mental health business research

2023 Work in America Survey

The changing landscape of workplaces has drawn heightened attention to the needs and expectations of workers across the nation when it comes to mental health support.

In October 2022, U.S. Surgeon General Vivek Murthy, MD, released the office’s first-ever Surgeon General’s Framework for Workplace Mental Health and Well-Being .

The results of APA’s 2023 Work in America Survey confirmed that psychological well-being is a very high priority for workers themselves. Specifically:

• 92% of workers said it is very (57%) or somewhat (35%) important to them to work for an organization that values their emotional and psychological well-being.
• 92% said it is very (52%) or somewhat (40%) important to them to work for an organization that provides support for employee mental health.
• 95% said it is very (66%) or somewhat (29%) important to them to feel respected at work.
• 95% said it is very (61%) or somewhat (34%) important to them to work for an organization that respects the boundaries between work and nonwork time.

Fortunately, the majority (77%) of workers reported being very (36%) or somewhat (41%) satisfied with the support for mental health and well-being they receive from their employers, and more than half (59%) strongly (22%) or somewhat (37%) agreed that their employer regularly provides information about available mental health resources. Further, 72% of workers strongly (30%) or somewhat (42%) agreed that their employer helps employees develop and maintain a healthy lifestyle.

One female, full-time employee from the West summed up her positive workplace experience as follows:

My direct supervisor is amazing at respecting time boundaries and being mindful of my workload. He encourages me to manage my schedule in a way that is best for my wellness.

A male, full-time employee from the South summed up his positive workplace experience this way:

My job is a great atmosphere for work—good with your mental health—and I am happy when I work—love my job.

Improvements are still needed

Although some survey results show positive developments, the data also reveal the need for improvements. In fact, 55% of workers strongly (21%) or somewhat (34%) agreed that their employer thinks their workplace environment is a lot mentally healthier than it actually is, and 43% reported worrying that if they told their employer about a mental health condition, it would have a negative impact on them in the workplace.

Workplace stress also remains at a concerning level, with 77% of workers having reported experiencing work-related stress in the last month. Further, 57% indicated experiencing negative impacts because of work-related stress that are sometimes associated with workplace burnout , such as:

• emotional exhaustion (31%)
• didn’t feel motivated to do their very best (26%)
• a desire to keep to themselves (25%)
• a desire to quit (23%)
• lower productivity (20%)
• irritability or anger with coworkers and customers (19%)
• feelings of being ineffective (18%)

Survey data show that many workers are not getting the breaks from this stress that they both need and want. Only about one-third (35%) reported that their employer offers a culture where breaks are encouraged. Only two-fifths (40%) reported that their employer offers a culture where time off is respected, and only 29% reported that their employer offers a culture where managers encourage employees to take care of their mental health.

One male, full-time employee from the South described the problem with his workplace as follows:

Workload, not having enough employees, and working long hours have negative impact on my overall mental health, happiness, and well-being.

The reality of workplace mental health supports

• Only 43% reported that their employer offers health insurance with coverage for mental health and substance use disorders.
• Only about one-third (35%) reported that their employer offers a culture where breaks are encouraged.
• Only 29% reported that their employer offers an employee assistance program.
• Only 21% reported that their employer offers meeting-free days.
• Only 17% reported that their employer offers 4-day work weeks.
• Only 15% reported that their employer offers company-wide mental health days.
• Only 12% reported that their employer has people on-site who have received mental health training.

For employers, a failure to provide the mental health and well-being support that workers are seeking could harm talent recruitment and retention. Among workers overall, 33% said they intend to look for a new job at a different company or organization in the next year. Among those workers who said they are unsatisfied with the mental health and well-being support offered by their employer, that number rose to 57%.

More Work in America

• AI, monitoring technology, and psychological well-being

Press release

• APA poll reveals toxic workplaces, other significant workplace mental health challenges

The Surgeon General’s Five Workplace Essentials

Psychological science informed the development of the conceptual framework for the U.S. Surgeon General’s Framework for Workplace Mental Health and Well-Being. The framework emphasizes the foundational role that workplaces should play in promoting the psychological health and well-being of workers and our communities as a whole, and lays out five essentials for pursuing workplace mental health and well-being:

• Protection from harm (including security and safety)
• Connection and community (including social support and belonging)
• Work-life harmony (including autonomy and flexibility)
• Mattering at work (including dignity and meaning)
• Opportunity for growth (including learning and accomplishment)

APA’s 2023 Work in America Survey tracks the surgeon general’s five essentials, as well as the central core principles of worker voice and equity, all with an eye toward promoting an equitable, productive, and psychologically healthy future of work.

Related psychology topics

• Healthy workplaces
• Striving for mental health excellence in the workplace

Protection from harm

Nearly one in five say they experience toxic workplaces

Fundamental to the surgeon general’s framework is the principle that employers should protect workers from toxic workplaces. Unfortunately, almost one out of five (19%) respondents in this survey stated that their workplace is very or somewhat toxic.

