The mental health crisis is not a natural disaster
Much of mental illness is preventable, and we should treat it as such.
The start of the school year is always a happy occasion. But this Fall, excitement has been mixed with concerns over students’ mental health. Rates of depression and anxiety are ballooning, particularly among teenagers, and psychological support services are stretched dangerously thin.
Understandably, policymakers are working around the clock to address mental health problems as they arise. Last year, for instance, the Bipartisan Safer Communities Act committed a whopping $1 billion to training and hiring school mental health professionals.
But training is slow, leading educators to scramble to provide adequate support for a population in need. In recent cases, schools have hired students with incomplete training or shifted responsibilities to non-specialist colleagues. Emergency room doctors are equally hard-pressed to provide sufficient support.
This makes me wonder whether focusing on the treatment of mental health problems is wise.
While efforts to expand professional support are laudable—it is vital to provide psychiatric care to all who need it—focusing on the human resources issue comes at a cost. It paints a picture of the mental health crisis as a kind of natural disaster, a capricious plague that we can only respond to after the fact. We see the rising tide of teenage anxiety and react by stacking sandbags—in this case, counselors and psychologists.
In a historical moment when earthquakes and floods are more and more frequent, we can be forgiven for applying the same lens to the mental health crisis. But it is the wrong way to look at the problem. Just as with cardiovascular disease or cancer, much of mental illness is man-made. By emphasizing the treatment of psychological suffering, we risk ignoring what causes it—and how much of it is preventable.
Let’s take a look at some data. During the covid-19 pandemic, the number of children with depression and anxiety symptoms was twice as high as before, according to a global overview study. CDC data revealed that the number of female high-school students with serious suicidal thoughts went up by 25%. And periodic surveys in the Netherlands showed that such symptoms of mental illness in adolescents were commonest during the harshest lockdown periods. Being cooped up with family, not able to go to school or connect with friends, caused hopelessness and worry to thrive.
Here's another data point. Like nearly all states of disease, mental illness overwhelmingly affects those who are less well-off. A 2003 overview piece in the American Journal of Epidemiology reported that in North America and Europe, people with the least education or income had roughly 80% greater odds of having a depression than those in the most privileged groups. A 2020 study specific to the U.S. showed that Americans with a family income below $20,000 had about 174% greater odds of having depressive symptoms than those with an income above $75,000.
Researchers often argue about the direction of causality for such statistics. Does having a depression not hamper your ability to make money? Yes—and this is why we need better support for people with mental illness to find employment.
But the reverse is also true. Living in socioeconomic deprivation causes mental illness. One exceptionally convincing study tracked the mental health of over 42,000 asylum seekers who were randomly assigned to communities in Denmark between 1986 and 1998. People who had been placed in neighborhoods with lower income levels and more social issues eventually developed higher rates of stress-related disorders and associated medication use than those who were assigned to better-off areas, even though there was no difference at the time of assignment.
Poverty harms the mental health of children, too. According to an international overview study, socioeconomically disadvantaged children and adolescents are two to three times more likely to develop mental health problems. And since children plagued by psychiatric symptoms enjoy less opportunity for educational achievement, the cycle continues.
What these findings demonstrate is that your mental health is strongly shaped by the circumstances under which you live. Just as folks living downwind from a steel plant run a much higher risk of developing lung cancer, children growing up experiencing social or economic deprivation are at greater risk of developing psychiatric symptoms.
So although the precise cause for the rise in teenage reported mental illness is still up for debate, we know that the bulk of mental health problems are related to adverse living circumstances like the ones cited above.
The good news is that this makes the youth mental health crisis not an unpredictable disaster, but a partially preventable problem. And this is why the push for mental health staff in schools should be matched by an equally herculean effort to prevent mental illness—particularly when we realize that training enough psychologists is currently not within our reach.
So, what can we do? There are many answers, but here is a top three. First, aside from caring for mental health in schools, preventing mental illness requires investing in the basic needs of families such as income security, reliable housing, and access to healthy food. Second, collaboration between sectors of the government is needed to promote well-being effectively and sustainably. And third, evidence-based preventative programs must be offered to specific groups at higher risk for mental health problems, such as young mothers and children of parents with substance use issues. If we roll up our sleeves, we can choose to turn the tide of teenage suffering and free up mental health professionals to focus on the illness that cannot be prevented.
In the end, these social investments will benefit everyone. As Kate Woodsome recently pointed out in The Washington Post, the societal returns of preventative action for mental health tend to outstrip its cost by far, because mentally healthy citizens are more productive and need less social care. And if prevention effectively eases demand for psychological services, we will lower attrition among currently overworked professionals. That will leave more support to go around for everyone.