The US has a mental health crisis that could undermine our democracy, US surgeons general say

While working in the West Wing under President George W.
Bush, then-US Surgeon General Dr. Richard Carmona got a terrible telephone call from his daughter. After he had been missing, she found Carmona’s adult son in a catatonic state. He sat in the corner of his father’s home for two days and he kept screaming “incoming, incoming.” Carmona’s son served in the army for 21 years, and Carmona said while he doesn’t talk much about it, his son has had “crippling PTSD” and been in and out of mental care facilities since that incident. Yet when the family initially sought help from the VA, Carmona said, even with all of his connections as surgeon general, they started to see the cracks in the country’s mental health care system.

“We’ve got to step up and provide the services for our veterans because they’re struggling,” Carmona said Thursday.

The US loses nearly 20 veterans a day to suicide, Carmona said, but veterans are not alone. Suicide is one of the leading causes of premature death in the United States, according to the US Centers for Disease Control and Prevention. In 2022 alone, nearly 50,000 people died by suicide in the US, an increase of about 2.6% from the year before. It is a problem that disproportionately impacts disadvantaged communities including racial and ethnic minorities, people who identify as LGBTQ+, those who live in rural areas and older people.

Carmona was part of an historic gathering Thursday of seven of the US surgeons general at Dartmouth there to talk about mental health and the crisis facing the US that has an inadequate mental health care system. The conversation was moderated by CNN’s chief medical correspondent Dr. Sanjay Gupta. One US surgeon general, Dr. David Satcher, had a prior commitment and sent a video.

Each US surgeon general, it didn’t matter if they served under a conservative or more moderate US President, agreed that the US needs to do more to address the mental health crisis. The problem is not just a concern for individuals, they said, it is a crisis so large that it could undermine the foundation of our democracy.

“The one thing you’re supposed to do as a parent is leave your children a better world than the world that was handed to you,” said Dr. Jerome Adams, President Donald Trump’s surgeon general. “I have to look at my three teenagers every day and know that I’m not handing them a better world, and I’m not handing them a better world that was left to me. And a lot of that is because of our failure to really focus on mental health and to do the hard things that it’s actually going to take to overcome this mental health crisis that we’re in.”

A 2021 report about protecting youth mental health from the current Surgeon General Dr. Vivek Murthy found that mental health problems have been particularly hard for the younger generation. A survey included in the report done in 2019 found that one in three high school students and half of female students reported persistent feelings of sadness, or hopelessness – an overall increase of 40% from 2009. The pandemic exacerbated all of these mental health issues, the CDC report found.

Many factors shape mental health, the report found: a person’s genes, brain chemistry, relationships with family and friends, neighborhood conditions, and social forces and policies. Young people also are, as the report said, “bombarded with messages through media and popular culture that erode their sense of self-worth telling them that they are not good looking enough, popular enough, smart enough or rich enough.”

Murthy’s report was not the first surgeon general call to action. The first, published in 1999 by President Bill Clinton’s surgeon general Dr. David Satcher, called for a better medical system that would treat both physical and mental health, and end the stigma that prevented people from seeking help for mental health problems.

Satcher’s report argued that mental health was “often an afterthought,” and it criticized the many barriers to getting access to treatment, with an emphasis on the financial. While millions lack insurance, even those with insurance don’t always get access to help. Insurance companies didn’t have to cover mental health care until a 2008 law mandated insurance cover mental health and help for substance use disorders in no more restrictive way than physical benefits.

Still today, more than a decade and a half after the Satcher report, barriers to care exist, Satcher said, including stigma as well as a significant shortage of providers, culturally appropriate care, and there’s a lack of leaders who want to make the mental health system fair and equitable.

“In order to eliminate disparities in health we need leaders who care enough, leaders who know enough, and leaders who will do enough and who are persistent enough until the job is done,” Satcher said.

Of the people who say they want help from a mental health professional, only 41% get treatment, according to Dr. Antonia Novello, President George H.W. Bush’s surgeon general, who said she was also concerned for the caregivers. “I have the feeling that we, the ones who are supposed to take care of you, have also a problem and no one is taking care of us,” Novello said. About 1 in 5 health care providers have depression and 63% have burnout, she said, and health care workers are facing record amounts of violence at work.

“There is a crisis to help you, I beg you to help us,” Novello said.

Adams also argued that the country cannot completely “treat our way out of the problem,” since only 20% of health is actually addressed in a doctor’s office. The rest of what impacts human health, including mental health, is what happens in communities.

“The other 80% happens in communities that are connected, that are supportive of women and minorities, that have childcare, that have good educational opportunities, that have a good paying job, or both. And I think we need to really focus on building those stronger communities,” Adams said.

Dr. Regina Benjamin, one of President Barack Obama’s surgeons general, agreed that the community needs to play a bigger role in mental health care.

“Health does not occur in the doctor’s office, or in the hospitals alone. It is where we live, where we learn, where we work, where we play, and pray, everything that we do,” she said. “So we have to take our health care where people are.”

When Benjamin published her 2012 Surgeon General report on preventing suicide, she said 150 people were dying every day from suicide, the equivalent of a small regional jet crashing every day. “The problems are still here,” Benjamin said. Physicians, especially primary care physicians, need the training to address physical and mental health needs, and there are many needs. When the current Surgeon General asked the Dartmouth audience how many people knew anyone who struggled with mental health, every single person raised their hand, Murthy said.

“A lot of people are walking around suffering,” Murthy said.

Murthy said, from a policy perspective, the country needs to invest more in primary care, train more mental health providers, ensure that insurance covers care, and get schools to teach children lessons in social emotional learning. The problems are “profound and entrenched and structural in nature,” but he said the mental health crisis is not solely a policy or programmatic crisis. It is also a “moral crisis.”

When he was about to have his first child in 2016, Murthy said, he was thrilled but also had trepidations. At the time he was concerned about the violence he was seeing, the rash of police shootings that involved mostly people of color, and the political polarization of the national election. People, he said, too often believe that everyone is mean-spirited and selfish and to survive they have to be that way, but he realized the world isn’t really like that.

“I think we’re actually more grounded in the core values of kindness and generosity, of service and friendship. I think that’s what we want,” Murthy said.

People can do a lot to support each other and create an environment that does not add to the mental health crisis. By the way in which people treat each other, by the programs and leaders they support, people should use their influence to create a world fueled by love and not fear, he said.

“A world fueled by love is a world where we’re kind to each other, where we’re generous. It’s a world where we value friendships,” he said. “We heal through the love that we give and the love that we receive. And when you realize that, you realize that we’re all healers, and this is a time that the world needs more healers.”

“If we truly want to go far, we truly want to build things that will last,” Murthy said. “If we truly want to lift up everyone, we have to move together.”

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