Consider This from NPR - What's Really Causing America's Mental Health Crisis?

Episode Date: September 24, 2022

This week the U.S. Preventive Services Task Force announced recommendations that doctors screen all patients under 65 for anxiety. Since the beginning of the pandemic, we've heard about sharp increases in the number of people suffering from mental health problems. With a health care system already overburdened and seemingly unable to deal with the rise in mental health issues, America is facing what is being called a mental health crisis.But are we losing sight of another crisis - the issues causing increased anxiety and depression in Americans?Host Michel Martin speaks with Dr. Danielle Carr about her recent essay in the New York Times, Mental Health Is Political.Learn more about sponsor message choices: podcastchoices.com/adchoicesNPR Privacy Policy

Support for NPR comes from NPR member stations and Eric and Wendy Schmidt through the Schmidt Family Foundation, working toward a healthy, resilient, secure world for all on the web at theschmidt.org. We really were starting to see an uptick in depression and anxiety among young adults and teens. That's clinical psychologist Andrea Bonnier. I think it's kind of disturbing in a way because I think with the added isolation, we're really seeing an uptick in self-harm and suicidal ideation. It probably won't surprise anybody to hear that anxiety and depression have been on the rise during the COVID pandemic. In fact, the World Health Organization says the pandemic has

triggered a 25% increase in anxiety and depression worldwide. But I think one really important thing to remember is that a lot of these trends were happening before the pandemic, too. We really were starting to see an uptick in depression and anxiety. So this week, the U.S. Preventive Services Task Force, an independent group of volunteer medical experts under the Department of Health and Human Services, came out with a draft recommendation, and it wasn't just for teens. For the first time, a panel of medical experts is recommending that American adults under the age of 65 be screened for anxiety. What we found was good evidence that screening and treatment of anxiety disorders in adults is effective in being able to help reduce anxiety symptoms

and connect people to the care that they need to be able to get the benefits of treatment. Lori Pabert is a member of the task force. She's a clinical psychologist and professor at the University of Massachusetts. Finding mental health services can be incredibly difficult, especially in areas where we have limited access to health care and related services. So the task force's hope is that putting forth this set of recommendations, including screening for anxiety, depression, and suicide risk, can help bring awareness of the need to create greater access to evidence-based mental health care throughout the country.

And she says that's in part because the mental health care workforce is already stretched thin. We need to expand that workforce to be able to meet the demand that we already have and the demand that could come from additional recommendations for screening. We also have a lack of connection between primary care and mental health care systems. And so it's going to be really important to work on integrating it so that we can help primary care clinicians more smoothly connect their patients with mental health care systems and with mental health care providers. But what if that's not enough or even relevant at all?

Consider this. While most people can agree that there's some kind of crisis in mental well-being in this country, what if better access to care isn't the main issue or even relevant to the root causes? What if, as our next guest suggests, more screening only points us in the wrong direction? That's coming up. From NPR, I'm Michelle Martin. It's Saturday, September 24th. At a certain point, you've got to call a spade a spade and say, certainly there are biological symptoms, like something is happening in the brains of people to make them feel despair. But we have to ask, okay, so what is causing those neurological and biological changes? And I think that it's the extreme stress of trying to survive an increasingly unlivable situation.

Danielle Carr is an assistant professor at the UCLA Institute for Society and Genetics. She argued in an essay for the New York Times that this isn't a mental health epidemic, it's a political crisis that is affecting mental health. If you look at the economic situation of most Americans since the 1970s, real income and real wages have been pretty consistently declining. Even last year, real hourly earnings decreased by 2.8%. And I think that we all can see that ordinary life is becoming harder and harder for most Americans while the economic and political elite continue to profit. Basically, if I could just put it this way, you're talking about addressing root causes.

You're saying that people are stressed because they don't have enough money or because their living conditions are untenable. So the idea of saying, gee, you know, we need to address the root causes of a crisis isn't a new one. Do you think there's something unique in this moment about the medical framing of it? Does that stand out to you? And why do you think that is? Yeah, absolutely. I think that there's been a kind of consumer movement since, let's say, the 1980s to destigmatize mental health issues. And that's wonderful. But I think that there's a third position to be staked out between total biological reduction and saying, this is only a kind of bodily disease,

like, I don't know, breaking your leg or something, and total denial of the biological reality, which is kind of what happened during the anti-psychiatry movement of the 1970s that said, well, mental illness is totally social. There's a needle to be threaded here to say that, psychiatry movement of the 1970s that said, well, mental illness is totally social. There's a needle to be threaded here to say that, yes, these are real biological conditions, but treating these conditions only through healthcare, only through access to things like cognitive behavioral therapy or medication is actually not addressing the root cause. And when

we're looking at population level rises in things like anxiety, depression, suicide, and so on, we have to look at the root causes. So earlier this week, an independent advisory panel to the U.S. Department of Health and Human Services recommended that all adult patients under 65 be screened for anxiety. So what do you make of this recommendation in light of what you were already thinking about this? Yeah, so I think that the fact that this is being recommended by a sort of US task force speaks to the extremely widespread nature of the phenomenon that we're looking at. But my worry here is that screening people in this way encourages them to think, oh, well, I'm experiencing anxiety. Anxiety must be a medical problem that's arising from a chemical imbalance in my brain.

