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Background

Each year in this country, one in five adults and one in six youth . Mental illness is associated with considerable disability and societal cost. It is the leading cause of  and individuals with serious mental illness die an average of  than the general population.

The social determinants of mental health have been described in the literature, and they are associated with mental health disparities. Growing evidence suggests that  and the  are disproportionately impacted and that experiencing  over one's life-span can significantly affect a person's mental health. Furthermore, many communities also are negatively impacted by limited access to employment and educational opportunities, safe neighborhoods, healthy food, secure housing, and early detection and health screening, and  to crucial mental health services (i.e. therapy and psychiatric care), contributing to sustained distress and impairment.  also is a major reason many people avoid or delay seeking treatment.  

The prevalence of mental illness in the United States was steadily on the rise prior to COVID-19, but it has nearly doubled during the pandemic.  as well as  have declared a national state of emergency in children's mental health, citing soaring rates of mental health challenges among children, adolescents and their families. Almost  report feeling worry or stress related to the pandemic that has had a negative impact on their mental health, causing  Restrictive  have tripled in prevalence in adolescents and young adults, as isolation and distress leads to destructive attempts to take control. In addition, many losses, experiences and emotions are not reported, contributing to the increasing prevalence of "silent sufferers" among us. Now, more than ever, mental health is a  that impacts all of us.

As a society, we must seek to understand better mental health needs and improve mental healthcare access and outcomes, change how and when we treat people suffering with mental health issues, and prevent mental healthcare from being overlooked and underfunded.

At Ïã¸Û6ºÏ¿ª½±½á¹û, we collaborate with community partners (e.g., Clinic for International Trauma Survivors, Coping with COVID, Texas Child Mental Health Care Consortium,  among others) to provide access to quality mental healthcare to the adults, children and families of Houston and the surrounding areas. We prepare the next generation of healthcare providers by offering various training programs – addressing sampling, measurement, analytic strategies, legal and ethical concerns and policy issues. More than 40 funded investigators are conducting research in most major psychiatric disorders and technologies, and many are examining key ethical and social issues in mental health, including , differential impact on  (including pediatric and adult groups), preventive approaches to , and  to address the current mental health crisis, to name a few. Yet, there is still much more we all can do to improve mental healthcare in this country and worldwide. We believe there are opportunities to implement smart solutions that can help build systems and cultures that promote mental health and improve the lives of those suffering due to mental illness.

Recommended strategies to address mental healthcare

1. Improve access to services by investing in telehealth solutions, mobile health clinics and other online community programs. We, like many institutions, rapidly implemented an array of telehealth and other creative options (like the nation's first portable and adjustable SmartPod clinic, "") during the pandemic. We pledge to continue to invest in making virtual care and digital technologies, especially for mental health services, a priority and encourage others to do the same. We also call on insurers (federal government, many state governments, and commercial insurers) and state and federal legislatures to permanently  to access to care (e.g., waived enforcement of HIPAA for Facetime and Skype, relaxed written consent and online prescribing laws, and expanded and ongoing Medicaid coverage of telehealth services), while continuing to focus on efforts to ensure privacy and quality of care.
2. Improve access to evidence-based treatments. There often is substantial lag between onset of mental illness and treatment initiation. Further compounding this problem is that treatment received does not always conform to accepted evidence-based standards. Thus, we highlight the need to promote the consistent use of evidence-based treatments for mental illness and ongoing training of professionals in application of proven, effective interventions.
3. Address workforce challenges and advance diversity and inclusion in mental health treatment. Even before the pandemic, there was a , especially in rural areas. We need to look at other ways to reduce the shortages in mental healthcare, such as social workers, community health workers, peer counselors and physicians to increase their self-efficacy for supporting individuals with mental health needs (i.e., recommendations, referrals). In addition to expanding the workforce, there is a critical need to advance mental health workforce equity to meet the various needs of patient populations, including those with co-existing medical and psychiatric complexity (e.g., anorexia nervosa). We need to prioritize  through dedicated programs to foster interest, engagement, leadership, career advancement and retention opportunities.
4. Integrate behavioral and mental health screening more broadly. Early detection of emotional and behavioral problems is crucial. Embedding and integrating mental health into  improves access and reduces stigma.  need to be a routine part of primary care services throughout the lifespan, and we must invest in other ways to make screening more manageable (i.e., effective mental health apps, use of readily available and representative screeners, investigation of ways to financially account for screening time (i.e., billing), trained mental health professionals on staff, especially in urgent care and childcare facilities). We also support screening in the workplace and believe schools (especially K-12) need to be equipped to provide on-site mental health services with careful consideration of privacy and trust concerns. We also support incorporating social media questions into routine clinical assessments, .
5. Mitigate early symptoms of and  associated with mental health through widespread culturally and linguistically appropriate education, programs and policies. Leadership from ,  (i.e., faith-based organizations) and schools is needed to reduce stigma and discrimination. Community partnership is needed to recognize and respond better to mental health challenges and remove barriers that prevent people from speaking up and getting the help they need. Developing and implementing curricula that are tailored to the individual, culturally informed and include  related to mental health . This approach should include tools to manage stress and resolve conflict. Thought and expertise is needed to ensure appropriate  (i.e., materials or toolkits in multiple languages, videotaped and print-outs, diverse images represented in these materials) and to select the messengers used (i.e., individuals who diverse communities value/respect). 
6. Create a culture that encourages and normalizes seeking care for mental health issues. This is especially true in medicine, where reports abound of  and . Trainees in particular may be at risk given their vulnerable position related to evaluation. We need to help people where they live and work to recognize and respond better to mental health challenges and remove  that prevent people from speaking up and getting the help they need. 
7. Prioritize and conduct empirical, longitudinal research to help identify, evaluate and address mental health. We can improve our understanding of protective factors and disease risk assessment, early diagnosis and multisector models of care. There are additional opportunities for supportive treatment interventions that address inequities in partnership with communities. Further research is needed to evaluate the effectiveness of  and to examine the . We also need to consider how this varies by gender, race and ethnicity. There is an opportunity to examine and better address significant  as it relates to mental health, including health conditions that disproportionately impact minority populations and possible bias from providers in responding to pain associated with those disorders. Additional studies also are needed to refine interventions based on the interactions between the  that include the  between race/ethnicity, socioeconomic status, mental health and healthcare.

Together, we can focus on improving the well-being of individuals and families by examining and improving mental health systems and creating a ,  and . A critical look at mental health challenges (while recognizing that each person's obstacles are personal and different) requires a systematic, evidence-based assessment of existing interventions, policies, resources and support to identify what has and has not worked. We believe that with further collaboration and commitment across all groups – providers, employers, policymakers, community stakeholders and consumers – we can take what we have learned, leverage emerging technology, and create a better future for mental and behavioral health that is inclusive, representative and accessible. 

Resources

For more information on Baylor mental health services, click here.

For adult mental health resources:

• Baylor Medicine Psychiatry and Behavioral Sciences

For pediatric mental health resources at Texas Children's:

Contributors: Clarice Jacobson, Faith Fletcher, Ph.D., Mary Anderlik Majumder, Ph.D., Eric Alan Storch, Ph.D., Toi Blakley Harris, M.D., J Wesley Boyd, M.D., Ph.D., Virginia D. Cline, Ph.D., Catherine M. Gordon, M.D., M.S., Wayne Goodman, M.D, Holland Kaplan, M.D., and Amy L. McGuire, J.D., Ph.D., on behalf of the Center for Medical Ethics and Health Policy, Department of Psychiatry, and Department of Pediatrics at Ïã¸Û6ºÏ¿ª½±½á¹û.