Solving the Mental Health Crisis in America. A Playbook (Part 1)

By Robert James Horne, Dr. Liz Jacoby PT, DPT, RYT-200, and Vaishnavi Labhishetty

Originally Published March 6th, 2024 at www.foresthilllabs.net

Introduction

There is a social crisis in America. Many symptoms are medical, but not the root causes. Those most often date back to childhood.

This is America’s mental health crisis.

We want to help reframe America’s approach to solving the mental health crisis. Much of the current U.S. strategy is focused on medical care for adults. We think the federal government should do more to educate and train all Americans, especially children, on using non-medical mental health care playbooks to improve their own mental health.

Giving people the means of preventing poor mental health from becoming a serious mental health condition is a strategy worth pursuing. Paired with modern approaches to improve care access and coverage for alternative medical service providers via federal payment reforms, we believe the mental health crisis in America can be ended.

The four main priorities of this mental health reform initiative we call T-R-E-E are:

1)??? Teach every resident, no matter the age, how to achieve and maintain their own ‘optimal states of mental health.’

2)??? Reweave the social fabrics of local communities and undertake other changes in society to make it easier for children, adults, and seniors to reach and maintain ‘optimal states of mental health’.

3)??? Establish a federal legislative strategy capable of succeeding in tough economic, political, and social times so that changes can take root quickly no matter the obstacle.

4)??? Ensure that all who live and do business in local communities, including the federal government, can collaborate resources and time under a unified federal funding strategy focused on helping local communities better succeed.

Federal payment reforms that better spend scarce resources and increase returns on funds spent will be needed to help local communities better succeed in prevention and medical response efforts. We believe the legislative framework proposed by Senators Bennet and Cornyn is the right place for our reform strategy.

Key Terms

We relied upon definitions used by the National Alliance on Mental Illness (NAMI) when writing this article:

• Mental illnesses are medical conditions that disrupt a person’s thinking, feeling, mood, ability to relate to others, and daily functioning. Just as diabetes is a disorder of the pancreas, mental illnesses are medical conditions that often result in a diminished capacity for coping with the ordinary demands of life.
• Serious mental health conditions include: major depression , schizophrenia , bipolar disorder , obsessive compulsive disorder (OCD) , anxiety disorders , post-traumatic stress disorder (PTSD) , and borderline personality disorder .

Reframing Issues to Identify Solutions

The daunting scale of the current crisis has left many lawmakers and local leaders scratching their heads. It is hard to solve a mental health medical care crisis when there are more sick people than medical workforces to treat them.

A series of insights, however, led us to believe that this crisis can be reversed if federal lawmakers and local communities are willing to consider new approaches to solving age-old problems. These insights include:

‘Mental Health’ is Not a Medical Condition

Americans often associate mental health with people in need of a doctor or therapist because of a serious mental health condition. Mental health, however, is not synonymous with mental illness or serious mental health conditions. Rather, it is defined as the absence of them:

“(mental health is) the condition of being sound mentally and emotionally that is characterized by the absence of mental illness and by adequate adjustment especially as reflected in feeling comfortable about oneself, positive feelings about others, and the ability to meet the demands of daily life.”

Other countries and international organizations define mental health differently. It is not an illness or condition but a way of living. Consider the following :

“Mental health is a state of mental well-being that enables people to cope with the stresses of life, realize their abilities, learn well and work well, and contribute to their community. It is an integral component of health and well-being that underpins our individual and collective abilities to make decisions, build relationships and shape the world we live in. Mental health is a basic human right. And it is crucial to personal, community and socio-economic development.

After the comparison of terms, it is easier to see the problem. The current U.S. mental health strategy, much of which waits for Americans to get sick before helping, overlooks the benefits of preventing poor mental health and many serious mental health conditions in the first place. If mental health is the active pursuit of well-being, and poor mental health stems from how people manage their own stress and trauma, chasing after serious mental health conditions like depression or anxiety disorders doesn’t make much sense when preventing them was an option.

