Americans Are Taking Meds and Flocking to Therapy. Is it Helping?

Wednesday, September 6, 2023

By Courtney Wise

Plus, a writer living behind bars describes how Taylor Swift’s music helps him remain “part of the world he left behind.”

---

For people with dementia, it takes a village – and greater integration – to provide a connected life

It’s time for another paradigm shift in the world of dementia care, experts told the New York Times. First there were nursing homes, now there are “dementia villages” growing across Europe. These microtowns complete with a grocery, theater, restaurant, coffee shop, and town square – all open to the public – are changing the model of dementia treatment. The staff of these establishments include nurses, doctors, psychologists, physiotherapists and social coaches who wear plain clothes and blend seamlessly into the background. 

Hogeweyk in Weesp, Netherlands led the way, mimicking a “real” town so well that many residents don’t realize they’re living under supervised care. But now, with the numbers of people with dementia growing rapidly, people who work with the elderly say it’s time to bring this kind of approach to existing cities and towns, including dementia patients in everyday life with the appropriate support and care. “Society really has to step up,” says Jannette Spiering, one of the founders of Hogeweyk. 

In the 14 years since Hogeweyk opened its doors, the number of people with dementia has grown from 35 million to 55 million, and the WHO expects diagnoses to explode to 78 million people within the next seven years. “People want to remain at home, they want to live in the community,” said Tarun Dua, chief of the Brain Health unit at the World Health Organization’s Department of Mental Health and Substance Use. “I think this is an important message. So even if we think in terms of dementia villages, how close they are to the community — that’s very important. They should be part of the community, rather than outside of it.”

But this kind of inclusion will require partnership with local municipalities – and lots of funding. Dementia villages can be created in Europe because their universal health care systems pay for it. The annual cost of care for Hogeweyk residents is about $90,000 to $100,000 per resident, the vast majority of which is subsidized by the Netherlands’ government. There are currently no dementia villages in the United States. “People had been [reluctant] to do it in the US because it’s a private-paying market,” said Larry Carlson, founder of Avandell, a dementia village built and supported by the faith-based United Methodist Communities. 

For it to happen in the U.S. will require, above all, a major cultural shift. “It is not a challenge, actually, to create something like this,” said Hogeweyk’s Spiering. “The more challenging thing is to create a society where people are really included, whatever label or diagnosis they have.”

---

Americans are taking meds and flocking to therapy. Yet mental illness and suicide is rising. What gives?

Everywhere you look these days, people are talking about mental health. Podcasts, books, and movies focus on the subject, and it’s no longer taboo for celebrities, athletes, or politicians to speak publicly about their challenges with mental wellness. The use of mental health services leapt by nearly 40% among US adults with commercial insurance from 2019 to 2022, a recent study found. Yet rates of depression and suicide continue to rise. So why, Time magazine wants to know, “is our mental health getting worse?”

How is it that with more treatment, Americans seem to be doing worse? That’s not true for survival rates for cancer or heart disease, it’s not true for diabetes diagnosis, “or almost any other area of medicine,” according to Thomas Insel, former head of the National Institute of Mental Health and author of Healing: Our Path from Mental Illness to Mental Health. (Insel was also a cofounder of MindSite News.

Experts point to numerous problems. One is the continuing imprecision of mental health diagnoses. Misdiagnosis and overdiagnosis are common, and a 2019 study asserted that some psychiatric diagnoses are “scientifically meaningless due to their inconsistent metrics, overlapping symptoms, and limited scope.” In a health care system that relies mostly on medications, inexact diagnosis often leads to ineffective treatment. Even when diagnoses are accurate, medications are not cure-alls.

While antidepressants are effective for some people, particularly those with severe depression, a large NIMH study from the early 2000s that compared the effectiveness of various antidepressants found that “none of them are very good,”  Insel said. “It was really striking how poorly all of the antidepressants performed across the entire population.” Psychotherapy helps many people, but its effectiveness may be hampered when insurers limit the number of sessions they will pay for. Teletherapy has increased access to therapy but may be less effective for many people than when it’s done in person. Plus, there remains a severe shortage of mental health providers and the cost of care keeps it out of reach for many.

Of course, no medications can cure circumstances like climate change, gun violence, imprisonment or trauma. Joseph Mancuso, now 35, has received some form of mental health care since his teenage years, and has often felt that the mental health system was mostly focused on trying to medicate him and get him out the door, rather than trying to understand the many factors and experiences that can lead to poor mental health. “I had a rough upbringing. I had a lot of people take advantage of me. I was bullied really badly in school,” Mancuso said. “I needed more than pills. I needed guidance.”

Insel, for one, says that to improve mental health requires improving the conditions of people’s lives – things like expanded access to affordable housing, education, and job training; increased community spaces and peer support programs; greater availability of fresh food and green space. “That’s not the way we roll in health care,” Insel said. The good news is that there are some signs of change.  

---

AP Photo Essay: Kashmiris seek mental health support in the midst of endless conflict 

The mountains of Kashmir may be one of the most stunningly beautiful places on the planet, but for 70 years, it has also been the site of endless war between India and Pakistan that has claimed the lives of tens of thousands of civilians. By now, nearly all of Kashmir’s 7 million residents have been affected by violence.

A 2015 study found that 45% of adults in Kashmir were experiencing symptoms of mental distress, including depression, anxiety and post traumatic stress disorder. Over the past 20 years, the mental health infrastructure of the area has grown from one clinic housing four psychiatrists to 17 government- sponsored clinics supported by six dozen professionals. This photo essay from the AP puts faces to a deeply challenging story.

---

An unlikely road to Taylor Swift fandom

When Joe Garcia first heard of Taylor Swift, he committed to not being a fan. Prince was the greatest songwriter of his lifetime, and she was a “blond fluff” whose “rise to teen-age stardom was an injustice.” But as he settled into a lifetime sentence, Garcia paid attention to Swift’s interviews when she popped on the TV screen. And slowly, he says in a New Yorker essay that he penned as a writer with the Prison Journalism Project, he developed an appreciation for the intention she brought to songwriting.

Later on, when a jail transfer left him without his TV, CD player, soap, toothpaste, lotion, or food, he and several inmates shared a pocket radio cranking out Top 40 hits. He became a fan, a Swifty, if you will. Her music helped Garcia reconnect with an old flame and lifted his spirit as he battled COVID-19. 

“I lugged all my property to an isolation cell in a quarantine unit, where I shivered and sweated through a brain fog for two weeks. My only human contact came from nurses in full-body PPE, who checked my vitals, and skeleton crews of officers — the ones who weren’t sick themselves — who brought us intermittent meals,” Garcia wrote. “I followed San Quentin’s death tallies on the local news. Would I die alone in this cell, suddenly and violently breathless? I made a playlist of Swift’s most uplifting songs, listening for the happiness in her voice.”

---

If you or someone you know is in crisis or experiencing suicidal thoughts, call or text 988 to reach the 988 Suicide & Crisis Lifeline and connect in English or Spanish. If you’re a veteran press 1. If you’re deaf or hard of hearing dial 711, then 988. Services are free and available 24/7.

---