The Future of Public Mental Health: Challenges and Opportunities

Centennial Issue
Mental health

Policy Points:

  • Social policies such as policies advancing universal childcare to expand Medicaid coverage of home- and community-based care for seniors and people with disabilities and for universal preschool are the types of policies needed to address social determinants of poor mental health.
  • Population-based global budgeting approaches like accountable care and total cost of care models have the potential to improve population mental health by incentivizing health systems to control costs while simultaneously improving outcomes for the populations they serve.
  • Policies expanding reimbursement for services delivered by peer support specialists are needed. People with lived experience of mental illness are uniquely well suited to helping their peers navigate treatment and other support services.

Mental illness is highly prevalent and a leading cause of disability globally and in the United States.1 In the United States, which is the focus of the article, one in five adults and youth ages 9 years old and older and one in six children ages 2–8 years old experience mental illness each year2–4; about half of the US population experiences mental illness at some point in their lifetime.4 In recent years, the stressors of the COVID-19 pandemic have increased psychological distress, anxiety, and depression across the globe. In the United States, youth and young adults have been particularly affected. Mental illness was increasing among US children and adolescents in the decade leading up to,5 and then further exacerbated during, the pandemic; in 2021, 44% of US high school students reported that they persistently felt sad or hopeless during the past year.6 Prior to the pandemic, fewer than 5% of young adults ages 18–29 years old experienced serious psychological distress.7 At four time points during the pandemic—April 2020, July 2020, November 2020, and July-August 2021—between 20% and 30% of US young adults ages 18–29 years old reported experiencing serious psychological distress,8 which has been shown to accurately predict serious mental illness.9 This suggests that the distress experienced during the COVID-19 pandemic could translate to long-term psychiatric disorders.

In the wake of the pandemic, mental illness and mental health are garnering increased attention across US society, including among the public, health care leaders and providers, the business community, and policymakers.10–15 Although often used interchangeably, “mental illness” and “mental health” differ in meaning. Mental illnesses are diagnosed conditions characterized by a clinically significant disturbance in a person’s cognition, emotional regulation, or behavior.16,17 Mental health is a broader construct encompassing a person’s state of mental or emotional well-being, including but not limited to mental illness.17 Although everyone experiences ups and downs in mental health, not everyone experiences the sustained impairment that contributes to the diagnosis of mental illness. We are experiencing a window of opportunity to reimagine the US mental health “system”—in reality, a set of highly fragmented organizations—and build a true public mental health system that both delivers clinical treatment for mental illness and promotes mental health at the population level. This article summarizes past gains and successes in US mental health, outlines failures and continuing problems, and discusses solutions, with an eye toward the role of social policy.


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  2. Cree RA, Bitsko RH, Robinson LR, et al. Health care, family, and community factors associated with mental, behavioral, and developmental disorders and poverty among children aged 2–8 years—United States, 2016. MMWR Morb Mortal Wkly Rep. 2018;67(50):1377-1383.
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  4. Substance Abuse and Mental Health Services Administration. Key Substance Use and Mental Health Indicators in the United States: Results from the 2019 National Survey on Drug Use and Health. HHS Publication No. PEP20-07-01-001, NSDUH Series H-55.Center for Behavioral Health Statistics and Quality: 2020. Accessed October 25, 2020.
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McGinty EE. The Future of Public Mental Health: Challenges and Opportunities. Milbank Q. 2023;101(S1): 532-551.