Prevalence of toxic workplaces varies by industry

People in client/customer/patient service were more likely than office workers to characterize their workplace as “toxic” (26% vs. 14%, respectively). Further, people who work in person were more likely to report a toxic workplace than those who work fully remote (22% vs. 13%, respectively).

The majority (59%) of those who were not at all or not very satisfied with their job described their workplace as toxic. Further, 58% of those who reported a toxic workplace also reported that they intend to look for a new job at a different company or organization in the next year, compared with only 27% of those who did not report a toxic workplace.

One respondent, a full-time, female employee from the South, said:

In general, providing more assistance and resources for the betterment of my mental well-being is something that my employer should be doing. In addition, they should be fostering better working relations and working to diminish the toxicity and animosity that exists between several coworkers.

Another respondent, a full-time, female employee from the Northeast, stated that her employer should:

Make the work environment better by limiting toxic people and everyone being treated with kindness and respect.

Toxic workplaces are associated with diminished psychological well-being

Those who reported a toxic workplace were more than twice as likely to report that their overall mental health was fair or poor (58%) than those who did not report a toxic workplace (21%). Likewise, more than three-quarters (76%) of those who reported a toxic workplace also reported that their work environment has a negative impact on their mental health, compared with fewer than one-third (28%) of those who did not report a toxic workplace.

Those who reported a toxic workplace were more than three times as likely to report having experienced harm to their mental health at work, compared with those who did not report a toxic workplace (52% vs. 15%, respectively). In addition, 77% of those who reported a toxic workplace also reported that their employer thinks their workplace environment is mentally healthier than it actually is, compared with 49% who did not report a toxic workplace.

Experiencing a toxic workplace is associated with certain demographic and workplace factors

• More females (23%) reported a toxic workplace than males (15%).
• More people living with a disability (26%) reported a toxic workplace than those without a disability (16%).
• Employees working for nonprofit and government organizations were more likely to report a toxic workplace than those in private industry (25% and 26% vs. 17%).
• Those in upper management were much less likely to report a toxic workplace (9%) than those in middle management (21%), front-line workers (26%), and individual contributors 1 (18%). (This finding raises the question of whether it may be difficult for upper management to relate to assertions of employees that a workplace is toxic when upper management may not, themselves, be exposed to that aspect of the workplace.)

1 Individual contributor is defined as someone with a middle level or senior position who does not have management responsibilities.

Too many customer/client/patient service providers are experiencing some form of verbal abuse at work

Almost one-quarter (24%) of respondents said someone within or outside their organization had yelled at or verbally abused them at work within the past 12 months. More than a quarter of those who work in person reported some form of verbal abuse (26%), which is significantly more than those who work remotely (18%). In addition, close to one-third (31%) of those who do customer/client/patient service reported some form of verbal abuse, compared with just under one-quarter of manual laborers (23%) and office workers (22%) who reported the same.

Likewise, close to one in five (19%) reported having experienced bullying at work. Unfortunately, the percentage was significantly higher among those living with a disability (27%) than among those without a disability (15%). And when it comes to physical violence, approximately one in 10 manual laborers (12%) reported that someone within their organization displayed physical violence toward them, whereas about one in 20 office workers (5%) reported the same.

Discrimination in the workplace is still common

Fundamental to the surgeon general’s framework is the principle that employees should be protected from discriminatory workplace practices. However, more than one in five (22%) indicated witnessing discrimination in their current workplace and 15% reported experiencing discrimination. In addition, nearly one-third (28%) reported having witnessed slights, insults, or jokes that devalued the identity or negated the thoughts and feelings of others based on their identity or background. Further, 19% said they were targets of such behaviors.

The discrimination being experienced was not limited to race, ethnicity, or gender. For example, one respondent, a full-time, female employee from the South, stated that the aspects of her job that have a negative impact on her overall happiness, mental health and well-being are:

Age discrimination, no room for growth, favoritism.

Another full-time, female employee from the South said that aspects of her job that have a negative impact on her overall happiness, mental health and well-being are:

The recent decision to suspend all remote work and return to the office 5 days a week, disability discrimination, supervisors scheduling meetings during lunch hours and not allowing breaks.

Protection from harm: Key facts and figures

• Most workers (87%) reported being very (45%) or somewhat (42%) satisfied with the physical health and safety practices at their place of work.
• Nearly one-quarter (22%) reported having experienced or been afraid of experiencing harm to their mental health at work.
• In 2023, 22% of workers experienced harassment at work in the past 12 months.

Illness, idleness, and turnover: The costs of a toxic workplace

For a sizeable portion of Americans, work is demoralizing, frightening, and even traumatic. “Toxic workplace” is an abstract term to describe infighting, intimidation, and other affronts that harm productivity. The result—in any context—is high absenteeism, low productivity, and soaring turnover. The surgeon general’s framework provides a solid guide for employers who want to foster a healthy work environment:

• minimize physical hazards, discrimination, bullying, and harassment
• reduce long working hours, excessive workloads, and resource deficiencies that hamper employees’ ability to meet job demands
• normalize mental health care as a resource for employees
• operationalize equity, diversity, and inclusion policies to address structural racism, ableism, and implicit bias
• engage employees in organizational goals and mission statements to foster enthusiasm and commitment

Read more: Toxic workplaces leave employees sick, scared, and looking for an exit

Connection and community

Most workers have it, but too many still experience loneliness, lack of belonging and a sense of rejection

The surgeon general’s framework emphasizes that organizations that create opportunities for social connection and community can help improve mental health and well-being. This workplace essential rests on two human needs: social support and belonging.

