may be, there are no other options. That apathy is easy to understand. When it comes to caring for the mentally ill, the arc of American history has nearly always bent toward failure. But the policies and programs that could undo this crisis have existed for decades.

In 1963, in what would turn out to be the last bill he signed into law, President John F. Kennedy laid out his vision for “a wholly new emphasis and approach to care for the mentally ill.” It involved closing the nation’s state psychiatric hospitals — which had become dens of neglect and abuse — and replacing them with a national network of community mental health centers. The centers, unlike the hospitals, would support and treat the formerly institutionalized so that they could live freely in their communities, with as much dignity as possible.

Lawmakers and health officials executed the first half of that vision with alacrity. Thanks to a roster of forces — Kennedy’s bill, new and effective antipsychotic drugs and a rising tide of activism for patients’ rights — the number of people housed in large psychiatric hospitals fell by 95 percent between the 1950s and the 1990s. But nearly 60 years after Kennedy’s bill became law, health officials and lawmakers have yet to realize the second half: There is still no community mental health system in America, but it is possible to start building one now.

Dr. Steven Sharfstein remembers the Boston State Hospital in Mattapan, a creaking 19th-century building where he and his fellow psychiatry residents were forced to send their most intractable patients.

“It was a terrible place,” says Dr. Sharfstein, who served as president of the American Psychiatric Association. “The lights didn’t always work, the patients wandered around like zombies. Nobody got better.”

Eventually, he and his fellow residents banded together and refused to go. Move the patients back to central Boston, they insisted, and treat them at the community mental health center. Their small protest was part of a growing movement to close state psychiatric hospitals across the nation and replace them with community-based care.

Those hospitals had also arisen from a movement: In the mid-1800s, after visiting hundreds of almshouses, jails and hospitals and seeing the horrid conditions that most people with mental illnesses lived in, the reformer Dorothea Dix begged health officials to create asylums where those patients could be treated more humanely. The first such facilities were small, designed for short-term, therapeutic care, and functioned more or less as Dix had hoped they would. But as local officials began foisting more of their indigent populations onto the states, they morphed into human warehouses. By the time Dr. Sharfstein started his career, most of them held upward of 3,000 patients, often for years at a time.

Advocates of a community-based approach argued that even the sickest psychiatric patients deserved to live in or near their own communities, that they should be cared for in the least restrictive settings possible and that with the right treatment (humane, respectful, evidence-based) the vast majority of them could recover and even thrive.

Kennedy’s bill was meant to enshrine these principles. The plan was to build some 1,500 community mental health centers across the country, each of which would provide five essential services: community education, inpatient and outpatient facilities, emergency response and partial hospitalization programs. Ultimately, the centers would serve as a single point of contact for patients in a given catchment area who needed not just access to psychiatric care but also help navigating the outside world.

The law did not provide long-term funding to sustain these new clinics — just seed grants for planning, construction and initial staffing. The hope was that once those grants expired, states would step in with their own resources. But this thinking proved overly optimistic. Rather than invest the money saved through asylum closures on mental health clinics, most states spent it on other priorities, such as cutting taxes or shoring up pensions.

As the initial grants ran out, programs that had been designed specifically for people with serious mental illnesses shifted focus, Dr. Sharfstein says. Some turned their attention to patients with better health insurance than the indigent had. Others tried tackling an array of nonpsychiatric crises. Alleviate homelessness and food insecurity, the thinking went, and even the most seemingly intractable mental illnesses would all but disappear. “Obviously, there is inherent value in addressing social ills,” says Dr. Paul Appelbaum, a Columbia University psychiatrist and an expert on the intersection of mental illness and law. “But the concept of community mental health became diluted to the point that it neglected psychiatric treatment.”

Congress tried to revive the flailing community mental health initiative in 1980, with a bill that would have more than doubled the federal government’s investment in Kennedy’s original plan . President Jimmy Carter signed that bill into law, but President Ronald Reagan repealed it the following year. He replaced it with a block grant program that gave state leaders broad discretion in how they spent federal mental health dollars. “It was more or less the death knell for a national community mental health system,” Dr. Appelbaum says. “They spent the money on all sorts of things, including things that we already knew were not working.”

In the end, less than half of the centers that Kennedy had envisioned were ever built. Marginalized people continued to spill out of state psychiatric institutions but found no meaningful safety net. By the 1990s, they were turning up in prisons and homeless shelters once again.

What stands out about this history now is not how disastrously wrong it all went but how close officials came to getting it right. The catchment area model laid out in the Kennedy bill would enable people in psychiatric distress to remain anchored in their communities. And single-point-of-access clinics would help families in crisis avoid the desperate gambit of seeking care through courts and judges. “The community mental health model was the right one,” says Dr. Appelbaum. “I talk to so many families who are in crisis today, and they have no idea where to turn.”

Congress could correct course now by writing a new bill that pulls the best of these past attempts together and builds on them.

Federal officials took a promising step in that direction in 2014, when they created a new community mental health demonstration project that enables Medicaid to pay mental health clinics based on what it actually costs to care for patients. “There are so many things you do to support a person with a serious mental illness that you cannot get reimbursed for,” says Mr. Ingoglia, of the National Council for Mental Wellbeing. “Sending case managers to jails and prisons and state hospitals to help clients transition into outpatient care. Working with police to screen the people that they encounter in their work.” The pilot program factors these essentials into the cost of care and reimburses centers accordingly.

So far, the resulting initiatives have proved more sustainable and more effective. In Missouri, behavioral health clinics are serving nearly 30 percent more patients by switching to the new model and have been able to provide same-day service to many clients. In Oklahoma, mental health clinics have effectively “put a therapist in every police car,” officials say, by outfitting cars with an iPad that contains a specially designed app. The program has helped reduce adult psychiatric emergency room visits by more than 90 percent and is now being implemented in homeless shelters and other contact points throughout the community.

Congress has already expanded this demonstration project, and scores of states are experimenting with the new model or planning to. But it will take more than pilot programs for these new centers to succeed where the early community mental health movement failed. Individual projects will have to be evaluated rigorously so that the most effective ones can be scaled. Hospitals, police departments, homeless shelters and other institutions will have to be brought along at every step so that mental health is neither siloed nor forgotten but instead becomes a fully embedded part of the wider community.

Education and outreach will also be essential. People with serious mental illnesses are far more likely to be victims of violent crime than perpetrators. But in an age where mass shootings and random street attacks have become commonplace, that fact has been buried in stigma. And a truly robust mental health system will have to include a range of services — not only outpatient clinics but also short-term care facilities for people facing acute crises, and some congregate institutions for the small portion of people who can’t live safely in the community. To prevent abuse, these facilities will need to be well funded, well monitored and held to a high standard.

None of this will be cheap. By most estimates, it would cost several billion dollars to fully fund and carry out the original community mental health vision today. But those costs would be partly offset by what police departments, jails and hospitals could save. The $193 billion in lost earnings that results from untreated mental illnesses should also be an incentive, and an eventual source of savings.

Americans have accepted the mistreatment and neglect of people with serious mental illnesses for far too long. It’s within our power to break that cycle now, and to change the way that the most vulnerable among us live for generations to come.

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How to rebuild America's mental health system, in 5 big steps

Paul S Appelbaum

A checklist of real, tangible ideas for President Obama to kick-start an integrated healthcare system that works. We've tried it before, and it is long past time to try again. (Yes, there will have to be a website.)

