2022, the Year of the Tiger, was the year mental health was fully embraced as a national issue – and seen, finally, as a major human crisis that had long been ignored. It was a year of unprecedented attention on mental health from the media, and unprecedented funding from politicians.

But it was also a year of backlash against efforts to build mental health supports and knowledge into schools, libraries and community centers. And it was a year when enthusiasm – dare I say irrational exuberance – for digital technology and psychedelics was tempered.

Here, then, is the MindSite News roundup of the 10 most important mental health stories of the year.

1. Covid poured gasoline on a simmering youth mental health crisis

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It took a pandemic for policymakers and the general public to discover what parents and doctors already knew: kids’ mental health had been deteriorating for years.

What happened: Cut off from the routines of school and emotional support from friends and social networks, many kids and youth found the loss of physical contact and worries about family finances and health too much to bear.

How bad: 37% of 9th through 12th graders surveyed said they had poor mental health early in the pandemic, 44% had persistent symptoms of depression, 20% considered suicide and 9% attempted it. LGBTQ youth reported worse mental health and more thoughts of suicide. The gender gap – teenage girls’ mental health has long been worse than boys’ – got wider.

The future: Many fear that the impacts of pandemic disruptions and lost schooling could follow teens into adulthood – but there are hopeful developments, too. Many schools are developing innovations to mitigate the damage – and working to overcome resistance from conservative groups that oppose schools’ role in supporting student mental health. “Many young people are resilient, able to bounce back from difficult experiences such as stress, adversity, and trauma,” wrote U.S. Surgeon General Vivek Murthy in a late-2021 report that raised the alarm.

2. Psychedelics head to the mainstream, but …

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Psychedelics are coming! Psychedelics are coming! Scientists, therapists, activists and investors have been giddy with excitement over the potential for psilocybin, MDMA and other mind-bending medications to treat mental health disorders like depression and post-traumatic stress disorder, trigger personal transformation and – oh, yes – make money.

Oregon and Colorado have legalized magic mushrooms in guided settings, perhaps catalyzing a national trend that is exciting lots of players: Nutritional supplement maker Irwin Naturals, for example, has been buying up ketamine clinics around the country as it seeks “to become the world’s largest chain of psychedelic mental health clinics.” Hundreds of clinical trials are approved or underway and within a year or so, the Food and Drug Administration could approve MDMA for treating PTSD and Compass Pathways’ psilocybin drug COMP 360 for treatment-resistant depression, based on their performance in trials. 

The MDMA trial, sponsored by MAPS, a not-for-profit developer, found that taking MDMA in guided sessions helped about two-thirds of combat veterans and others who suffered for years with severe, debilitating PTSD. In the Compass trial, one of a handful of larger studies, a single dose of COMP360, along with psychological support, reduced symptoms of treatment-resistant depression in 29% of patients after 3 weeks and 20% after 12 – small numbers until you consider that these are severely depressed patients that were not helped by other therapies.

Still, clinical research is in its early stages – most trials have been small and without control groups. Yet the potential for a wide range of benefits remains.

And investors? Well, after the values of both publicly traded and private psychedelic companies soared to frothy levels in 2021, the market came back to earth in 2022, experiencing even greater losses than the stock market as a whole. Psychedelics Investing News published a year-end review on the decline of psychedelic stocks, and the value of a psychedelic stock index plummeted 63% on the year.

The two largest psychedelic companies, Compass and Atai Life Sciences, each lost 66% of their market value – even as Compass gets ready to start a clinical trial that could lead to FDA clearance for COMP360 for treatment-resistant depression.

3. Overdose deaths pass 100,000 per year, with late hints of a slowdown

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This year brought some bits of positive news about America’s unrelenting epidemic of overdose deaths, but one symbolic number outweighed the rest:

Total drug deaths in 2021 didn’t just touch the 100,000 milestone, they roared past. The Centers for Disease Control and Prevention projects 108,886 people died of drug overdoses in 2021, a 16% increase from the previous year. Nearly 1 million people have died from overdoses over two decades. Three-quarters of last year’s deaths involved opioids, and fentanyl was detected in 90% of them. Overdose is now the leading cause of death for Americans 18 to 49, according to a Washington Post analysis.

A glimmer of hope: The steady rise in drug mortality has slowed for nine consecutive months and actually declined a bit in the four most recent months with available data: April to July. But experts, who celebrated reversals in the past only to see them reverse soon after, caution not to read too much into the change.

Better tracking: The Biden administration this month revealed a new tool that tracks most non-fatal overdoses weekly down to the county level. The near real-time data could help local law enforcement and public health workers, who have long complained that overdose statistics lag so far behind that they do little to help local authorities act swiftly to prevent deaths.

