2023: a year of significant transition for mental health crisis care
It’s 2023, and mental health care is in high demand. Unfortunately, the mental health industry has experienced a substantial uptick in need, and current directives have been insufficient. More specifically, crisis care has been severely lacking in recent years.
While the U.S. mental health system is aware of these trends in mental health among its population, we’re ill-equipped, and clinicians are burned out. However, this systemic issue is on the cusp of change in 2023.
The need for more mental health providers for consumers in the U.S. is a piece of the puzzle: most of my colleagues working in outpatient settings are at or beyond capacity for patients. In addition, community mental health centers in my area are beyond typical capacity—with months-long waitlists.
Prevalence of mental illness
An estimated 1 in 25 adults has a severe mental illness, based on data from 2023. Suicidal ideation and behaviors have been trending upward in the past decade, and we are still in a global pandemic that caused increased isolation and significant life changes for many.
Recent mental health reports indicate:
- 21% of adults are experiencing a mental illness (all levels of severity)
- 11% of adults with mental illness are uninsured, preventing ease of access to mental health services
- 55% of mentally ill adults receive no treatment (28 million people), and 26.7% reported severe MH issues
What is a mental health crisis?
A mental health crisis is any event where an individual may be putting themselves or others in danger or experiencing mental health symptoms with such intensity that they require outside help. The need is immediate due to feeling severely distressed. According to the American Psychological Association (APA), the most common sign of crisis is “a clear and abrupt change in behavior.”
Regardless of symptoms, specific mental health crises present an immediate need:
- Talking about engaging in self-harm or suicidal behaviors
- Increased or new illicit drug use
- Intense emotional distress that interferes with the ability to function
- Engaging in impulsive or reckless behavior
Problems in crisis intervention
There’s an overall lack of emergency department mental health resources. For example, I’ve heard of cases where a patient in crisis is held for hours in the ED due to the limited availability of inpatient openings in area psychiatric facilities. In addition, recent studies show that many ED mental health cases are not urgent, suggesting our resources are not being utilized appropriately.
Data from 2022 shows 350 consumers for every mental health provider (including psychologists, counselors, psychiatrists, and social workers). Assuming 21% of these consumers have a mental illness, this means a conservative estimate of 74 individuals per provider—an enormous caseload for one clinician (for reference, my practice has about 40 clients I see regularly).
Cost of care remains a significant barrier for many individuals in the U.S., as well as a lack of education on how to seek services:
- 42% of adults with mental illness not seeking care
- 27% of adults not seeking care due to lack of awareness of services
- 26% of adults believed they could manage their mental health without pursuing help
- 19% of adults claimed they had no time to get treatment
- 17% of adults indicated that their health insurance does not pay enough for mental health treatment
Studies show that of individuals unable to pursue care, there’s a higher incidence of chronic medical conditions and mental health concerns that arise. This could result in higher levels of care (e.g., intensive outpatient or inpatient treatment) if resources are not utilized. This costs more money for insurance companies and consumers.
Starting with less stigma
The past decade has observed a reduction in the stigma of mental illness and seeking care. I occasionally even encounter a therapy client in public, and they readily greet me like a casual acquaintance—this has evolved over recent years. Patients would walk the other way in the early days of my counseling work a decade ago!
The incidence of issues has increased, but so has the willingness to talk about it and seek help. People are engaging in vulnerable conversations, and social media’s focus on mental health has encouraged individuals to identify concerns and feel less alone in seeking treatment.
Talking about mental health addresses proactive approaches, such as reaching out to a potential counselor or downloading a helpful smartphone app to add calmness to your day.
Some changes expected to take place in 2023 are:
- Employers will improve offerings for employees with free EAP sessions and training for supervisors to identify mental health concerns
- Reduced cost of mental health care with new mental health parity rules
- Improved provider reimbursement to retain more counselors to provide counseling
- The U.S. Department of Health and Human Services plans to improve the capacity of the 988 Lifeline by growing its existing mobile crisis intervention services and developing improved crisis response
- The U.S. Department of Education is expected to initiate substantial grants used to increase the number of mental health professionals in higher-need regions
Impact of the Pandemic on Mental Health Care
The COVID-19 pandemic saw reported increases in mental and emotional distress, according to the U.S. Census:
- 11% of adults reported experiencing anxiety and depression in 2019 before the pandemic
- 40% of adults reported experiencing anxiety and depression in 2020 after the onset of the pandemic
In my private practice, I saw increased client referrals during the COVID-19 pandemic and had to add people to a waitlist frequently. Also, referring therapy patients to colleagues was challenging, as many of my therapist contacts already juggled an intense caseload of therapy clients.
I conducted more safety plans for harm reduction with therapy clients over the past 2-3 years than in all the years of practicing in an outpatient mental health setting.
Pandemic life created a blurred line between work and home with increased work-from-home jobs—causing confusion and carryover stress between settings. This cascade of effects increases relationship conflict and marital stress, impacting children and friendships.
Additionally, the use of technology increased with the pandemic. Youths of all ages began attending school virtually, and increased time at home led to more screen time—which indirectly and negatively affected mental health.
Screen time increased dramatically; however, a positive aspect of the COVID-19 pandemic is the increased prevalence of virtual options for mental health, which has opened doors and provided access to more providers through telehealth.
Importance of preventative measures
Preventative measures include:
- Outpatient mental health services from community mental health centers and private practice therapists
- Employee Assistance Programs – typically a benefit from employers that allows an employee to utilize several free therapy sessions
- Increased ability to earn and use paid time off to prevent employee burnout
- Access to education on mental health issues to address early detection of concerns before they spiral into crises
In my experience, improving preventative care translates into fewer crisis calls for mental health emergencies. I believe crisis needs would be reduced with improved access to outpatient counseling, employee assistance programs (EAP), partial hospitalization programs, and group therapy.
Employers appear to be waking up to retaining employees (and avoiding the cost of replacing lost employees) involving mental health care. It’s becoming a line item in budgets for companies, with benefits like EAP and providing free or reduced-cost access to smartphone apps (e.g., Calm, Headspace). According to the WHO, $1 trillion is lost annually in productivity due to anxiety and depression, and offering such benefits could help.
Businesses and school systems are realizing that the investment in the mental health of workers and students is cheaper than in the loss of productivity from mental health issues.
Mental health systems train employers and supervisors to recognize employee concerns and provide wellness education.
Not all companies are on board with mental health initiatives. Still, I hypothesize that they will understand that they only stand to benefit from taking care of their employees over time. Recognizing burnout, asking how workers are doing, and focusing on wellness are essential.
There’s hope in 2023
In conclusion, mental health issues are on the rise in all age groups. However, while many mental health treatment services, online therapy platforms, and medication providers exist in the U.S., barriers remain. Growing demand for mental health services coupled with a shortage of mental health providers, plus a lack of insurance coverage and high costs, create a system built for people with substantial incomes.
I’m hopeful that the landscape for mental health crisis care will improve, with greater access and increased options at all levels of intervention in 2023.
Empower Mental Wellness 