It was my first day of graduate school. Naive. Excited. Scared and ready to learn how to be a therapist. I was ready to make a difference in the world. Then I was thrown a curveball. In an opening remark the professor said,
“ Being a therapist is great, however its like being a medic. You patch people up and put them back out into the world. If you really want to make change you have to get involved with informing policy”
Not the start to this path that I had expected. Afterall, I was studying to be a therapist because, as most therapists, I wanted to make a difference. I didn’t want to be a “medic”.
Mental Health Crisis
With that little bit of wisdom, duty called and I had to focus on the task at hand. Finishing Graduate School. Fast forward and since that day in 2008 anyone with an internet connection knows that our culture has what has been coined a “mental health crisis”. For many this crisis is much more than a headline. It's personal, its in our family, our work, our community or it's the person reading this article right now.
Since the issue of mental health has become more accepted and more widely publicized so have proposals about the cause and the solutions. Most people don’t have their nose in the papers and academic articles that expand on these ideas so we are left with what trickles down into the mainstream though the media and ‘talking heads’. There are a few ideas that circulate around more than others. These are things like mental health awareness, destigmatization of mental health to increased access to care and training more mental health professionals. These are all worthwhile and noble tracks to pursue and we should continue to do so. For many years I lived exclusively in these camps and I will continue to support them, just not exclusively.
To The Root
When it comes to policy change, where do we start? The answer is: At the beginning.
It is well accepted that the quality of our attachment styles are primarily formed from ages 0-3, and some would argue, 0-5. How does attachment relate to the current mental health crisis you ask? The development of attachment to our caretakers is what lays the foundation of how we value/percieve all the parts of ourselves, how we regulate our own emotions and nervous system, how we trust others, how we develop and learn empathy and attunement and how we see the world as a whole and our place in it. For the sake of brevity in this article lets focus on how attachment establishes our ability to regulate our own emotions and nervous system.
Policy Change #1: Extended Maternity and Paternity Leave
To establish attachment with a newborn the number one prerequisite is that the parents must be physically available. Remember, primary attachment is established in year 0-5. The percentage of mothers who are required to go back to work after less than 2 weeks postpartum is astounding. After birth the mother is the womb meaning the child relies on the mother for emotional regulation and security. If a mother has to return to work so soon after birth this is a huge stress and a child will mirror the emotional capacity and function of its primary caretaker. Fathers, or the other parent, play an equally important role in establishing attachment and fostering attunement. It is not realistic to ask new parents to remain emotionally regulated while juggling a new baby, a career, a relationship and other responsibilities. This cultural expectation is a relatively recent one whereas throughout history raising a child, especially at a young age was done with more frequent proximity and availability of the primary caretakers.
I don’t think we want to go back to these times but it is important to acknowledge that human needs and human nature do not take a backseat due to societal advancements.
These ideas are not meant to shame or to guilt anyone. Instead quit the contrary. Life is hard with never ending responsibilities, stress and tragedy. Add a child into this and the context of life changes and we are expected to adapt quickly, often without enough guidance, support and time. This also is not to say that a mother or father should not pursue a career or special interest. The primary point is to emphasize the massive importance of creating whatever environment we can, even amidst the chaos, to be physically and emotionally available for our children.
While it may seem like a pipedream, especially in the United States, there is a real need for policy change that allows for the opportunity for parents to spend, at a minimum, those first fragile months, as stress free and as present with their family as possible.
Policy Change #2: Plausible Economic Security
Now I am a therapist and will not pretend to be an expert on government economic policy. However, anyone reading this has most certainly felt the effects of inflations across all areas of life. Financial insecurity is a pervasive issue that casts a long shadow over the mental health of individuals and families across the United States. In an era marked by inflation, soaring home costs, and stagnant wages, many families find themselves caught in a relentless struggle to make ends meet. This economic strain is not just a matter of financial stress but also impacts the emotional and psychological well-being of parents, which in turn affects their interactions with their children.
The continuous pressure to secure basic necessities can severely impair a parent's emotional regulation. When parents are preoccupied with financial concerns, their ability to be present and responsive to their children can be compromised. This lack of emotional regulation and presence is crucial as it hinders their capacity to attune to their children's needs. Attunement—the ability to recognize, understand, and respond to a child’s emotional states—is essential for forming secure attachments. These attachments are foundational to a child's development, affecting their future emotional and social competencies.
