Mental health care is in high demand. Psychologists are leveraging tech and peers to meet the need

[This article is part of the 2024 Trends Report]

Ninety percent of the public think there is a mental health crisis in the United States today, with half of young adults and one-third of all adults reporting that they have felt anxious either always or often in the past year, according to a 2022 survey conducted by the Kaiser Family Foundation and CNN. One-third of respondents could not get the mental health services they needed. When asked about the specific barriers to accessing care, 80% cited cost and more than 60% cited shame and stigma as the main obstacles. The shortage of mental health providers is also prohibitive, with 60% of psychologists reporting no openings for new patients, according to APA’s 2022 Covid-19 Practitioner Impact Survey.

Mental health providers throughout the country share a sense of urgency to find new ways to meet the high demand for services, and innovators are exploring interventions that diverge from traditional therapy models. The creative approaches include forms of support that require less time commitment from individuals, can be offered through digital devices, or both. Clinicians and researchers are seeing the benefits of these strategies in settings such as community clinics and college campuses, where psychologists experience a duty to serve and patients are open to exploring new options to access help.

“The lack of access to mental health care is an equity issue,” said Martyn Whittingham, PhD, a licensed psychologist in Ohio who developed a brief group therapy intervention. “Too often people from marginalized communities struggle to access quality psychotherapy, and these innovative strategies can provide support to many more people.”

The use of mental health apps continues to skyrocket. Certain apps, such as digital therapeutics, can cost between $300 and $1,500 per year and are typically not covered by insurance. Psychologists are advocating at the state and federal level for health insurance organizations to cover the fees. Even though digital therapeutics have significant potential, psychologists are also “still figuring out how to use these tools in the context of clinical workflows,” said Stephen Schueller, PhD, an associate professor of psychology at the University of California, Irvine. “Evidence suggests that people benefit most from digital therapeutics when the apps are used in conjunction with some form of human support.” People may need coaching to troubleshoot technical problems and check-ins to see if symptoms are improving, he said.

Digital therapeutics could play an important role in providing support for underserved communities—specifically, people who speak languages other than English. But most mental health apps are only available in English. The Latinx community represents the largest non-White community in the United States, yet only 14.5% of mental health apps studied in a recent literature review had Spanish-language operability (Muñoz, A. O., et al., Frontiers in Digital Health, Vol. 3, 2021).

Schueller recently launched a study using a digital therapeutic called SilverCloud that offers cognitive behavioral therapy skills and practice exercises to help people address anxiety, depression, insomnia, and other issues. His team is using the Spanish-language version and training Spanish-speaking laypeople from the community to coach monolingual Spanish-speaking patients to use the app effectively. Schueller’s team is exploring how the addition of human support to the SilverCloud intervention impacts clinical outcomes and engagement with the app and how to best integrate this digital therapeutic into care delivery.

Jessica Schleider, PhD, an associate professor of medical social sciences at Northwestern University in Chicago, has been studying interactive digital tools that allow social media users to access single-session interventions that could be completed in one sitting. She was interested in creating a form of support beyond the automated crisis hotline messages users often receive when algorithms for social media platforms detect high-risk searches, such as “suicide” or “kill self.” Data revealed that few people were using these resources because the messages felt impersonal and invalidating, said Schleider. “These new interventions are not designed to solve problems in one session, but helping people make one good choice can shift the trajectory of their lives,” she said.

Open science has been a trend among researchers for many years, but psychologists are now also uniting to share the most reliable clinical assessment tools available with the public on one website. The idea to build this type of resource originated from Mian-Li Ong, PhD, a former graduate student working with Eric Youngstrom, PhD, a professor of psychology and psychiatry at the University of North Carolina at Chapel Hill. Eager to break down walls between psychology and the public, Youngstrom and several students formed Helping Give Away Psychological Science (HGAPS), a nonprofit organization working to share psychology to promote well-being.

Youngstrom and colleagues reviewed and statistically analyzed dozens of free assessment instruments for several conditions—including depression, anxiety, posttraumatic stress disorder, and attention-deficit/hyperactivity disorder—and made the most reliable measures available on the HGAPS website. People can take the tests online and then receive assessment scores, which they can share with providers. “Many therapists provide treatment without using a rating scale or screener,” said Youngstrom. “We tend to ask clients why they want therapy and focus treatment based on the response, but assessments can identify important issues that clients may not be aware of.” He hopes the assessments will prompt more people to seek therapy and benefit as much as possible from treatment.

HGAPS has also started building pages on Wikiversity that share the most reliable assessment tools in multiple languages for 16 mental health conditions, including autism spectrum disorder, bipolar disorder in youth, and substance use disorder. Some Wiki pages are also related to popular shows, such as Squid Game, offering mental health resources related to topics covered in the show, such as food insecurity and sexual violence. According to the HGAPS dashboard, there have been more than 400 million views of the organization’s resources on the web.

