All Articles Healthcare Insurers The US is in a mental health crisis. Here’s how we can fix it

The US is in a mental health crisis. Here’s how we can fix it

Severe mental illness and deaths of despair have both reached historic highs in America. But targeted and intentional interventions can help turn the tide.

7 min read



Suicide is one of the leading causes of mortality in the US. Nearly 50,000 people in the country died by suicide in 2022, the highest number ever recorded. The suicide death rate among adolescents and young adults between 10 and 24 years old has soared 52.2% from 2000 to 2021.

Deaths of despair, or those caused by suicide and alcohol or drug use, reached nearly 210,000 in 2021, a more than threefold increase from a little over 60,000 in 1999. Mortality rates are higher among certain population subsets as well as historically underrepresented groups than their counterparts.

These sobering statistics and troubling trends amount to what psychiatrist Thomas Insel, former director of the National Institute for Mental Health, called an “indictment” of the mental health care system in the US.

“We’re in a bad moment,” said Insel, speaking at AHIP’s recent Consumer Experience & Digital Health Forum in Nashville, Tenn. If not for the COVID-19 pandemic, mental health in the US would be the public health crisis of the century, Insel said. He’s not alone in that thinking: 9 in 10 adults believe the US is mired in a mental health crisis, according to a 2022 survey.

While recognizing the current state of the country’s mental health can be partially attributed to the “long tail of COVID,” Insel said the crisis has been building for a while. According to the CDC, the adjusted suicide rate from 2011 to 2022 rose 16%.

Many of the shortcomings and disparities revolve around serious mental illness, or diagnosable mental disorders that limit or interfere with at least one major life activity, said Insel, who added that many people with SMI are incarcerated, experiencing housing insecurity or homeless, rather than being treated. People with a SMI typically live about 20 years less than those who don’t have one. What’s worse, Insel said, is that many effective treatments are available.

“What an indictment that they’re dying of things that we actually know how to treat,” Insel said. “We have done something really egregious by not treating people with these mental illnesses.”

Digital therapeutics: Benefits and challenges

The proliferation of digital therapeutics in recent years, particularly during the pandemic, has made mental health care more accessible and started to level the playing field, Insel said. “The digital mental health revolution is going to be enormously helpful. It democratizes care and gives patients options for providers.”

Virtual mental health care was “the best thing that came out of COVID” because it increased access, significantly reduced appointment no-show rates and boosted engagement “in a major way,” said Suzanne Kunis, president and CEO of NovaWell and vice president of behavioral health solutions at Horizon Blue Cross Blue Shield of New Jersey. Kunis was part of a panel discussion about digital therapeutics.

Although care options and access have increased, these factors still remain problematic, particularly among child psychologists. Ensuring patients are getting the right type of care is also challenging – and necessary – Insel said.

“It’s a fundamental problem. We have really focused on how you get more people access to care, when it isn’t the care they need,” said Insel, who added that providers must think beyond accessibility and home in on quality, as well as matching patients with the right clinicians, in mental health care. “If you’re looking for care, you want to target your issues and find a therapist trained for it.”

Seeing the wrong type of mental health professional for a particular issue is akin to visiting a cardiologist for a broken foot, said Marjorie Morrison, CEO and co-founder of PsychHub, who moderated the discussion with Insel and was one of the speakers on the digital therapeutics panel. “That’s what we do in mental health,” Morrison said.

In addition to pairing patients’ needs to their providers’ specialties, for digital therapeutics to fully live up to their potential, outcomes must be measured and a regulatory framework needs to be built out, Insel said. Digital solutions are already set up to analyze and record measurable data — for instance, some tools can detect if a person has a mental health issue or is in a mental health crisis based on their voice inflection and speech patterns.

“We have all the tools to objectively measure,” Insel said. “It’s not enough to just have more people getting treatment online. You need to see results.”

That will be important going forward because being able to provide quantitative evaluations of these therapeutics could spur further investment, said Bill Evans, founder and general partner of investment firm Rock Health Capital, who spoke on the digital therapeutics panel.

“As an investor, we think about the spectrum of FDA-cleared software as a medical device and digital therapeutics with validated outcomes,” Evans said. Metrics will also help patients discern “what’s good and what’s snake oil,” Insel said.

A balanced approach

Although digital therapeutics hold great promise, they are not a panacea, the panelists agreed. Incorporating digital therapeutics into overall care plans can — and should — complement treatment and not be the sole component, Morrison said. “[Digital therapeutics are] helpful at the right place and time, but you need more,” Morrison said. “It’s not a black or white thing. It’s part of a whole ecosystem of what can be helpful for different people at different times.”

Harry Ritter, founder and CEO of Alma, said empowering providers from diverse backgrounds to use these solutions to create culturally tailored, mental health-focused ecosystems can help them reach more patients and reduce deep-seated disparities in care. “Building trust through clinicians is huge,” said Ritter, who spoke on the digital therapeutics panel. “We need to empower them and focus on them more.”

Being proactive rather than reactive will also go a long way toward improving mental health care in the US, said Insel, who added that oftentimes, people who are at risk only receive care during a crisis. Even more troubling, the US has allowed mental health care to “become a criminal justice problem” rather than a clinical one, Insel said. “We don’t want to touch it. These folks really have become our untouchables.”

Our approach to care also needs to fundamentally change, Insel said.

“If we’re going to fix this, we have to say, ‘This is a medical problem,’” and it needs a medical solution component along with a mental health one, Insel said. “We should talk about mental health the same way we talk about cancer. These are super-serious medical problems that deserve the same level of investment and research.”

“It’s a reality for all of us”

The pandemic helped bring greater awareness to the burgeoning mental health crisis in this country. “We’ve been in a crisis for years,” Kunis said. “People are finally recognizing it.” Federal lawmakers passed the Bipartisan Safer Communities Act in 2022 in the wake of the mass shootings that same year in Buffalo, N.Y., and Uvalde, Texas. The law created a new, $8.5 billion federally funded program to treat people with substance use disorder and SMI. The investment is the biggest financial commitment the government has ever made toward mental health, Insel said.

The mental health crisis in the US eventually touches everyone, Insel said. “There are two types of families in the country: families that are struggling with a mental illness, and those that haven’t struggled yet.” But the spotlight shone on mental health during the pandemic has given people impetus to act. “People are paying attention, so we can move things forward,” Morrison said.

COVID-19 also opened many eyes to the scale, seriousness and severity of the country’s mental health crisis. “Now you see the impact on people’s lives,” Kunis said. “It’s not a philosophical story or debate. It’s a reality for all of us.”