Why Mental Health Therapy is Growing in the USA

Almost double the number of Americans have sought mental health treatment now than was the case two decades a historical reflection of declining mental health up to the present day, but with increasing access to virtual care and destigmatization trends.

In 2004, 13 percent of adults reported having seen a therapist, psychiatrist, or other mental health professional in the past year, according to a Gallup poll. In 2022, it grew to 23 percent.

The trends started long before COVID-19; in fact, it was the pandemic that caused another surge in the demand for care, especially among young adults. Share of Americans aged 18-44 who received mental health treatment over the past 12 months, including medication and counseling or therapy, jumped from 18.5 percent to greater than 23 percent from 2019 to 2021, according to the data from the Centers for Disease Control and Prevention.

“There was undoubtedly a huge demand for our services shortly after the pandemic onset,” said Daniel Fridberg, associate professor of psychiatry at the University of Chicago.

Most psychologists reported more patients contacting them with anxiety, depressive, or stress-related problems starting in 2020, and then again in 2021 and 2022, according to the American Psychological Association’s survey.

Some health experts connect the increased demand to the declining mental health scenario due to the pandemic, which raised the number of Americans self-reporting symptoms of depression and anxiety.

On the contrary, according to some health experts, numbers tell yet another story of success: teletherapy.

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Mark Olfson, an Elizabeth K Dollard professor of psychiatry, medicine, and law and a professor of epidemiology at Columbia University Irving Medical Center, said, “I think there is evidence for the rising rates of depression, especially among young people.”

However, he added, “The most important factor driving the increasing demand for psychotherapy is a basic structural change, how psychotherapy is delivered.”

According to health policy research organization KFF, telehealth barely existed before the pandemic, accounting for just 1 percent of outpatient visits concerning mental health and substance use. In 2020, telemedicine skyrocketed to account for 40 percent of outpatient visits made during the March to August period for mental health and substance use issues. This percentage was still relatively good the next year and, by then, other outpatient care was returning to mostly in-person visits.

There are downsides to telehealth mental health services. First of all, trained professionals in the field would find it somewhat more difficult to pick on up on body language in teletherapy sessions than in in-person sessions, and there is an obvious potential increase in distractions by background noise, pets, and family members while in teletherapy. But the statistics suggest otherwise: for many patients, it works out to virtual therapy or counseling.

So strong is the sentiment toward virtual therapies, according to an online survey of 1,200 people by YouGov and Forbes Health last year: About 63 percent of teletherapy users found that intervention effective. “

Olfson offered convenience as one further reason that made teletherapy attractive, as patients could undergo their appointments virtually anywhere there is are phone or Internet connection.

Another amiable factor was privacy.

“The people don’t have to drive across town and sit in a waiting room for their friends or neighbors to see them, waiting for a counselor or psychotherapist,” Olfson said.

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The stigma against mental illness and the inability to work through it got stronger in the past and somewhat faded over the years, especially among younger people, further contributing to more Americans receiving mental health treatment today.

Studies indicate that Gen Z, people born from 1997 onwards, have a much higher degree of comfort when talking about mental health than older generations. Gen Z feels even more comfortable going into treatment for their mental health issues or going to therapy.

According to the American Psychological Association’s 2019 report, 37 percent of Gen Z received some form of psychological treatment or went for therapy, as compared to 35 percent of millennials and 26 percent of Gen Xers.

“When I speak to younger patients, many of them are quite open with their friends about their mental health. They talk about therapy, their diagnosis, and what they’re doing to deal with it,” said Fridberg from the University of Chicago. “That’s a real shift.”

Unfortunately, even as more and more Americans have begun to seek help for their mental health, they find very few professionals able to assist them. This gap is becoming dangerously wider.

Estimates from the Department of Health and Human Services indicate that the national shortage of mental health providers-including psychiatrists, school counselors, and family therapists-could exceed 10,000 health care professionals by 2025.

