Expert Contributors: Christine Yu Moutier, Anna K. Costakis, Jennifer Hames, Shana Hoffman, Dr. Bernard DiCasimirro, Jonathan Alpert, Dr. Anne Marie O'Melia, Dr. Aaron Weiner
With the United States facing a growing mental health crisis, it is crucial to have a thorough and sophisticated understanding of this issue. Recent data reveals a distressing scenario: as per the National Institute of Mental Health, approximately 20% of adults in the United States are afflicted with a mental illness, totaling more than 51 million individuals in 2019. The prevalence of mental health issues among adolescents has significantly risen, posing a particularly concerning situation for the younger population. This crisis not only affects individual well-being but also has significant ramifications for our communities and healthcare systems. The annual economic burden of major depressive disorder is estimated to be $210.5 billion, encompassing both direct costs and the impact on productivity.
The COVID-19 pandemic has worsened this intricate network of challenges, serving as a catalyst that has exposed underlying issues. The Centers for Disease Control and Prevention (CDC) documented a notable surge in the proportion of adults reporting symptoms of anxiety or depressive disorders during the pandemic, escalating from 36.4% to 41.5% between August 2020 and February 2021. Moreover, the pandemic has exposed the inequalities in mental healthcare, as marginalized communities are disproportionately impacted by systemic inequities and obstacles to receiving treatment.
The New York Editorial has undertaken a mission to analyze and comprehend the complexities of this multifaceted crisis by collaborating with a diverse array of mental health experts. These experts, including clinical psychologists and healthcare specialists, provide a diverse range of perspectives that shed light on the extent and scope of the crisis. They offer both a diagnostic perspective on the current state of mental health in the U.S. and innovative solutions and strategies to tackle this complex problem.
Facilitating the collaboration of specialists:
We have strived to establish a platform that amplifies the voices of experts with clarity and intention. We have gathered viewpoints from diverse sectors of mental health care to guarantee a comprehensive perspective. Dr. Christine Yu Moutier advocates for a national suicide prevention plan, emphasizing the complex risk factors associated with suicide. Meanwhile, Dr. Aaron Weiner focuses on the distinct mental health difficulties experienced by adolescents during these challenging times. Every specialist adds a component to the enigma, aiding our comprehension of the numerous aspects of the crisis.
Expert Opinion 1:
- Christine Yu Moutier, M.D., Chief Medical Officer, American Foundation for Suicide Prevention
Suicide continues to be an urgent national problem. In 2022, 49,449 people died by suicide in
the United States — the highest toll in recent history. At the same time, the national rate has
stayed fairly level over the past five years.
Suicide is complex with multiple contributing risk factors in each instance of suicide — mental
and physical health conditions, lack of access to healthcare, trauma, family history of suicide,
access to lethal means, and environmental factors.
Tackling this complex public health issue demands that we ramp up our investment in a truly
actionable national suicide prevention plan. Federal appropriations for suicide prevention pale in comparison to the per capita investment in other leading causes of death. We must implement evidence-based, culturally relevant suicide prevention education and interventions at scale to save lives — in our nation’s schools, workplaces, faith-based organizations, healthcare and correctional settings, and in firearms communities. We also need to recognize and address the intersectionality of suicide risk with opioids and other substances, as well as social media.
At the individual level, a strong public health approach starts with advancing our sophistication
in addressing mental health as health, learning the risk factors and warnings signs of suicide,
reaching out and having open and honest conversations about mental health and suicide, as
well as connecting those who are struggling to resources like the 988 Suicide and Crisis Lifeline
or a mental health professional.
Just one suicide is devastating and painful, but I also find reason to hope. More than ever,
stigma is decreasing and our culture is becoming more open to talking about suicide, more
people are seeking mental healthcare, and scientific research is teaching us about suicide’s
connection to brain health and producing effective clinical and community interventions. We all
have the power to be a lifeline.
