In recent years, the United States has seen an increase in mental health awareness. Therapy and counseling have become popular topics in books, podcasts, movies, and celebrities, from athletes to politicians, openly discuss their mental health struggles . This change has led to a notable increase in mental health services and their use. The prevalence, awareness and normalization of mental health problems is such that federal estimates suggest that about one in eight adults in the United States are currently taking antidepressants and one in five have recently received mental health care. In fact, according to a recent study in JAMA Health Forum, the rate of mental health service utilization among commercially insured adults increased 40% from 2019 to 2022. However, regardless Despite increased interest in and access to mental health care, many reports suggest that mental health in the United States is deteriorating. According to a report by the National Center for Health Statistics, which tracks suicides in the United States from 2001 to 2021, suicide rates have reportedly increased significantly. Furthermore, according to Gallup polls, only 31% of Americans describe their mental health as ‘excellent’, a rating that has dropped significantly. As reported in the Times’, Dr. Thomas Insel, a psychiatrist who ran the National Institute of Mental Health (NIMH) from 2002 to 2015, said, “The trend is going in the wrong direction, even as there is an increasing many people seek care. “That’s not true with cancer [survival]That’s not true for heart disease [survival]That’s not true with diabetes [diagnosis]or nearly any other field of medicine.” This worrying trend raises an important question: why does the demand for mental health care outstrip its effectiveness? Diagnosis and Treatment Challenges In medical practice, objective data are used to guide diagnosis and treatment. For example, high blood pressure leads to the use of antihypertensive medications and cancer diagnoses based on biopsy results. However, psychiatry faces a particular challenge because it lacks clear metrics. Unlike other medical fields, where solid evidence and statistics drive diagnosis, psychiatry relies heavily on the Diagnostic and Statistical Manual of Mental Disorders (DSM). This guideline sets out diagnostic criteria based on duration, impact, and appearance of symptoms. The subjective nature of psychiatric diagnosis has therefore led to problems of ‘misdiagnosis’ and ‘overdiagnosis’. As the Times reported’, “Dr. Paul Minot, whose nearly four decades as a psychiatrist has not prevented him from being critical of the field, feels his profession is too quick to gloss over the “ambiguity” of mental health, prescribing diagnoses certainty when in reality there is a gray area. Indeed, research shows that both misdiagnosis and overdiagnosis are common in psychiatry. A 2019 study even concluded that psychiatric diagnostic criteria are “scientifically meaningless” due to inconsistent data, overlapping symptoms, and limited scope. That is a sobering conclusion, because diagnosis largely determines treatment.” Many people who have been in and out of treatment for years have also mentioned how they were diagnosed differently by different medical professionals for the same symptoms. This can lead to distrust in medical authorities and misdiagnosis can lead to medication misallocation. Medication: Are they treating it right? Antidepressants are among the most consumed and most prescribed medications in the United States. But even when using them, not many people do not get the desired results. While some report positive results with antidepressants, research shows that their effectiveness may not be as expected. A study published by NIMH in 2006 on ‘Study of Sequential Alternative Treatments for Relieving Depression (STAR*D)’ found that antidepressants provide only modest benefits and little effect. of them may not be as significant as previously believed. Today, the theory that serotonin deficiency causes depression, which led to the development of drugs like Prozac, is increasingly being questioned. As reported in the Times’, “Moncrieff’s research as well as the work of other scientists shows that depression is not caused.” by low serotonin levels, at least not completely. And if serotonin isn’t the main problem, Moncrieff says, then taking these drugs “doesn’t correct the chemical imbalance. It is creating a chemical imbalance.” Is there a general approach? Critics say psychiatry often relies solely on drugs to address symptoms without addressing the root causes of mental health problems. Instead of prescribing medication, they advocate a more holistic approach that helps individuals address life problems, manage stressors, and build resilience. Problem-solving therapy, which focuses on teaching individuals how to cope with challenges, is one such alternative. Beyond the therapy room, improving mental health requires shifting focus away from traditional therapy. While expanding access to care is important, it is equally important to prioritize quality over quantity. This involves measuring not only the process of care but also the actual improvement in a patient’s condition and their ability to lead a fulfilling life. In addition to therapy, addressing the social determinants of mental health, such as affordable housing, education, and community support programs, can be equally impactful. The paradox of increased mental health care utilization coupled with worsening mental health conditions in the United States demonstrates the need for a multifaceted approach. Emphasizing comprehensive, patient-centered care, understanding the limitations of medicine, and addressing broader societal issues are all necessary steps to address this new challenge. Read more: Should you exercise on an empty stomach?
