2021

As challenges like Covid-19 and the reckoning on racism continue to take a toll on Americans’ mental health, it brings new urgency to the long-standing issues like the cost of accessibility of care. Spending on mental health treatment and services reached $225 billion in 2019, according to an Open Minds Market Intelligence Report. That number, which is up 52% since 2009, includes spending on things like therapy and prescription medications as well as stays in psychiatric or substance abuse rehabilitation facilities. In fact, depression alone is estimated to account for $44 billion in losses to workplace productivity, according to a recent report from Tufts Medical Center and One Mind at Work. Beyond the cost of mental health care, access to care is improving but still a big issue. Access and coverage for mental health and substance abuse treatments have improved in recent years thanks to the 2008 Mental Health Parity and Addiction Equity Act, which barred health insurers from making coverage for mental health more restrictive than for physical ailments. But there are still a lot of medical and insurance loopholes that exist that make it difficult for patients to get affordable care, says Angela Kimball, National Director of Advocacy and Public Policy at NAMI. And there are many other factors too, she says. Rural parts of the country tend to lack access to more specialized treatment options, similar to the barriers that exist in traditional physical medicine.

Prince Harry and Oprah Winfrey's documentary series focusing on mental health awareness is heading to Apple TV+ later this month. Titled The Me You Can't See, the show will feature Winfrey and the Duke of Sussex discussing mental health journeys and emotional well-being with a number of high-profile guests, including Lady Gaga, Glenn Close, and NBA players DeMar DeRozan and Langston Galloway. Winfrey and Harry will open up about their own experiences too. With conversations transcending culture, age, gender, and socioeconomic status, the goal of the series is to challenge stigmas around mental health and let viewers know that they're not alone. Producers behind the show also teamed up with 14 "accredited and respected experts and organizations from around the world to help shed light on different pathways to treatment," according to Apple. “Now more than ever, there is an immediate need to replace the shame surrounding mental health with wisdom, compassion, and honesty," Winfrey said in a statement. "Our series aims to spark that global conversation." The docuseries was created in partnership with an advisory board of more than a dozen mental health professionals including Dr. Ken Duckworth, NAMI CMO.

People with bipolar disorder experience dramatic changes in emotion, mood and energy, sometimes all in the same day. “It’s like a roller coaster ride —& I’m different day to day and hour to hour,” says Nicole, 30, of Denver, CO who was diagnosed with bipolar disorder six years ago. “I have periods when I’m very creative and outgoing — people describe me as being more attractive and alluring. I have a higher sex drive, and I do a lot of writing and artwork. But then I slip into a depressive state, and it feels like being in wet cement. I just want to curl up in the fetal position and sleep all day.” Be flexible with plans: When you’re scheduling something with a friend who is struggling, “give him the choice to participate or not,” says Katrina Gay, CDO of NAMI. Understand that if he does come with you, he may have to leave early, and that it might be really hard for him to make any long-term commitments.

A bevy of bills before the state legislature seeks to improve how state and local agencies assist people struggling with mental health crises and related issues. They’re both promising and overdue. One of them, House Bill 786, “Enhance Local Response/Mental Health Crises,” would provide funding for pilot programs to study how local police departments could respond to nonviolent emergency calls involving mental health, homelessness, substance use or other behavioral problems, with teams that include mental health professionals. Rep. Donny Lambeth, R-Forsyth, is among the bill’s primary sponsors. “Our goal is not to demonize law enforcement, but to address the fact that they are not properly trained to be the primary or most appropriate responders in all situations,” the petition states. “There are times when law enforcement is the right professional, and there are times when they are the default professional, simply because of the existing system.” But the legislation and petition follow a string of highly publicized incidents throughout the nation in which police responded to people experiencing mental health crises with force that tragically led to the death of the person in need. “A person shouldn’t lose their life because they’re experiencing symptoms of a mental health condition,” Angela Kimball, national director of advocacy and public policy at NAMI, said in an interview last year. “People deserve help, not handcuffs.”

