As we countdown the days to 2025, there is much to anticipate in the year ahead. Driven by breakthroughs in area such as artificial intelligence, medicine development, gene therapies, and even rocket technologies, the pace of change in 2025 may be either exhilarating or terrifying depending on your perspective.
Gratefully, some — perhaps even most — of the changes we experience next year will be gradual. Other changes, however, could be radical. And the latter is not necessarily a bad thing. Because there is possibly no area of modern America that needs radical change more than our stagnate system for preventing and treating mental illness.
Mental health in the U.S. received unexpected levels of attention in the years following the COVID-19 pandemic, when researchers observed dramatic increases in depression and anxiety in the population1. However, the even more important statistical trend about mental health received far less coverage. Namely that many mental health conditions — including severe mental illness, autism, ADHD, suicide, and depression and anxiety — had already been increasing for years before the pandemic. The most recent epidemiological data suggest that more than one in five Americans are now living with a mental health condition2.
This means that the mental health crisis was not a side effect of the pandemic, although the latter surely added fuel to the fire. The mental health crisis similarly cannot singularly be attributed to any recent political movement or technological development, as neither can account for the already worsening mental health trends that preceded them.
Instead, to accurately understand the mental health crisis in the U.S., one arguably must go back even decades earlier when the initial signs of these trends emerged.
Figure 1 below provides a comparison of the conventional — but oversimplified — model of mental illness versus our current (but still widely underrecognized) model.
Conventionally, mental health professionals such as psychologists and psychiatrists are taught the narrow model that mental illness is mostly a result of adverse psychosocial experiences that affect brain function in theoretical (but difficult to directly measure) ways such as neurotransmitter depletion and dysfunction. Talk therapy and psychotropics attempt to help people redress these experiences and correct underlying biological changes. Yet although there are real and important barriers that limit access to these evidence-based treatments for millions of people, there are also millions who have tried many of these treatments without receiving substantial benefit. This suggests that simply expanding access to mental healthcare isn’t enough.
Figure 1 above implies that even granting full population access to conventional mental health therapies would be insufficient because conventional mental heath therapies fail to address important non-psychosocial causes of mental illness. Figure 2 offers a more comprehensive biopsychosocial model of mental health treatment based on our best current science.
In the 80s through early 2000s, when the current U.S. mental health crisis was still a slow-growing infant, there was a parallel slow rise in another sector of public health that has also since become a modern crisis: metabolic diseases such as obesity, diabetes, and non-alcoholic liver disease. Research increasingly suggests this overlap is not a coincidence. As shown in Figure 2 above, appreciating how these metabolic and environmental factors3 frequently contribute to both physical and mental illness could transform our current treatment paradigm from one that tries to reduce mental health symptoms to one that addresses root causes.
Mental illness and metabolic diseases share much of the same biology. When obesity is caused by chemicals in our air, water, and food, for example, we call them obesogens4. Yet despite clear associations between precisely the same classes of chemicals and mental illness5-6, we still lack a catchy meme to describe the relationship.
If “depressogens” or “psychogens” ever become part of our mental health vocabulary, remember that they are grounded in our already well-substantiated understanding that chemicals in our food, water, air, and other sources of modern life are “endocrine disruptors” that alter our hormone patterns. Because hormones are long-lasting chemicals in the body that regulate the function of the brain and other organs, artificially disrupting them is a dangerous game for our health.
What could the next paradigm of mental health treatment look like in this biopsychosocial model?
- Mental health treatment could become multidisciplinary rather than the current mostly siloed model. Mental health providers, for instance, would have compelling reasons to work more closely with primary care providers and other biomedical specialists to improve the understanding of their patient’s symptoms and potentially enhance treatment efficacy.
- Conventional mental health treatments could be combined in personalized ways with behavior interventions that improve metabolic function, such as nutrition, sleep, healthy fat loss, and physical activity.
- Standard mental health assessments could be augmented with routine medical testing for metabolic disorders (insulin levels, blood glucose, liver function, C-reactive protein, etc.,), with the latter results becoming a regular part of the conceptualization and treatment planning.
- Educating about and testing for at least the most established endocrine disruptors and environmental toxins linked to obesity, metabolic diseases, and mental illness — along with potential efforts to reduce exposure to these agents — could become a long overdue part of how mental providers consider and treat mental illness.
Mental healthcare in the U.S. can get better. But to do so, it will have to change.
