What To Read: Ben Miller is putting mental health in context

This week, we interviewed Ben Miller, a musician, psychologist, and health policy wonk who writes Mental, a publication about mental health and current events.

This interview has been lightly edited for length and clarity.

What’s your Substack about in one sentence?

Mental is a weekly newsletter that highlights how current events connect back to our nation’s mental health and addiction crisis.

How did you enter the world of mental health advocacy?

While going through my training to get my doctorate in clinical psychology, I saw firsthand the problems individuals had getting access to mental health care. I saw families suffer because the system made getting help next to impossible. I also worked in primary care, which sees a lot of mental health problems, and I learned that being there in the moment when someone needs help can change a person’s trajectory and their overall health outcomes.

Most importantly, I learned the power of integration – bringing mental health to wherever people are. That’s why I pursued mental health policy. I wanted to fix the system so that the integration of mental health was the norm, not the exception. Simply put: policy helps enable and scale solutions.

Why does your publication focus specifically on policy solutions to mental health?

Although policies are one of the most significant barriers that prevent people from accessing care, many see policy as someone else’s responsibility. We think, “Policy is too complicated.” I write Mental to help simplify policy and convince people that policy is everyone’s responsibility.

The system and structure we have isn’t working, and it remains stuck that way because of policy. As a result, we hear the same stories over and over. Stories of a family in crisis who can’t find help. Stories of loved ones lost too soon. Stories of financial ruin. We need to fix all this with sweeping reforms and better enforcement, accompanied by individual actions that reduce stigma and create inter-community support systems.

For example, there’s a federal law that requires health insurers to cover mental health and addiction services in the same way that they cover care for physical health services – the MHPAEA. In the absence of any legislative efforts to hold insurers accountable, many aren’t actually doing what they are required to. There are policy solutions for a problem like this!

How has the pandemic impacted mental health outcomes?

Our mental health and addiction crisis was greatly exacerbated by Covid-19. It’s an epidemic within the pandemic. Calls to the SAMHSA Disaster Distress Helpline increased by 891 percent from March 2019 to March 2020, and the number of adults reporting symptoms of anxiety or depression from April 2020 through March 2021 was triple the 2019 number of people who reported such symptoms. In addition, we saw a 27 percent increase in drug overdose deaths when looking at 2020 data compared to 2019.

Our mental health and addiction crisis isn’t going to end when the pandemic ends, either. Years before Covid-19, we were consistently losing an increasing number of Americans to suicide, drugs, or alcohol. In 2019, we lost 156,242 people to these deaths of despair. Given the indicators of worsening mental health throughout 2020, it’s unlikely that we will buck the trend of the past few years.

Part of the reason why I’m so motivated to write Mental is to stymie the number of Americans we see dying each year. There’s so much we can do if we finally stop treating mental health as separate and different from physical health. Mental health is foundational and core to our health, and because of that we desperately need to integrate it through policy.

What's a popular myth or misconception about mental health, and what's really going on?

Younger millennials and Generation Z are very open about their mental health, especially compared to their parents, grandparents and great grandparents. This fills me with hope for the future, but a very dangerous misconception that stems from younger millennials’ and Generation Z’s willingness to talk about their thoughts and feelings is that they are just “soft” generations that need to “toughen up.”

All of us have mental health. Talking about it isn’t a sign of weakness. It’s a sign of strength. My hope is that more people come to see and appreciate that, in particular men, because so long as we conflate mental health with weakness, we will never see the current mental health and addiction crisis as the threat to human life that it is.

What are some of the most promising mental health policies you've seen tested? What can we learn from those experiments?

The most powerful, policy-driven transformations I’ve read about and seen are those that give laypeople the evidence-based training and tools they need to help each other. One example I recently shared is from Zimbabwe. Dr. Dixon Chibanda, a psychiatrist who lost a patient to suicide, spent years testing a model that trains lay health workers to intervene on mental health related issues. Dr. Chibanda found that when people (grandmothers, in particular) were taught a structured approach to identifying problems and finding workable solutions, public health outcomes improved.

Policies that would enable everyday people to take better care of themselves and others would have a hugely positive impact, especially in the absence of system-level changes. Our mental health and addiction workforce is already overwhelmed, so we need an all-hands-on-deck approach – a solution that creates a new workforce in community, by community, and for community.

Who’s another Substack writer you’d recommend?

I enjoy Gen Dread. Britt Wray writes beautifully about mental health and climate.

I also enjoy reading My Sweet Dumb Brain and Foreign Bodies. In the former, Katie Hawkins-Gaar shares her thoughts and feelings after her husband’s passing. The latter focuses on destigmatizing mental health among immigrant and refugee communities.

Subscribe to Ben’s newsletter, Mental.