In 2019, 156,242 Americans were lost to alcohol, drugs or suicide – one person every three and half minutes. More than 39,000 of those deaths were tied to alcohol misuse – a 4 percent increase over 2018 – and drug-induced deaths in 2019 increased by 5 percent to account for 74,511 of the totals.
Several government reports highlight how broken our mental health system is. The 2020 Defense Department Inspector General report found that over half of service members and their families who needed mental health care did not receive it. The Substance Abuse and Mental Health Services Administration found that over 56 percent of adults with mental illness did not receive any treatment in the past year, nor did 35 percent of those with serious mental illness. And a recent Government Accountability Office report highlighted a multitude of issues at multiple levels for mental health, including ongoing challenges with health insurance, enforcing laws like mental health parity and finding the right clinician who can help. In one survey, almost 30 percent of people reported not seeking care because they did not know where to go.
Perhaps most concerning is the impact that COVID-19 has had on our kids and younger adults. Thirty-one percent of those ages 18-29 report stress has had a major impact on their mental health. Emergency Department visits among children ages 12-17 were 31 percent higher in 2020 than the year prior, and between Feb. 21 and March 20 of this year, ED visits for suspected suicide attempts were 50.6 percent higher among girls ages 12-17 than during the same period in 2019. Schools are overwhelmed by the mental health needs of students but must make difficult decisions on where to invest their limited resources.
The need to solve for these and other existing problems is real and immediate. And with broad majorities in both parties now understanding the importance of addressing mental health, I believe it is the time to enact immediate fixes for people in need, as well as begin to lay the foundation for a reimagined mental health system – a mental health system that is grounded in community and an integral part of our broader health care infrastructure.
On Tuesday, I had the immense honor of speaking before the Senate Finance Committee about the issue that is mental health in America. It’s an issue that existed before the COVID-19 pandemic, and because of it, an issue we now more than ever need Congress to aggressively address by focusing on three key priorities.
First and foremost, we need to consider all the places that people show up with need and be prepared with a mental health response. Mental health should not be left just to the mental health system to manage. From community settings like schools and workplaces to health delivery settings like primary care, one of the best ways we can begin to enhance access and more proactively address mental health needs is to integrate these services.
We need to bring mental health care to where people are, and to most immediately meet this moment, the best place to start is in primary care, the largest platform of health care delivery. In one poll, 70 percent of adults agreed that it would be more convenient if their mental health and substance use services were integrated into their primary care doctor’s office.
To do this, we must create more global and flexible funding mechanisms for primary care practices who are working to integrate mental health. Our payment mechanisms often reinforce a siloed delivery model, and this must change.
Second, we must reconsider the design and capabilities of our workforce. Demand for care has far outpaced the supply of mental health clinicians, and it is inconceivable to rely upon clinician recruitment strategies alone to meet our ever-growing need, considering 33 percent of those seeking care wait more than a week to access a mental health clinician, 50 percent drive more than one-hour round trip to mental health treatment locations and 50 percent of counties in the United States have no psychiatrist.
We must map out mental health utilization and gaps to better determine where services are needed and for whom. And then we must invest in our community workforce – those like peer support specialists, community health workers, or more broadly, lay people in our communities. If we train them in mental health skills to help become the first line of mental health support, we complement our clinical enterprise and enhance the overall capacity for communities to address mental health needs.
Finally, we must modernize and connect our federal programs and systems to collaboratively solve for common mental health problems. Because there are multiple agencies, funding streams, and programs that support mental health, performing a landscape analysis can create a strategy for synergistic efficiencies by breaking down silos across federal agencies and departments, and allow for a more cohesive plan for mental health.
This is a moment that necessitates bold action on the issue of mental health in America. Let’s not squander it.
Benjamin F. Miller, PsyD, is a clinical psychologist, chief strategy officer at Well Being Trust, and an advisor/board member for Inseparable; he is also an adjunct professor at the Stanford School of Medicine and author of a weekly newsletter called Mental: Fighting the fragmentation of mental health one policy at a time.
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