Finally! Through a confluence of events—the pandemic, a reckoning around racial injustice and health inequities, a recognition of the impact of social media on mental health, and influencers speaking out about their own mental health—we now have attention focused on mental health. As a psychiatrist and physician leader, I have often commented that we need an all-of-society approach to mental health. Therefore, I commend President Biden's commitment to mental health that was announced in his State of the Union address, including the five-point plan to solve for the many issues surrounding patient capacity and access to mental health care. The president is right in saying that this plan will impact every single American, because mental health impacts every single American, either directly or indirectly.
To be sure, we have been here before. Both Presidents Kennedy and Carter had mental health initiatives, state and local elected officials and judicial officers at all levels have supported efforts, and various community-based stakeholders have developed programs and initiatives. What we have not had is a full-on sustained commitment with the appropriate resources and coordination nationwide to address mental health, from prevention to intervention. So mental health is once again center stage, but the question remains: Will we ensure this commitment evolves into action, thus leading to improved outcomes at both the individual and population level?
We need a public health framework for a mental health system that is proactive, coordinated, and comprehensive with a full continuum of services.
As a child and adolescent psychiatrist, I am particularly concerned with the mental health of our nation’s children. Today’s youth and young adults are living in an age of anxiety. There is an increase in the number of suicides in that age group. School children are having to participate in active shooter drills. Bullying has increased, in part, because of the “protection” of anonymity behind a virtual screen.
Youth are bombarded with messaging and images of unattainable perfect lives, perfect families, and perfect relationships, while success is measured by “likes.” Normal teenage mistakes are amplified on social media, and now when adolescents and young adults make mistakes or are bullied, the situation can escalate quickly on social media, in some cases with deadly consequences.
So, the “moment” of crisis is clear. And so are the questions: Will we as a society meet this moment? Will we ensure sustained funding and resources for a workforce that is necessary to address this moment? Will we harness the power of technology to truly solve problems? Or will we become enamored with shiny new objects that are “feel good” solutions but don’t lead to improved health outcomes and could in fact worsen existing health inequities?
Will we work to measurably lessen the stigma that still exists around seeking help for symptoms and mental health disorders? Will we commit to eliminating language that stigmatizes those with mental disorders, inclusive of substance use disorders? Will we ensure equitable access to services, a research agenda that disaggregates data by race, gender, zip code, and social drivers of health to better inform interventions?
Will we commit resources to early childhood and socio emotional learning? Will we commit to a data infrastructure that allows real-time actionable data and evidence-informed policy? Will we commit to ensure that technology improves health outcomes? Will we commit to solutions that are not Either/Or, but instead comprehensive and coordinated to match the diversity and complexity and magnitude of the problem?
The answers to these questions and many others are to be determined. But I am cautiously optimistic. I am buoyed by this Administration and the bipartisan commitment I have seen over the last few years. I am buoyed by the many who have been in the fight for better care for those with mental health needs for decades and are willing to continue the fight. I am buoyed by conversations that are occurring in C-suites across this country with a stated willingness to partner with the experts and those impacted by our current mental health crisis to develop solutions.
The call-to-action is to commit to a long-term, sustained effort on mental health and its continuum. We need to be proactive about creating a public health framework for a mental health system that is proactive, coordinated, and comprehensive with a full continuum of services including the use of technology and innovation.
The framework of this public health model of the future would need three specific prongs to be effective: a data infrastructure, a commitment to resources, and public-private partnerships to create informed policy to drive execution, all complete with a continuous evaluation and feedback loop to inspect what we expect. The call-to-action is for an all-of-society approach to ensure the focus on mental health is sustained. Will we meet this moment?