Changing Human Behavior is Key for ‘Mental Health’

How people respond to internal and external stimuli throughout the day influences their state of mental health. Changing the behaviors people demonstrate as daily habits and routines is one way to fix poor mental health in America. We therefore found explanations of the reasons behind people’s behavior helpful when crafting our solution.

The psychologist Abraham Maslow created a hierarchy of needs model for understanding human motivations and why they influence predictable behavior patterns. The model rank-orders behaviors into sequential levels of motivation that can result in predictable human behaviors. Human behavior is at the root of every consideration people go through daily. How and whether to get out of bed are just the first of many.?Consider it as a graph.

Two levels of particular importance for this paper:

• Social. The third level, social, is ranked just below food, shelter, and safety in importance. The biggest need people have once the basics of human survival have been met are healthy interpersonal relationships as well as with others. Social connections within a local community can give residents a sense of belonging and respect that all people seek in one form or another. This is because connecting to other people and our internal selves is good for one’s own mental health.Physical and social connections can provide a positive sense of self and belonging that social media connections cannot give users. These positive connections can also lead to secondary benefits such as having empathy for others. The converse is also true: a lack of self-love or respect for those around us, regardless of the reason, can lead a person to socially disconnect from themselves and others with negative outcomes like loneliness often the result.
• Self-Actualization. The fifth and highest level of personal attainment is self-actualization. An optimal state of mind capable of succeeding in good times and bad. Something we should ideally all be striving for daily.“(Self-actualization) involves a person knowing themselves, understanding their full potential, and reaching it…According to Maslow, people who become self-actualized find motivation in growth and possibility rather than trying to gain something they lack. They see things that they or their community could achieve, and they pursue them, whether or not it results in an external reward. Other characteristics that Maslow felt self-actualized people possess include : Realistic perception of reality

Acceptance of imperfections

Flexibility and spontaneity in pursuing goals

Autonomy and responsibility

Consistent and strong morals

Appreciation for life

Creativity

Being self-actualized does not mean a person has no problems and is always happy. Self-actualization is an ongoing process of achievement throughout a person’s life.”

The authors consider self-actualization to be a connected state with ourselves and those around us and defined as “…a state of mental well-being that enables people to cope with the stresses of life, realize their abilities, learn well and work well, and contribute to their community.”

The bottom line: People need positive social connections in their lives to achieve and maintain optimal states of mental health.

People Can Heal Their Own Poor Mental Health

Many forms of poor mental health are directly influenced by the decisions we make each day. Something as simple as choosing to drink a glass of water before reaching for a cell phone when waking up in the morning can positively influence a person’s state of mental health for the day. Most everyone knows that eating lunch outside can lead to better mental health than sitting at an office desk under fluorescent lights. What we sometimes forget are to view these choices as prized opportunities to influence our own mental health for the day.

Some forms of mental health therapy utilize a process called Eye Movement Desensitization Reprocessing (EMDR) to help heal from old traumas.

“This method involves moving your eyes a specific way while you process traumatic memories. EMDR’s goal is to help you heal from trauma or other distressing life experiences. Compared to other therapy methods, EMDR is relatively new. The first clinical trial investigating EMDR was in 1989. Dozens of clinical trials since EMDR’s development show this technique is effective and can help a person faster than many other methods.”

A more recent approach is an offshoot of EMDR called The Flash Technique.

The Flash Technique is a recently developed therapy procedure that involves having the client at least partially resolve a traumatic memory without consciously engaging it. Preliminary research has found Flash to be non-distressing, safe, rapid, and effective.

These healing approaches leverage mechanical aspects of body and mind into a strategy for how to move beyond negative thoughts or responses holding us back. There are many more examples like Vagus Nerve stretches that can return a person to a sense of calm when under anxiety and stress. Our conclusion is that humans possess many different mechanisms within body and mind capable of helping them achieve and maintain optimal states of mental health with the proper education and training.

Mental Health Medical Services Can Be Repurposed for Non-Medical Use

The main form of service delivery for people seeking medical care for serious mental health conditions and illness is therapy. Many of the services used in therapy sessions are educational and designed to guide people through a self-administered process of working with one’s own emotions, feelings, and thoughts effectively to heal. We contend that teaching children these lessons at an early age can help them prevent some serious mental health conditions.