Teen mental health has continued to suffer amid the pandemic, and going back to school in person, while a welcome sign of normalcy for some, could be daunting for others, experts said in a virtual town hall event hosted by Harvard University. “Entering the fall is going to be a really stressful time for young people because a number of kids have decided to continue remote learning, but when the fall comes, everyone for the most part will most likely go back to school,” said Dr. Christine Crawford, adult and child psychiatrist and associate medical director for NAMI. Going back to school full time will likely bring up strong emotions for teens, Crawford said, and some may feel anxious or more depressed. “When they’re in the classroom studying, there is a tendency to compare yourself to your peers around you,” Crawford said. Daniel Gillison, CEO of NAMI, said nationwide, there has been a sharp increase in the number of emergency room visits by people under 18 related to mental health concerns. “It’s no secret our young people are not all right,” Gillison said.

Davis was already prone to suicidal thoughts as someone with bipolar disorder. Then he got the coronavirus in April 2020. Lingering effects have left him with anxiety and a depression he calls “pretty damn awful.” A research study reported in Lancet Psychiatry found a third of Covid-19 survivors were diagnosed with a neurological or psychiatric condition in the six months after being infected; 17.4% had an anxiety disorder. Even if survivors like Davis are able to push past the stigma that’s long caused people to shy away from mental health treatment, finding a provider that’s covered by insurance and still accepting new patients can seem insurmountable. “You might have an insurance card, but actually finding a provider in-network is extraordinarily hard even for people with quote-unquote good insurance,” said Jennifer Snow, director of public policy at NAMI. Most large plans have some mental health coverage, ”but even with the increased coverage we still find actually getting care is a problem for many people,” Snow said. “Many times people are forced to get care out-of-network, which can make care unaffordable.”

Mental health influencers are flourishing; platforms like Instagram and Twitter make their resources accessible and shareable, catnip for people who find therapy overwhelming, alienating, or financially out of reach. According to the National Alliance on Mental Illness, mental health care should always take one’s culture into account. “Our culture, beliefs, sexual identity, values, race and language all affect how we perceive and experience mental health conditions,” reads a statement on its website. “It is therefore essential for culture and identity to be a part of the conversation as we discuss both mental health and mental health care.”

People in recovery will tell you that addiction isn’t just about neurochemical dependency, or intoxicating substances, or thrill-seeking behaviors. Addiction is also connected to control, security, and self-worth — all of which took a massive beating during the pandemic. Addiction trends accelerated during Covid-19 as stress levels increased and support networks crumbled. When Men’s Health polled 1,111 people, 75% of respondents said they are close to someone struggling with addiction and 40% reported an increase in cravings for addictive substances or behaviors. One reason: They didn’t have other people around to keep them feeling connected, grounded, and upbeat, says Ken Duckworth, M.D., CMO of NAMI. The fraying of connectivity can trigger addictive behaviors — alcohol, painkillers, drugs, porn, gambling — and relapse for those in recovery. There’s also still a stigma attached to addiction, which means people often suffer in isolation.

This journey is rarely a straight path, and it's a road rarely walked alone. When we set out to understand the state of addiction and recovery as the world navigates a deadly pandemic that has made social connection and self-control exceedingly difficult, and also survey 1,111 people to better understand the bigger picture when it comes to people's attitudes and perspectives regarding addiction. Seven percent of people surveyed wished someone would intervene in their addictive behaviors. If no one does, try Community Reinforcement Approach and Family Training. “It’s using relationships for good,” says Ken Duckworth, M.D., CMO of NAMI. “It’s designed for people who love you.” Mental-health services are not on pause during the pandemic, from online counseling to virtual 12-step meetings. In fact, “some people would say that AA on Zoom is better because you can actually see one person at a time and you’re not as distracted,” Dr. Duckworth says.

Systemic racism and hostile racial environments are nothing new in the United States, but 2020 and 2021 to date have marked a significant milestone in awareness and lack of tolerance for it. Ironically, while this upheaval has created the potential for change, it has also put a strain on the mental health of many Black Americans, whose stress may be increased by continued media reports of violence and police brutality. “Racism is a public health crisis,” says Daniel H. Gillison Jr., NAMI CEO. In fact, a growing body of research shows that experiencing racism increases the risk for anxiety, ulcers, insomnia, mood swings, and emotional and social withdrawal.