A National Moonshot for Mental Health

Our country is in the midst of a mental health crisis that is just as dire as climate change and extreme weather, or racial injustice, or poverty and food insecurity, or gun violence, or socially determined health disparities. Failing to address persistent barriers to equitable access in our communities — especially among our children and adolescents — actually amplifies the impact of these other challenges and makes solutions more difficult to effectively implement. Collectively they drive the present moment — our darkest age of mental and emotional wellbeing.

Some statistics:

• Between 2018 and 2021, the suicide rate among Black people ages 10 to 24 rose by 36.6%
• 1 in 3 high school girls reported in 2021 that they seriously considered suicide — up nearly 60 percent from a decade ago
• In 2021, 42% of high school students felt so sad or hopeless almost every day for at least two weeks in a row that they stopped doing their usual activities
• More than 140,000 people die each year because of alcohol related causes, and overdose deaths from opioids increased by 500% among 15–24-year-olds since 1999
• Two-thirds of people with diagnosable mental health disorders will never be diagnosed or receive proper treatment

For two years running, the American Academy of Pediatricians, American Academy of Child and Adolescent Psychiatry and the Children’ Hospital Association have jointly declared a state of National State of Emergency in Children’s Mental Health in the U.S. The U.S. Surgeon General’s Office issued a rare advisory and has continued to warn of a growing crisis in the nation’s mental health for young people, calling it the nation’s defining challenge. Last month, Dr. Vivek H. Murthy called again for additional investment in mental health at the state level to fund treatment and help fight stigma.

It seems clear that our collective soul as a nation requires a bold commitment to mental health so that we can create a brighter, more hopeful future.

What’s Causing This?

I have a voracious appetite for public health news, especially as it relates to mental health, and it seems clear that the causes of this mental health crisis are complex and varied: overuse of social media platforms, bullying, an erosion of empathy and compassion. Increasing levels of substance abuse and addiction are exacerbating mental health problems at the same time as people have less access to treatment and education about self-care.

Maybe at the heart of it, young people are suffering because their parents are struggling. As I learned when I worked for a mental health organization, sometimes the most impactful treatment begins not with the children, but with the parents. A change in adult behaviors and emotions can have a transformational effect on kids. And parents who understand mental health are in a better position to steer their children toward the right care.

But there are other troubles brewing. Adult Americans, especially those of color or in lower income brackets, are faced with a labyrinth of worries, from the rising costs of education and healthcare to financial insecurities amid a volatile economy, not to mention the dire warnings and threats of imminent natural disasters and climate change. Our politics are ominously polarized and the news is abundantly negative, from reports of mass shootings to police violence to community strife.

People with mental health disorders like anxiety or depression are more vulnerable, especially if they don’t get helpful treatment and support. And getting help isn’t easy. Benedict Carey wrote a heart wrenching Op-Ed in which he shares a powerful example of the dilemma faced while answering calls at a crisis hotline in North Carolina. I was equally stymied by the challenge he recounted as he attempted to direct someone in need to the right resources.

A National Moonshot for Mental Health

Big desperate challenges call for big solutions. In February 2023, President Biden reignited the cancer moonshot that he had led in 2016 as Vice-President. The goal is touted as ambitious, but achievable: reduce the death rate from cancer by at least 50 percent over the next 25 years, and improve the experience of those living with and surviving cancer, ultimately ending cancer as we know it.

We have also witnessed how bold policies like the President’s Emergency Plan for AIDS Relief (PEPFAR), launched 20 years ago, can have sweeping impacts on daunting public health concerns. Through PEPFAR, the U.S. government has invested over $100 billion in the global HIV/AIDS response, the largest commitment by any nation to address a single disease in history, saving 25 million lives, preventing millions of HIV infections, and accelerating progress toward controlling the global HIV/AIDS pandemic in more than 50 countries.

Can’t we do something similar for the defining crisis of our time?

