Mental Health in 2020

By and large, physical health is still more straightforward and (often) more tangible than mental health, but over the course of the past decade, there’s been increased willingness to recognize mental health as an essential part of one’s well-being. In short, we’ve come a long way. As a mental health advocate and reporter, I’ve seen the advancements up close and personal and can say with certainty that in 2010 I wouldn’t have dreamed of writing pieces like “How to talk about mental health issues at work” or “A mental health check-in: 14 questions to ask your child” for a national news outlet. Such topics just weren’t so, well, topical back then.

With the help of mental health experts, we’ve taken a look at some of the most significant breakthroughs concerning mental health over the last 10 years, as well as where we need to do better going forward.

After centuries of shame and misrepresentation, the term ‘mental health’ is losing the stigma

“Historically, when people have talked about ‘mental health’, they usually meant severe mental illness,” Dr. Mark van Ommeren, a mental health expert who works with the World Health Organization, tells NBC News BETTER. “Today, ‘mental health’ can also mean common conditions like anxiety and depression. In more places (though it depends on where you are), people understand mental health simply as an aspect of overall health. Our awareness is shifting, and mental health is coming out of the shadows.”

What has helped to advance our awareness of mental health as an integral part of overall health on a global level? There’s no distinct “trigger moment”, as van Ommeren sees it.

“I think about this a lot because it’s absolutely true internationally,” van Ommeren says. “I see more and more governments getting interested in [mental healthcare], and more people talking about it, but unlike say, the #MeToo movement, which is also about a problem that has been in the shadows, there’s not one thing that triggered awareness about mental health and caused everyone to see it as a huge thing.”

Instead, a constellation of factors and moments have led to our amplified awareness of mental health and the roles it plays in our daily lives. Traditional media (including TV dramas like “This Is Us”), social media (which sees countless individuals and groups sharing #mentalhealth stories) and perhaps above all, mountains of clinical research, have helped steer us in a more enlightened direction.

“Years of study after study showing that [mental health] conditions are common have created a snowball effect,” says van Ommeren. “Media has played a positive role here, as have influential people who are starting to speak more about their mental health, which helps to reduce the stigma.”

Dr. Don Mordecai, MD, Kaiser Permanente’s national leader for mental health, also credits celebrities for being outspoken about their own mental health challenges, as well as younger generations who have “become more vocal about the need to break stigma and encourage people to get help.”

But mental illness has yet to be normalized the way physical illness has been

“While we have come a long way with normalizing discussions about mental healthcare and showing different versions of it in the media, we have significant lengths to go to remove the stigma and to increase access to mental healthcare,” says Kryss Shane, a social worker and educator. “We continue to see mental healthcare as a response to problems, rather than something recommended for everyone as a way to improve life in general. If we are able to alter this understanding, it will not only further remove stigma, it will encourage people to seek out help before they are in crisis. In addition, we must advocate for recognition that all [people] in minority groups ought to have access to affordable and reliable mental healthcare, in order to have a healthy outlet for coping with the ever-present (and the increase of) micro-aggressions and hate.”

We’re learning how words matter in conversations about mental health

Over the past decade, there’s been a growth spurt in our evolution of understanding the importance of language in the role of talking about mental health issues. Many of us have come to embrace gestures like “trigger warnings” when sharing sensitive/mental illness-related content online, just as we’re grasping why it’s better to say that someone has “died by suicide”, rather than employ the crasser but previously perfectly acceptable alternative, “killed themselves”.

“The conversations we have now we would never have had 10 years ago,” says Mike Thompson, president and CEO of the National Alliance of Healthcare Purchaser Coalitions, and past president of the New York City chapter of the National Alliance for Mental Illness (NAMI). “We’re more open and interested in talking about mental health and about respecting it.”

We’re also paying more attention to the words we use and how we use them (take for instance the fact that the nonbinary pronoun “they” was Merriam-Webster’s word of the year in 2019), just as we’re opening our minds to the reality of “gaslighting” and other toxic behaviors. We’re increasingly sensitive about how to talk to and empathize with others who may be suffering, which serves as a subtle but significant win for the advancement of our mental health as a society.

