So many statistics say that life in the U.S. is getting better. Unemployment is at the lowest level since 1969. Violent crime has fallen sharply since the 1990s—cities such as New York are safer than they’ve ever been. And Americans lived nine years longer, on average, in 2017 than they did in 1960. It would make sense that the psychic well-being of the nation would improve along with measures like that.
Yet something isn’t right. In 2017, 47,000 people died by suicide, and there were 1.4 million suicide attempts. U.S. suicide rates are at the highest level since World War II, said the U.S. Centers for Disease Control and Prevention on June 20, when it released a study on the problem. And it’s getting worse: The U.S. suicide rate increased on average by about 1% a year from 2000 through 2006 and by 2% a year from 2006 through 2016.
Although suicide is the starkest indicator of mental distress, others abound. Drug overdoses claimed 70,000 lives in 2017, and 17.3 million, or 7%, of U.S. adults reported suffering at least one major depressive episode in the past year. Life expectancy, perhaps the broadest measure of a nation’s health, has fallen for three straight years, in part because of the rise in drug overdoses and suicides. That’s the first three-year drop since 1915 to 1918.
The problems may have different and varied causes, but what they add up to is a national mental health epidemic. The damage is on the scale of the global financial crisis, yet we lack the institutions, policies, and determination to address it. The government’s response has been inadequate, says Paul Gionfriddo, president of Mental Health America, an advocacy group. “The dollars have gone more to deep-end services in jails and prisons. It’s a really bad idea to put the money into jails because the people don’t belong there.”
“I’d like to say things have improved a lot, but they haven’t”
Mental health problems manifest in a number of ways and encapsulate a wide range of conditions, including substance abuse disorders, crippling anxiety, schizophrenia, and suicidality. A person’s susceptibility depends on genetic, social, and environmental factors. These contributors are believed to be intertwined; psychological stressors can activate a genetic predisposition, so life circumstances matter a lot. And the U.S. is home to some particularly challenging ones: stagnant wages; rising health-care costs; the proliferation of highly addictive opioids after a marketing push from major drug companies; the disappearance of well-paid blue-collar jobs and the emergence of the gig economy; the lack or limited availability of treatment and services. The destructive powers of technology, be it in the form of social isolation or cyberbullying, have been cited in the rising number of teens killing themselves. Suicide is the second-leading cause of death for 10- to 34-year-olds. Then there’s the prevalence of guns, which are used in half of all suicides.
Whatever the causes, mental illness and substance abuse are social and economic catastrophes. They cost U.S. businesses $80 billion to $100 billion annually, according to a literature review put out by the Center for Workplace Mental Health, which also showed that some two-thirds of people suffering from either mental health or substance abuse disorders don’t receive any treatment for their conditions. Unchecked mental health conditions can result in violence. In America, workplace shootings have become almost routine. The latest: On the afternoon of May 31, 2019, a disgruntled city employee killed 12 people at a municipal building in Virginia Beach, Va.
Some federal actions have contributed to the crisis. Out of concern that patients were trapped in mental hospitals without a path out, President John F. Kennedy signed the Community Mental Health Actin 1963 to provide funding for new services in the community. The law “drastically altered the delivery of mental health services and inspired a new era of optimism in mental health care,” according to the National Council for Behavioral Health. It also came at a time when new psychiatric drugs were emerging, supporting the hope that the future was going to be brighter for people in need of care.
Almost 60 years later, it’s clear things haven’t worked out that way. “People with severe mental illness can still be found in deplorable environments, medications have not successfully improved function in all patients even when they improve symptoms, and the institutional closings have deluged underfunded community services with new populations they were ill-equipped to handle,” Daniel Yohanna wrote in “Deinstitutionalization of People with Mental Illness: Causes and Consequences” in the AMA Journal of Ethics in 2013. That’s left people without the comprehensive care they would need to recover from drug addiction or suicidal thinking. Yohanna cites a poll of experts who say that 50 beds per 100,000 would meet Americans’ acute and long-term care needs. In some states the number is as low as 5 per 100,000. “I’d like to say things have improved a lot, but they haven’t,” he says today.