What we learned from a large-scale study about America’s mental health

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Majorities of Americans of all ages, races, generations and backgrounds say the U.S. has a mental health crisis.

Nine in 10 Americans in a new survey by CNN and the Kaiser Family Foundation say the country as a whole faces a crisis on that front, and about half of adults say they’ve experienced a severe mental health crisis in their family.

CNN ran a series of stories this week based on the KFF poll. Read the keynote here. And read this from CNN’s survey team about how the survey was conducted.

There’s also 988 – the three-digit number anyone can call in a crisis, but which the survey found few people know about.

For a broader look at the survey findings, I spoke with Ashley Kirzinger, director of survey methodology at KFF, over email about what we learned from the project. Our conversation is below.

WHAT IS MEANING: This is such a striking headline – 90% of Americans believe the US is facing a mental health crisis. Are there many things that 90% of Americans agree on? Also, can we say definitively that these results suggest change? Are more people now saying the US is in a mental health crisis?

KIRZINGER: You are absolutely right, we usually talk about how divided the country is and rarely do we have data that such a large majority of adults agree on. While we can’t definitively define this as a change because we don’t have an earlier comparison question using the exact wording, other data points show that there has clearly been a shift in people’s experience over the past few years. For example, the proportion of adults reporting symptoms of anxiety or depression in federal survey data has quadrupled during the pandemic. In addition, data from the CDC (US Centers for Disease Control and Prevention) shows that there has been an increase in both the number of drug overdose deaths and suicide rates. Many of these trends predate the pandemic, and some have worsened. I think this additional data helps explain why such a large majority now identify the current situation as a mental health crisis. People see their friends, family members, neighbors and in some cases themselves struggling. With more than half of all adults saying they or a family member has experienced a severe mental health crisis, it makes sense why we have nine in 10 who say the U.S. is facing a crisis.

WHAT IS MEANING: What prompted CNN and KFF to undertake this project? What did you see that made you think this was worth doing?

KIRZINGER: During the Covid-19 pandemic, polls by both KFF and CNN have shown that there is increased concern about the mental health of both adults and children in the US, and the toll the pandemic is having on the mental health of people, but also the barriers to those seeking mental health. Stress and worry about yourself and loved ones getting sick or dying from Covid-19, losing your job, losing childcare for working parents are just a few examples. Starting in earnest in March 2020, we found that around half of adults say the worry and stress of the pandemic is having a negative impact on their mental health. And for some groups, such as parents and younger adults, the proportions reporting negative impact are even higher. All of this made both the KFF and CNN teams interested in doing a project that focused solely on mental health, with some attention paid to the populations we know have been hardest hit by the pandemic.

WHAT IS MEANING: But the pandemic is not an overarching theme in the results. Why so?

KIRZINGER: When we started this project, it largely focused on the specific stress of the pandemic, but the truth is that for many Americans, the pandemic is now on the back burner and they are dealing with the normal stressors of everyday life. However, the worries and anxieties that arose during the pandemic have not gone away, and so people have to balance going back to work, getting their children back to school and dealing with many of the mental health issues that have arisen over the past two years. I think that while the survey questions don’t necessarily focus on the pandemic, the experiences and concerns of the past two years are definitely influencing how people responded to the survey.

WHAT IS MEANING: Is there a detail or number that surprised you?

KIRZINGER: As I began digging into the data, the disproportionate share of young adults reporting negative mental health, anxiety, depression, and difficulty accessing care continued to surprise me. I think the most striking data is that nearly half (47%) of adults under 30 say there was a time in the past year when they thought they might need mental health services or medication, but didn’t have received them. This shows there is still a lot of unmet need, even with three in 10 younger adults saying they have received mental health care in the past year. And when asked why they didn’t get the care or medication they thought they needed, the most cited reason among younger adults was the cost of such care.

WHAT IS MEANING: There is a real divide between older and younger Americans in the survey. How do younger and older Americans view mental health differently?

KIRZINGER: I’ve already talked about how younger adults report having more difficulty accessing care; but the perception of mental health is another difference between younger and older people. Half of young adults say they have felt anxious “always” or “often” in the past year (compared to a third of adults overall), a third describe their mental health or emotional well-being as “fairly satisfactory” or “poor ” (compared to 22% of adults overall), and four in 10 say they have been told by a doctor or other health professional that they have a mental illness such as depression or anxiety. The good news is that the majority of younger adults also report feeling comfortable seeking care for mental health issues and discussing mental health with their friends or relatives.

WHAT IS MEANING: I guess we are not asking the children themselves about their mental health, but there is a real concern in the results about children’s mental health. Do the results suggest that this is more than adults expressing a natural concern for younger people?

KIRZINGER: You’re right, this is a survey of US adults, but it includes a large sample of parents who we ask to report on their children’s experiences. And yes, the majority of parents and non-parents are concerned about how depression, alcohol or drug use, anxiety, and other mental health issues are negatively affecting teens in the US. But when we also ask about children’s experiences, parents’ concerns about the impact of the Covid-19 pandemic on children and teenagers have been a major theme in many KFF surveys over the past two years. Previous research we did earlier in the pandemic, when many schools were still in session, suggested that parents whose children attended online school reported more mental health and behavioral problems for their children than those who attended attended school. This new survey finds that around half of parents (47%) say the pandemic has had a negative impact on their child’s mental health, including 17% who say it has had a “great negative impact”, and a further three in 10 say there was a “minor negative impact.” So I think we have evidence that this goes beyond the general level of concern and reflects something that parents see in their children.

WHAT IS MEANING: There is near-unanimity about the existence of a mental health crisis, but division about how to deal with it. The country is divided over what role the government should play. There is a divide among adults about whether calling 911 would help in a given situation. What paths does the study suggest we should take to address this crisis?

KIRZINGER: A quarter of the public say they think calling 911 during a mental health crisis would do more to “hurt” than “help” the situation, including three in 10 black adults and four in 10 LGBT adults. In addition, larger shares of Hispanic adults and uninsured adults report not knowing who to call if there is a mental health crisis and also say they would not know where to find mental health services. However, when told about the new 988 number, a large majority of these demographics say they are likely to call if they or a loved one is experiencing a mental health crisis. Unfortunately, most adults say they haven’t heard anything about this new hotline.

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