Expert Opinion 2:
- Anna K. Costakis, MD, Director of Psychiatry Residency Training at Staten Island University Hospital
We are much more attuned to the mental health needs post-pandemic because almost 50% of the population developed symptoms of depression or anxiety in the course of the pandemic with ongoing symptoms and distress so prevalent even now. Despite this tremendous need, there are abysmally few resources, and those resources are incredibly difficult to access. Why is this? Psychiatry, just like primary care, is undervalued in our medical system and our society. Only in the last couple years have psychiatry residencies become more competitive as medical students move away from other underpaid, undervalued specialties. The number of psychiatry residency spots hasn’t caught up to the need for psychiatrists, and subspecialty psychiatry fellowship spots, such as in child and adolescent psychiatry, continue to be few and far between compared to the tremendous need. Nurse practitioner schools have become factories churning out new NPs with very limited experience prior to graduating and learning on the general population without adequate supervision only causing worse problems down the line.
From a consumer perspective, the obstacle course required to conquer to find a psychiatrist or therapist is a ridiculous challenge that requires a patient’s entire village to solve. What is needed is a coordinated system of all levels of care in psychiatry allowing for a dashboard to always be updated on whether a therapy spot is open or evening psychiatry medication evaluation spot is open remotely or in person and accepting which insurance after the patient goes through a centralized entry point to access services within any healthcare system. The efficiency that is embraced within a system that specializes in nationally recognized orthopedic surgery should be adopted by our healthcare systems in other areas such as psychiatry to match patients with doctors and therapists, objectively measure symptoms to monitor progress in treatment, and to allow the medications and treatments that are recommended by the treatment team to be readily accessible rather than spending hours on the phone begging insurance companies to fax various forms and then submit appeals to have these recommended treatments covered.
We have become victims of our silos without access to cross-silo resources, data, and ultimately support for our suffering patients, and unfortunately, all these systems and society will feel the repercussions for decades to come. Mental illness is difficult enough that jumping through 900 additional hurdles to access good care shouldn’t also be part of this experience.
Expert Opinion 3:
- Jennifer Hames is an associate clinical professor in the Department of Psychology at the University of Notre Dame and is the clinic director of the Notre Dame Psychological Services Center, which is the training clinic for doctoral students in the clinical psychology Ph.D. program. Hames' area of expertise focuses on empirically supported treatments, suicide risk assessment and management, cognitive behavioral therapy, clinical supervision and evidence-based practice.
"The U.S. has been on the brink of a potential mental health crisis for years. It is undeniable that the distress and disparities that arose in response to the pandemic and racial reckoning in our country widened some of the existing cracks in our nation’s mental health care system, contributing to our current crisis. The pandemic also led to unprecedented inflation, which has affected the amount of disposable income people have to seek mental health care. However, even before the pandemic, it was challenging to find a therapist or psychiatrist, with waitlists in some communities exceeding six months. The high deductibles and session limits on many health insurance plans also made it challenging for people to use their insurance for mental health care. Reimbursement rates for mental health providers who accept insurance are often very low, leading many mental health providers to not accept insurance so that they can better support their own families. This, in turn, creates additional financial barriers to seeking care. As people are unable to access care when they need it due to system-level or personal barriers, mental health concerns are then left untreated, which can contribute to worsening symptoms and a growing national crisis. One avenue to increasing access to mental health care is through strong advocacy for improved mental health care benefits for consumers and for higher insurance reimbursement rates for mental health care providers.
"In addition, relatively few mental health providers are trained to offer treatments that have been shown by research to be effective at treating various mental health concerns (e.g., cognitive behavioral therapy or dialectical behavior therapy). Advocacy efforts to require mental health providers to receive training in evidence-based therapies prior to licensure would help the public have more reliable access to high quality care that can more efficiently alleviate their distress. It is also critical to increase the general public’s awareness of evidence-based therapy. Those looking for mental health care would benefit from looking at the following websites to find the names and descriptions of therapies that have been shown by research to be effective (evidence-based adult therapy: https://div12.org/treatments/; evidence-based child therapy: https://effectivechildtherapy.org/therapies/). Subsequently, on an initial phone call with a mental health care provider, the individual could ask whether they provide that type of therapy and then proceed accordingly."