N o genuine system of mental health care exists in the United States. This country's diagnosis and treatment of mental health problems are fragmented across a variety of providers and payers – and they are all too often unaffordable. If you think about it, the list of complications is almost endless:

  • Families of loved ones with mental illness recount horror stories, as several have in the Guardian's interactive series this week .
  • Patients transitioning from inpatient to outpatient treatment often fall between the cracks.
  • Mental health and general medical treatment are rarely coordinated.
  • Substance abuse treatment usually takes place in an entirely different system altogether, with little coordination.
  • Auxiliary interventions that are so essential to so many people with serious mental illnesses – supported housing, employment training, social skills training – are offered through a different set of agencies altogether ... if they are available at all.

Our mental health system is a non-system – and a dysfunctional non-system at that.

The evidence is everywhere that things have been getting worse – more and more Americans with mental illness are stranded in emergency rooms, for example, and simply for want of hospital beds. And that is in no small part because nobody has tried, in more than 50 years, to design a comprehensive mental health system for all Americans.

It's time to try again.

mental health clinic 1955

The last major rethinking of the system's flaws began, in 1955, with an act of Congress that resulted in the appointment of something called the Joint Commission on Mental Illness and Health. The commission's report, Action for Mental Health , offered a vision of community-based mental health treatment: a new clinic would be created for every 50,000 persons – for prevention and early intervention services. People who once had to wait for their symptoms to become bad enough to go to the hospital before anything could be done? They would receive prompt care in their own communities and return quickly to life as usual – back at work, living with their families, seeing their friends.

Soon came the downsizing of large state hospitals and, in 1963, the passage of the Community Mental Health Act. That legislation envisioned the creation of a network of mental health centers spanning the country, so that every citizen would have a single point of access. A person experiencing early symptoms of mental disorder could receive emergency, inpatient, partial hospitalization and outpatient care – all in the same place – while her family was educated about her disorder and how best they could help.

Unfortunately, fewer than half of the centers were ever built, and adequate support for their operation was never provided. As federal funding ceased, many of the existing centers shifted away from caring for the most seriously ill ... to serving paying customers. The promise of an effective community-based system of care remains unfulfilled.

Yet we are, half a century later, in a different world for which a different vision may be required – a vision of comprehensive care aimed at helping people with mental illness continue to be functioning members of society. But the essential notion of having an integrated system of healthcare – a system that recognizes the spectrum of needs associated with mental disorders, from family therapy to medication to supported housing – is too important to relinquish.

President Obama can kick-start planning for a genuine system of mental health care, by establishing a presidential commission to suggest realistic, re-inventive steps forward.

It could be a landmark moment, right now, today.

Here's what it might take:

telephone hotline

  • No one struggling with depression or trying to find help for a troubled child should have to spend weeks figuring out whom to call. In every area of the country, a single point of contact should be created to respond to questions and triage people in need of help to appropriate services. Today, much of this information can be provided online – think of the live chat boxes on many business and banking websites, or even the pop-up video for customer support on Amazon's Kindle Fire tablet.

pill box patient services

  • Today people are too often left to their own devices when it comes to assembling and monitoring the package of services they need. Too often people can't find what they’re looking for. These services can range from medication to family therapy to rehabilitation services. Care coordinators should be available to shoulder those burdens – not patients and families.

group therapy session

  • People with mental disorders need more than just a pill – but that's often all that's available to them. Psychotherapy can help them understand and deal with the problems they face. Substance abuse commonly accompanies mental disorders – and must be addressed equally seriously. Many people with serious mental illnesses need assistance with job training and housing as critical parts of their recovery.

jail cell hospital

  • Most mental health problems can be dealt with inside a community, but when emergencies arise it becomes essential to have access to crisis services, short-term respite beds and inpatient care. Low payments from insurers for mental health treatment have led to the closure of many inpatient units, resulting in a backlog of people in crisis being held in emergency rooms – sometimes for days or weeks.

hospital paperwork

  • Today, paying for mental health care is nobody's responsibility. Insurers pay as little as possible, often denying claims on flimsy grounds. States have cut more than $4bn from their mental health budgets in the last six years . The federal government directly contributes only a tiny amount to supporting mental health treatment beyond the coverage it provides through Medicare and Medicaid. A joint federal-state commitment is needed to funding the infrastructure of a care system, while insurers' feet are held to fire to make certain they live up their obligations under the Mental Health Parity Act.

In the 21st century, with our instantaneous electronic communications, it may be less important to house these kinds of services in a single site – but it's no less important to insure that they are all available.

A half-century of patchwork efforts to improve one or another aspect of the mental health system has resulted in abject failure. Unless we take a comprehensive approach, and mend the safety net that protects us all, we will fail again.

Let's get to work.

Paul S Appelbaum is the Dollard Professor of Psychiatry, Medicine and Law at Columbia University, and a former president of the American Psychiatric Association.

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Five Improvements We Should Make to Mental Health Care

Even if they won’t prevent gun deaths..

As two clinical psychologists, we ought to be thrilled when public conversations draw attention to mental health. After all, mental health problems tend to be under-researched , undertreated , and overstigmatized . So when President Donald Trump promises, as he did last week, to “tackle the difficult issue of mental health,” it should be music to our ears.

We’ve had a hard time feeling positive about this new attention to our field, though, because far from an honest investment in health care, these suggestions are simply an obvious deflection from talking about guns. And what’s more, there’s a clear downside to putting mental health in the limelight on the heels of tragic school shootings: It suggests a strong link between violence and serious mental illness that simply doesn’t exist. It also detracts from the real and pressing issues facing mental health care in our society.

If politicians were serious about preventing and treating mental health, they would be tending to our broken mental health care system. What should politicians actually talk about when they talk about mental health? We compiled a list of priorities—and, spoiler alert, bringing back mental institutions did not make the cut.

1. Invest Early to Protect Kids and Families

The child welfare system is the first line of defense for kids who are neglected, abandoned or abused—kids who may be most vulnerable to mental health problems in the future. But this system is too often overwhelmed and underfunded. For example, Sam Brownback’s dramatic tax cuts in Kansas resulted in budget shortfalls that devastated the state’s mental health system, particularly its child welfare system. With 222 fewer psychiatric beds today than in 2013 and record-setting numbers of kids in the system, troubled foster kids in Kansas have been sleeping on couches in contractors’ offices because there is nowhere else for them to go. Kansas is not alone: In the wake of the opioid epidemic, caseloads have ballooned around the country, and funding has often not caught up.

Children in foster care may need enriched mental health services, like multidimensional treatment foster care ( MTFC ), a wraparound approach that combines family- and youth-focused therapy. A 2011 study in Washington state concluded that every dollar spent on MTFC saved the government $5.28 in reduced juvenile delinquency costs. An Oregon study of preschoolers found that by reducing foster care–placement instability, MTFC saved the state thousands of dollars per case. Despite this evidence that MTFC is incredibly cost-effective, a 2017 report found that less than 5 percent of foster children with serious mental health problems participated in evidence-based treatment programs like MTFC. A 2016 bill to revamp the foster system and emphasize family reunification unanimously passed the House but was lobbied out of existence in the Senate.

We could also make investments that could try to get ahead of some of the problems that cause kids to end up in foster care in the first place. As the only industrialized nation without any guaranteed paid parental leave , the U.S. fails to give families a break when they need it most. The lack of family leave hurts poor families the hardest; many low-income women go back to work within a few weeks of delivering an infant. Giving families proper support from the get-go might have benefits for parents and kids.

2. Focus on Treatment Over Punishment

The U.S. incarcerates more of its citizens than any other developed nation. Many of those citizens suffer from serious mental illness. A 2016 report found that in every U.S. county with both a jail and a psychiatric facility, a greater number of mentally ill adults could be found in the jail than the hospital.

