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Mental Health: America’s Next Public Health Crisis

The year 2020 was extraordinary. As the world faced the deadly global pandemic, the daily existence of individuals and families across the United States was shaken and turned upside down, changing our everyday life (home, work, and play) as we knew it. The consequences to public health include social isolation, sickness, grief, unemployment, and an abrupt halt to all of our daily routines.

The unexpected, unprecedented COVID-19 pandemic has been enormously hard on many while hitting others on a deeper level and bearing down on their mental health in a very detrimental way.

In any given year, 1 in 5 Americans experience a mental illness.[1] Depression alone is estimated to cost the American economy $210 billion annually,[2] with 50 percent of that cost shouldered by employers. The cost of treating people with both mental and physical illnesses is 2 to 3 times greater than for people with physical illnesses alone.[3] The costs associated with treating depression in America are likely underestimated since less than half of adults with mental health disorders seek treatment[4] and even fewer receive evidence-based care.

The emotional toll of COVID-19

Emotional and mental distress has been pervasive in communities impacted by the COVID-19 pandemic. The COVID-19 pandemic has particularly ravaged Black and Latinx communities. They were hit disproportionately hard by massive unemployment resulting from the economic devastation in the pandemic’s wake.

Additionally, younger adults, ethnic minorities, essential workers, and unpaid adult caregivers reported having experienced worse mental health outcomes, increased substance use, and elevated thoughts of suicide. More than half of U.S. adults said that the worry and stress related to the virus have negatively affected their mental health.[5] At the height of coronavirus-related lockdowns, depression rates tripled.[6] During the peak of the pandemic, rates of anxiety, trauma and stress-related symptoms, substance use, and serious suicidal thoughts increased[7] and will continue to persist in the months and years after the pandemic has abated.

Pre-COVID-19, seeking mental health services was typically limited by stigma, cost, and availability of providers. As the pandemic rolled on, demand for mental health and addiction services skyrocketed, and the demand exceeded capacity and the availability of providers.[8]

Federal and state resources: paths to prevention, intervention, treatment, and recovery

The Administration is directing $2.5 billion in funding to address the nation's mental illness and addiction crisis. These needed funds will be distributed into two key buckets by the Substance Abuse and Mental Health Services Administration (SAMSA).

  • $1.65 billion will go toward the Substance Abuse Prevention and Treatment Block Grant, which provide states and territories funding to improve existing treatment infrastructure and create or improve prevention and treatment programs
  • $825 million allocated through a Community Mental Health Services Block Grant program will help states to deal expressly with mental health treatment services

Meeting people where they are: exploring digital delivery models to deliver therapy

Proven interventions, including cognitive behavioral therapy (CBT), acceptance and commitment therapy (ACT), and dialectical behavioral therapy (DBT), reduce distress and impairment associated with concerns such as depression, anxiety, trauma, substance use, and sleep disturbances.[9]  These approaches also improve individual resilience in the face of everyday stressors and significant life events.

CBT and ACT were once considered the sole domain of licensed therapists, counselors, or psychologists. The core principles of these mental health therapies are learnable and practiced through readily accessible self-help guides, mobile apps, and electronic delivery models. We are in a predicament where more people seek mental health support only to be discouraged and disillusioned by long wait times for an appointment with licensed therapists. Electronic delivery options offer immediate access to evidence-based therapeutic interventions for a wide range of mental health concerns.

One study noted that only a small segment of individuals interested in self-guided therapy applications on a mobile device or computer use them despite their efficacy and availability, even when the apps were promoted by an employer or healthcare provider.[10] The benefits of a coached eCBT approach uniquely combine well-established platforms of self-guided digital therapy with the positive effects of an in-person therapeutic relationship. This combined approach delivers notable outcomes for the treatment of depression and anxiety symptoms. The result is a personalized therapy journey tailored to the individual and supported by regular coaching interventions to enhance motivation and internalize new skills, leading to a sustained reduction in depression and anxiety symptoms.

The time to act is now

Despite these promising results, adoption remains a high barrier to utilization of digital coaching tools. Factors that could improve adoption include increased availability and awareness of evidence-based mobile applications that address a range of mental health concerns, validation of the efficacy and protection of personal privacy, and of great significance, promotion by a certified health provider.

Mental health support is not a “one size fits all” endeavor. Approaches that offer many sizes for many people hold promise to lower barriers to entry for users of digital mental health tools. Digital solutions that can scale the intensity of service — ranging from self-guided activities (low acuity) to coach supported stress management, grief support, or goal attainment to specialized therapy or medication management (high acuity) — allow users to engage with a platform throughout their wellness journey and not just when there is a critically urgent need by the individual.

By leveraging available resources, applying science-backed technologies, and building partnerships, states have an opportunity to expand capacity in a cost-effective manner to treat the impending mental health crises.