May 24, 2024 - Health

Why the mental health crisis feels stuck

Illustration of a collage of three people with scribbles over their faces and abstract textures.

Illustration: Shoshana Gordon/Axios

COVID forced us to talk — a lot — about Americans' deteriorating mental health. Four years later, the scale of the problem hardly appears to have gotten better, in large part because the system (perhaps unsurprisingly) remains ill-equipped to do much about it.

Why it matters: The complexities of mental illness, stressors of modern life and a dearth of straightforward solutions present barriers that we don't really even know how to start climbing.

  • And in most cases, problems stuffed under the umbrella of mental health won't be solved by the health care system alone.
  • "We've gotten better at measuring the extent of mental health problems…but we do not have good strategies for addressing a lot of them," said Sherry Glied, dean of NYU's Robert F. Wagner Graduate School of Public Service.
  • "It's not like we have a pill and we're not giving it to people. We don't know what to do," she added. "The stuff that we are doing doesn't seem to have much effect. Maybe it has some effect, but it's not great, for sure."

Where it stands: The post-pandemic era has featured the stubborn persistence of the youth mental health crisis, emergency rooms swamped with psychiatric patients and greater openness to heavy-handed policy approaches to the most severe manifestations of mental illness.

Between the lines: Turning the corner on a problem as large and nebulous as America's mental health crisis will be a monumental task.

  • But in some areas we're spinning our wheels while in others we're throwing partial solutions at problems that won't get better without holistic solutions, including much greater societal investment in social supports.
  • Regardless, the status quo isn't working.
  • "We've expanded access to care enormously over time, and we've got a lot more mental health practitioners than we ever did before, and that does not show up in any measures of people's well-being," Glied said. "Even though we know individual people get benefits from this…from a population level, this intervention has not had a big effect."

The other side: Increased attention to a mental health crisis that Americans view as a top threat to public health has also brought new urgency and new ideas.

  • "I think we're trying new stuff. The places where I would expect some opportunities for better outcomes are around the way we handle mental health crises — we're putting in more money, we're putting in more technology, we're doing it in new ways," said Richard Frank, director of the Brookings Institution's Center on Health Policy.
  • "I have seen more investment in the last three years in mental health — from the perspective of expanding access to services and investments in prevention — than I've seen in nearly 30 years that I've been in public health," Murthy told me at last week's Axios event.

What we're watching: New drugs may offer more options for patients stuck mostly with decades-old therapies, and there's growing awareness that better understanding the biology of mental illness will help find and match patients to treatments.

  • But the population most in need of more effective treatments is increasingly caught up in a growing wave of public intolerance for homelessness, public drug use or erratic behavior on the streets.
  • That's opened the door — in even the bluest of states — to shifting more of the mental health crisis response onto law enforcement, without commensurate increases in resources for treatment or social supports.
  • "If you're trying to get people out of public spaces, that might work," said Keith Humphreys, a Stanford University psychiatry professor. "But that doesn't solve the problem of the person's illness."
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