The U.S. is experiencing a mental health crisis. According to recent surveys, rates of depression, anxiety and opioid addiction, particularly among young people, are alarmingly high. Also mounting are rates of suicide, hate crimes and rampage killings, as is the demand for mental health services. A survey published in January by the California Health Care Foundation and the Kaiser Family Foundation found that more than half of those surveyed thought their communities lacked adequate mental health care providers and that most people with mental health conditions are unable to get needed services.
These statistics indicate that there is a gap in state and federal oversight of public mental health. The federal office of the surgeon general oversees operations of the U.S. Public Health Service, which communicates health recommendations to the public, but that is a huge portfolio that ranges from nutrition to vaccines to environmental hazards to mental health. The Substance Abuse and Mental Health Services Administration (SAMHSA) oversees and provides support to mental health services specifically, but it tends to focus on addiction and shorter-term, behavioral modalities. Moreover, it appears to be dominated by a medical orientation, which may not be adequate to address the intense psychological needs of many in the nation. And neither office appears to have the staff, budget and expertise to tackle the diversity of problems in the mental health sector.
For that reason, Congress should create an office dedicated to public mental health—the office of a “psychologist general.” He or she would coordinate closely with the office of the surgeon general, as well as related government agencies such as SAMHSA, to oversee and advise the public regarding strictly psychological (that is, nonmedical) approaches to public mental health care. Such a position could be filled by a psychologist, a counselor, a social worker, a researcher or a psychiatrist—but he or she must have specific expertise in psychological approaches to public mental health. In addition, the psychologist general should be a distinguished professional who has a superlative knowledge of evidence-based approaches to health care and who has a collaborative view of how psychology and medicine can work together to optimize it.
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Some of my colleagues have asked why we shouldn't have a psychiatrist general rather than a psychologist general as overseer of public mental health. My answer is that although these specialists are integral to the health care system, the statistics demonstrate that their contributions do not appear to be sufficient. Moreover, there are indications that many in our society are overmedicated and that potent psychological methodologies could give people the resources to function more sustainably on their own or in conjunction with appropriate medical care.
A psychologist general at the forefront of mental health research and delivery would send a strong message that psychological well-being is prized on a par with physical health—a message in keeping with the phrase “Life, Liberty and the pursuit of Happiness.” More important, it is a message that resonates with contemporary needs. As a major review of the literature demonstrates, there is every indication that by addressing these needs our nation will save on medical costs as well.
Just as in the case of the surgeon general, the psychologist general would be nominated by the president, with the advice and consent of Congress. Candidates might come from the U.S. Public Health Service—or it might make more sense for Congress to authorize selections outside of this corps because there are many qualified psychologists, counselors, social workers, researchers and psychiatrists who may not officially be part of the corps but who hold equivalent, and perhaps in some cases superior, credentials in the promotion of psychological approaches to public mental health. In either case, the time is ripe for a psychologist general. It is both economically warranted and morally imperative.
