It's in the water

Meaningful solutions to address mental health begin by seeing it everywhere

I remember Christmas one year, my sister and I received one of those “magic eye” books. You know the ones, right? Inside the book are pages upon pages that require you to stare at the page until an image emerges. At first glance, the page just looks like a bunch of 2d colors and shapes, but when you learn to relax, learn to let your eyes lose focus, then, in that moment, the 3D image pops into view. There’s something fascinating about seeing that image that seems to hide a secret world within its intricate patterns. It was frustrating to do, but once you saw the image, it was a massive success and you wanted everyone else to share in your discovery. Even to this day, I wondered how this fun illusion book worked.

Turns out, these optical wonders are actually called stereograms. The actual “magic” lies in our brain's knack for stereopsis, which is its clever ability to perceive depth from differences in the images captured by our eyes. Stereograms feature repetitive designs, often created by a computer, that when viewed just right (cue relaxed focus and convergence), trick our eyes into merging the images and voila, a 3D illusion pops out of nowhere! Our brain decodes the disparities between the left and right images, conjuring up the perception of a hidden object lurking in that seemingly ordinary pattern. The creators were smart to call it “magic eye” as it does feel like magic.

But here’s the thing. The image is always there - it’s just our ability to see it that changes.

When we talk about mental health, we often only talk about the obvious things, the pieces of the problem or solution that are right in front of us. As I wrote about last week, we point to things like lack of beds or not enough clinicians as the reason why things aren’t getting better. In fact, as I was preparing for writing this piece, I went back and looked at several of these posts to see the themes. Sure enough, so many of the posts focused on technical solutions to massively complex social problems. And while there’s always room for those, in and of themselves, they are insufficient.

This week, in a wonderful interview on Mindsite News, my friend and health commissioner of New York City, Dr. Ashwin Vasan, said, “We need to start looking at mental health as a cross-cutting issue that often manifests in conditions or causes of death we would otherwise not refer to as mental health. We have to see it almost in the groundwater.”  

I think he’s totally spot on. We have to begin to see mental health as a part of every program, every policy, and every investment. It’s not just up to the mental health field, or even those in health care, it is much bigger than that. And I think that, in large part, is what Ashwin is pointing to. There’s a role for everyone when we are creative enough to cross sectors and blanket the field with an all encompassing approach. If we don’t do something at this scale, with new partners, we only get random 2d images on a page that rarely makes sense to the casual observer, and even worse, leaves us stuck in the status quo which we already know isn’t working. By understanding mental health as more than just mental health care, we can foster a comprehensive approach that addresses the complexity of human well-being, acknowledges the social determinants that influence mental health, and promotes a society that values and supports mental well-being for all. I encourage you to read the whole interview as there’s a lot of great ideas in there, and Ashwin’s highlighting of this systems level need for change is inspiring.

But this is work hard to do in a fragmented and often contentious policy and political environment. We look to the easy answers, hoping that one of them will lead to a meaningful change that allows us to claim a win. The truth is, we have dug ourselves into a pretty big hole that’s not going to be easy to escape from by just adding a few more resources here and there.

What are some ways we can begin to see mental health in the ground water? I think there are a few, all of which are challenging, but all of whom are more likely to bring us to a different place on mental health outcomes.

Follow the money: It’s no surprise that we spend more on health care than any other country in the world. The US has seen it’s annual spending on mental health problems increase significantly over the years from $171.7 billion in 2009 to more than $250 billion in 2019. The irony is that despite significant spending on mental health only about half of folks had access to any treatment prior to the pandemic. Because we have little to no transparency in the mental health field, it feels like its time to watch where some of our dollars go and what we get from them. There are so many exciting ways to use data to see who receives care, in what setting, and what cost. I bet when we follow some of these patterns, we will see new opportunities for redesign and reinvestment.

Get the private sector more involved: The private sector has the potential to contribute significantly to improving mental health outcomes through novel approaches. With all the resources they have, they can make a huge impact. This may include innovative ideas like using technology, leading on the implementation of comprehensive workplace mental health initiatives, advocating for robust mental health benefits and insurance coverage, and forming partnerships with community partners. It’s hard to see with so many resources how the private sector could not drive more innovation, increase accessibility, and promote mental well-being through their vocal leadership and active investments.

Stop seeing social programs as disconnected from health: In 2023, it’s wild that I have to say this, but our investments in social programs have more of a profound impact on our mental health than practically anything else we could invest in. Investing in social programs is crucial for our health as it addresses what we’ve called the “social determinants” for the last several decades. These social programs tackle issues such as poverty, inequality, education, housing, and access to health care. And we know it works. For example, investing in education can improve health literacy, empower individuals to make healthier choices, and enhance employment opportunities, leading to better overall health; basically, giving people a robust platform to have a chance to succeed. Or consider how access to affordable housing and nutritious food can prevent chronic diseases and support physical and mental health. Yet whenever we see programs like this come up in the policy space we ignore their massive impact on mental health. This means we need to be doing much more advocacy and acknowledgment on policies that support the social side of health. Instead of just advocating for more dollars for mental health, let’s also advocate for more dollars for social programs that we know will impact mental health and then declare that as a mental health victory, too!

Allow communities to lead: Like that new record you play on repeat, the song I can’t get enough of is the one where our communities are the frontline answer to the most complicated problems we face. There’s the obvious things we know like how communities play a vital role in supporting each other with mental health by fostering a culture of empathy, understanding, and open communication, and creating safe spaces for individuals to seek and offer help. Establishing community-led initiatives, such as peer support programs or community initiated care, empowers individuals to recognize and respond to mental health challenges effectively. Don’t discount how engaging in small acts of kindness, showing compassion, and checking in on neighbors and friends can make a significant difference. But perhaps most importantly, we need to let our communities lead with what they think is best for their future. There’s no better way to find unique and innovative solutions than to authentically engage community in their ideas for advancing mental health.

I don’t want to be a leader for the field who keeps staring at the page unable to see what’s underneath. I bet you don’t want to either. There has to be a way to “unsee to see” that allows us all a better sense of what the solutions are we should be working towards. While it may feel frustrating to not be able to see the solutions that are right in front of you, don’t give up, I promise it will be worth it in the end.