The importance of designing interventions that can reach more people is gaining momentum not only in the digital arena but also in individual and group therapy contexts. Data show that most patients do not return after their first therapy appointment, even when providers recommend ongoing treatment (Hoyt, M. F., et al. [Eds.], Single-Session Therapy by Walk-In or Appointment, Routledge, 2018). Aware of this reality, psychologist Windy Dryden, PhD, professor emeritus of psychotherapeutic studies at Goldsmiths University of London, started offering a form of therapy that could effectively help patients in one session. He has trained counselors at more than 20 universities in the United Kingdom to use the model, and the majority of patients he sees through an employee assistance program opt for one session even though eight sessions are covered by insurance (Australian & New Zealand Journal of Family Therapy, Vol. 41, No. 3, 2020).

In the last year, demand for Dryden’s single-session therapy training has increased because managers at health care agencies are motivated to reduce waiting lists. “I’m happy to provide training for this purpose, but this is not the primary purpose of single-session therapy,” Dryden said. “The goal is to help people walk away from a session with the help they are looking for.”

Patients complete a questionnaire before the session and share what they want from the meeting, how they have sought help in the past, what helped and what didn’t, and other information. Many patients struggle to accurately assess threats and their ability to cope in the face of threats, so Dryden helps them talk through scenarios to improve their accuracy. “This intervention is designed for populations that are poorly served,” he said. “People get what they want and waiting lists come down.”

Evidence suggests that the single-session approach is helping patients. In a systematic review of studies involving single-session therapy to treat anxiety disorders in youth and adults, researchers found that this intervention was superior to no treatment and similar to multitreatment sessions in reducing anxiety symptoms (Bertuzzi et al., Frontiers in Psychology, Vol. 12, 2021).

Focused brief group therapy (FBGT) is another strategy that increases access by empowering participants to practice skills in a safe environment. The model, which involves 8 to 12 sessions of group therapy, was developed by Whittingham when he was an associate professor of clinical psychology at Wright State University. The counseling center’s providers had long waitlists and a desperate need for an intervention that would fit within the school calendar system. “I knew students were developmentally concerned about relationships, and I wanted to use the power of the group to help people,” Whittingham said.

Participants take a preassessment called the interpersonal circumplex to understand their specific type of relationship distress. The tool assesses traits like assertiveness, dominance, agreeableness, and warmth, and members collaboratively establish goals with the therapist to improve relationships. During the meetings, participants restate their goals and practice new behaviors. If someone shares difficulties with a relationship, a group member who is striving to be less conflictual could practice being supportive by asking follow-up questions and affirming the individual. “This is not role play,” Whittingham said. “By interacting in real time, people experience deep physical and emotional responses because they are often afraid of rejection.” When they take risks by trying new behaviors and experience acceptance, participants are more willing to try the new behaviors in their lives, he said.

Although FBGT originated in the university setting, an increasing number of health care organizations have started contacting Whittingham to learn how to implement the model. Psychiatrist Meenakshi Denduluri, MD, was drawn to FBGT because the groups were here-and-now focused rather than centered on skills-based psychoeducation. Denduluri, who recently led FBGT in the Stanford University Department of Psychiatry and Behavioral Sciences in California, had also noticed that patients in individual therapy often struggled with interpersonal patterns that inhibited their ability to progress in treatment. “The psychological safety in the therapy groups allowed people to take interpersonal risks that they could not take in their personal lives,” she said.

College campuses are also increasingly leveraging the healing power of social connections to boost support for students struggling with mental health issues. Although peer support programs are not new, they are proliferating on campuses nationwide amid a current mental health crisis and a renewed understanding that supporting students is the responsibility of the whole campus community—including peers, said Zoe Ragouzeos, PhD, LCSW, executive director of Counseling and Wellness Services at New York University. These peer programs can reduce stigma, reach more people, and increase diversity in the support options, she explained.

Mental health providers at New York University were eager to incorporate peers into the school’s student support offerings in 2023, which prompted Ragouzeos to launch a peer listening program in which participants divided into pairs and responded to a prompt, such as “What is on your heart right now?” The participants took turns listening and sharing with responses of either “Is there more?” or “Thank you for sharing.” Partners ended the conversation by expressing in a positive way how it felt getting to know the other person. Survey results from more than 500 students showed that most participants felt less stress, anxiety, and overwhelm after the peer listening interactions. “It was remarkable how many students feel that they don’t have a forum in which they can speak about what is going on without interruption,” Ragouzeos said.

Peer support programs range from psychoeducation, in which trained students provide information on mental health topics, to support groups, where students gather in formalized settings to share their experiences and feelings. Ragouzeos has seen robust interest among students to learn how to help peers who are struggling and have conversations that boost well-being. “We can’t meet the needs without them because too few people come through the formal channels of counseling services,” said Ragouzeos. “It is our responsibility to find ways to engage students in helping each other and ensure they have the right resources to support one another safely.”