September 25, 2022

By Don Sapatkin

Good Monday Morning, MindSite News readers, and L’shanah tovah u’metukah – wishing you a sweet new year. The Jewish New Year is a time for reflection and today’s Daily is a Big Think newsletter: One piece makes the case that mental health is political; another argues that the term itself is a euphemism. A conservative writer says the mental health crisis is a spiritual one. Plus: Exhausted musicians are canceling tour dates to protect their mental health. And San Diego County is weighing a huge overhaul of its behavioral health system to focus on lower-level services to reduce hospitalization. Read on!

Mental health is political

“What if the cure for our current mental health crisis is not more mental health care?” asks Danielle Carr, a UCLA assistant professor, in a provocative opinion piece for the New York Times. Her point, nicely made in the headline, “Mental Health Is Political” is that “a crisis that affects mental health is not the same thing as a crisis of mental health.”

Carr is not suggesting that rising levels of mental and emotional stress aren’t real. She is saying that much of the stress is not an individual problem but, rather, is caused by the folks who run the world. She argues that the effects of political arrangements of power and resources seem like objective facts, a sleight of hand that conveniently makes questions like “Who caused this thing?” and “Who benefits?” vanish. In the same way that “climate catastrophe caused by corporate greed becomes a ‘heat wave,’” she writes, the result of stress and pressure created by social inequity is reframed as a medical problem. And that, of course, puts the focus on the individual and ignores systemic causes.

Carr’s essay opens Part I of an ongoing Times opinion project titled “It’s Not Just You.”  Another piece, by Huw Green, a clinical psychologist in the U.K., notes that the word “health” normally implies an absence of illness, but “mental health” is no longer used that way. “The idea of mental illness, or mental disorder,” he writes, “has come to be supplanted by a broader umbrella notion, ‘mental health,’ which somehow, confusingly, gets used to refer to states of both wellness and distress.”

The term mental health “conjures phenomena that are, more or less, relatable: anxiety and depression. But who is being excluded as a result?” he asks. “The change in language was supposed to address stigma. But it has simply moved our attention away from the very people who face the most stigma — those with diagnoses of schizophrenia, for example…” Green has a lot to say. 

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San Diego wants to transform its behavioral health system to focus on lower-level care

San Diego County is considering a massive overhaul of its behavioral health system that shies away from a major increase in psychiatric hospital beds, currently in short supply, and instead proposes huge increases in less-restrictive community-level care, the San Diego Union-Tribune reports. The plan emphasizes new “warm and welcoming” respite centers staffed partly with peer workers, and a major expansion of skilled nursing facilities that specialize in neurobehavioral treatment. It’s a strategy that the plan’s architects believe will allow people to be more effectively treated over time.

The proposal’s sprawling ambitions will require large investments in human services and infrastructure. It projects a need for nearly 126,000 “bed days” (each equivalent to a one-day hospital stay) for short-term “crisis” respite care. The use of specialized skilled-nursing beds for long-term treatment would need to increase 13-fold. The use of adult residential facilities where people with severe mental illness can stay after treatment, would have to nearly triple.

The plan posits the idea that making less intensive resources available to people early on in their course of illness would dramatically decrease the need for the most restrictive kinds of care and that investing in hospital-level resources are a bad bet. In fact, it concludes that two out of every five psychiatric hospital admissions can be prevented.

“A lot of the system pressure that we feel right now doesn’t reflect a dramatic increase in the prevalence of serious mental illness,” said plan architect Luke Bergmann, San Diego County’s behavioral health director. “It’s reflecting the fact that we don’t have a continuum of care that is designed around what we know about behavioral health, which is that it is a chronic, relapsing condition that is best managed through continuous care.” 

Musicians canceling shows to take mental health breaks

Arlo Parks is among the performers who have told fans they’re taking time off to take care of their mental health. Photo: Shutterstock.

Taking a cue from professional athletes, musicians from Justin Bieber to the rapper Russ are cancelling tours to protect their mental health. The Guardian identifies two reasons for the emerging trend: musicians’ increasing willingness to talk openly about their mental health struggles and the demands of their profession, and the industry’s frantic efforts to bounce back from the pandemic by super-charging touring and promotional schedules.

British singer-songwriter Arlo Parks told fans earlier this month that after 18 grueling months on and off the road, she was taking some time off from her current U.S. tour to focus on her mental health. Just days before, rocker Sam Fender, another Brit, announced that he was canceling a handful of remaining performances in his North America tour after a whirlwind year had left him burned out. “It seems completely hypocritical of me to advocate discussion on mental health and write songs about it if I don’t take the time to look after my own mental health,” Fender said in a statement posted on Instagram. “I’ve neglected myself for over a year now and haven’t dealt with things that have deeply affected me.”  

In other news … 

Conservatives in the age of anxiety.” In an opinion piece in World magazine, Christian conservative writer Samuel James argues that while his fellow conservatives are sometimes skeptical about the existence of a “mental health crisis,” the data of such a crisis is too striking to dismiss. He suggests that a western mental health crisis does exist but is essentially a product of the triumph of technology and materialism over human connection and spirituality. “The modern mental health crisis is compelling evidence that material wealth and comfort are not synonymous with well-being,” he writes. “The ascendance of anxiety reflects a systemic failure of our technological and economic systems to create meaningful human connection.”

Worried about gambling too much? Take Ohio’s new online quiz to gauge your risk for gambling addiction. WOSU public media has more.

To ease overcrowding, Oregon’s only state-run psychiatric hospital has been ordered to release patients who were charged with criminal offenses but deemed unfit to stand trial due to mental illness, Portland’s KGW  reports. These so-called “aid and assist” patients were sent from jails to the 800-bed hospital for treatment aimed at helping them stabilize so they can participate in their own defense. But with their numbers rising sharply, there’s little room left for civilly committed patients thought to be dangerous to themselves or others but not facing criminal charges.

Virginia has developed a successful program to get doctors into mental health treatment, according to an American Medical Association blog post. That’s a major accomplishment since 63% of physicians said in a survey last winter they were experiencing symptoms of burnout – yet just 1% typically use wellness resources available to them.

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.

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Type of work:

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...