Amid mental health crisis, UCLA Fielding professors call for public mental health efforts that address the societal conditions responsible

In a special issue of the American Journal of Public Health, guest editors Vickie M. Mays and Susan D. Cochran call for a reframing and redoubling of public mental health efforts.

With the United States facing a growing mental health crisis, much of the focus has been on the need to improve access to clinical services for individuals experiencing distress. But in a special issue of the American Journal of Public Health (AJPH), two UCLA Fielding School of Public Health experts say too little attention is being paid to the need for public mental health efforts that address the societal conditions that are contributing to increases in anxiety, depression, grief, post-traumatic stress disorder (PTSD), and other mental health disorders.

As guest editors of “The Social Context of Mental Health, Bereavement, and Grief: A Call for Public Mental Health,” published by AJPH March 27, UCLA Fielding professors Dr. Vickie M. Mays and Dr. Susan D. Cochran call for a redoubling of public mental health efforts. The special issue highlights the social contexts in which psychological distress, mental health disorders, bereavement, and complicated grief begin, as well as outlining public health strategies that take these contextual factors into account toward the goal of preventing or lessening the severity of mental disorders and promoting mental well-being.

The massive loss of life and the economic and social effects associated with the COVID-19 pandemic have exacerbated a mental health crisis that was already well underway, Mays and Cochran — who are clinical psychologists — write in the issue’s lead editorial. The societal change being experienced, they note, is compounded by the frequency of mass shootings, hate crimes, overseas wars, and the rising occurrence of natural disasters associated with climate change. 

“Not all problems of mental health are genetically or biologically driven — some of what we’re seeing comes from the social conditions of this time in which we live,” says Mays, a distinguished professor in UCLA Fielding’s Department of Health Policy and Management. “With all that’s going on in our society, many people are experiencing being anxious or depressed. As well, we are seeing an uptick in suicides among some of the youngest members of society. The projection is for a substantial increase in what we call prolonged grief disorder. It’s going to get worse, and yet we aren’t connecting the dots well enough of how people feel and what is going on in society these days.”

The special issue proposes a reframing of the role of public mental health and its need for policies and resources to address the increasing mental health spiral in the United States. While the field has increasingly focused on addressing social factors known to influence physical health, such as education, income, discrimination, and housing, Mays and Cochran argue that this approach has been less emphasized for mental health, where much of the attention has been devoted to increasing access to mental health treatment services for individuals.

“As a society we tend to focus on the individual, both vulnerabilities and responsibilities, but much of the distress we’re seeing results from policies and social contexts,” says Cochran, a distinguished professor in UCLA Fielding’s Department of Epidemiology. “Mental well-being is connected to hopefulness, and in many cases, improving people’s mental health requires addressing issues related to their ability to pay their bills and put food on the table. Mental well-being is also connected to fairness. When people come to believe that their own efforts will not result in desired achievements it may lead to perceptions of helplessness and disappointment, which may lead to risk for more serious mental health and substance use disorders. Something is wrong when we are seeing increased suicides among children 5-12 years of age, and we should try to better understand why this is happening.”

The importance of addressing social determinants of health in efforts to improve people’s mental well-being is illustrated in the AJPH special issue by Margarita Alegría of Massachusetts General Hospital’s Disparities Research Unit. Alegría and colleagues found that in a diverse population of individuals experiencing psychological stress and PTSD related to economic struggles, those who were referred to services for trouble paying utility bills reported fewer PTSD symptoms, improved levels of functioning, and better quality of care. The authors stress, however, that to be effective, the referrals must be accompanied by mechanisms to ensure that the services are delivered.

Two other articles in the special issue emphasize the importance of taking into account historical legacies of colonialism and racism when addressing mental health burdens, grief, and bereavement. An editorial by the University of Hawai'i at Manoa’s Lorinda Riley and her colleagues argues that individual psychological services following the devastating 2023 fires in Lahaina, Maui, will be insufficient in alleviating the long-term grief of residents without also addressing the collective community trauma from longstanding policies related to water rights, protection of indigenous cultures, and property ownership. Similarly, an article by Christopher D. E. Willoughby of the University of Nevada, Las Vegas, and Élodie Edwards-Grossi of Paris Dauphine University in France makes the case that successfully addressing the mental health needs of the Black/African American population requires understanding the historical legacy and enduring influence of psychiatric stereotypes about racial groups dating back to slavery.

The social context of suicide is the topic of a pair of articles. A study first-authored by Alina Arseniev-Koehler of the University of California, San Diego, along with authors Mays and Cochran, examined the documentation for more than 270,000 suicide deaths from 2003 to 2020. They found that the public health records for males who died by suicide were less likely than those for females to include notations of mental health conditions or treatment interventions. The authors conclude that gendered norms about social behavior may be contributing to an under-recognition of men’s distress. A separate commentary by Jane L. Pearson and Christine P.C. Borba of the National Institute of Mental Health calls for new research and approaches to inform more effective prevention strategies in light of the alarming increase in suicide among racial, ethnic, and gender and sexual-identity minority youth.

The special issue also includes a study by Brea L. Perry of Indiana University and her colleagues in which they found that depression and anxiety increased significantly in emerging adults during the COVID-19 pandemic in 2021, with strong and cohesive social networks associated with greater resiliency and lower severity of symptoms. In their editorial, Mays and Cochran note that the study underscored the shortcomings of technology as a replacement for in-person interactions in nurturing and sustaining young adults’ social development. 

“While it is widely recognized that COVID has impacted youth,” Mays and Cochran write, “the Perry et al. paper shows the need for balance in public health policy advisories so that the focus is not just on infection control, but also on policies' mental health consequences, particularly for emerging young adults.”

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