How increases in mental health issues have transformed the helping professions.

In the past two decades, mental health issues have been skyrocketing across the world, creating a need for mental health professionals. These days, we even talk about the mental health “industry,” terminology that was simply not used 20 years ago.
We need both short- and long-term solutions to this problem that, importantly, affects us all. And evolutionary psychology can help.

When I started teaching psychology at the State University of New York at New Paltz in 2000, the job market for graduating psychology students was so-so. Back then, a student pretty much needed a doctoral degree in clinical psychology to become licensed to practice therapy in New York (and in other states). And these doctoral programs were (and still are) famously competitive.

When I met prospective students and parents at Open House events back then, I was always honest and explained that not every psychology undergraduate student who wanted to go into a career related to therapy would get there.

Things have changed a lot. Fast forward to 2023. State guidelines in New York (and in all states across the US) have changed dramatically. Licenses to practice therapy these days may be obtained by people with master-level degrees in clinical mental health counseling, social work, school psychology, and more. This trend has transformed the broader field of therapy dramatically.

These days, when a parent of a prospective student asks about therapy-related job opportunities after graduation, I can quite honestly say that there is now a large industry related to the mental health professions. Our students who obtain graduate degrees in a number of fields are highly employable. And many of these graduate degrees are at the master’s (as opposed to doctoral) level.

These days, we literally use the term “mental health industry.” This is a huge change that I’ve seen over my career.

On one hand, this fact has benefits. People who study psychology and who want to go into a therapy-based career can do so much more easily than was the case two decades ago.

But this same set of facts speaks to a problem as well. And that problem stands as something of an elephant in the room. Mental health problems in the industrialized world have, over the past two decades, essentially skyrocketed. And this fact is particularly true among late adolescents and young adults (see Twenge et al., 2019). In fact, skyrocketing mental health issues were documented prior to the pandemic. By all accounts, the pandemic only exacerbated the problem.

While we hear the term “mental health industry” these days, we also hear the term “mental health crisis.” And this fact is ultimately a problem for all of us.

In support of this portrait, it is noteworthy that a Google search from today (3/1/2023) of “mental health industry” turns up more than 4.5 million hits while a Google search (also from today) of “mental health crisis” turns up more than 20 million hits. These statistics are, in an important way, quite telling.

Short-Term Solutions to the Mental Health Crisis

Increases in diagnoses such as depression and generalized anxiety disorder beg for solutions given how deeply debilitating these disorders can be for the lives of so many. Workers in the psychopharmaceutical industry along with the broader suite of therapeutic professionals are essential workers in the modern day. Counseling centers at colleges and universities around the US report being deeply understaffed. Therapists around the nation are hardly hurting for work, with a high proportion needing to turn new clients away simply due to workload issues.

Further, as is true in so many domains of life in the US, mental health care is more accessible for people with monetary resources than it is for those without (see Hodgkinson et al., 2017). This is life in the United States, where income inequality runs rampant and bears on nearly all major social issues.

Long-Term Solutions to the Mental Health Crisis

While bolstering educational and professional efforts related to the mental health professions is essentially necessary at this moment in history, I’d argue that we need to think about both short and long-term solutions to this issue concurrently.

I once heard a renowned sociologist, Peter Callero, share a useful thought exercise related to this topic. It is essentially: Imagine that you are standing near a river and every hour you spot a new person who is stuck in the current, drowning, and clearly in need of help. The question: What would you do? Many people respond by saying that they would go out into the water, perhaps in a small boat, and try to save each person. That is, of course, a great short-term solution. But another way to think about it is within a larger frame. Why does this problem keep happening? In this thought exercise, you are then provided with this new information: A major bridge that is upstream from where you are standing has a dangerous and hard-to-spot hole in it. And all of these victims had fallen through this hole. Peter essentially made the case that the optimal fix is not to save each individual person but, rather, it would be to fix the bridge (which is akin to fixing the system).

Which, in terms of the modern mental health crisis, begs this question: How do we fix the bridge (so to speak)?

If you follow my work, you may know that I focus on an evolutionary understanding of human behavior. And from this perspective, there is a keen focus on situations related to what we call “evolutionary mismatch” (see my and Nicole Wedberg’s book Positive Evolutionary Psychology on this point). Mismatch is essentially the idea that living in conditions that are mismatched from the environments that surrounded the evolutionary history of one’s ancestors often leads to problems. As technology advances at breakneck speed, we can think of mismatch as becoming more and more of a problem each and every day. Often without us even noticing.

These days, a high proportion of people report that they primarily communicate with others through screens. They primarily eat processed foods. They don’t exercise as much as they should because they simply don’t have to. They often live hundreds or even thousands of miles from their closest kin. And they often live in large cities which, ironically, tend to correspond to relatively high levels of loneliness as well as relatively high rates of various mental health problems. And these facts have been documented in locations across the globe (see Srivastava et al., 2009).

It’s probably naive to think that increasing rates of evolutionary mismatch is the only macro-level cause of the increases that we are seeing in mental health issues in the modern day. But from where I stand, it sure seems like a solid starting place for us, as a global community, to begin to think about how to develop systemic fixes regarding the mental health crisis that surrounds us.

All kinds of problems famously follow from living a life that is not consistent with the environments that our ancestors evolved in (see Giphart & Van Vugt, 2018). At the very least, it is a solid working hypothesis that mismatch serves as a large-scale problem that undergirds the modern mental health crisis. To my mind, the more educated that government and industry leaders become in terms of our evolved psychology, the better able we as a global community can mitigate the adverse effects of evolutionary mismatch.

Bottom Line

Years ago, we never used the terms “mental health industry” or “mental health crisis.” Yet here we are. An abundance of research has shown that mental health issues are on the increase across the industrialized world (see Srivastava et al., 2009; Twenge et al., 2019). This problem, which affects all of us, needs both short- and long-term solutions. Ramping up the mental health industry is critical in terms of the short term.

When it comes to understanding the systemic issues that underlie this broad problem, we need to carefully think about long-term solutions. From where I stand as an evolutionary behavioral scientist, it seems that increases in evolutionary mismatch, which have been nothing short of dramatic in recent years—with the rise of social media and similar technologies—likely play a large role in this issue at a systemic level. If we really want to help address the mental health crisis that surrounds industrialized nations around the world, educating people about our evolved psychology is nothing short of essential.

References

Geher, G. & Wedberg, N. (2020). Positive Evolutionary Psychology: Darwin’s Guide to Living a Richer Life. Oxford University Press.

Giphart, R. & Van Vugt, M. (2018). Mismatch. Robinson.

Hodgkinson, S., Godoy, L., Beers, L. S., & Lewin, A. (2017). Improving Mental Health Access for Low-Income Children and Families in the Primary Care Setting. Pediatrics, 139(1), e20151175.

Srivastava, K. (2009). Urbanization and mental health, Industrial Psychiatry Journal, 18, 75-76.

Twenge, J. M., Cooper, A. B., Joiner, T. E., Duffy, M. E., & Binau, S. G. (2019). Age, period, and cohort trends in mood disorder indicators and suicide-related outcomes in a nationally representative dataset, 2005-2017. Journal of Abnormal Psychology, 128, 185-199.