Out to sea

Thoughts on the surprising similarities between a shipping crisis and America’s mental health

Let’s start with a question: What do a supply chain shortage and America’s mental health have in common?

More than meets the eye, it turns out.

Many of us have seen the recent images of container ships off the coast of Southern California waiting to be unloaded. From these images tends to come a narrative that, if only we could improve the capacity of American ports, the shipping challenges we are facing would disappear.

It’s much the same with mental health. It is routinely found that large swaths of the American population lack access to care and the professionals who can provide it. From these commonly-cited issues, it is easy to draw the conclusion that if only we had more facilities for care and individuals to staff them, our nation’s mental health issues would disappear.

These narratives aren’t wrong, exactly. But they’re far from being the whole story. Because while expanded capacity at American ports or a larger number of mental health professionals might make a measurable difference in the lives of most people, the truth of the matter is that in each case, entire systems of delivery are what hold us back—not just one single aspect of delivery.

When it comes to supply chain issues, for example, we also need to consider what happens after a container arrives on our shores. There are the truck drivers who haul supplies across a vast network of highways. There are railyards that house large shipments of containers. There are the workers who oversee the transfer of goods from containers to warehouses, and from warehouses to stores. And above each of these individual efforts, there is a complex logistical system that depends on precise timing and exact quantities of delivered goods to meet demands. Under normal circumstances, this system usually works. But as the pandemic has revealed, it is highly sensitive to disruptions. Simply put, it has not been resilient.

This closely mirrors some of the realities of our mental health system, which has many moving pieces beyond the number of mental health professionals and service centers. There is a complex set of rules that govern how care is financed, whether at the federal, state, or individual level. There is a web of regulations around who even qualifies for mental health services. There is an absence of cooperation between national and local leaders on filling gaps in coverage. And sitting above it all are both social and structural stigma regarding mental health in America that prevents a more open and robust discussion about the steps we need to take. The outcome is scattershot policy that only makes it harder to deliver the mental health services that so many Americans need right now.

This leads to the key point I want to make. Leaders in the policymaking space, whether it’s a supply chain issue or mental health care challenges, need to look past isolated issues and think in terms of the systems and macro-level policies that ultimately shape individual outcomes. In other words, we need to stop identifying the wrong shortage. It’s not that too many container ships are stuck waiting out at sea; it’s that we have a system unable to handle disruptions. It’s not that we have a shortage of semiconductors; it’s that an entire industry is built in such a way that leaves us vulnerable and without resiliency. It’s not that we have too few mental health care facilities; it’s that the entire system of care delivery is flawed.

This might sound like a pretty pessimistic way of thinking about America’s systems of delivery, but I don’t want to leave you with a sense that we are powerless. In fact, there is plenty we can do. And the first thing we need to do is start thinking big. This means taking a broad view of our health systems, community life, our judicial system, education, and life in the workplace, seeking to understand how they interact and shape mental health. In fact, Well Being Trust has issued a framework specifically designed to help us do just that.

We are at a point where various crises, not least of which being the COVID-19 pandemic and climbing deaths of despair, are beginning to pile up. To address them, one-off solutions won’t be enough. But by ensuring that our public policy challenges are met with wholistic responses, we can progress to a place where every ship can come to port, where every container reaches its destination, and where every person has their mental health needs met.