In the wake of the pandemic, many celebrities and everyday people became more comfortable speaking up about their mental health struggles and trying to destigmatize the act of seeking help. Numerous articles and posts now infiltrate our feeds, identifying symptoms of common mental illnesses and chronicling therapy experiences. These are welcome trends in the face of pervasive societal stigma surrounding mental health.
Whenever we face mental health struggles, well-intentioned people often say, “Just get therapy!” or seek other professional help. Unfortunately, it’s not that simple. Even with increased awareness, few people discuss the structural cracks in the current mental health system that make it ill-equipped to satisfy our ever-growing needs.
Let’s start with getting help. In many parts of the United States, there is still a severe mental health professional shortage despite increased demand. Over half of U.S. counties don’t have a practicing psychiatrist, and an estimated 8,000 more professionals are needed to ensure an adequate supply. This shortage disproportionately affects under-served communities, like people of color and the LGBTQIA+ community.
In addition to individual and societal stigma that prevents people from seeking help, we often overlook the insidious structural stigma, defined by the American Psychiatric Association as government or organizational policies that (un)intentionally limit access to mental health care. One example is subpar insurance coverage.
Insurance companies employ tactics that often prevent people from accessing care in a timely manner. Companies exclude mental health professionals from their networks or provide low reimbursement rates to cut costs. For people on Medicare and Medicaid, reimbursement rates are even worse. Consequently, many practicing professionals refuse to accept insurance.
Most infuriating are insurance companies’ arbitrary rules regarding “medically necessary” coverage. A recent article from ProPublica noted how insurance companies deny patients care if they have improved on a given treatment or take too long to get better.
Reading between the lines, mental health services are only available to those who can afford them, live in an area not impacted by shortages and are fortunate enough to have an insurance provider who values mental health treatment. This is an unfortunately rare combination of circumstances. Many people with serious needs don’t get the necessary help until they’re in crisis and treatment becomes infinitely more complex.
Many psychiatric conditions have a genetic component that makes someone more susceptible to certain mental illnesses. Our system minimizes the role of social determinants (“upstream” factors) and the surrounding environment on someone’s mental health, which oftentimes contribute to or even cause mental illness. While medication and therapy are valid forms of treatment, they are a few of many tools in our treatment toolbox. The social determinants of health are defined by the World Health Organization as the conditions in which people are “born, grow, work, live, and age.” These include income inequality, food insecurity, discrimination, adverse childhood experiences and more. Research from a 2021 National Center for State Courts report about mental health found that young people from low-income household environments were twice as likely to experience anxiety and depression. Similarly, people in socially marginalized communities based on their race, gender and more experience higher rates of mental illness than their non-marginalized counterparts. These findings seem obvious: if someone’s quality of life diminishes, it will hurt their health.
Mental health professionals and primary care providers don’t always consider a person’s “upstream” factors when evaluating someone’s mental health. A year ago, I was in a situation that adversely impacted my ability to function to the point where I sought professional help. I was prescribed antidepressants at the time. I wished someone asked me about my life circumstances and maybe helped me work through it. It wasn’t until I addressed my situation that my mental health finally improved.
However, for many people, mental illness is not situational. Mental illness results from various root causes, and we must account for this complex etiology. Until the system starts addressing these upstream factors, we will never manage the burgeoning mental health epidemic. Addressing these structural issues requires systemic changes that will take time to implement. These may include social initiatives or, in the case of insurance companies, more effective regulatory policies.
People should not stop seeking help, and we should keep encouraging them to do so. At the same time, we deserve a robust mental health care system that truly works for the people. These structural flaws may seem beyond our control, but the consequences of not addressing them affect us personally—think of the insurance companies that deny treatment. It’s ridiculous that I could only find information about these issues from psychiatry websites and scholarly articles. We must start spotlighting this topic in mainstream media and public discourse. The more we talk about it, the more people will care and successfully advocate for meaningful systemic change. After all, our collective well-being depends on it.