Furthermore, the stress of financial insecurity can disrupt the home environment, making it a space of tension rather than comfort and stability. In such environments, the opportunities for positive interactions—so crucial for healthy attachment—are markedly reduced. Over time, children raised in such conditions may be at higher risk for various mental health issues, including anxiety, depression, and difficulties in forming their own healthy relationships.
Addressing the broader economic pressures that contribute to financial insecurity is therefore not only a matter of improving economic outcomes but is also critical for the mental health of current and future generations. By acknowledging and tackling the root causes of economic strain, there could be a significant positive impact on the mental health landscape, enhancing the ability of parents to provide the nurturing and stable environments that are so critical for healthy psychological development.
Policy #3: Access to Responsible Use of Alternative Medication
The current mental health crisis in the USA has reached a critical point, with conventional treatments such as SSRIs, SNRIs, and tricyclic antidepressants often failing to meet the needs of many patients. Initially hailed as breakthroughs, these medications have not universally delivered on their promise, often providing incomplete relief and accompanied by undesirable side effects. This has left a significant portion of the population still struggling with debilitating mental health conditions, underscoring the urgent need for alternative therapeutic options.
The potential of psychedelic medications in clinical settings offers a promising horizon. Recent studies on substances like psilocybin and MDMA have shown remarkable results in treating conditions such as depression, PTSD, and anxiety, often where traditional medications have failed. These substances appear to facilitate deeply therapeutic experiences that can lead to significant and rapid psychological improvements. For instance, psilocybin has been shown to reduce symptoms of depression and anxiety with lasting effects after just a few sessions. The efficacy of these treatments points to how neuroplastic changes induced by psychedelics can fundamentally alter the way patients process emotional and psychological trauma.
A policy change that supports the responsible clinical use of psychedelic medications could therefore be a crucial step towards addressing the mental health crisis more effectively. By integrating these treatments into mainstream healthcare under controlled conditions, we can provide patients with new, more effective therapeutic options. Such a policy shift would not only expand the toolkit available to mental health professionals but also signify a progressive approach to understanding and treating mental health issues. Given the potential of these substances to catalyze profound, positive changes in mental health, it is both a logical and necessary evolution in mental health policy to explore and embrace the clinical applications of psychedelics.
Policy Change #4 : Reconceptualize the Training and Education of Therapists and other Healers
This one may not be a governmental policy change however it is a topic that deserves consideration and attention.
The training of mental health professionals is a cornerstone upon which the quality of mental healthcare rests. However, current educational programs often fall short in adequately preparing therapists to meet the deep emotional needs of the public, particularly in the realms of trauma and the complex healing processes of individuals. This gap in education is concerning, akin to a physician lacking knowledge of how the body heals from physical ailments.
One significant shortfall is the insufficient focus on trauma and its long-lasting impacts. Trauma, especially complex trauma resulting from prolonged exposure to distressing experiences, requires a deep understanding of its intricacies, including its manifestation in various psychological symptoms and behaviors. And remember, when we say trauma we literally mean “ a wound”. An emotional wound or a wound to our sense of self and dignity or a separation from parts of ourselves. Unfortunately, many training programs provide only a cursory exploration of these topics, leaving therapists underprepared to recognize, understand, and treat trauma or emotional dysregulation effectively. This oversight can lead to misdiagnosis, inappropriate therapeutic interventions, and ultimately, a failure to provide the healing environment that clients desperately need.
Additionally, the healing process itself, a critical area of knowledge for any therapist, is often glossed over in conventional mental health education. Understanding how individuals heal emotionally is as essential as knowing the symptoms of the disorders themselves. Healing is a dynamic and individualized process, involving not just the alleviation of symptoms but the reintegration of the individual's different parts so that life can feel whole and with acceptable meaning again. Training programs frequently emphasize diagnostic skills and therapeutic techniques without a corresponding emphasis on the holistic and often nonlinear journey of emotional healing.
There is a pressing need for more robust and comprehensive training for mental health professionals that spans all elements of the human condition. This should include an in-depth exploration of trauma, an understanding of the diverse paths to healing, and the development of skills to support complex emotional needs effectively. Enhancing the curriculum to include these components will equip therapists to provide more effective, empathetic, and informed care, significantly improving outcomes for individuals grappling with mental health issues.
After 15 years I can confidently say that my professor was on to something. Don't get me wrong, the world needs healers, but the magnitude of change our culture longs for might just depend on the long reach of government policy. On second thought, it may depend on the long reach of the healing people to the powers that be.
At Root Counseling, we understand the complexities involved in the mental health crisis and are ready to help the issue at the root. To learn more about our services and therapists, you can do so here.