Almost every community in America has a strategy for improving the intellectual and physical health of children. It starts early in the womb and is heavily focused on intellectual and physical development. Often missing is a plan for how local communities can help children develop strong emotional foundations.

Turning medical services into educational curriculum for children is one step the authors believe would have a demonstrable impact on their future well-being. Lessons that teach people how to distinguish the thoughts behind their emotions can be given to children through their parents and local schools. Lessons that teach children how to make their own decisions effectively. Time honored lessons like how to identify future opportunity costs before making a choice.

The authors anticipate that a whole-community approach to implementing a strategy to focus on the emotional and mental development of children can help prevent many serious mental health conditions that would otherwise occur.

‘Prevent & React’ is the Cure for U.S. Strategy

Most of the U.S. strategy for addressing the mental health crisis is focused on medical care. The rules governing medical care markets in the U.S. often require a medical diagnosis and prescription before service. It is therefore understandable why some suggest the philosophy of the U.S. strategy is to wait for people to get sick before offering them medical services and products to recover.

The U.S. government spends $380 billion a year to fund this strategy , and yet each year the numbers of Americans with a serious mental health condition goes up. Continuing to pursue this strategy of reacting to illness with medical care doesn’t make sense to the authors when the potential exists for people to prevent their own poor mental health with proper education and training.

A prevention strategy, one capable of reaching and staying with every child throughout life, can help reduce the numbers of new serious mental health conditions. This in turn should take pressure off existing medical workforces and allow them to focus medical care on higher-acuity patient access.

The Federal Government Spends A Lot of Money…Sometimes Poorly

According to a white paper released by Senators Michael Bennet (D-CO) and John Cornyn (R-TX), the federal government alone spends the $380 billion a year on mental and behavioral health through various programs and other funding sources. The federal statutes and regulations governing how local communities can spend the money are inefficient and limit the returns from these investments.

Further, there remains no unified federal funding strategy that aligns the goals and operations of various federal agencies and departments that make these funds available. This lack of a concerted strategy results in differing timelines and redundant administrative requirements that decrease the value of each dollar spent.

The authors believe that a collaborative and unified funding strategy could provide more returns on these funds while increasing the value of each dollar spent.

Workforce Alternatives Can Increase Access to Medical Care & The Value of Each Dollar Spent on Mental Health

There is a lot to unpack here but the basics are that alternative service delivery workforces often come with their own unique business models and price structures. If you are paying for a doctor, they are likely to bill you for each service and good used during the visit. A therapist is more likely to charge per visit, an A.I. service provider via a monthly subscription fee, and a volunteer is likely to charge nothing.

All these options are available to local communities today with proper planning. These alternatives provide lawmakers and local communities the means of reducing reform costs while also increasing the value of each dollar spent. You can read our article on this topic for more on this topic.

Solving the Mental Health Crisis in America

Many of the root causes of mental illness in adults originate in childhood. A failure to properly prepare children for the rigors of life as adults is a fundamental contributor to the current mental health crisis. The U.S. does not have the financial resources nor medical workforces to provide every American suffering from poor mental health with a doctor or therapist.

Our conclusion: new ways are needed to solve age-old problems.

A reform effort that includes ‘non-medical mental health care’ is one more likely to succeed over what is possible today. We believe that the care quality and economic benefits of prevention as a concept in healthcare can be made actual if the U.S. were to reimagine how it funds mental health services in local communities. Every program created within local communities that can successfully teach and train children to improve their own mental health daily has the potential to prevent future illness in generations of Americans.

We believe that a unified federal, state, and local spending and operations strategy can help improve the return on current investments. One that allows local communities more flexibility to plan for the future while reducing the administrative burden required from so many different federal agencies. One that allows federal lawmakers better returns from these investments. We believe that one consequence of this approach will be more resources for community engagement. Another would be opportunities to redevelop the social fabrics of local communities around regular social engagement and personal improvement. A win for everyone.