Few jails and prisons offer comprehensive psychiatric services. Even when psychiatric treatment is recommended by judges, inmates may experience prolonged delays for services due to lack of funding. Take one example: Tyler Haire , a 16-year-old boy with seven different mental health diagnoses who stabbed his father’s girlfriend, was placed in jail awaiting a court-ordered psychiatric evaluation—and ended up spending 1,266 days in jail while he remained on the waitlist for one of the 15 beds in the state hospital forensic unit. Ultimately, he never saw a psychiatrist, received any therapy, or took psychiatric medication. Instead, he was frequently placed in solitary confinement, a practice that is known to worsen symptoms but is still used with mentally ill inmates. It is not only counterproductive but often more expensive to jail mentally ill inmates than to treat them in the community. We need to offer alternatives to incarceration for the mentally ill.

3. Make Mental Health Treatment Affordable and Accessible

The good news is that we have made remarkable progress in developing research-backed psychological interventions that work to treat chronic and serious mental illnesses, ranging from depression and anxiety to substance abuse and psychosis. The bad news is that only a small fraction of people who need these services actually receive them. One estimate by the Epidemiologic Catchment Area Survey reported that 40 percent of adults with severe mental illness did not receive any psychiatric care within a one-year period. Many individuals will continue to suffer from serious mental illness until we can reduce barriers to treatment access.

Why is it so hard to get effective treatments to the public? One reason is that mental health treatments remain largely unaffordable to many, especially those from lower socio-economic or disadvantaged groups. Mental health parity laws, which mandate insurer reimbursement for mental health treatment, have been in place for more than a decade—but enforcement of these laws can be stymied by, among other things, a lack of treatment providers. In 2016, Congress passed the 21 st Century Cures Act, which includes a number of mental health parity provisions, but budget delays have slowed the distribution of funds , and funding for some programs—such as a community mental health block grant—have already been cut.

Recent cuts to Medicaid may worsen the problem; an estimated 40 percent of recipients of Medicaid expansion under the Affordable Care Act, for example, have mental health issues. Changes to the ACA have also allowed insurance policies free of essential health benefits to again be sold, creating concerns that the mentally ill would return to using emergency rooms for basic mental health treatment.

There’s additional work we can do to bridge the gap for those who cannot easily find treatment. This includes addressing structural barriers , including limited access to transportation, language and cultural barriers, and unstable living conditions. This includes taking advantage of recent technological advances such as online clinical interventions and support groups, phone-based psychotherapy, and flexible administration of treatments by nontraditional and lay mental health providers, including peer-support and peer-to-peer health care approaches .

4. Support and Fund Mental Health Research

If we want to offer the most effective mental health treatments, we need cutting-edge research to test those treatments and understand how they work. The National Institutes of Mental Health (NIMH), the nation’s largest funder of mental health research, has seen flat budgets since 2003, and currently funds less than 20 percent of the proposals it receives . This tight funding environment discourages new researchers from entering the mental health arena and slows research progress.

Over the past decade, NIMH has moved away from funding clinical trials and mental health–services research in favor of neuroscience research that examines the underpinnings of mental illness. This shift has produced incredibly valuable research but has also left a vacuum in terms of studies focused on the dissemination and implementation of treatments in the community.

The National Science Foundation, another science-funding agency, has repeatedly weathered proposed cuts to its budget , including proposals to entirely cut its Directorate for Social, Behavioral, and Economic Sciences (SBE), which includes psychology. SBE has been a frequent target in Congress, and several lawmakers have called for social science funding to take a back seat to disciplines such as math and computer science. Without social science research, we cannot make progress in understanding mental health.

5. Combat Unwarranted Stigma

There is well-documented stigma against those who suffer from psychiatric illness , and our reaction to shootings is a clear example. According to a new ABC News pol l, “Americans by a 2-to-1 margin blame mass shootings mainly on problems identifying and treating people with mental health problems, rather than on inadequate gun control laws.” Contrary to the stereotype that mental illness leads to violence, research actually suggests that those with mental illness may, in fact, be more likely to suffer as victims of violence than as perpetrators . One study found that gender and ethnicity were much stronger predictors of a person’s potential to be violent than mental illness. In cases where violence is connected to mental illness, substance use is typically involved .

Inaccurate conceptions of dangerousness and violence also cause harm to both society at large and to individuals with psychological disorders. People may be reluctant to seek treatment if they fear judgment or stigma by a society that views mental illness as synonymous with violence. And research suggests that this is particularly true for underrepresented minorities.

We could all take action to combat this stigma by reorienting conversations—in our own lives and lobbying to politicians to do the same—away from sensationalized and unsupported links between mental illness and violence and toward mental health parity, integration with physical health care, and better funding and access to mental health screening and services. And we should address mental health care not because it will “stop shootings” (because it is orthogonal to that issue) but because it is a necessary ingredient for any society that values the well-being of its citizens.

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The Mental Health Crisis In America | Facts, Causes, & How To Fix It

  • America’s Mental Health Crisis

Causes Of The Mental Health Crisis

How to fix the mental health crisis.

how to fix mental health in america

According to a recent survey, 9 out of 10 adults believe the United States is facing a mental health crisis. Indeed, in recent years, Americans have endured a variety of stressors that cause or worsen mental health issues. 

To end this crisis, we must expand access to mental health treatment and address the root causes of mental suffering in this country. 

Facts About America’s Mental Health Crisis

While the mental health crisis affects all Americans, it’s particularly difficult for marginalized groups. More than 1 in 5 U.S. adults describe their mental health as only “fair” and “poor,” and many of these individuals identify as LGBT or make less than $40,000 per year. 

Similarly, a third of adults reported feeling constant or frequent anxiety over the past year, including over half of LGBT adults. About 1 in 5 adults also reported constant or frequent depression or loneliness. 

In addition, about half of adults have faced a severe mental health crisis in their family, such as a family member requiring in-person treatment for self-harm.

Substance Abuse

During the mental health crisis, many people have turned to substance abuse. While abusing drugs may temporarily make you feel better, it poses a high risk of substance use disorder (addiction) and overdose. 

According to the Centers for Disease Control and Prevention (CDC), the annual overdose death rate topped 100,000 for the first time in 2021. 

Young People

The crisis has also taken a toll on young people. In 2020, mental health-related emergency visits among U.S. adolescents increased 31%. Also, according to a recent CDC survey, almost 1 out of every 3 U.S. teens describe their mental health as poor. 

Likewise, nearly 20% of high school students have experienced serious suicidal thoughts, and 9% have attempted suicide. In fact, suicide is the second-leading cause of death among U.S. citizens ages 15 to 24. 

Researchers have identified a number of stressors that play a role in the nation’s mental health crisis:

The COVID-19 Pandemic

The COVID-19 pandemic brought significant challenges for all U.S. citizens, regardless of age, wealth, or social status. Over a million Americans lost a close loved one to the disease, and many more saw their loved ones become seriously ill or hospitalized. 

The resulting anxiety and grief wreaked havoc on the nation’s overall mental health. 

In addition, stay-at-home orders left Americans isolated from their family and friends. Isolation can cause or worsen a number of mental health conditions, including anxiety, depression, and substance use disorder. It also leads to greater social media use, especially among young people. 

Young people who spend too much time on social media often report serious self-esteem issues.

Finally, the pandemic caused a surge of economic anxiety. Numerous Americans lost their jobs, suddenly struggling to pay for shelter, food, and medical care. Studies show that this type of poverty often leads to mental health concerns. 

