Let’s Close the Gap on Mental Health for Good in 2023
By: Walter Panzirer, Trustee, Helmsley Charitable Trust. This article originally appeared in the Grantmakers In Health Bulletin.
Before the COVID-19 pandemic, a mental health crisis was growing in America, with 1 in 10 adults reporting symptoms of anxiety or depression. Today, that number is 3 in 10 (Kaiser Family Fund 2023). The recently launched 988 hotline—the mental health equivalent and alternative to 911—is a monumental step forward in changing how we acknowledge and respond to mental health needs nationally. It finally puts mental health on equal ground with physical health—a recognition long overdue—but it is only a first step in addressing the multitude of behavioral health needs.
This is a critical time for philanthropy to step up investments in the historically neglected area of behavioral health (Zimmerman 2020). There is an urgent need for resources and funding. Nowhere is that truer than in rural America, where there is only one psychiatrist for every 30,000 people (Capriotti et al 2020). Finding ways to close this gap in care is a focus for the Helmsley Charitable Trust, where I am a Trustee, and has been top of mind for me since the earliest days of my career when I served as a paramedic, in law enforcement, and as a firefighter.
There is no question we are in a race to make up for decades of underinvesting in behavioral health, compounded by growing needs. I applaud those in philanthropy and government alike who recognize that reversing those needs is a long-term endeavor requiring holistic approaches that re-examine our social safety nets. This includes looking at how to reverse diminishing economic opportunities attributed to the plummet in mental health among some adult men (Case and Deaton 2020) and changing the definition of what it means to be healthy as a nation—to name but a few of the root causes believed to be driving the mental health crisis, independent of and exacerbated by the pandemic.
In the meantime, we face an all-hands-on-deck moment to address current needs. Philanthropy can often act more nimbly than local, state, or federal governments, and we are in a fortunate position to help transform care in communities with novel solutions that respond to expressed needs. Like most grantmakers, we do a lot of listening to the experts in our backyards and the other places where we invest. As a former first responder, wanting to be sure that communities can offer support close to home when someone is in crisis is a priority—geography should never dictate your access to care. We have learned a lot along this journey about how we can help, and I want to share some of that.
The social isolation necessitated by the pandemic is one factor in the current mental health crisis facing people everywhere, especially adolescents. It is even more acute in rural communities. Crisis treatment that allows children to receive help while also maintaining routines can be beneficial for many who need care. To help address this need, our longtime grantee Avera Behavioral Health now offers the greater Sioux Falls region’s first partial hospitalization service for youth (Avera Health 2022), a service that was only offered to adults in the past. It lets kids stay connected to the parts of their lives, such as school, that ground them as they heal. Another ongoing challenge in the communities we serve is staffing shortages. To help alleviate this issue, psychiatry training programs must combine with other efforts to grow or attract talent (Chattha 2022) to rural communities. That remains an ongoing challenge.
We must also reimagine what treatment looks like. There is a spectrum of care available to people in need of mental health support. While some may benefit most from in-person care, many behavioral health services can be delivered remotely, even in a person’s home. In fact, telebehavioral health was proven to be almost as effective as in-person care when it comes to decreasing depression and anxiety among rural populations (Plescia 2023). Innovations in telehealth, and the increasing use of video, became mainstream because of the pandemic. These innovations increase access for many, especially in rural areas, and enhance privacy for those wary of the stigma that too often still accompanies care-seeking.
Historically, a call to 911 during a mental health crisis in most communities meant that law enforcement would be first to respond. I can tell you from experience those are very hard calls to respond to and in far too many cases people in crisis end up in jail—an awful outcome. Now, using telehealth in South Dakota and Nevada, Virtual Crisis Care means that officers have tablets and can use telehealth technology to provide 24/7 immediate access to behavioral health professionals, rather than having to take people to the emergency room or to jail for lack of better options (Crime and Justice Institute 2021). Not only are people getting connected to proper care, but this helps to unburden over-taxed rural hospitals and gives law enforcement much needed support (Longhi 2022).
When people do need in-person care right away, Emergency Psychiatric Assessment Treatment and Healing (EmPATH) units and Psychiatric Urgent Care help ensure that the right kind of care is available. EmPATH units allow for quicker assessment of and attention to mental health issues in a calmer and more supportive environment than traditional emergency rooms (CentraCare 2021). The impact of EmPATH units cannot be understated—patients are less likely to be admitted to hospitals for suicidal ideation (Kim et al 2021). These units are common in urban communities, but Helmsley has helped bring them to Montana and Minnesota, along with 24/7 Psychiatric Urgent Care in South Dakota.
We cannot ignore the effects that pandemic isolation and anxiety have had on the mental health of all, especially children and adolescents. We are working with our partners to help respond, but we cannot do this alone. This is a moment for anyone who can, and especially those in philanthropy, to decide how to be a part of meaningful solutions. Don’t be afraid to start small. Do be afraid of inaction. The health of our nation is on the line.
Avera Health. “Avera Ready to Open New Behavioral Health Wing,” March 3, 2022.
Capriotti, Theresa, Dufour, Lillian, and Pearson, Tiffany. “Health Disparities in Rural America: Current Challenges and Future Solutions,” Psychiatry Advisor, February 18, 2020.
Case, Anne, Deaton, Angus. Deaths of Despair and the Future of Capitalism. Princeton: Princeton University Press, March 17, 2020.
“CentraCare St. Cloud Hospital EmPATH Unit: Treating Patients with Emergency Mental Health Needs.” Youtube, uploaded by CentraCare, September 14, 2021.
Chattha, Pritma. “How to fix the nursing shortage—and recruit the next generation of frontline heroes,” Forbes, June 6, 2022.
Crime and Justice Institute. “South Dakota’s Virtual Crisis Care Pilot Program: A Model for Rural States,” December 2021.
Kaiser Family Fund. “Adults Reporting Symptoms of Anxiety or Depressive Disorder During COVID-19 Pandemic,” January 2023.
Kim, Allison K, Lee, Sangil, Tate, Jodi, Vakkalnka, J. Priyanka, and Van Heukelom, Paul. ”Emergency psychiatric assessment, treatment, and healing (EmPATH) unit decreases hospital admission for patients presenting with suicidal ideation in rural America.” Academic Emergency Medicine, Vo. 29, 2: 142-149.
Longhi, Lorraine. “$3.8M grant aims to help rural mental health,” Las Vegas Review-Journal, June 29, 2022.
Plescia, Marissa. “Telebehavioral Health Is as Effective as In-person for Rural Populations.” MedCity News, January 3, 2023.
Zimmerman, Ken. “Mental Health Needs to Be a Top Priority for Philanthropy. Here’s Why,” Inside Philanthropy, June 29, 2020.