9 minute read
America’s Mental Health Crisis
DESPITE CALLS FOR BROADER MENTAL HEALTH RESOURCES, THERAPY IS STILL INACCESSIBLE FOR MANY.
By Rachel Hale, Culture Editorial Assistant Illustrated by Maya Hofmann
Between the stressors that school, work and life present, more than 43.8 million adults report struggling with mental health in a given year. However, out of those with reported mental illnesses, only 43% receive counseling.1 Despite calls for more discussion on therapy accessibility, barriers like societal stigmatization, finances and logistics hold Americans back from the mental health resources they need, with marginalized communities facing the highest risk. Despite the progress America has made in recent years, mental health is still highly stigmatized in many communities. Getting help for mental illness should be the same process as going to the doctor for a physical injury, yet nearly a third of Americans have worried about the judgment they would face from others if they sought out mental health services. Additionally, 21%, have even lied to avoid telling people they were seeking mental health services.2 In households or communities that don’t believe in modern therapy options, asking for help is rarely an option. This stigma also exists within ourselves, internalized as the belief that it is weak to ask for help or that we are a burden for allowing others to support us. Referred to as the silent epidemic, America’s mental health crisis is not put at the forefront of health priorities, yet it affects millions, with 1 in 25 U.S. adults experience a serious mental illness3 and up to one in five U.S. kids showing signs of a mental health disorder in a given year.4 In general, there is a lack of education regarding mental illness, with many states only requiring one semester of health education in public schools.5 Furthermore, these classes are often taught by physical education teachers who may not be trained in health and mental illness education. This lack of education makes misleading information about mental illnesses even more harmful.
1 “Mental Health By the Numbers,” NAMI, 2020, https://www.nami.org/mhstats. 2 Paul Wood, “New Study Reveals Lack of Access as Root Cause for Mental Health Crisis in America,” National Council, 2018. 3 “Mental Health By the Numbers,” NAMI, 2019. 4 “Children’s Mental Health Report,” Centers for Disease Control and Prevention, March 12, 2019. 5 Take Care Staff, “Is Health Education in America Comprehensive?,” WRVO Public Media, 2018.
The large virtual platforms that exist across social media can serve as breeding grounds for this misinformation to spread, with some users romanticizing mental illnesses like anxiety, depression and eating disorders as a trend. Furthermore, bigname fashion brands, such as Urban Outfitters and Forever 21, have taken mental illnesses up as an aesthetic more than a few times, depicting mental illness in an inaccurate and damaging way.6 These forms of media and advertisement are highly influential, especially to a young audience, and contribute to harmful mental illness stereotypes, making many who could benefit from therapy too afraid to ask for help. For those who do seek help, obstacles regarding cost, logistics, and availability stand in the way of a clear path to therapy. With some hourly sessions going for upwards of $65 to $250 a pop, therapy is unaffordable for many.7 The therapist’s experience, session length and location of the therapy are all factors that can affect pricing. Furthermore, restrictions on choosing a therapist within an insurance network, meeting a deductible or getting a referral can be a long process.
Many who need therapy are not able to afford health care, racking up the cost significantly with skyrocketing outof-pocket pricing. A study on access and cost barriers to mental health care found that 47% of respondents who needed therapy named finances or not having health insurance as their primary reason for not getting help. The same study found that 37% of working-age adults with severe mental illness were uninsured for at least part of the year.8
6 The WALK Magazine, “Mental Illness Is Not a Fashion Statement,” The WALK Magazine, 2018. 7 Therapy FAQs, “How Much Does Therapy Cost?,” GoodTherapy.org Therapy Blog, March 21, 2019. 8 Kathleen Rowan, Donna D McAlpine, and Lynn A Blewett, “Access and Cost Barriers to Mental Health Care, by Insurance Status, 1999-2010,” Health affairs (Project Hope) (U.S. National LiEven if a patient can afford therapy, they may not be able to physically travel to an office. If therapy isn’t accessible within 70 miles, a working parent or busy employee may not have the time in their day to drive three towns over for a therapy session. Others may not have access to a car or to timely public transport in their area. These factors of cost and logistics, when combined with low availability, provide a hard struggle. With such a high demand for mental health care, patients can wait weeks, months and even years before getting an appointment slot with a therapist or specialist. A workplace shortage of professionals means that there are not enough providers to meet the needs of the public, with under-trained new staff sometimes substituting serious, professional care.9 Even when appointments are made, many are skipped negatively affecting those unable to be scheduled. According to former National Council for Behavioral Health President and CEO Linda Rosenberg, for every one day of wait time, “you lose 1% of the patients — so if you have a 21-day wait, 21% of the patients seeking care just will give up and not show up.”10 In marginalized communities, such as BIPOC and LGBTQ+, therapy is inaccessible at a higher rate due to factors like stigmatization, systemic socioeconomic trends, language barriers and a lack of diversity among providers. While most minority groups have a similar percentage of mental health disorders as white people, minorities are affected by mental illness at a longer and more serious rate. Members of these communities may also experience a higher rate of stigmatization, making them less likely to report mental illness or symptoms of mental illnesses than those in other communities. A study on mental health care among minorities found that a Black person living in a county with all Black people was 85% less likely to be diagnosed with depression than a Black person living in a county with no other Black residents, indicating that racial and ethnic community norms can impact the way mental health help is viewed.11 →