More flexible prescribing: The CDC softened its six-year-old opioid prescribing guidelines for doctors, essentially acknowledging that the aggressive attempt to slow the overdose epidemic had negative effects on many legitimate pain patients. The guidelines led some physicians to stop writing prescriptions for patients whose pain had been well-managed by opioids. The sudden cutoff pushed many into withdrawal and led some to seek drugs on the street, helping fuel the rise of fentanyl. The updated guidance emphasizes better communication with patients, exploring alternatives therapies and flexibility in prescribing opioids. It encourages doctors to taper patients off opioids when they can, while avoiding rapid reduction or abrupt discontinuation.

4. Congress throws record amounts of money at mental health

2022 was a banner year for mental health funding. New and expanded programs in last summer’s gun safety bill combined with generous increases built into the year-end spending bill combined to smash previous records. Many states dramatically increased support as well.

Bipartisan Safer Communities Act: The first major gun-safety law in 28 years provides almost $15 billion in new funding for mental health and school safety, school-based mental health programs, children and family mental health services and crisis intervention programs. A full $1 billion will help states pay for student programs like mentoring, crisis intervention, and violence and suicide prevention. $500 million is targeted to recruit and retain school mental health professionals. And another $500 million will prep school mental health providers to work in high-need schools.

Omnibus spending bill: The year-end package to keep the government running includes a series of mental health reforms and funding increases. They include:

•$2.8 billion, a 34% jump from fiscal year 2022, for mental health programs in the Substance Abuse and Mental Health Services Administration. This includes $385 million to help community health centers upgrade to become Certified Community Behavioral Health Clinics that provide comprehensive care, including 24/7 crisis services, to anyone in need.
  
•$4.2 billion, a bump of 2%, for substance use services funded by SAMHSA. Almost half of that goes to block grants to the states for treatment and prevention.

5. A workforce shortage proves critical

For years, Americans – especially political and business leaders – took the workforce of people who tend to our mental health for granted. Then Covid-19 exacerbated a long-simmering mental health crisis just as demand for their expertise skyrocketed. The result: the nationwide shortage of mental health workers exploded.

The history: Mental health and addiction services workers have for years put up with inadequate compensation along with chronic understaffing in challenging jobs. Many psychotherapists dropped out of insurers’ networks in disgust. Pandemic-triggered increases in anxiety, depression and other mental health problems boosted the need.

The result: States face gaps of varying sizes that they are unable to fill. Schools are short of counselors. People wait months to see a therapist, if one is available at all.

Graduates at the 2022 SPIRIT commencement ceremony for peer support specialists. Photo: CRE8R Marketing and Creative Agency, LLC

Solutions: Telehealth helps. More funding does too, although it takes time to train new clinicians. Building a cadre of peer support workers can have more rapid impacts. The National Governors Association recommended building a pipeline to address the children’s mental health workforce shortage through incentives to offset the cost of training programs, apprenticeship models and aligning two- and four-year college curriculums.

6. In digital behavioral health, the unicorns lost their luster

What a difference a year makes.

On Dec. 8, 2021, Cerebral Health ended a press release about its latest round of VC funding with this line: “Cerebral was founded and launched in January 2020 and is now the fastest growing mental health company in history.” Cerebral was valued at $4.8 billion, thanks in part to a pandemic-era rule that allowed prescribing of controlled drugs online. Digital behavioral health apps were riding high.

It was a tough year: In July, Cerebral executives said they had repriced their privately held shares “to reflect a 95% drop in valuation from the peak,” according to Bloomberg News. The company was accused of pressuring its providers to overprescribe stimulants. Major retailers stopped filling its prescriptions, leaving patients scrambling to get their meds. The Department of Justice opened an investigation and the company fired its CEO and founder. Simone Biles, the Olympic gold medalist known for her public struggles with mental health, severed her relationship with the company two weeks ago.

Talkspace, another hot startup, may be sold following its founders’ departure – part of an investment pullback that Business Insider attributed to the realization that mental health care costs more than over-excited venture capitalists had anticipated.

Despite the bad year, digital mental health isn’t going away. The market is projected to exceed $69 billion globally in 2030, with an annual compound growth rate of 20.3%, according to a December report by Market Research Future.

7. For women and trans people, a year of growing fear

Abortion rights advocates gather and march outside the Hamilton County Courthouse in Cincinnati, Ohio, on July 2, after the Supreme Court overturned Roe v. Wade last week — ending a woman’s constitutional right to abortion. (Photo by Jason Whitman/NurPhoto via AP)

Waves of fear and anxiety spread among women and the transgender community throughout the country this year. The Supreme Court threw out women’s right to abortion, allowing states to impose onerous restrictions. Thirteen states now have total or near-total abortion bans, according to the Guttmacher Institute. Research has found that limiting access to abortion increases depression and anxiety and boosts the risk of suicide among women of child-bearing age.

