Struggles with mental ill-health are the world’s leading cause of disability. Beset by the coronavirus pandemic, underresourced mental health systems have strained to keep up. But access to care is limited by three major obstacles: a dearth of professional care providers, embedded stigma surrounding mental health problems and a distrust of institutions.
The scenario is by no means uniformly dire. Both the public and private sectors have demonstrated a willingness to promote change. Innovative programs show promise for improving efficient access to care, whether a community’s financial resources are large or small. They combine the latest science with digital delivery of information and services and collaborative efforts among people with mental health challenges, professionals and the community at large.
Digital care options through teletherapy and all manner of new apps have seen explosive growth during the pandemic. Online services reach the most remote regions and circumvent fears of stigma for making the decision to seek treatment. They can effectively extend the capacity of health and social services. But they cannot overcome the scarcity of professional therapists. The dearth of providers who coordinate care means that even app-based teletherapy confronts challenges in reaching people in need.
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One solution is to bolster peer and community support to extend the effectiveness and reach of in-person and online mental health care. A major development has seen people with mental illnesses help others by providing peer support to show that they are not alone in their struggles with mental health. People confronting mental health issues assist recovery by building trust among their peers with similar experiences. Care teams made up of peers lead group discussions and serve as coaches for others experiencing mental challenges. Training and support for community health workers also help. Community health workers are lay members of a community tasked with providing basic health care, including prevention, health promotion and rehabilitation services, thereby extending care to more people in need worldwide. Research has begun to show the effectiveness of these approaches even when delivered online.
Publicand private sectors in several countries have developed programs combining these approaches. Online mental health support and services such as Togetherall, ReachOut, 7 Cups and UCLA STAND, often co-designed and advised by community peers, have become trusted sources of help and referral for young people, their families and others in distress and coping with mental ill-health. A public-private partnership, Strong 365’s NYWell is a digital outreach pilot project to assist young people facing the onset of serious mental illness. NYWell’s search engine and social media ads link to a Web site that provides assistance ranging from self-education and online peer support to more intensive professional care. The site has attracted thousands of visitors from the time of its launch in New York State in November 2020. About half of visitors take a self-administered mental health screening test. One in 10 connect online with a peer or therapist, and one in five of those are referred to care in the community. The program is expanding, and a randomized controlled trial has begun to measure its effectiveness. Early findings indicate that youth facing serious mental illness are willing to engage in what is called tiered online care, ranging from peer interactions to sessions with professional therapists.
Continued progress will require collaboration among people with mental illness, community workers, mental health and technology professionals, public and private sector leaders, and others. The programs show promise, however, of furnishing a breakthrough in care for people wherever they are.
This is an opinion and analysis article, and the views expressed by the author or authors are not necessarily those of Scientific American.