A new federal funding strategy is needed to solve the mental health crisis. A plan that places greater attention and resources toward educating and training Americans on ways to improve poor mental health as early in life as possible. A plan for how every American can improve their own state of mental health no matter the age or circumstance. A strategy for how to create modern federal payment systems capable of making medical services and workforces more readily available to address care shortages. All while also increasing the value of each federal dollar spent and lowering the overall costs of care. A better working relationship between the federal government and local communities.

We recommend the federal government rethink how resources are made available to local communities as a means of establishing non-medical care opportunities for residents. We envision an effort where local governments, businesses, and local volunteers help foster environments that provide positive social connections and engagement opportunities for all residents regardless of circumstance. For purposes of legislation, these services should be considered non-medical or self-care prevention services.

This plan should prioritize a dedicated strategy to prepare children to improve their own mental health. A strategy to develop the minds of children like those already in place to improve their physical health and intellectual performance.

America’s Most Wanted:

A' Bold Vision’ for Mental Health Reform

In September 2021, Senators Michael Bennet (D-CO) and John Cornyn (R-TX) released A Bold Vision for America’s Wellbeing: It’s Time to Redesign the U.S. Mental & Behavioral Health System .?The Senators describe three core components of their legislative approach. They are:

“1)??? Relationship Adjustment. The many different programs and authorities that the federal government uses to fund services act as individual silos lacking ability to cooperate effectively because each fail to coordinate effectively with the others. Congress should begin to redefine its relationship with communities and local health systems to create or otherwise improve access to medical and non-medical mental and behavioral health services for those in need. The goal is to promote greater leadership within communities through use of federal financing mechanisms that appropriately balance the national interests of the federal government with those of local leaders and citizens. Much of the foundation needed to support modern systems are already in place. Therefore, reforms should focus on reprogramming and redevelopment activities where possible throughout federal agencies, like better connecting public health and mental health systems, to minimize disruption.

2)??? Redesign the System. Congress will establish a strategy for redesigning mental and behavioral health services in America, including improved funding mechanisms. In doing so, Congress should also help the Administration develop a modern national strategy for:

• How annual federal funds and other resources can be better spent.
• Better integrating and implementing whole health systems approaches to mental and physical health and breaking down existing care silos.
• Modernize and better equip local workforces to meet growing service demands while ensuring the quality of those services does not suffer.
• Leverage common access points within a given community where Americans can improve their mental health journey regardless of circumstance.

3) Reevaluate Continuously. Congress can use an annual update process to drive meaningful reform incrementally and improve the feedback loop between the American people’s experience and the federal government’s response.”

This framework provides a meaningful way to express reforms the authors view as critical for solving the mental health crisis in America today.

It lays out a viable means of establishing a national non-medical mental healthcare healing and prevention strategy. A process by which we can help teach children to prevent future serious mental health conditions. One that gives adults and seniors more tools to improve healing and overall wellbeing.

Senator Bennet and Cornyn’s Bold Vision is the type of legislative framework that lends itself well to our reform ideas. Taken together, a strategy capable of reversing America’s mental health crisis.

Conclusion

American culture has traditionally avoided mental health conversations, so it makes sense that parents rarely taught their children to develop a relationship with mental health at an early age. We contend that more can be achieved if society is willing to change direction.

Lawmakers and local leaders willing to step back from traditional orthodoxy in order to reassess the problems and solutions is the key to solving this crisis. Everyone has a role to play in the future society we envision. The authors are trying to do their part. We hope you find your own way to participate.

Contributions

Our sincerest thanks to Aaron Poe, Denise U. Tordella, M.A, LPC, LLC, James Emit, Jim Bialick, Rob Purdie, and Tia Moretti, LSW, OCPC, for their contributions.

Dedication

This work is dedicated to Vaelyn Tahiri Jacoby who was born February 5th, 2024, at 8lbs 8oz. And to Margaret Wherenberg, who experienced discrimination from people throughout her life…and chose to love them in return.