Red State politicians took aim and fired at transgender youth, forbidding treatment that physicians say they need – and threatening both the doctors who provide it and the parents who want it to support their kids.

Violence against the LGBTQ community increased and mass shootings at LGBTQ nightclubs spread terror. Librarians were likened to sex offenders for keeping award-winning books on LGBTQ themes on their shelves. The mental health of both trans people and librarians took a hit.

Across the country, lawmakers introduced 344 anti-LGBTQ bills this session and passed 25, according to the Human Rights Campaign. Alabama, for example, made it a crime punishable by up to 10 years in prison to provide puberty blockers, hormones and medical procedures to trans youth under 19. An Arizona parent told USA Today that lawmakers are “trying to legislate [my 15-year-old son] out of the state and out of existence.”

A rare bright spot: A new law was passed by Congress and signed by President Biden protecting same sex (and interracial) marriage.

Since the mass killing at Club Q in Colorado Springs, Zofia Janusz has stopped dyeing her hair pink. It’s safest, the 19-year-old student told the Washington Post, if no one can guess she’s a lesbian. Janusz knows there are a lot of LGBTQ people publicly demanding acceptance and refusing to be silenced, and she wants to fight alongside them. “But I don’t know that I want to be brave right now. I kind of want to just keep being alive.”

8. The (unfulfilled) promise of 988

A simpler way to get help in a crisis – dial 988 – launched in July with ambitious plans to eventually remake the country’s disjointed crisis response system.

Short-term success: 195,083 calls to the renamed 988 Suicide & Crisis Lifeline were answered by call-takers in November, up 38% from the same month last year at the old 800 number. Texts and chats through the website increased far more.

Challenges: The national line relies on a network of more than 200 local call centers. Few states have provided stable funding, and experts say the $300 million in federal help this year isn’t nearly enough. Many calls get diverted to other states, where counselors aren’t familiar with mental health resources in the caller’s hometown.

Hopes and dreams: A big part of 988’s goal is to reduce calls to 911 and move the handling of mental health crises away from police while easing pressure on overcrowded hospital emergency rooms. A bigger goal, far into the future, is to reimagine how the nation responds to mental health crises by creating new services and seamless transitions from crisis call to mobile response to needed treatment in a crisis center.

9. For mental health parity, two steps forward – and a big step back

The movement to ensurefull parity between physical and mental health care” in insurance coverage got a high-visibility boost in President Biden’s State of the Union address. Other big developments this year:

Enforcement begins: The Labor Department began aggressively auditing health insurers for compliance with a 16-year-old law requiring plans that include mental health to provide coverage at the same level of physical health. The audits are ongoing but the first public report painted a damning picture of an industry that often did not take parity seriously and constantly found creative ways around the law, forcing regulators to play whack-a-mole.

A devastating court ruling: A federal appeals court in California reversed a landmark decision that ordered United Behavioral Health, the nation’s largest health insurers behavioral health unit, to apply the same standards of care when deciding whether to pay or reject claims for mental health and substance abuse treatment as it does for physical and surgical treatment. The judge’s order that UBH reexamine the 600,000 denied claims using objective standards was put on the shelf. The plaintiffs are seeking review of the three-judge panel’s decision by the full appellate court.

10. Involuntary commitments gain support on both coasts

High-profile moves to force seriously mental ill people into treatment came from the unlikeliest places: California and New York City, where civil liberties have long been taken seriously. Politicians were pushed by the huge numbers of homeless people in the Golden State and a string of high-profile crimes involving mentally ill people in the Big Apple.

In New York: Mayor Eric Adams announced that police and emergency medical workers will remove people with severe, untreated mental illness from streets and subways and bring them, involuntarily, to hospitals even if they pose no risk to others. The city, he said, had a “moral obligation” to help them. Opponents say that without enough funding and mental health beds, Adams’s effort will flop, like those of previous mayors.

In California: Gov. Gavin Newsom, with near-unanimous support from the legislature, developed a plan that creates new courts in all 58 counties authorized to order someone with an untreated psychotic disorder into treatment if petitioned by a family member, provider or first responder. The mandatory plan could last up to two years and include treatment, social services and housing, ideally diverting the person from incarceration and homelessness. The CARE Court will have $63 million in start-up funding and can theoretically tap into billions of dollars in funds dedicated to mental health, homelessness and human services set aside for related services.

Elsewhere: While civil liberties proponents have forcefully opposed both plans, they’ve had little luck so far. Other cities and states around the country also are loosening restrictions on involuntary commitments, although none have offered as thorough an approach as California or devoted an equivalent share of funds – although even supporters of Newsom’s plan say it won’t be nearly enough.

Don Sapatkin

Don Sapatkin is an independent journalist who reports on science and health care. His primary focus for nearly two decades has been public health, especially policy, access to care, health disparities...