Expert Opinion 4:
- Shana Hoffman, CEO of Lucet, an organization that partners with health insurers to get patients access to digital behavioral health treatment for more than 22 million people in all 50 states.:
“America’s mental health crisis has been widely reported with increased demand for treatment and a limited (and shrinking) pool of providers cited for exacerbating the issue. As this plea for expanded mental health resources continues to grow, we are also seeing an explosion of new market entrants (there are more than 10,000 mental health and wellness apps in the Apple store alone) and alternative clinical resources made available to meet growing needs, but each comes with varying levels of quality, outcomes reporting and ultimately, efficacy.
In order to meaningfully address the issue of mental healthcare accessibility, it will be important to not only ensure that the treatment options are available to all who require them but that we are also giving patients the tools to navigate and connect to the landscape of treatment options, identifying the care plan that works best for them. When you break your arm, your journey to care, from X-ray to cast is quite simple. This isn’t the case with mental health where there is no one-size-fits-all solution. Rather it’s only by connecting patients with high-quality care pathways that align with their unique needs and preferences, that we can expect to have the longitudinal patient engagement and treatment adherence outcomes that will have a fundamental impact on mental healthcare accessibility challenges moving forward.
Technology is well poised to help patients in their efforts to weave together care resources. This includes taking their modality (in-person vs. virtual treatment) and provider (gender/race/sexual identity) preferences into consideration, which has proven to be important when it comes to building the trusted care team relationships that are so vital to effective behavioral healthcare delivery over time.”
Dr. Bernard DiCasimirro, Chief Medical Officer of Lucet:
“Since the pandemic, there is less stigma around seeking behavioral health resources; therefore, people feel like they’ve been given permission to explore their mental health and emotions. We’ve seen this publicly with celebrities and professional athletes setting a new standard that it’s okay to ask for help and find accessible treatment resources. However, it has been proven that the U.S. does not have the healthcare infrastructure to support this care demand. The system is overwhelmed, and so are healthcare providers.
Mental health must be hyper-personalized, and individuals need to be linked with the right providers able to address their unique needs and preferences via the right modality at the right time. Patients are significantly vulnerable when seeking behavioral healthcare, which in turn can create a fatigue element to the treatment process. In our current system, patients may have to see multiple providers before finding the right one. If a patient is on their third go-around with a new provider, they’re likely to feel exhausted and decide they can move forward without treatment.
So, how can we prevent the behavioral health crisis from deepening? To keep patients from falling through the cracks, individuals need to continue to be empowered to know their options for treatment--virtual or in-person care-- and know they can find a behavioral healthcare provider that specializes in their condition or meets their diverse preferences to combat patient fatigue. In tandem, healthcare providers should prioritize care navigation. This means helping an individual find the right provider or a different physician if they’re not a proper fit, which plays directly into value based care initiatives to get patients the best care possible rather than fee-for-service where it’s more about the money than the patient.”
Expert Opinion 5:
- Jonathan Alpert is a licensed psychotherapist and author of Be Fearless: Change Your Life in 28 Days
Therapists, the real ones and the armchair ones, have unwittingly unleashed a culture of self-
validation to the point of self-obsession and this has contributed to the growing mental health crisis in America. We forget to tell people that it’s not all about you. The world does not revolve around your feelings. Other people matter too. This culture of narcissism has been the primary culprit behind an erosion of trust in our institutions and in each other. This is, in fact, an inevitable result of our obsession for validation: if someone does not say what I want to hear, or believe what I believe, then they are “toxic” or “gaslighting” or have sinister intent. Those who oppose my worldview become harmful. This needs to change.