Social Issues

Many Americans have developed anxiety due to devastating social issues such as climate change, racial inequality, and gun violence. These issues can also worsen preexisting mental health problems, especially in people directly impacted by them. 

Lack Of Access To Mental Health Treatment

About 56% of Americans seek or want to seek mental health treatment for themselves or a loved one. Unfortunately, many of them can’t access that treatment, often due to a lack of health insurance. Indeed, about 85 million Americans are uninsured or underinsured. 

Even those who can afford treatment may have trouble finding it, as many mental health providers have lengthy wait lists. 

Because the mental health crisis affects so many U.S. citizens, it requires government intervention. Recently, the Biden Administration outlined a comprehensive plan to end the crisis. First, it aims to strengthen the mental health workforce by: 

  • improving the size and diversity of the behavioral health workforce
  • expanding access to peer support workers
  • improving access to the 988 Suicide and Crisis Lifeline
  • helping states offer Certified Community Behavioral Health Centers (CCBHCs), which provide 24/7, comprehensive behavioral health care to vulnerable Americans regardless of their ability to pay

Connect Citizens With Mental Health Care

In addition, the administration seeks to connect more U.S. citizens with mental health care services by:

  • launching FindSupport.Gov , a user-friendly online resource that helps people find mental health treatment 
  • providing mental health services in schools
  • launching services to support the mental health of workers, including the Mental Health at Work Initiative and the Workplace Stress Toolkit
  • decreasing stigma for service members and veterans
  • providing mental health services to caregivers
  • reducing disparities in maternal mental health
  • promoting behavioral health equity 

Prevention Efforts

Finally, the administration aims to create healthy, supportive environments to prevent mental illness from occurring in the first place by:

  • improving youth resilience
  • promoting the importance of social connection
  • investing in early childhood mental health
  • improving suicide prevention efforts
  • launching public call-to-action to support research
  • improving employee wellness
  • expanding access to long-term recovery support for people with substance use disorder and co-occurring mental health disorders

If you or someone you love struggles with poor mental health, please reach out to an Ark Behavioral Health specialist. Our board-certified healthcare providers offer personalized, evidence-based care to help you or your loved one build a fulfilling life.

Written by Ark Behavioral Health Editorial Team

©2024 ark national holdings, llc. | all rights reserved., this page does not provide medical advice..

CNN - 90% of US adults say the United States is experiencing a mental health crisis, CNN/KFF poll finds The National Council - Study Reveals Lack of Access as Root Cause for Mental Health Crisis in America White House - Fact Sheet: Biden-⁠Harris Administration Announces New Actions to Tackle Nation’s Mental Health Crisis

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Sleep: an underappreciated mental health fix

how to fix mental health in america

Tuesday, February 20, 2024

By Courtney Wise

how to fix mental health in america

Greetings, MindSite News Readers. In today’s Daily, chronic insomnia can exacerbate mental health conditions, but sleep researchers have strategies that offer help and hope. A pair of physicians discuss the relationship between weight loss drugs and mental health. A troubled former football player dies tragically – while in LA County’s custody. And, to defeat loneliness, try reaching out to some old friends. 

Confronting the hazards of sleep deprivation – and what to do about it

My 40-year-old cousin has been in business for himself the past 15 years. Renowned for successfully managing real estate deals that others figure are too much trouble, he and his business partner have built a thriving company together, now employing almost 20 people across two offices in Detroit and a nearby suburb.

how to fix mental health in america

To my mind, it’s time for both of them to delegate more responsibility to their capable team and enjoy the fruits of their labor. But as workaholics, they’ve embraced the rockers’ mantra, “I’ll sleep when I’m dead.” I don’t think they really get the connection between the two. There’s mounting evidence that sleep deprivation weakens the immune system, making people more vulnerable to physical illness. And as the New York Times reported , it also can wreak havoc on mental health. 

The Times points to an analysis of 19 studies that found poor sleep makes it difficult to think clearly or perform certain tasks that depend on solid motor functioning. More than anything though, sleep deprivation contributes to mood conditions like anxiety and depression. In fact, half of respondents to a 2022 survey conducted by the National Sleep Foundation who slept less than 7 hours per night reported having depressive symptoms. That’s because poor sleep changes how people experience stress and negative emotions, said sleep researcher Aric Prather. “And for some, this can have a feed-forward effect — feeling bad, ruminating, feeling stressed can bleed into our nights,” he added.

So what can adults do to get the 7 to 9 hours of sleep per night experts recommend? Some suggestions seem pretty simple and not directly connected to sleep. For instance, Prather says keeping your bedroom free of clutter and lowering the temperature in the room can help. The clear space encourages calm while the cooler air nudges your body’s core temperature to drop – as it does naturally while asleep. Set the mood for resting too, by putting smartphones and tablets away an hour or two before bed.

In some cases, insomnia is a side effect of medications intended to treat mood disorders. If you notice that’s your challenge, go to your doctor and let them know. They can adjust your dose or even switch medications, said Ramaswamy Viswanathan, a psychiatrist and the incoming president of the American Psychiatric Association. And if you’re bookish like me, titles like Say Goodnight to Insomnia by Gregg D. Jacobs may help. It teaches readers to reframe their thoughts and ruminations about sleep, using cognitive behavioral techniques for insomnia (CBTI). They helped Emily, a marketing exec suffering from insomnia. She’d begun suffering from worsened anxiety, including panic attacks. Journaling her thoughts helped to shift them. For example: “What if I’m never able to fall asleep again?” became “Your body is made to sleep. If you don’t get enough rest one night, you will eventually.” She still uses the strategies today, nearly 20 years after she first learned them. 

Weight loss drugs and mental health – a psychiatrist and endocrinologist examine the relationship

how to fix mental health in america

Mental illness and obesity often go hand-in-hand, say physicians Jody Dushay and Karen S. Greenberg. Dushay, an endocrinologist and Greenberg, a psychiatrist, even coordinate care for their shared patients by checking in with each

other (both work at a Harvard teaching hospital in Boston) to ensure that medications each prescribes won’t affect drugs that a patient is already using.

As weight-loss drugs in the GLP-1 family – including semaglutide (Wegovy and Ozempic), liraglutide (Saxenda and Victoza), dulaglutide (Trulicity), and a newer molecule, tirzepatide (Zepbound and Mounjaro) – explode in popularity, the need for such coordination has increased.  In an op-ed for STATNews , Dushav and Greenberg write that patients come to each of them with questions, including “Will Wegovy make my depression worse?” and “Can I take Wegovy now that I’ve gained 50 pounds on the antipsychotic?”

On the first question, the drugs come with warnings about a possible risk of increased suicidal thoughts and actions, but the FDA and a group of Canadian researchers have concluded in preliminary reviews that, so far, there’s no evidence of a causal link. Another large, recent study found that the drugs were associated with a decrease in suicidal thinking.

The second question is more complicated. Drugs that treat mental illness – notably antipsychotics – lead to weight gain, and weight gain itself exacerbates mood disorders like anxiety and depression. Some people also overeat to self-medicate mental illness, thereby gaining more weight. Weight loss drugs can positively affect mental health – when they work. People experience less social isolation and increased self-esteem after dropping excess body weight.  Emerging evidence even suggests that GLP-1s may reduce depression and substance use disorders and may even improve cognitive function . 

