Scientific American - 11.2019

(Nancy Kaufman) #1
12 Scientific American, November 2019 Illustration by Matt Harrison Clough

THE NEWS FROM THE EXPERTS Kirk J. Schneider^ is a psychologist and a current member^
of the Council of the American Psychological Association.

The U.S. Needs

a Mental

Health Czar

The country is facing a psychological

crisis—and nobody is really in charge
By Kirk J. Schneider
The U.S. is experiencing a mental health crisis. According to
recent surveys, rates of depression, anxiety and opioid addic-
tion, particularly among young people, are alarmingly high. Also
mount ing are rates of suicide, hate crimes and rampage killings,
as is the demand for mental health services. A survey published
in January by the California Health Care Foundation and the
Kaiser Family Foundation found that more than half of those
surveyed thought their communities lacked adequate mental
health care providers and that most people with mental health
conditions are unable to get needed services.
These statistics indicate that there is a gap in state and feder-
al oversight of public mental health. The federal office of the sur-
geon general oversees operations of the U.S. Public Health Ser-
vice, which communicates health recommendations to the public,
but that is a huge portfolio that ranges from nutrition to vaccines
to environmental hazards to mental health. The Substance Abuse
and Mental Health Services Administration (SAMHSA) oversees

and provides support to mental health services specifically, but it
tends to focus on addiction and shorter-term, behavioral modal-
ities. Moreover, it appears to be dominated by a medical orienta-
tion, which may not be adequate to address the intense psycho-
logical needs of many in the nation. And neither office appears to
have the staff, budget and expertise to tackle the diversity of prob-
lems in the mental health sector.
For that reason, Congress should create an office dedicated to
public mental health—the office of a “psychologist general.” He or
she would coordinate closely with the office of the surgeon gen-
eral, as well as related government agencies such as SAMHSA, to
oversee and advise the public regarding strictly psychological
(that is, nonmedical) approaches to public mental health care.
Such a position could be filled by a psychologist, a counselor, a
social worker, a researcher or a psychiatrist—but he or she must
have specific expertise in psychological approaches to public
mental health. In addition, the psychologist general should be a
distinguished professional who has a superlative knowledge of
evidence-based approaches to health care and who has a collab-
orative view of how psychology and medicine can work together
to optimize it.
Some of my colleagues have asked why we shouldn’t have a
psychiatrist general rather than a psychologist general as over-
seer of public mental health. My answer is that although these
specialists are integral to the health care system, the statistics
demonstrate that their contributions do not appear to be suffi-
cient. Moreover, there are indications that many in our society
are overmedicated and that potent psychological methodologies
could give people the resources to function more sustainably on
their own or in conjunction with appropriate medical care.
A psychologist general at the forefront of mental health
research and delivery would send a strong message that psycho-
logical well-being is prized on a par with physical health—a mes-
sage in keeping with the phrase “Life, Liberty and the pursuit of
Happiness.” More important, it is a message that resonates with
contemporary needs. As a major review of the literature demon-
strates, there is every indication that by addressing these needs
our nation will save on medical costs as well.
Just as in the case of the surgeon general, the psychologist
general would be nominated by the president, with the advice
and consent of Congress. Candidates might come from the U.S.
Public Health Service—or it might make more sense for Con-
gress to authorize selections outside of this corps because there
are many qualified psychologists, counselors, social workers,
researchers and psychiatrists who may not officially be part of
the corps but who hold equivalent, and perhaps in some cases
superior, credentials in the promotion of psychological ap -
proaches to public mental health. In either case, the time is ripe
for a psychologist general. It is both economically warranted
and morally imperative.

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