Mental health: The power of connecting requires the power of investing

As millions of Americans prepare to connect in person or virtually for the holidays, it is a good time to consider the power of human relationships and the role of mental health care in strengthening connections. At the same time, there is an urgent need to support mental health care providers. 

A recent global survey sheds light on attitudes about human connection in a digital world. Findings suggest that despite technology’s evolving ability to learn and understand a person’s needs and preferences, people still desire interpersonal connection when working through complex issues. 

Another recent study shows a dramatic spike in calls to mental health helplines during the COVID-19 pandemic. Callers reported feelings of loneliness and fear; the chance to connect with someone offered a sense of hope. Experts state that social isolation is a key contributing factor to poor physical health outcomes in this population, one that was exacerbated during the pandemic.

As a registered nurse and licensed clinical social worker, building and nurturing trusting therapeutic relationships with clients is a large component of my work. 

Nursing and social work are among health care roles that center around the use of relationships as a healing tool. One distinct application is in the community mental health setting, where interdisciplinary professionals — psychiatrists, nurses, social workers and peer counselors — offer empowering, supportive relationships to those struggling with mental illness and substance use conditions. These relationships can foster dignity, hope and recovery. 

One in 20 adults in the U.S. experiences a serious mental illness and one in 26 has co-occurring mental health and substance use conditions. Individuals with mental illness are more likely to experience social determinants of ill health and have disproportionately high rates of chronic physical disease and premature death.  

The pandemic amplified issues of mental ill-health, indicating a growing need for access to professional support. Health care workers themselves can suffer from high rates of anxiety and depression, as can children and teens. 

A survey found that in response to growing concerns about mental health, about 40 percent of employers have added mental health and substance use benefits; a substantial proportion of employees use them.

To offer mental health services, there must be more mental health professionals. To choose a career in the field, clinicians are often optimistic that the intangible rewards will transcend the low pay and emotional toll. Yet mental health professionals often report burnout because of emotional exhaustion, which can lead to job dissatisfaction and resignation. 

Shortages of mental health care providers mean that systems of care are overloaded and the need for services is set to outpace mental health workforce availability across much of the United States in the coming years. 

Research suggests that the turnover rate among frontline behavioral health staff is high — for example, reaching 37 percent in Michigan in 2017. In response to mental health care worker shortages, leaders in Michigan are steering grant money toward attracting graduates into the field by giving $10,000 awards to help pay for costly schooling.

Strengthening the workforce requires a shift in cultural values along with investment of resources. Increased spending by federal and local governments, as well as private and public health care institutions, is essential. It is urgent to care for the people in need of services by caring for those who provide the services. 

Nonprofit organizations and government mental health providers must offer higher salaries, conduct research on the workforce, enhance information technology infrastructure, and carry out demonstration projects that will move away from archaic fee-for-service reimbursement models. Perhaps investments can be made to support a better work-life balance by defining full time as a 32-hour work week for the same pay. 

In Chicago, Mayor Lori Lightfoot announced that an extra $52 million will be set aside for mental health in 2022. This includes creating 29 mental health positions in high-need areas in the city’s South and West Sides. Many say this is a step in the right direction. 

In other parts of the country, similar moves are happening. Some emphasize prevention and early intervention for mental health. Sen. John Cornyn (R-Texas) recently introduced a bipartisan bill aimed at establishing a federal standard for mental health crisis response, which has shown promising results in Texas. 

A recent poll by the National Alliance on Mental Illness confirmed deep dissatisfaction with the mental health system. Most respondents, regardless of political affiliation, want to see changes and say they support using state and federal funds to improve crisis and ongoing care. 

On a global level, the World Health Organization (WHO) recently made a case for a radical shift in thinking about how to treat mental illness and promote mental health. Suggestions include placing emphasis on recovery-based interventions and human rights. The WHO highlights models of care from around the world that largely center on relationships and compassionate listening to promote wellness and increase one’s ability to manage symptoms and live meaningful lives.

U.S. community mental health organizations long have provided the kind of relationship-based services that the WHO calls for, and have found a way to survive amid budget cuts and despite complicated Medicaid reimbursement processes. Without frontline staff doing the work, the missions of these organizations would be reduced to mere words. 

To keep this important work alive, it must be recognized that patients and mental health professionals are worth more than what the systems invest in them.

In the mental health field, it is important to celebrate baby steps. But when it comes to budgets and supporting people who do challenging relationship-based mental health work, bigger steps are needed to maintain healthy human connections — not just on holidays, but every day. 

Diana Krishnan is a community health registered nurse at Rush University in Chicago and a Public Voices Fellow of The OpEd Project.