This mindset – thinking the world is conspiring against you and you’re right, and all the other people in your life must be wrong – is making people sicker, not healthier. Social media (Instagram and TikTok) is filled with real therapists spewing nonsense advice that labels everyone a victim, and fake therapists masquerading as real ones, also spewing bad advice. The terms “narcissist” and “trauma” are everywhere, and misused, often lacking the nuances that make a diagnosis real. People have created this cult of trauma where they think everything is a trauma response. Breaking a fingernail and being upset is not PTSD. Sometimes things happen, hardship even, but that doesn’t mean you’ll experience PTSD. Sometimes it simply is part of the human experience and not pathological. Similarly, just because someone might be a selfish jerk and treat you poorly, doesn’t mean that person can be diagnosed with narcissistic personality disorder. Yet the term is dangerously thrown around creating division in friendships, relationships, the workforce, and society.
Rather than seeking to understand why someone might act the way they do and consider your role in it, people are quick to throw out loose pop psychology labels because the terms are so easily and readily available and thus, weakens our collective mental health. The time is now to hit the reset button and reevaluate how we think about ourselves, others, and mental health.
Expert Opinion 6:
- Dr. Anne Marie O'Melia, a triple board trained physician with board certifications in pediatrics and general psychiatry. Dr. O'Melia is also the Chief Clinical Quality Officer at Pathlight Mood and Anxiety Center (Pathlight). Pathlight is a national mood and anxiety center treating a full spectrum of mood, anxiety and trauma-related services for children and adolescents, and adults of all genders.
The pandemic stretched an already stressed health care system towards a breaking point. Isolation; grief; lack of access to resources and care, especially in marginalized and rural communities; insurance barriers; developmental disruptions with loss of structured activities and celebrations; and provider shortages all contributed to an increased need for support. Our kids were impacted the most. All of us who interact with children are called to action to work to reverse this trend, including parents and other family members, teachers, coaches, health care providers, spiritual leaders. We need to connect with and validate kids, support them in understanding and tolerating strong emotions. We need help kids where they are—show up asking questions and demonstrate we care.
During the pandemic, we lost some of the protection from the school system. Visible health concerns and the impacts of toxic stress went under-detected. Kids now present to care with higher acuity and complexity--their diagnostic picture worsened. Now more than ever kids are diagnosed with eating disorders, anxiety, and depression – often all three – with more than 60% not getting the treatment they need.
This spring, the Biden-Harris administration outlined ways we can begin to tackle this issue, including allocating funding to support school-based programs. Grant funding helped to increase access to school-based mental health professionals in high-needs school districts, and that’s a good start. For the first time in years, we’re seeing a downward trend in suicide rates for children.
But it’s not enough. We need to train and recruit more mental health providers, especially from marginalized communities. I would love to see something like Teach for America’s model of developing and supporting educators to tackle the mental health professional shortage and lack of provider diversity—both of which are critical to expanding access. By adding to the overall number of trained practitioners, as well as increasing the diversity of them, kids are more likely to access support.
While there is a lot of work ahead of us and the details may seem bleak, there are some silver linings. Some schools implemented mental health programs to support students and we’re starting to see the results from those efforts. Virtual treatment options have helped to increase access and reduce barriers for families in rural and marginalized communities. With focused efforts to build the mental health workforce, and putting them where kids already are, we can continue to make improvements and save lives.
Expert Opinion 7:
- Dr. Aaron Weiner, PhD, ABPP and board-certified psychologist and an addiction specialist.
In 2021, the American Academy of Pediatrics and other national medical organizations joined together to declare a national emergency in child and adolescent mental health in the wake of the COVID-19 pandemic as record numbers of young people found themselves struggling to cope with depression, PTSD, loneliness, anxiety, addiction and dozens of other mental health challenges. These problems did not occur in a vacuum, nor were they caused by the pandemic; rather, the pandemic intensified issues that already existed and brought a variety of otherwise unnoticed gaps in the treatment of mental health into sharper focus. We learned quite quickly that we were woefully underprepared to handle the psychological fallout of the pandemic. And, as the pandemic wanes we still find ourselves in crisis trying to help people cope with what they've experienced over the last few years: loss of loved ones, social isolation, job insecurity, housing insecurity, relational conflict--just to name a few.
