In recent years, there has been an increase in mental health awareness in the United States. Therapy and counseling have become common topics in books, podcasts and movies, and prominent figures from athletes to politicians are openly discussing their mental health issues. This shift has led to a significant increase in mental health services and their use. Such is the prevalence, awareness, and normalization of mental health issues that federal estimates reveal that approximately one in eight American adults now take antidepressants, and one in five has recently received mental health care. In fact, according to a recent study by the JAMA Health Forum, there was a 40% jump in the use of mental health services among adults with commercial insurance from 2019 to 2022. However, despite this growing interest in and access to mental health care, various reports suggest that mental health in the US is deteriorating. According to a report by the National Center for Health Statistics, which tracked suicides in the US from 2001 to 2021, it was reported that suicide rates have increased significantly. Furthermore, according to Gallup polls, only 31% of Americans describe their mental health as ‘excellent’, a rating that has seen a significant decline. As reported by the Times’, Dr. Thomas Insel, a psychiatrist who led the National Institute of Mental Health (NIMH) from 2002 to 2015 said: The trends are going in the wrong direction, even though more people are seeking care. “That is not true for cancer [survival]not valid for heart disease [survival]not true for diabetes [diagnosis], or almost any other field of medicine.” This troubling trend raises a critical question: why is the demand for mental health care greater than its effectiveness? Challenges in diagnosis and treatment In medical practice, objective data are used to guide diagnosis and treatment. For example, high blood pressure leads to hypertension medication, and cancer diagnoses are based on biopsy results. However, psychiatry faces a unique challenge since there are no clear metrics. Unlike other medical fields, where hard evidence and statistics drive diagnoses, psychiatry relies heavily on the Diagnostic and Statistical Manual of Mental Disorders (DSM). This manual establishes diagnostic criteria based on the duration, impact, and appearance of symptoms. Consequently, the subjective nature of psychiatric diagnosis has led to issues of ‘misdiagnosis’ and ‘overdiagnosis’. As the Times reports, “Dr. Paul Minot, whose almost four decades of work as a psychiatrist has not stopped him from loudly criticizing the field, believes that his industry is too quick to cover up the “ambiguity” of mental health, presenting diagnoses as safe, when in fact there is a gray area. Indeed, research suggests that both misdiagnosis and overdiagnosis are common in psychiatry. One 2019 study even concluded that the criteria on which a psychiatric diagnosis is based are “scientifically meaningless” due to inconsistent metrics, overlapping symptoms, and limited scope. It’s a sobering conclusion, because the diagnosis largely determines the treatment.” Many people who have been in and out of therapy over the years have also mentioned how different medical professionals diagnosed them with different symptoms for the same symptoms. This can lead to mistrust of the medical agency, and a misdiagnosis can lead to the wrong prescription of medication. Medicines: are they being treated correctly? Antidepressants are among the most commonly consumed and prescribed medications in the US. But even with their use, there aren’t many individuals who don’t get the results they need. While some report positive results with antidepressants, research shows that their effectiveness may not be as expected. A study published by the NIMH in 2006 on the ‘Study of Sequenced Alternatives to Treatment for Depression (STAR*D)’ shows that antidepressants have only modest benefits, and their effects may not be as significant as previously believed. Today, the theory of serotonin deficiency causing depression, which led to the development of drugs like Prozac, is increasingly being questioned. As reported in the Times, “Moncrieff’s research, like that of other scientists, suggests that depression is not caused by low serotonin levels, at least not entirely. And if serotonin isn’t the main problem, says Moncrieff, taking these drugs “doesn’t correct the chemical imbalance. It creates a chemical imbalance.” Is there a holistic approach? Critics argue that psychiatry often relies solely on medication to address symptoms without addressing the underlying causes of mental health problems. Instead of prescribing pills, they advocate a more holistic approach that helps individuals solve life’s problems, manage stress triggers and build resilience. Problem-solving therapy, which focuses on teaching individuals how to cope with challenges, is one such alternative. Outside the Therapy Room Improving mental health requires a shift in focus from traditional therapy itself. While expanding access to care is critical, it is equally important to prioritize quality over quantity. This includes measuring not only the process of care but also the actual improvement in the patient’s condition and their ability to lead a fulfilling life. Beyond therapy, addressing social determinants of mental health, such as affordable housing, education, and community support programs, can be equally influential. The paradox of increasing use of mental health care while deteriorating mental health in the US illustrates the need for a multifaceted approach. Emphasizing holistic, patient-centered care, understanding medication limitations, and addressing broader societal issues are key steps in addressing this new challenge.
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Source: newstars.edu.vn