By Rychel Johnson, M.S., LCPC, Licensed Clinical Professional Counselor
Updated on February 13, 2024
Published on April 17, 2023
In 2023, 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 healthcare 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
Based on research data from CDC, an estimated 1 in 25 adults has a severe mental illness. 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 healthcare services
- 55% of mentally ill adults (28 million people) receive no treatment and 26.7% have reported severe mental health 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 external help. The need for help is immediate as they feel 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, the following specific mental health crises present an immediate need:
- Talking about engaging in self-harm or suicidal behaviors
- Increased or new illicit drug use
- Experiencing intense emotional distress that interferes with the ability to function
- Engaging in impulsive or reckless behavior
Problems in crisis intervention and the current mental healthcare situation
There’s an overall lack of emergency department (ED) 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 an area’s 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 healthcare 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).
Moreover, the cost of care remains a significant barrier for many individuals in the U.S. along with a lack of education on how to seek services:
- 42% of adults with mental illness were not seeking care
- 27% of adults were not seeking care due to a lack of awareness of services
- 26% of adults believed they could manage their mental health issues 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 among individuals unable to pursue care, there’s a higher incidence of chronic medical conditions and mental health concerns arising. 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.
Trends in 2023: Starting with less stigma
The past decade has observed a reduction in the stigma of accepting 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 proactive approaches to address mental health issues, reaching out to a potential counselor or downloading a helpful smartphone app may help add calmness to one’s day.
Some changes expected to take place in 2023 are:
- Employers will improve offerings for employees with free sessions under the employee assistance program (EAP) and training for supervisors to identify mental health concerns
- Reduced cost of mental health care with new mental health parity rules will be introduced
- Provider reimbursement will be improved to retain more counselors to provide counseling
- The U.S. Department of Health and Human Services plans to improve the capacity of the 988 Suicide & Crisis 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 regions with higher levels of need
2020-now: Pandemic-era impact
According to the U.S. Census Bureau, the COVID-19 pandemic saw a reported increase in mental and emotional distress:
- 11% of adults reported experiencing anxiety and depression before the pandemic in 2019
- 40% of adults reported experiencing anxiety and depression after the onset of the pandemic in 2020
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 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 stress carry-over 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 given 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
- EAPs – typically a benefit from employers that allows employees 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, (EAPs), 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 and 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 educational systems are realizing that the investment in the mental health of workers and students is cheaper than facing 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 among 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.
