Spend Smarter, Not Harder: Prevention Can Cure a Mental Health Crisis

By Robert J. Horne , Jim Bialick , Dr. Liz Jacoby, PT, DPT, RYT-200, Saverio V. Feudo , Kristen O’Neill , Will Hinman , John Burnam , and Andrew Horne for KPG Lede?

Published July 24th, 2023

Part 5: New Dimensions in Mental Health Series

Key Takeaways

• A flawed federal strategy that waits for a medical diagnosis before helping people is fueling a mental health crisis and needless federal spending.
• Prevention is the cure for America’s mental health crisis.
• Principles necessary to reimagine mental health policy include:1. Prevention as a federal funding strategy can reverse the mental health crisis.2. Knowledge and skill development can prevent poor mental health and illness.3. How prevention is taught matters – look to other cultures for effective alternatives.

Introduction

It takes less money and time preventing health problems than reacting to them. Prevention services taught to Americans through vocational education models and personal skill development can effectively reverse mental illness and the mental health crisis. Lawmakers pursuing reform can draw inspiration from other cultures that have successfully used education and skill development to address community-wide issues like poor mental health.

?In this article, Part 5 of the New Dimensions in Mental Health series, we provide additional insights and legislative principles lawmakers can use to reimagine federal policy. ?

4th Principle: Prevention is the Means of Reversing the Mental Health Crisis

“An ounce of prevention is worth a pound of cure.”- Benjamin Franklin - ?

The numbers of Americans with a mental illness increases annually. There are not enough doctors to treat everyone with a mental illness unfortunately, nor sufficient financial resources to train enough new medical providers to fill the gaps. Therefore, as discussed previously , the U.S. strategy is not a viable way to solve the mental health crisis unless significant reforms are undertaken.

Greater emphasis must be placed on prevention to overcome this challenge. ?Proactive policy approaches like prevention can serve as powerful legislative tools to overcome hard-to-solve problems. Consider the value of proactive behaviors as a general principle in business:

Behaving proactively is distinctive and vital because most of what we do is pretty passive, and dictated by past habits and routines, current circumstances and pressures, or biases that support the status quo and keep us on a familiar path. Proaction thus differs markedly from our most common behaviors.

Numerous instances of preventative policymaking can be found within federal statutes that capture this value well. For instance, prevention in the health care market offers products and services to people before they become sick, reducing treatment costs by precluding mental illness. Diabetes prevention services are a prime example. Prevention services in health care have been shown to work regardless of the subject matter. The state of Ohio has taken this principle one step further by offering skill development as a service to citizens. Ohio’s Prevention Strategy of Education :

…focuses on the delivery of prevention services to target audiences with the intent of increasing knowledge and skills. It involves two-way communication between a facilitator and a participant. Prevention education promotes the health and safety of students, schools and communities.

In the authors’ experience, looking outside traditional orthodoxies to solve federal policy problems can lead to promising solutions. Prevention as a skill development service is a novel concept for solving the mental health crisis, and the costs of teachers and educational curriculum can be significantly less than doctors and medical services. Prevention as a national funding strategy is therefore capable of reversing the crisis and reducing federal spending. The question for federal lawmakers: whether the federal government can help Americans prevent their own poor mental health and illness.

5th Principle: Skill Development is the Means of Prevention in Mental Health

“In every single thing you do, you are choosing a direction. Your life is a product of choices.” - Dr. Kathleen Hall, CEO of the Stress Institute and Mindful Living Network -

People make an estimated 35,000 decisions every day, and the consequences of these choices greatly influence happiness and mental well-being. How one chooses to connect with others, or whether to pursue a purpose in life , are examples of these choices.

There are many strategies that can help people choose wisely, like identifying the opportunity costs of a decision, yet these lessons are not learned at young ages.

When I talk to young people trying to decide what to major in (college),?I encourage them to study economics ?for this reason. While psychology is billed as the science of thinking and decision-making, economics (especially microeconomics) is the science of human action. Why did consumers purchase product A and not product B? How would behavior change if the price went up? What if the price went down? How would the price change (and why) if the quantity supplied decreased or increased? The insights from questions like these can be applied to our own lives and to the lives of other people with whom we work.

