These problems are tragically concentrated among the young. More than 3 million people ages 12 to 17 had at least one major depressive episode in 2017 — most accompanied by some form of severe impairment. The highest prevalence of major depressive disorder is among people ages 18 to 25. Some claim these numbers have risen mainly because of increased reporting. But that can’t be true of suicides. The suicide rate for people ages 18 and 19 increased 56 percent between 2008 and 2017. The rate of suicide attempts among people ages 22 and 23 doubled in the same period. The number of emergency room treatments for self-harm has increased, as well as hospital admissions for suicidal thoughts.
America’s mental-health crisis is very real. Yet explanations for this rising tide of despair feel insufficient. The trend doesn’t seem tied to broad economic indicators — though the death of the blue-collar economy in some places might play a role. Some have tried to blame the anxieties produced by a “gig economy” — but indicting Uber for human hopelessness seems a stretch.
Ready access to highly addictive opioids certainly is a source of numbed despair in many communities. Ready access to firearms plays a role in many suicides. Digital addiction and social media have transformed — and distorted — the social lives of most young people. Digital connection can deliver the poison of cyberbullying intravenously, in a steady drip. The withdrawal from direct, human contact with friends is associated with a variety of mental-health issues.
A few things we know. Many Americans have tragically limited access to mental-health services. Some health- insurance plans don’t provide adequate coverage. Some people are forced to drive long distances or wait on long lists. Some are discouraged from seeking help by continuing stigma. (About 20 percent of Americans have lied to cover up their pursuit of mental-health services.) As a result of all these factors, more than one-third of adults with major depressive disorder don’t get treated. About 60 percent of adolescents who have major depressive episodes don’t receive care.
We know that jails and prisons are not the best places to provide mental-health care — though likely more than 350,000 people with mental illness are currently behind bars. We should not trust many of these cases to the tender mercies of the penal system.
And we know that the deepest human needs can’t be described in purely material or political terms. Though friendship, belonging and shared purpose are intangible, they are as essential to humans as air and bread. Yet nearly half of Americans say they are often lonely. About 20 percent of millennials report they have no friends at all. Many of us have lost faith in the institutions that once gathered individuals into common effort and identity. Many of us have grown rusty in the task of social connection.
Mental health is different from many other policy issues. It involves both a public debate and personal responsibility to friends and acquaintances — a duty of active, empathic, invasive concern.
Isolation is the growth medium for severe depression and suicidal thoughts. Without hearing some other, kinder voice, the echoes of self-condemnation can grow louder and louder. Without outside intervention, a downward spiral can be rapid, uninterrupted and deadly. People who struggle with depression need others in their lives who are alert to the signs of suffering and violate polite boundaries. They need someone who is willing to say: “You may not want to hear this, but I care about you and I’m worried about you. Please tell me how you are hurting and allow me to help.”
This voice can come from a health-care professional. It can come from family members, or from friends and colleagues, or from a support group in which the confession of need is expected and welcomed. On mental-health issues, progress will be measured by increased focus and resources — but also by the loving welcome of our deepest selves.