Federal laws put mental health on par with physical health

But in the opinion of Keith Humphreys, professor of Psychiatry and Behavioral Sciences at Stanford and former Senior Policy Advisor, White House Office of National Drug Control Policy, by far the “best thing that has happened” recently happened on the governmental end of things, chiefly under President Obama.

“The best thing that happened is multiple sweeping federal laws putting mental health on the same level as physical health,” says Humphreys, referencing both The Mental Health Parity and Addiction Equity Act of 2008 and the Affordable Care Act (ACA) of 2010. “I was at the White House at the time [from 2009 to 2010] and it was so extraordinary for me to look and see an essential healthcare benefit defining mental health. It was the dream.”

But people who need help often fail to get it, and the demand overwhelms the supply

These federal laws may have looked like the dream, but Humphreys is quick to note that they were followed by something of a nightmare.

“The worst thing of the last decade has been the undermining of the [federal] protections by multiple sources,” says Humphreys. “Insurers, as proven in court in some cases, have denied care that people are entitled to. More recently, you have the undermining by our current administration of the financial structure of healthcare markets. All this makes it harder to get protections that were promised. It is the most tragic thing, and people — children — are dying because of it. We created the greatest opportunity we ever had, but there was a rollback against much of the revolution. The Parity Act passed at the end of 2008, and people thought they won — but the industry fought back and still is fighting. Of course, it’s not just mental health patients that have been harmed but anyone relying on health insurance for care.”

Mental health clinicians like Shannon Curry, a clinical psychologist and director of the Curry Psychology Group, see firsthand just how dire the need for mental health care is — and perhaps more appallingly, just how bad people are actually trying to get the said care to no avail.

“It is incredibly upsetting to be unable to treat so many people who need care,” says Curry. “Our practice provides pro-bono services to the beneficiaries of a charity for women who have experienced trauma and are recovering from substance use disorders; however, the need for care far extends beyond one charity, and this is an issue that desperately needs addressing from our policymakers.”

The most important step we can take toward advancing mental health care in 2020 and beyond, is giving people — all people — access to it.

The advent of telemedicine and meditation apps are a helpful boost

Getting an affordable appointment with a therapist in person might be humiliatingly difficult, but at least there has been wide advancement in the accessibility of mental health support online.

“If you think of the conventional way of how people receive mental health support it would be once a week driving to the therapist and then going home. That takes time, but with telemedicine and meditation apps, people can do it from home in little bits,” says van Ommeren. “This is a reason for optimism. In this way, mental health support is being made more available.”

But here too, there’s room for improvement — room that Dr. Mordecai expects will be filled.

“Technology will continue to evolve as a way to deliver mental health care, ranging from stand-alone skills-based apps, to coaching, to interaction with licensed professionals,” Mordecai says. “We also expect technology to help keep track of someone’s mental health in both active monitoring (ask the person in various ways) and passive monitoring approaches which will take advantage of machine learning and AI techniques to identify those who may need assistance long before a crisis emerges.”

We need to step up our prevention and mitigation game

If technology can help people before the onset of a mental health crisis, that would be a significant help — because right now, we’re not doing so great in the department of prevention.

“Generally speaking, relative to a number of other countries, we do a bad job in preventing illness in our society,” says Dr. John Krystal, MD, chair of the Psychiatry Department at Yale Medicine. “As much as possible, as we expand the health literacy of Americans, we need to make sure that we also increase their understanding of mental illness and addiction. We can do a better job of early detection and early intervention when we do a better job of looking out for ourselves, our families, our friends and our co-workers. Stigma is what develops when we view a problem like depression or addiction as something that happens to others; stigma goes away when we appreciate that mental illness and addiction could happen to us and those that we care for. When that happens broadly in our society, we will invest more in providing access to assessment and treatment. We will also invest more in discovering the causes and better treatments for these illnesses. After all, if we can have a war on cancer, why can’t we have a war on depression?”