And I think that there's something kind of depoliticizing about that. It's true that psychiatric medication does help some people, but psychiatric medication tends to not perform in, when you do meta-analyses of these clinical trials, tends to not really perform very much better than placebo, that is like a sugar pill. And so what worries me about this is that people will be slotted into thinking about their lives as if they have a medical problem, rather than that they are located at a sort of moment in history and a moment in politics where society is producing these emotions in them. And those emotions are actually quite warranted and deserve to be taken seriously and indeed organized around. The COVID-19 pandemic isn't the first time this country

has experienced heightened mental health challenges with young and working adults. Danielle Carr thinks we can learn from what did not work in the past. That's coming up. I think a good kind of example here is if you look at the so-called opiate epidemic, right? Now, we all know what happened there because of years of reporting, but there was, you know, the sort of post-industrial underclass in the United States was quite intentionally subject to an artificial so-called epidemic of addiction that was pushed by pharmaceutical companies with very little pushback, if any, from a political class. And it took quite a bit of organizing and quite a bit of reporting to... And quite a bit of dying. And quite a bit of dying to... And quite a bit of dying. And quite a bit of dying to connect those dots. I was in Ferguson, Missouri,

a couple of weeks after Michael Brown was killed. And there were many street demonstrations. And as we now know, there were some of which were violent, most of which were not. But there was a lot of kind of mass, you know, mobilization, a lot of activity around this. It was very, you know,

upsetting to some people, very welcome to other people. It drew a lot of activity around this. It was very upsetting to some people, very welcome to other people. It drew a lot of outside attention. And I remember this all coincided with school starting, and there were a lot of fights at school, to and from school, a lot of fistfights. And I was wondering, and I remember remarking to somebody about this, gee, I wonder if these kids are getting any help processing this. And I remember the person kind of reacted very angrily and was like, this is not their problem. This is everybody's problem. And I was like, yeah, but can't both be true? Can't both be true? I'm certainly not saying that if you are insured and have access to the medical system that you

shouldn't avail yourself of the things that you think will be helpful. And certainly when it comes to children, I think that it is probably generally good to increase the number of school counselors and people that are available to talk and help them through their lives. What worries me is the specific medicalization of these different symptoms that can result in the increasing prescription of psychiatric medication that, you know, these are not drugs without side effects. These are very, these are serious drugs that alter brain chemistry. And so I think that we need to exercise real caution in how those are being prescribed. But I mean, what we're talking about here with kind of medicalization is by no means

a new phenomenon. One of the things that concerns me about this screening task force or screening plan is that it sort of institutionalizes a certain narrative about causality. So, for instance, the rate of suicide and alcoholism and a variety of psychiatric diagnoses are very high among Native American populations in this country. Now, if you look at it from a historical and political perspective, the reasons for that could not be more clear, right? This is a group of people who have been systematically screwed over by the American political establishment pretty severely. However,

there are a series of programs that have been instituted to screen Native Americans for fetal alcohol syndrome. And the narrative that's kind of installed there is that some sort of neurological change is happening in the bodies of these children that makes them more likely to have a suicidal behavior or to have psychiatric problems. And so you can see the switch that's happening there, the switch from looking at things from a historical and political and social perspective to saying there is something wrong with these people's bodies. And if we to saying there is something wrong with these people's bodies. And if we treat the thing that's wrong with their bodies, then we can call it a day and we'll have solved the problem. And this is not true. So what kind of reaction are you

getting to your piece? I'm fascinated by this because I can imagine people saying, yeah, you're anxious if your lights are about to be cut off. And why is this a surprise? On the other hand, I can see people saying, well, you're discouraging people from getting help that they need at a time when we're trying to release the stigma of mental health and mental well-being. So you tell me, what's the reaction been and what do you make of it? I think one of the best responses that I read was from a commenter on the article who's a therapist in, I want to say, South Side of Chicago, who told a story about, you know, treating this teen and realizing that

the kid didn't have enough money to go get lunch and giving him $10 to go get lunch. And he said, you know, I think that that helps that kid more than prescribing anything or even more than therapy. And so I think that the response has been to underline that I'm indeed not saying anything that isn't quite obvious to anyone who has worked in this field for any period of time. That was Danielle Carr. She is an assistant professor at the UCLA Institute for Society and Genetics. It's Consider This from NPR. I'm Michelle Martin. Support for NPR and the following message come from the Kauffman Foundation,

providing access to opportunities that help people achieve financial stability, upward mobility, and economic prosperity, regardless of race, gender, or geography. Kauffman.org