Everyone feels the effects of these life-altering realities, but adolescents in particular are the most vulnerable to mental health struggles in emotionally tumultuous times. Why? Adolescents are mature enough to understand the severity and complexities of what's happening, but lack the cognitive development to know how to cope properly with their fear, concern, anxiety and stress. Additionally, these complicated emotional hurdles are compounded by "typical" adolescent struggles, such as pressures to perform at increasingly competitive levels in school, grappling with navigating their social landscape, searching for independence and identity--all while lacking the social support needed to succeed, as research tells us that unprecedented numbers of teachers and parents are feeling burned out. The result: adolescents are navigating complex social, emotional, and developmental challenges while feeling largely isolated and alone.
Compounding the problem, adolescents are particularly ill-equipped to cope with these fears and challenges, as the critical thinking, logical center of their brains (the prefrontal cortex) is still immature and they are more powerfully driven by instinctive impulses and emotions. One of our strongest instincts is to avoid discomfort and pain, and teens are looking for any way to alleviate their uncomfortable experiences. As a result, escapism-based industries have aggressively stepped up to meet the demand for quick-fix coping "solutions," with teens and young adults squarely in their marketing crosshairs. Amongst young people, concerning trends related to social media, gambling, alcohol, nicotine, THC, and excessive gaming are propelling teens deeper into pathological mental health crises. So we find ourselves in a self-perpetuating cycle: in trying to relieve emotional and mental discomfort, teens are turning to whatever easily accessible, quick-fix, feel-better solution they can find, leading to dependence on these "solutions" -- which, by nature, actually worsen mental health problems. Anxiety, depression, and stress (to name a few) have all been shown to significantly increase as a side-effect of these addictive behaviors--and let's not forget that addiction, in and of itself, is a mental health concern.
The good news is that our best defense against this worsening trend is well within our reach. Our vulnerable young people need a solution that is easily accessible and helps them actually feel better--they need social support, education and resources to cope with what they're feeling in healthy ways. We can utilize public health campaigns to raise awareness of the signs of mental health problems, providing accurate information about how to address those problems in sustainable ways. To be effective, these campaigns need to focus on reducing stigma so that teens will be open and talk about their problems when they arise. Caregivers (parents, teachers, etc) also need training in how to recognize behavioral health concerns and create a safe space to talk--free from fear of punishment or shame. These efforts will go a very long way towards identifying and addressing mental health problems early on - before they have time to develop and worsen. Integrating emotional coping skills in school curricula would also provide teens with healthy options for coping with stress so that they are less likely to resort to unhealthy options (like addictive behaviors).
We will never fully eliminate the root cause of the mental health crisis - pain, discomfort, fear and anxiety will always be part of the human experience, and we will always be driven to seek ease of suffering. However, education, social support and de-stigmatization of mental health treatment are solutions that work in the long-term and will gradually reduce the severity of the crisis we're seeing today. Our undertaking must be to make people aware of these solutions and empower them to use them.
Charting a Path Forward: Uniting for Mental Health
Upon synthesizing the knowledge of these experts, several prominent themes become apparent. Firstly, there is a distinct requirement for comprehensive restructuring in the healthcare sector, which includes implementing policy modifications and reassessing insurance frameworks to guarantee wider and fairer availability of mental health services. Furthermore, the significance of employing culturally sensitive and evidence-based methods in both treatment and prevention cannot be overstated, given the wide range of experiences and requirements of those impacted. Furthermore, the experts unanimously advocate for a change in the way mental health is perceived and discussed, emphasizing the need to remove the stigma and make mental health conversations more commonplace.
The path ahead is unquestionably arduous, but the wisdom imparted by these specialists illuminates the way ahead. To tackle the intricacies of this crisis, we can adopt cooperative and diverse strategies while giving importance to mental well-being at both personal and societal levels. The New York Editorial is dedicated to actively participating in this vital discourse, aiming to ignite transformation and make a valuable contribution to the collaborative endeavor of enhancing the mental health panorama of the nation.