Dushay and Greenburg say that clinicians increasingly see GLP-1s as “the only really effective medications for obesity in patients with mental health disorders.” That doesn’t mean, however, that patients taking weight-boosting drugs to treat their mental health conditions can simply switch to GLP-1s without risking a worsening of the mental illness, they add. As I said, it’s complicated. “The arrows connecting obesity and mental illness point in both directions,” Dusahay and Greenberg conclude. “It is easy to overlook these double arrows, but our patients, doubly stigmatized, need our combined areas of expertise to determine the best path forward.”

A mentally ill ex-NFL player died in custody. His grieving family wants to know why

how to fix mental health in america

Stanley Wilson, Jr. wasn’t just a football star like his namesake father. Both played professionally in the NFL and, unfortunately, both struggled with serious mental illness. Injury ended the younger Wilson’s professional career after three seasons with the Detroit Lions, while his father, Stanley Wilson, Sr. is perhaps most famous for missing Super Bowl XXIII because of his drug addiction. The elder Wilson finally overcame that addiction and now enjoys a stable home life, but his son will never get the opportunity, the Los Angeles Times reports . 

After committing a series of home invasions while naked and in the midst of psychotic breaks, Stanley, Jr. was arrested and taken to LA County’s notorious Twin Towers jail. He was held for five months, then transported on Feb. 2, 2023 from the jail to a state hospital. He died 37 minutes after arriving. His family wants to know why. Two autopsies, one from the county Medical Examiner and another ordered by the family, conclude he died of a pulmonary thromboembolism – the sudden blockage of blood vessels that send blood to the lungs. But what caused the blood clot? Was it the result of an unexpected medical emergency or triggered by excessive force and restraint used against him? The sheriff’s department and the hospital each claim the other was responsible for Wilson at the time of his death. His frustrated parents have filed a $45 million wrongful death suit. 

The elder Wilson went through a lot and eventually was able to come to grips with his mental illness and addiction and . He laments that his son never got the same chance. “When I was younger, there were times when I wasn’t receptive to even accepting the fact that I had mental illness,” he said. “Stanley had his moments where he was trying to get help, but he would crawl back into his cavern of darkness. I’m just sad he wasn’t given the chance to come out of that cavern. That was taken from him.”

Feeling lonely? Try reconnecting to friends you already know

Want to maximize your feel-good quotient this year? Enhance your interpersonal relationships, says therapist Emma Nadler, in a column for the Washington Post . It’s advice based partly on the Harvard Study of Adult Development , a study ongoing since 1938 to learn what helps people to live healthier lives filled with meaning, connection, and purpose. Over 85 years, the study has found that those who live the longest and remain the healthiest have strong positive relationships with others. Strong relationships weren’t only deterrents to loneliness, but also heart disease, diabetes, arthritis, and cognitive decline. But how does one build close friendships as an adult? Aren’t people paired up in their closest friendships already?

One way is to reconnect with an old friend, Nadler says. Research shows that people who haven’t heard from you in a long time enjoy getting a text, email, or phone call to see how they’re doing. To really blow them away, send a handwritten letter or record and send a voice memo. It’s a way to reconnect with a strong personal touch, without the added pressure of a real-time phone call. Once reconnected, invite people to spend time with you. Commit yourself by suggesting a specific time or even an event to attend. Therapist Esther Perel suggests buying two tickets to concerts or museum tours you want to attend so that you can invite someone. You could also take walks or bike rides or work out togther. Then, be fully present: If you’re dining together, put your phone away to fully embrace your time together. And most of all, if the experience is positive, don’t let it be the last time you connect. Fight through what feels like “first date jitters” and make regular time on the calendar to get back in touch. Regular meetups reduce the stress of future planning and leave more time to focus on the joy of the relationship.

In other news…

For astronauts, social isolation is the norm. A typical space mission for NASA astronauts is six months long. But if NASA has its way, the coming decade will see the first missions to Mars – and several people will leave Mother Earth for three years to become the first humans to walk on the Martian surface. One of the biggest psychological challenges will be having no contact with people back home. A new documentary , Space: The Longest Goodbye, looks at how astronauts Kayla Barron, Matthias Maurer, Cady Coleman and others are preparing, with the help of NASA psychologist Al Holland, to handle “extreme isolation that could gravely affect their three-year journey.” Click here for a look at the trailer .

Practice saying no. It’s good for your mental health. People pleasers tend to feel bad about declining invitations or requests for help – often to their own detriment. But in this CBS Mental Health Minute , a Chicago psychiatrist breaks down the benefits of saying no alongside tips on how to start doing it.

If you or someone you know is in crisis or experiencing suicidal thoughts, call or text 988 to reach the  988  Suicide & Crisis Lifeline  and connect in English or Spanish. If you’re a veteran press 1. If you’re deaf or hard of hearing dial 711, then 988.   Services are free and available 24/7.

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Gen Z and millennials want to have a chat about mental health. With politicians

Elena Moore, photographed for NPR, 11 March 2020, in Washington DC.

Elena Moore

how to fix mental health in america

A student at Santa Clara University holds a sign in support of increased mental health services on campus, during a rally in the winter of 2021. Dai Sugano/MediaNews Group/The Mercury News via Getty Images hide caption

A student at Santa Clara University holds a sign in support of increased mental health services on campus, during a rally in the winter of 2021.

Just a few weeks after entering the Maryland legislature last year, House Delegate Joe Vogel introduced his first bill.

Inspired by the young people he met while campaigning around his Montgomery County-based district, it focused on relieving up to $30,000 in student debt for mental health professionals working in Maryland public schools.

"They wanted to elect someone who was going to make student mental health a priority," Vogel remembered.

The policy received bipartisan support, and legislation including Vogel's language was signed into law last May.

Now, Vogel is running for Congress in Maryland's 6th District, an open seat currently held by Democratic Rep. David Trone, who is running for Senate. If elected, the 27-year-old would become just the second member of Generation Z in Congress.

His platform includes addressing what he calls a mental health crisis, in part facing young people today. He told NPR that his age adds an important perspective to his work on the subject.

"The toxicity that we see on social media platforms ... the fear of what the climate crisis is going to hold for our generation. I mean, all of these things, I think, have a unique impact on our generation," Vogel said.

"But on top of that, we're also a generation that is having to deal with this mental health crisis without adequate resources," he added.

Many young Americans are vocal about their struggles with mental health compared to older age groups . It comes at the same time as both Democratic and Republican leaders work to address the issue.

For young Americans, politics breaks the American dream instead of building it

For young Americans, politics breaks the American dream instead of building it

What Young Voters Want in 2024

Consider This from NPR

What young voters want in 2024.

The latest Harvard Youth Poll found that nearly half of Americans under 30 reported feeling down, depressed or hopeless, and 56% said they felt nervous, anxious or on edge at least several times a week.

John Della Volpe, the director of polling at the Harvard Kennedy School Institute of Politics, has spent more than two decades researching young people and did work for President Biden's presidential campaign in 2020.

He argued younger generations are distinctively affected by coming of age in a politically tumultuous time.

Compared to older generations, Gen Z and Millennials (43 years old and under) ranked "the state of the country/world" as the top factor associated with their happiness when given a number of topics — according to research from Della Volpe's polling firm, Social Sphere. When asked more generally about happiness levels, the survey also found Gen Z reported the lowest levels.

"We can see a link between young people's concerns about the divisions in our country, the time in which they have grown up, America's relationship with the world," Della Volpe explained.

'We're not just voting. We're also running.' David Hogg launches young candidate PAC

'We're not just voting. We're also running.' David Hogg launches young candidate PAC

"The concern about these issues in the public sphere are something that is unquestionably connected to their high levels of anxiety and depression. I think this is a relatively new phenomenon," he said.

