For people seeking help in mental health crises, formal response services may fall short of their needs, a new study published Aug. 18 in Health Affairs Scholar shows.
The study finds that while most U.S. adults who experienced a mental health crisis in the past year sought help, few pursued formal crisis services like the 988 Suicide and Crisis Lifeline or mobile crisis teams. Those seeking help opted instead for their known doctors, therapists, and counselors, as well as informal, peer-based, or community-oriented supports.
de Beaumont spoke with the first and senior study authors Andrew Anderson, PhD, and Catherine K. Ettman, PhD, about what their research means for improving awareness of and access to mental health crisis services.
What does this study tell us about the prevalence of mental health crises in the United States?
CE: Nearly 1 in 10 Americans self-reports experiencing a mental health crisis in the past year and 1 in 4 did not seek help. Among the people who sought care, both formal and informal supports were important. These findings can inform real-world practice to ensure that both formal and informal supports can be prepared as needed.
AA: It is important for public health resource allocation to adequately prepare for the needs of the public. We can better prepare to meet the needs of the 23 million adults who may potentially experience a mental health crisis in a given year.
What do these findings tell us about how people use formal and informal mental health crisis services?
AA: Both formal and informal supports serve separate purposes and can help people when they are experiencing mental health crisis. To the extent that they can work together, informal supports can help increase capacity of formal supports, and formal supports can help patients to be able to return to communities. The findings suggest that both formal and informal supports matter when adults experience mental health crises.
CE: Among people who reported having a mental health crisis and seeking help, over 50 percent went to a doctor, therapist, or counselor; this reinforces the importance of maintaining access to care and mental health care for patients. The next most used resource was friends and family, highlighting the importance of social support and meaningful relationships to support mental health.
How can informal services especially be made more equitable to reach groups with the highest burdens of crisis?
AA: The goal is to have institutions where people can call or go if needed when in mental health crisis. SAHMSA’s goals recommend that people have someone to call, someone to help, and have somewhere to go that is safe if needed in a moment of mental health crisis. Informal services (like peer networks, church groups, or neighborhood organizations) often reach people who mistrust, avoid formal systems or prefer informal supports. Making them equitable means resourcing groups that already serve communities with the highest burdens of crisis. Training and funding peer specialists, faith leaders, and community health workers ensures that “someone to call” includes familiar and trusted people.
In what ways does access to mental health crisis services need to change?
CE: It is notable that people with lower income, housing instability, and unmet medical needs were more likely to report mental health crisis, reminding us that groups with more stressors are more likely to experience poor mental health. Investing early in prevention and in upstream assets can help people to have the best mental health possible.
AA: A crisis is the most downstream and adverse outcome of social drivers of mental health. We need to have supports in place for people when they have these moments, and we should also be investing in the upstream factors that prevent poor mental health to begin with.
What is your call to action?
AA: We need more investment in the mental health crisis system, both formally and informally. More awareness of mobile crisis teams, the 988 hotline, and mental health crisis-trained responders can help to address patients’ needs in times of crisis.
CE: Given the high percentage of people engaging doctors, therapists, and counselors, having adequate mental health trained providers and health insurance to pay for care can help to ensure that people have access to the health care needs when they arise — and that they do not avoid care due to cost.
This study uses data from the sixth annual wave of the COVID-19 and Life Stressors Impact on Mental Health and Well-being (CLIMB) study, a nationally representative, longitudinal survey conducted through AmeriSpeak Panel managed through NORC at the University of Chicago. The CLIMB study is supported by the de Beaumont Foundation.
