The Mental Health Crisis, How We Got Here, and Where We Go Next


Addressing the mental health crisis in the United States requires innovation in treatment and recovery, and the development of mechanisms to provide and pay for it appropriately.

When assessing the current state of mental health in the United States, the problem is often referred to as an epidemic that has been exacerbated by the COVID-19 pandemic. I would argue against such a label. We don’t have a mental epidemic. Rather, the pandemic has opened people’s eyes and led to a sudden realization about mental health that it is a crisis – and a crisis that has been with us for a long time.

Everyone, at every level, in every sector, in every part of the country has a mental health need. The crisis is not mental health and illness. Rather, it is our ability—or indeed inability—to meet this growing, universal need.

Leveling the playing fields for physical and mental health

One of the reasons we are in the crisis the nation is currently facing is that mental health has never received the same attention that physical health has. This is mainly due to a lack of understanding of the brain compared to all other parts of the human body.

Remember that we understand the heart and can replace the heart. We don’t understand the brain well and we can’t replace it. We can treat blood sugar effectively, but we don’t treat behavioral health disorders effectively. While we are aware of some treatments that may work for behavioral health, we do not apply those treatments with the rigor and objectivity that we apply treatments to physical health disorders. We’ve invested a lot in understanding neurological disorders and can now treat some of them, but we don’t have great funding or science on behavioral disorders.

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What needs to happen if we hope to bring the mental health crisis under control is that we begin to discuss mental health disorders with the same openness, understanding, and focus that we deal with physical health disorders. We can begin by focusing on mental health disorders as part of every individual, whether that person has physical or mental disorders. This is a crucial way to destigmatize mental illness.

Face the challenge head-on

In addition to creating a level playing field in the perception and approach of mental health versus physical health, we need to work to provide better access to behavioral health care. In some cases, the use of technology is improving and will continue to improve access. But we don’t just have to focus on access, we need to focus on availability. Access and availability go together. One may have the opportunity to seek mental health treatment but may not have the availability – or vice versa. Both access and availability are severely limited in rural areas, inner-city areas, and other already underserved areas.

There is no question that improving mental health will also require a focus on measurement-based care. This applies not only to measuring value from a payment perspective, but also to the quality of the services provided. This commitment to measurement-based care and its role as a driver of pay and quality is largely absent in behavioral health today.

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If we want to improve access, availability and outcomes, we need to focus on another area: cost management. That will require the same attention we need to give to the other areas that are neglected in mental health. We must commit to improving access, availability and measurement of outcomes while ensuring treatment is also cost-effective and of the highest quality.

We need to recognize that mental health needs a focus on the potential for recovery, not just treating symptoms. In other words, how can we help someone recover from a behavioral disorder rather than just treating the symptoms of the disorder and hoping that person never gets worse? Research has shown us that about 2 in 3 people living with serious mental illness experience partial to full recovery.

Finally, if we hope to move the needle in the mental health field sooner or later, we must recognize that the mental health treatment model differs from the physical health treatment model, and adjust our payment mechanisms accordingly. What and how we pay for in behavioral health is different than physical health. We generally do not pay for what is needed for mental health. We pay for diabetes education treatment. When was the last time an insurance company paid for treatment for depression?

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Thomas Insel, MD, former director of the National Institutes of Mental Health, said it takes three things to effectively treat mental illness: people, place, and purpose:

  • Of people, he argues the importance of making sure people with mental illness have people in their lives who can support them. We do not pay for people who can fill these roles.
  • In terms of place, he argues that people with mental illness need a place to live – one that offers comfort and safety. We do not pay to reduce homelessness and improve a person’s housing situation if doing so is detrimental to their well-being.
  • With purpose he argues about the importance of giving people a purpose, e.g. B. a job. We do not pay for individuals to help people with mental illness achieve a purpose as part of their treatment.

The reason none of these are paid for as part of mental health treatment is because they are not paid for as part of physical health treatment. If we are ever to address the mental illness crisis in this country, we must consider these facets as an integral part of treatment and recovery and develop the mechanisms to provide and pay for them accordingly.



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