At the same time, mental health has made its way into politics with elected officials and candidates linking high-profile political issues — including regulating social media companies, addressing drug addiction and combating gun violence — to concerns over young people's well-being.

Hannah Wesolowski, the chief advocacy officer at the National Alliance on Mental Illness (NAMI), sees recent policy moves relating to mental health as part of a major shift in how politicians discuss the issue.

"There's almost no policy issue that doesn't have mental health overlap," she said, "whether you're talking about immigration, education, health care, reproductive rights, veterans. Across the board, all of these issues have mental health repercussions and a mental health impact."

"So if a policymaker is not focusing on it, they're missing a big part of the story here and a big opportunity for solutions."

A broadly bipartisan topic

In a recent campaign video featuring President Biden having lunch with a family in North Carolina, he discussed the topic of mental health with one of the teenage kids, who spoke about starting to see a therapist.

"There's nothing different than breaking your arm and having a mental health problem," he said, "it takes real courage, genuinely, I really am proud of you."

Throughout Biden's term, his administration has taken steps to address mental health, unveiling a strategy as part of his Unity Agenda , a series of policies the White House argues can be bipartisan efforts.

They've invested collectively over half a billion in funding towards helping increase the number of mental health professionals in schools . Plus, in 2022, the administration launched a 24/7 mental health emergency hotline, known as 988, which former President Donald Trump first established in an executive order before leaving office.

During Trump's term, he focused on reducing substance abuse in response to the opioid crisis and secured $9.5 billion for veterans' mental health support services. His campaign told NPR that the former president and GOP 2024 front-runner has already unveiled plans linked to mental health, including addressing drug addiction through "faith-based counseling, treatment, and recovery programs."

Some states are trying to boost youth voter registration. Here's what they're doing

Some states are trying to boost youth voter registration. Here's what they're doing

Rural voters lean red, young voters lean blue. So what's a young, rural voter to do?

Rural voters lean red, young voters lean blue. So what's a young, rural voter to do?

Though the broader topic of mental health has some potential bipartisan avenues for success, NAMI's Wesolowski argues that political division over high-profile social issues still hurts young Americans.

Specifically, she pointed to issues related to LGBTQ rights, particularly following the wave of restrictions on trans health care access last year, which she argued negatively affect the mental well-being of transgender and nonbinary young people

"That to me is one of the areas where the political rhetoric can be most damaging," she said. "We know rates of suicide and suicidal ideation in transgender, nonbinary youth are extraordinarily high . And when you hear politicians constantly saying there's something wrong with you, you're not 'normal,' that's really problematic."

Where the voters come in

Another partisan split is on the role of mental health in response to instances of gun violence. Throughout his administration, Trump and Republican allies repeatedly called for mental health reforms in the wake of mass shootings instead of changes to gun control policy. It's an association that mental health experts largely disagree with , arguing that while mental health reforms are important, access to guns is a crucial cause of the violence.

And the effects of gun violence may be a potential cause of some young people's mental strain, with over a third of young people under 30 expressing worry about a potential mass shooting when they're out, according to the latest Harvard Youth Poll.

Worry surrounding gun violence is an issue that conservative analyst and pollster Sarah Longwell has heard, particularly from young progressives.

Last fall, she conducted separate focus groups with young conservatives and progressives. She argued that some young progressives "catastrophize" certain issues relating to gun violence, climate change and financial insecurities.

"They don't say the words, 'mental health.' I don't want to be the one to categorize them as mental health," she said. "That's the main thing I see, is just how dark people think it is."

Harris is taking the lead on gun violence prevention. Will she reach young people?

Harris is taking the lead on gun violence prevention. Will she reach young people?

Young voters focus more on issues than candidates in 2024 presidential election

Interview highlights

Young voters focus more on issues than candidates in 2024 presidential election.

But among young conservatives, Longwell said, those same issues don't have the same effect.

"They still kind of catastrophize about Biden," she explained, "but they're more cheerful about the world."

That said, for young people who do feel affected by the current divisions in American politics and struggle with mental health issues, politicians addressing these topics go a long way, according to Della Volpe.

"This is a primary way for elected officials to create some sort of connection with their younger constituents, who question whether or not they could possibly understand or even [have] interest in empathizing with their plight," Della Volpe said.

It sticks out to Dakota Duncan, a 27-year-old middle school teacher based in Morganton, North Carolina.

As someone who sees a counselor for anxiety and depression, Duncan explained that talking about these issues has always been important to him. But since becoming a teacher, a job he began during the pandemic, it's taken on a new value.

"I've had students really frankly say to me, 'How are we supposed to learn if we don't feel safe at school?' And what do I say to that?" he asked.

He told NPR that the divisiveness of the country is not lost on his students or himself. And though he is a Democratic voter, Duncan can appreciate the work Trump did on mental health during his tenure.

"When I do hear President Biden or any elected official bring it up, it's a relief," he said. "And it makes me think more highly of them because I know that they're at least aware that this matters."

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Watch CBS News

Teen mental health is in crisis, study shows. What can parents do?

By Sara Moniuszko

Edited By Paula Cohen

March 6, 2023 / 6:00 AM EST / CBS News

Results from a recent Centers for Disease Control and Prevention survey add to the evidence that  teen mental health is in crisis, with particularly concerning numbers surrounding teen girls. 

The survey found around 1 in 3 high school girls in the U.S. have seriously considered attempting suicide and more than half of teen girls, 57%, reported feeling "persistently sad or hopeless" — a record high.

By contrast, 14% of high school boys told the 2021 survey that they had seriously considered attempting suicide, up from 13% in 2011. 

Among LGBQ+ students, close to 70% said they experienced persistent feelings of sadness or hopelessness during the past year, more than 50% had poor mental health during the past 30 days and almost 25% attempted suicide during the past year.

Alyssa Mairanz, a licensed mental health counselor and owner of Empower Your Mind Therapy , says the numbers are distressing, yet unfortunately, she "wasn't surprised."

"There are a few things that teens nowadays deal with that older generations didn't have to deal with," Mairanz notes, including social media , which can lead to harmful comparisons and online bullying, as well as the impact of the COVID-19 pandemic on developing minds.

So what can parents do to make sure their teens are OK?

Know the line between normal and not

"There's so many things that are typical with teens that aren't necessarily cause for concern, like general moodiness (and) fighting with parents," Mairanz says. "Parents don't know when it's cause for concern and what's more normal, so I think understanding that line is super important."

She says it may be a sign of something more serious if you see your teen...

  • is in intense, longer-lasting low moods.
  • is becoming more isolated or withdrawn, including not wanting to socialize or see friends.
  • is not wanting to get out of bed.
  • is engaging in risky behaviors, including physical aggression or intense substance use.

Another sign that often goes under the radar? High perfectionism.

"A teen that's really setting these very high, unrealistic standards for themselves in terms of anything — could be grades, friends, looks," she says. "When it's really that high, it's definitely a warning sign. These can often lead to depression (and) suicidality."

Discussing the results of the recent survey on CBS News "Prime Time," Dr. Debra Houry, chief medical officer at the CDC, noted that changes in sleep and appetite can also be an indicator. 

Listen and validate

"When parents are more validating to their child and focus on what they need versus what maybe the parent is assuming, teenagers tend to be much more open and willing to come to their parents when they're struggling," Mairanz says.

So, instead of opening a dialogue the intention to provide solutions, which may look like this:

  • Responding to an upset teenager with, "Oh it's fine," "It's not such a big deal" or "It's all going to be OK."
  • Or saying, "Let's talk about how we can study better" or "Let's create more intense notes" when a child does poorly on a test.