brary of Medicine, October 2013). 9 Cindy Dampier, “Mental Health Care Appointments Often Come with a Long Wait. 3 Ways to Cope While Help Is Delayed,” chicagotribune. com (Chicago Tribune, December 12, 2018). 10 Ibid. 11DT. Takeuchi J. Abe-Kim et al., “The Association of Racial and Ethnic Social Networks with Mental Health Service Utilization Across Minority Groups in the USA,” Journal of Racial and Ethnic
This is present within other marginalized communities as well. Lesbian, gay, and bisexual adults are twice as likely to suffer from a mental health disorder than heterosexual adults are. In the same vein, transgender adults are four times as likely as cisgender individuals to experience a mental health condition.12 Furthermore, a lack of representation among therapists can make therapy feel like a less welcoming space for members of marginalized groups. While 86% of the U.S. psychology workforce is white, only 4% is Black.13 Despite being vulnerable populations, mental health is the least accessible to marginalized groups, putting them further into a cycle of harm. Across college campuses, mental health resources should be a necessity, with the number of students visiting counseling centers increasing by about 30% on average annually from 2009 to 2015.14 However, services still fall short for many, with common issues including subjecting students to long wait times, a shortage of experienced workers and having a general lack of information about how to receive help. While the International Association of Counseling Services recommends having at least one therapist for every 1,000 to 1,500 students15, the average university falls short, having only one counselor for every 1,737 students.16 A graduate student at Stanford explained that in her time at the university there was no on-campus therapy available at their mental health center, and off-campus options presented transportation and availability issues. In a struggle that is not uncommon, she has seen students needing to choose between groceries and therapy co-pays.17 Across the country, a student at New York University was only able to find an affordable therapist in the city after the NYU Student Health Center insurance coordinator helped her find options. However, she notes that she
Health Disparities, Springer International Publishing, January 1, 1970. 12 “LGBTQI,” NAMI, 2020. 13 Luona Lin, Karen Stamm, and Peggy Christidis, “How Diverse Is the Psychology Workforce?,” American Psychological Association, 2018. 14 “Center for Collegiate Mental Health Annual Report,” Center for Collegiate Mental Health Annual Report, Penn State University, 2015. 15 “Staff to Student Ratios,” International Accreditation of Counseling Services, International Accreditation of Counseling Services, October 16, 2019. 16 David R. Reetz et al., “The Association for University and College Counseling Center Directors Annual Survey,” The Association for University and College Counseling Center, 2016. 17 Leehi Yona, “The Mental Health Resources Crisis at Stanford,” The Stanford Daily, January 31, 2020. wouldn’t have known it was an option if it wasn’t directly mentioned to her, as there wasn’t a mention of this service’s existence anywhere on the SHC website.18 This lack of transparency is an issue across college campuses, where receiving therapy is often a long and laborious process. The COVID-19 pandemic has heightened these issues, with millions of students affected by state licensure laws regarding where therapists can practice. With many students choosing to complete the fall semester online, access to therapy is less of a promise now than ever.19
America’s mental health crisis has gone without attention for far too long. If we are going to start to address the need for broader mental health resources, we must make therapy more accessible to everyone. New up and coming online and virtual therapy options offer an alternative to in-person help, which can mitigate issues of transportation and location. Services like Talkspace and Lantern are working to make virtual therapy a reality, providing a variety of licensed professionals digitally.20 Creating more affordable and accessible options for therapy on college campuses and beyond would greatly benefit those who suffer from mental illness, and society as a whole. Many of the people who would benefit from therapy are part of the same communities to which it is highly unavailable; in order to address America’s looming mental health crisis, we must start by making therapy more accessible. ■
18 Helen Wajda, “The Inaccessibility of the Student Health Center,” Washington Square News, January 27, 2020. 19 Lauren Lumpkin, “College Students Count on Their Schools for Mental-Health Help, but Now Many Can’t Get It,” The Washington Post, June 7, 2020. 20 “Mental Health Resources,” Healthline (Healthline Media, July 14, 2017).