Understanding the opportunity costs of decisions could be an invaluable tool in the hands of children, helping prevent bad outcomes by better understanding the consequences of actions before being taken. Strategies like this can help improve everyone’s decision-making and well-being as a consequence. Therefore, it is curious why society hasn’t found a way to give people this knowledge at young ages.

The authors find that America’s treatment of mental health education, as services for sale rather than fundamental lessons all children should learn at young ages, is part of the problem. For instance, Cognitive Behavioral Therapy (CBT ) – well regarded by mental health professionals in the treatment of anxiety, depression, and post-traumatic stress disorders (PTSD) – is a medical service that helps individuals understand the relationship between beliefs, thoughts, and emotions. Like diabetes prevention, CBT uses education and skill development to manage an illness.

The educational components of CBT and other mental health services like Parts Works would be beneficial in the hands of everyone, especially at young ages. Such insights can help children develop sufficient awareness and the skills necessary to make good decisions as a prevention strategy for their own lives. Children capable of sound decisions are more likely to grow into happy adults, yet many Americans find out about CBT when they are diagnosed with a mental illness.

The components of effective decision-making are known, and the curriculum is available for people to learn. Getting these lessons into the hands of Americans at young ages should be the policy goal.

6th Principle: How Prevention is Taught Matters - Look to Other Cultures for Effective Alternatives

“A Senegalese poet said ‘we will conserve only what we love. We love only what we understand, and we will understand only what we are taught.’ We must learn about other cultures in order to understand, in order to love, and in order to preserve our common world heritage.” -?Yo Yo Ma, White House Conference on Culture and Diplomacy -

Comparisons with other cultures suggest the way people are educated is as important as what they are taught. In the United States, children are placed into structured academic and sports programs at young ages, typically between 3 to 5 years old. While this approach offers benefits, it takes time away from unstructured activities like play known to improve mental and physical development including brain health .

Finnish children, on the other hand, start schooling at age 6. They learn using play-based educational approaches versus academics and the results are remarkable.

Finnish schools -- where students begin “preschool” at age 6 -- prioritize play-based learning opportunities such as arts and crafts over desk work like handwriting and reading early in a student's education. The early focus on playtime doesn't seem to hold students back when it comes to literacy ‘later in their education.’ According to a Stanford University analysis, Finland is one of the world’s most literate societies, with?94 percent of those who begin upper secondary school ?-- a three-to four-year program students enroll in at the age of 16 or 17 -- graduating. Based on Program for International Student Assessment (PISA) test results and graduation rates, the nation’s school system is?ranked among the world’s five best .

Teaching children through play and creative expression is very different from academic approaches favored in the U.S., yet the outcomes are much better. The fact that Finnish children begin their educational journey later in life yet perform better than Americans is notable.

Modern vocational training or Montessori education more closely align with Finland’s approach. Just like woodworking or typing classes in grade school, vocational training teaches students the skills needed to excel at a chosen profession. Because of this, vocational training is increasingly valued by employers in high-paying industries and an ideal model for training children to succeed in life.

The distinction between blue-and white-collar workers has faded as tech-driven jobs fill the gap. Vocational schools are still dedicated to trades, but the trades have changed to include jobs in healthcare, computer science, and information technology.

Alternative teaching methods are only a part of Finland’s success. The country also places social value on high-performing teachers and financially rewards them.

But the most important effort has been in the training of teachers, where (Finland) leads most of the world, including the United States…

The results speak for themselves. People in Finland brag about their culture of mental and physical resilience . The suicide rate in Finland has decreased by 50% since 1990, and recognition as the happiest country on earth - ranked first in the World Happiness Report for six consecutive years – reinforces the effectiveness of their approach. Other countries that use similar methods, like Vietnam , have also achieved positive results. U.S. lawmakers pursuing reform can gain valuable insights from the experiences of other cultures.

Conclusion

As a practical matter, America cannot afford the financial or social costs of the mental health crisis. Waiting for people to develop a mental illness before helping them is a flawed federal strategy that results in poor outcomes and needless federal spending. Prevention is the strategy needed to improve personal happiness and reverse the mental health crisis .

Next up, more principles federal lawmakers can use to reimagine mental health policy.

Click here for more mental health reform principles .

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