Mairanz suggests listening and validating, instead.

"Parents don't necessarily even realize how their response to their teenagers can have an impact. ... But a lot of times, the children really just need the emotional support. Because when they hear a solution, they hear, 'OK, I'm not doing enough,' rather than, 'OK, this is a struggle and it's understandable that you're upset.'"

Houry says being as "open and nonjudgmental as possible" can help a child feel more comfortable coming to their parent.

Keep an eye on social media usage

Parents should look out for a "real codependency" between their kid and their phones, which can look like being on social media and not taking breaks, Mairanz advises.

"Especially if it's impacting their ability to function, go to school, do their homework, be with friends… it's important to try to make sure teens get a break from all of that," she says.

Don't be a stranger to your child's circles

It's important not only to talk to your child, but to know your child's friends and their friends' parents, Houry says. 

"That way you're able to have an open communication with families around you, build that support system and have a good sense of where your child is and what they're up to," she explains. 

Don't ignore a child asking for help

If a child asks for professional help, don't brush it off. Experts say that's a sign to take action. 

"Sometimes there's still a stigma around therapy, especially with parents because (they) want their children to be OK and they take it very personally when we're not," Mairanz explains. "It's unfortunately common for parents to be like, 'You're fine. This is just normal teenage stuff, you don't need help.'"

If a child isn't comfortable enough to ask for support, look out for signs they need professional help, including self-harm, increased substance use, withdrawing from school or a change in sociability. 

Make sure you're OK too

While it's important to focus on the teen, Mairanz says it's also crucial for parents to realize they need to focus on themselves. 

"Whether it has to do with their own mental health issues or specifically around parenting, kids pick up a lot - so if a parent is really struggling, it's important for them to deal with that," she says. "Know that part of helping your teen is also helping yourself."

If you or someone you know is in emotional distress or crisis, you can reach the 988 Suicide & Crisis Lifeline by calling or texting 988. You can also chat with the 988 Suicide & Crisis Lifeline here . 

For more information about mental health care resources and support , The National Alliance on Mental Illness (NAMI) HelpLine can be reached Monday through Friday, 10 a.m.–10 p.m. ET, at 1-800-950-NAMI (6264) or email [email protected].

  • Mental Health

Sara Moniuszko is a health and lifestyle reporter at CBSNews.com. Previously, she wrote for USA Today, where she was selected to help launch the newspaper's wellness vertical. She now covers breaking and trending news for CBS News' HealthWatch.

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Things to know about California’s Proposition 1

Members of the Resiliency Empowerment Support Team (REST) Letha Croff, left, and Torie Baxter, second from left, talk to a homeless person sleeping under a bridge in Chico, Calif., Feb. 8, 2024. A measure aimed at transforming how California spends money on mental health will go before voters in March as the state continues to grapple an unabated homelessness crisis. The REST Program does daily visits to homeless encampments to get them into treatment or housing. Butte County officials fear the REST program would lose its funding if California voters approve Proposition 1 (AP Photo/Rich Pedroncelli)

Members of the Resiliency Empowerment Support Team (REST) Letha Croff, left, and Torie Baxter, second from left, talk to a homeless person sleeping under a bridge in Chico, Calif., Feb. 8, 2024. A measure aimed at transforming how California spends money on mental health will go before voters in March as the state continues to grapple an unabated homelessness crisis. The REST Program does daily visits to homeless encampments to get them into treatment or housing. Butte County officials fear the REST program would lose its funding if California voters approve Proposition 1 (AP Photo/Rich Pedroncelli)

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SACRAMENTO, Calif. (AP) — California voters this March will decide on a statewide ballot measure that Democratic Gov. Gavin Newsom said would transform the outdated mental health system and address the ongoing homelessness crisis.

Proposition 1 , the only statewide initiative on the March 5 ballot, is also one of the most complicated and lengthy measures in recent years. It takes up 68 pages of the 112-page voter information guide.

At the center of the proposition is the question of how counties could use funding that comes from a voter-approved tax on millionaires in 2004. Revenue from the tax, now between $2 billion and $3 billion a year, has mostly gone to counties to fund mental health services as they see fit under broad guidelines. It provides about one-third of the state’s total mental health budget.

The ballot measure would give the state more power over how it’s spent. It also would allow the state to borrow $6.38 billion to build 4,350 housing units, half of which would be reserved for veterans, and add 6,800 mental health and addiction treatment beds.

President Joe Biden walks toward members of the media as he arrives at the White House in Washington, Monday, Feb. 19, 2024, after returning from Rehoboth Beach, Del. (AP Photo/Andrew Harnik)

Here’s a closer look at the details:

How is the money used now?

Under the current model, of the money going directly to the counties, 76% of the it funds mental health treatments, housing, outreach and crisis programs for people with mental health issues; 19% goes to prevention and intervention programs such as cultural centers and school-based mental health counseling; and 5% goes to innovative projects to increase treatment access.

The state keeps 5% of the tax revenues for administration costs.

How would it change under Proposition 1?

The state would more clearly specify how the money would be spent, with a greater focus on people with serious mental health disorders such as schizophrenia and major depression or substance use issues like excessive drug use or alcohol consumption. About a third would go toward housing and rental assistance for homeless people with serious mental health or addiction problems and 35% would go to mental health treatments and support for that population. Of the remaining roughly 35%, at least half would go to prevention services for youth and the rest would fund all other programs including workforce training, innovation projects and prevention services for adults.

Counties could shift up to 14% of funding between the categories, pending the state’s approval. The state would keep 10% for administration and other initiatives.

What programs would be boosted?

Transitional and permanent housing for chronically homeless people with serious mental health or addiction issues would see more money. Mental health treatment programs and support services such as rental assistance and vocational programs for this population also would see a boost.

What programs are at risk?

County officials can’t say which programs would face the biggest budget hit, but they anticipate some outreach services, homeless drop-in centers, and wellness programs run by peer-support groups would be impacted.

In Butte County, where officials would have to carve at least 28% of funding from existing programs toward housing, even the homeless outreach team that goes out to encampments to get people to sign up for housing and treatment is at risk of budget cuts. The program started more than a year ago and is funded with the mental health innovation money.

Diverting funding from services to housing also would mean less federal matching money, Butte County Behavioral Health Director Scott Kennelly said.

Who supports the proposition?

Newsom has taken the lead in boosting the proposition , fundraising more than $10 million and appearing in television ads to promote the plan.

He also has the support of law enforcement, firefighters, the state’s hospital association, the National Alliance on Mental Illness California and a slew of big city mayors.

Who opposes it?

Opponents of the proposition include mental health and disability rights groups, the Howard Jarvis Taxpayers Association and the League of Women Voters of California.

Several county officials have also expressed concerns with the measure. They worry that the change would threaten programs that keep people from becoming homeless in the first place.

how to fix mental health in america

Gina McCarthy: ‘We can solve America’s health crisis, if we fix our climate crisis’

The Wider Image: These Houston residents dream of moving to where the air is clear

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  • Indoor air pollution a problem with 40 million U.S. homes using gas with poor ventilation
  • Health Care Without Harm addressing healthcare sector's 8.5% contribution to all U.S. emissions

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Mark Hillsdon is a Manchester-based freelance writer who writes on business and sustainability for The Ethical Corporation, The Guardian, and a range of nature-based titles.