The power of a single appointment

The importance of designing interventions to reach more people is gaining momentum not only within the digital space but also in personal or group therapy. In data, for example, when taken to the limit, it has been shown that most patients never return after their first therapy appointment, even though providers recommend ongoing treatment (Hoyt, M. F., et al. [Eds.], Single-Session Therapy by Walk-In or Appointment, Routledge, 2018). Similarly, psychologist Windy Dryden, PhD, was mindful of this reality in creating an effective form of therapy: one that could be delivered well in one session. For example, he has trained counselors at 20-plus universities in Britain to be able to use the model, and for the most part, patients he sees through an employee assistance program opt for one session even though eight sessions are paid to the insurance (Australian & New Zealand Journal of Family Therapy, Vol. 41, No. 3, 2020).

Over the last year, the demand for Dryden’s training in single-session therapy has soared as health care agency managers have been galvanized to reduce waiting lists. “I’m happy to provide training for this purpose, but this is not the primary purpose of single-session therapy,” said Dryden. “The goal is to help people walk away from a session with the help they are looking for.”

Patients fill out a brief questionnaire, where they share what they want to get from the session and how they have sought help previously, what has helped and what has not, and other demographics. Dryden said, “Many patients do not accurately perceive their dangers and coping abilities against those dangers; I assist them in verbalizing these scenarios.” “This is for the underserved population,” he said. “People get what they want, and waiting lists come down.”

Evidence indicates that single-session treatment is beneficial for patients. In a systematic review of studies involving single-session therapy in treating anxiety disorders in youth and adults, researchers found this intervention superior to no treatment and similar to multi-session treatments for reducing symptoms of anxiety (Bertuzzi et al., Frontiers in Psychology, Vol. 12, 2021).

Learn by doing

Focused brief group therapy (FBGT) is one of those above strategies, which increases access as participants are empowered to practice their skills in a safe environment. This was the model that Whittingham had developed while being an associate professor of clinical psychology at Wright State University. Providers at the counseling center had long waitlists and dire needs for something to fit within the calendar system of the school. “I knew students were developmentally concerned about relationships, and I wanted to use the power of the group to help people,” Whittingham said.

Participants take a preassessment called the interpersonal circumplex to understand their specific type of relationship distress. Specifically, for the traits of assertiveness, dominance, agreeableness, and warmth, members would collaborate to establish those goals with the therapist, alongside improving relationships. In the meetings, participants would restate their goals and practice new behaviors. For example, if someone has difficulty regarding a relationship, a group member trying to be less conflictual can practice being supportive by asking follow-up questions and affirming the individual. “This is not role play,” Whittingham said. “Deeply emotional and physical responses occur because they have a real fear of rejection in real time.” Taking new actions and later receiving approval by others to increase the risks means, according to him, that people will feel more comfortable with the breaking of boundaries in real life.

While FBGT was initially introduced in the university setting, more and more health care organizations have started getting in touch with Whittingham for his expertise on the subject. Psychiatrist Meenakshi Denduluri, MD, said she found FBGT appealing because the groups were focused on the here and now, rather than skills-based psychoeducation. Recently, Denduluri conducted FBGT at the Stanford University Department of Psychiatry and Behavioral Sciences in California, but had also noted that patients in one-on-one therapy often repeated certain relational patterns that were barriers to their therapeutic progress. “The psychological safety in the therapy groups allowed people to take interpersonal risks that they could not take in their personal lives,” she said.

College campuses are also beginning to harness the healing power of social connectedness to improve their support of students struggling with mental health issues. Peer support programs aren’t new, but they are multiplying on campuses around the country at a time of great mental health need and at a moment when it’s being understood again that supporting students is everyone’s responsibility on campus, including peers, Zoe Ragouzeos, PhD, LCSW, executive director of Counseling and Wellness Services at New York University, said. According to her, these peer programs reduce stigma, make it possible to reach a larger audience, and increase diversity in support options.

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