The mental health epidemic must be met by declaring a daring new set of goals, along with plans to achieve them. Here are a few:

• Reduce hospitalizations due to self-harm and suicide attempts, and dramatically decrease suicide completions, with targets for five and ten year timeframes
• Increase the percentage of the 24 million US children and adolescents with a mental health disorder who get treatment with aggressive but achievable goals
• Get real about solving the critical shortage in mental health providers so that there are well-trained professionals to care for all of the new patients
• Institute universal screening programs so that we can identify and even prevent mental health disorders early
• Set standards for mental health literacy and achieve them in our schools, because knowledge is power

We need a broad coalition of Federal, State and local governments, NGOs, socially-responsible corporate leaders and philanthropists to fund, promote and support this vast effort in service of audacious goals. Progress on our moonshot will be measured in new screening practices, public awareness and education campaigns, innovation in mobile technology for mental health care, and investment in school-based mental health. One day, maybe we’ll have a national pledge to live as “mental health citizens,” steeped in knowledge but also in patience, understanding, tolerance, empathy and kindness.

Stigma continues to be the largest barrier in the face of revolutionizing child mental health care and finding a way forward out of the crisis and to a holistic focus on children’s health, wellbeing, and a sane and caring society. Progress has been made, but more work is required to ensure that conversations about our feelings and emotional struggles are open, honest and commonplace. Here’s how we can continue to fight stigma and educate as part of our Moonshot:

• Large Media Campaigns
  Nothing resonates more powerfully than shared human experiences — simple stories, told well — and this can be an effective platform to engage and create public awareness. I have led the development of large anti-stigma and awareness campaigns that enlisted 100+ celebrities. These campaigns included “trusted messengers” — influencers like Zoe Saldana, Jonah Hill, Emma Stone, Margot Robbie, Octavia Spencer, Andrew Garfield, Jim Gaffigan, Jesse Eisenberg, Sarah Silverman, and Mark Ruffalo — who told poignant, hopeful stories about their own experiences with mental health and learning disorders that resonated incredibly with kids and families. Between 2017–2020, the campaigns were featured on NBC Nightly News, Today, and covered by 675+ media outlets, reaching 526 million+ on social media, garnering over 9 billion media impressions.
• Weekly Public Awareness, Information and Education Series
  Broadcast television is built to serve the broad public interest with PSAs, the emergency broadcast system, and special news reports. Industry executives, academic experts and policymakers must work together to devise a series of televised town halls, featuring preeminent researchers in mental health, government officials and leaders in education and mental health counseling. This might also include celebrities and prominent personalities to garner more public interest. If we’re serious about a moonshot for mental health to meet ambitious goals, I suggest that this warrants a weekly series that could be set on cable or network television.
• Scripted and Reality Television Entertainment
  Can scripted entertainment series and reality television take the lead on improving our psychological mindset? The answer is yes, the entertainment industry can do more. Corporate media executives bear an important responsibility to add critically important messaging before and after episodes, and to weave narratives that stir action, and advise and motivate us on ways to cope and practice self-care. This work is already under way as part of a coalition including Viacom and USC Annenberg, among others, but it needs to be supercharged.
• Digital Media Content Moderation Policies and Guidelines
  According to Common Sense Media, on average, 8- to 12-year-olds use about five and a half hours of screen media per day, while 13- to 18-year-olds use about eight and a half hours of screen media per day. Between 2019–2021, media use grew for tweens and teens by 17 percent. This growth is significant, and researchers continue to investigate the correlation between mental health and screen use. Lawmakers are intensely interested as well. We read about the concerns over TikTok and other social platforms almost daily, and Congress continues to take up issues like content moderation and bullying. I believe that digital media is in its infancy and can be reshaped now through a concerted national campaign, proper Federal guidelines, corporate and public policies to ensure that screen use is limited, and that content for young people seizes on the opportunity to guide, inform and bolster self-esteem and support emotional wellbeing. My old colleagues at the Child Mind Institute are already working on this, and there is a clear foundation for a powerful coalition.

Summary

Our country can reset our priorities and rethink how to achieve improvements to our mental health at scale. Our health systems are outdated, our approach to mental health antiquated. The U.S. has a long history of championing rugged individualism. Those ideals may have served well during westward expansion, but our approach needs to be updated to meet life in the 21st century. Now is the time for leaders to make bold proclamations and set strategic plans to realize the progress our young people need. As a nation, neglect of these disorders has already cost us too much pain and loss — in our families, our schools and neighborhoods, even in our business performance, productivity and GDP. If we embark on such a daring and audacious goal to set an entire nation on a healthier course, we might be surprised to see other societal challenges fall by the wayside in our dogged pursuit of a better psychological and emotional foundation for all.