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COMMENTS

  1. How to fix America's broken mental health care system

    How to fix America's broken mental health care system by CHJ Fellow Deb Gordon A psychiatrist works with a young patient (Photo by Loic Venance/AFP via Getty Images) February 16, 2021 At age 19, Ryder Dunagan stood on the Brooklyn Bridge and prepared to jump. Instead, he checked himself into a hospital.

  2. A Simple, Yet Powerful Solution to the Mental Health Crisis ...

    A Simple, Yet Powerful Solution to the Mental Health Crisis: Peer Support SEP. 20, 2022 By Christine Moutier, M.D. and Ken Duckworth, M.D. Our nation's mental health crisis is arguably at an all-time high. The demand for treatment has soared, exacerbating the shortage of mental health providers and adding to their already-significant waitlists.

  3. How to Transform the U.S. Mental Health System

    The analysis and findings are organized under three goals for mental health system transformation: promote pathways to care, improve access to care, and establish an evidence-based continuum of care so patients get the help they need Many Americans experience mental illness, but the majority of those in need of assistance go untreated.

  4. How to Fix the American Mental Healthcare System for Good

    We can start by building the promised system of community-based care. This begins with creating small group homes in communities across the country where individuals with mental illness can live indefinitely for an affordable price.

  5. Transforming the Mental Health System

    Focusing on recovery; Promoting health and wellnes s; and Ensuring access to supports and services. Focus on Recovery: The goal of all mental health services and systems should be to support individuals at all stages of their recovery to live their best lives.

  6. Strategies to Repair a Broken System: Mental Health Care

    1. Robust integration of mental health care and physical health care "When we ignore mental health within our larger system, it's less effective for our overall care," Miller said.

  7. The national mental health crisis

    APA's 2020 Stress in America survey released in October revealed that Americans have been profoundly affected by the COVID-19 pandemic and are struggling to cope with the disruptions on top of other factors creating stress, including political conflict, the impact of racism, and an economic downturn.

  8. Transforming Mental Health Care in the United States

    The U.S. mental health system has reached a moment when a historic transformation to address persistent problems appears realistic. These problems include high levels of unmet need for care, underdevelopment of community-based supports that can help avoid unnecessary emergency care or police engagement, and disparities in access and quality of services.

  9. Perspective: We Must Address America's Behavioral Health Crisis Now

    To address longstanding behavioral health workforce shortages, we are urging Congress to: lift the cap on Medicare-funded residency slots; bolster student loan repayment programs; promote efforts to reduce variability of scope-of-practice laws and support changes that drive integration of care teams; and support efforts to place behavioral healt...

  10. The State of Mental Health in America

    2023 Key Findings In 2019-2020, 20.78% of adults were experiencing a mental illness. That is equivalent to over 50 million Americans. The vast majority of individuals with a substance use disorder in the U.S. are not receiving treatment. 15.35% of adults had a substance use disorder in the past year.

  11. How Do We Fix America's Mental Health Care System?

    Broadcast live streaming video on Ustream At the end of February at the Newseum in Washington, D.C., the Hill hosted a event on the economic and human consequences of policies that limit access to treatment to mental health services.

  12. 4 Big Ways We Can Change Mental Health Care in America

    Here are four suggestions we believe would go a long way toward fixing the mental health care system: 1. Increase Mental Health Care Funding Mental health concerns are estimated to cost...

  13. Why Therapists Are Worried About America's Growing Mental Health Crisis

    Dec. 17, 2021. As Americans head into a third year of pandemic living, therapists around the country are finding themselves on the front lines of a mental health crisis. Social workers ...

  14. Reducing the Economic Burden of Unmet Mental Health Needs

    While Federal and State laws require parity in coverage between mental and physical health services, mental health services are more than 5 times as likely to be charged out-of-network, and in ...

  15. What will it take to fix the U.S. mental health crisis? 'A social

    Leading up to the 2022 Summit, where Insel will be among the Main Stage discussion leaders, Health Evolution Editor-in-Chief Tom Sullivan spoke with Insel about the book, trying to accomplish something similar for mental health to what former Vice President Al Gore did for climate change, why it will take a social movement to fix U.S. mental hea...

  16. The US Mental Health System Is So Broken That Even Money Can't Fix It

    Finally, I was able to spend one day a week for a 6-week period to shore up my expertise caring for children and adolescents and their families with mental health problems. After a 2 week "retirement" from my general Pediatric practice I was fortunate to begin seeing child and adolescent mental health patients working with my B/D Peds mentor.

  17. The Solution to America's Mental Health Crisis Already Exists

    Community-based mental health clinics serve the vast majority of Americans with serious mental illnesses. These patients tend to be low-income, to be disabled and to rely on Medicaid, whose ...

  18. How to rebuild America's mental health system, in 5 big steps

    Thu 29 May 2014 08.08 EDT N o genuine system of mental health care exists in the United States. This country's diagnosis and treatment of mental health problems are fragmented across a...

  19. 6 Real Policy Solutions to the U.S. Mental Health Crisis

    1. Destigmatize mental health Nearly one third of U.S. citizens worry about others judging them for seeking out mental health resources. In the face of stigma, even the most sophisticated...

  20. How to fix America's broken mental health care system.

    1. Invest Early to Protect Kids and Families The child welfare system is the first line of defense for kids who are neglected, abandoned or abused—kids who may be most vulnerable to mental...

  21. The Mental Health Crisis In America

    Social Issues Many Americans have developed anxiety due to devastating social issues such as climate change, racial inequality, and gun violence. These issues can also worsen preexisting mental health problems, especially in people directly impacted by them.

  22. Americans must act now to fix youth mental health crisis

    Americans must act now to fix youth mental health crisis. October 13, 2023. by Schroeder Stribling and Kenna Chic. One of us is a national behavioral health advocate whose peer support work ignited a decade-long journey to reform the system. As a peer supporter, I have worked with several youths and young adults who became entangled in ...

  23. Sleep: an underappreciated mental health fix

    That doesn't mean, however, that patients taking weight-boosting drugs to treat their mental health conditions can simply switch to GLP-1s without risking a worsening of the mental illness, they add. As I said, it's complicated. "The arrows connecting obesity and mental illness point in both directions," Dusahay and Greenberg conclude.

  24. Student debt, climate change, AI drive Gen Z anxiety crisis

    Generation Z is America's most diverse cohort yet — but they're united by deep anxieties about the world around them.. Why it matters: A collision of political, economic and social trends has minted a generation in which huge numbers of people struggle to cope with the present and feel even worse about the future. By the numbers: Gen Z — people roughly between the ages of 12 and 27 ...

  25. As Gen Z gets ready to vote in 2024, mental health is political for

    The latest Harvard Youth Poll found that nearly half of Americans under 30 reported feeling down, depressed or hopeless, and 56% said they felt nervous, anxious or on edge at least several times a ...

  26. Teen mental health is in crisis, study shows. What can parents do?

    For more information about mental health care resources and support, The National Alliance on Mental Illness (NAMI) HelpLine can be reached Monday through Friday, 10 a.m.-10 p.m. ET, at 1-800 ...

  27. Things to know about California's Proposition 1

    How is the money used now? Under the current model, of the money going directly to the counties, 76% of the it funds mental health treatments, housing, outreach and crisis programs for people with mental health issues; 19% goes to prevention and intervention programs such as cultural centers and school-based mental health counseling; and 5% goes to innovative projects to increase treatment access.

  28. Gina McCarthy: 'We can solve America's health crisis, if we fix our

    America is All In report shows energy transition could help save 35,800 premature deaths from 2024-2035; ... "We can solve our health crisis, if we fix our climate crisis." ...