Most workers are generally satisfied with their workplace relationships

Encouragingly, 89% of respondents said they are very or somewhat satisfied with their relationships with their coworkers, and 86% indicated they are very or somewhat satisfied with their relationships with their managers or supervisors.

Similarly, 82% said their workplace fosters positive relationships among coworkers, and 79% indicated that their workplace fosters positive relationships between managers and the people they manage. Moreover, most workers (81%) indicated that their workplace provides opportunities for collaboration and teamwork.

One respondent put it this way:

My company is like family. We do care for one another and do believe that we are stronger when we work together.

Yet workplace loneliness is experienced by a meaningful percentage of workers

Although most workers report being generally satisfied with their workplace relationships, more than a quarter (26%) said they have experienced feelings of loneliness or isolation at work. Despite the fact that those workers interact with others frequently, the prevalence of feelings of loneliness was higher for those in the customer/client/patient service industry (35%) compared with those doing office work (23%) or manual labor (22%).

Moreover, these feelings were more prevalent among workers with household incomes of less than $50,000 (31%) compared with those with household incomes of $50K–$124.9K (24%).

Feelings of loneliness and isolation were not confined to remote workers. Indeed, 25% of fully in-person workers reported feelings of loneliness and isolation.

Certain groups feel they do not belong at work

An overwhelming majority of workers (94%) said it is very or somewhat important to them that their workplace be a place where they feel they belong.

A male, part-time employee from the South, for example, stated that the aspect of his job that has the most positive impact on his overall mental health, happiness and well-being is:

They give me a sense of peace and that I belong here.

Unfortunately, one in five (20%) strongly or somewhat disagreed with the statement, “when I’m at work, I feel like I belong.” Black (23%) and Hispanic (22%) workers were more likely to feel a lack of belonging than their Asian (14%) colleagues.

Interestingly, only 10% of upper management employees did not feel a sense of belonging, compared with 19% of individual contributors, 22% of middle management, and 25% of front-line workers. This finding raises the question of whether it may be difficult for those in upper management to understand and relate to the lack of belonging felt by a quarter of front-line workers.

Certain groups feel unsupported because of their identities

Close to one-third (30%) of workers said they feel their workplace does not support them because of an aspect of their identity, such as race/ethnicity, gender, sexual orientation, ability status, age, etc.

This perceived lack of support was more common among workers ages 18–25 (45%) and 26–43 (34%), compared with workers who were 44 and older (11%–25%). Black and Hispanic workers were more likely to report feeling a lack of support from their employers (39% and 34%, respectively) than their White (27%) counterparts. In addition, the perceived lack of support due to identity was higher in LGBTQ+ workers (38%) compared with non-LGBTQ+ workers (29%).

Connection and community: Key facts and figures

• Fortunately, most workers (89%) reported being very (47%) or somewhat (42%) satisfied with their relationships with their coworkers.
• Most (82%) strongly (38%) or somewhat (44%) agreed that their workplace fosters positive relationships among coworkers.
• However, nearly one in five strongly (6%) or somewhat (13%) disagreed with the statement, “when I’m at work, I feel like I belong.”

How to foster connection at work

Psychologists describe two types of connections. “Strong ties” are close relationships, such as family members and good friends. “Weak ties” are acquaintances, like the people you chat with at the office water cooler. Research shows that weak ties are just as important as strong ones to a person’s life satisfaction. Psychologists suggest the following five tips to create a culture of community within the workplace:

• Make it a priority—create time and space for people to connect
• Use structured activities
• Establish norms
• But be flexible
• Get creative

Read more: A sense of belonging is crucial for employees

Work-life harmony

Many workers are achieving satisfactory work-life harmony, but there is too little respect for time off

The surgeon general defines work-life harmony as the integration of work and nonwork demands through the human needs of autonomy and flexibility. Work-life harmony involves, among other things, the amount of control one has over the “how, when, and where” one does their work.

Work-life harmony is associated with psychological well-being

Approximately eight out of 10 respondents (81%) reported being either very (42%) or somewhat (40%) satisfied with the amount of control they have over how, when, and where they do their work. Importantly, those who reported satisfaction with their level of control were much more likely to report that their overall mental health level is good or excellent (79%) compared with those who reported being unsatisfied with their level of control (44%).

Similarly, those who reported satisfaction with their level of control were much less likely to report that their work environment has a negative impact on their mental health (32%) compared with those who reported being unsatisfied with their level of control (62%).

Work-life harmony also involves having enough flexibility to mitigate conflicts between work and home life. Workers who said they did not have the flexibility to keep their work and personal life in balance were more likely to report that their work environment had a negative impact on their mental health (67%) compared with those who did have that flexibility (23%).

When asked to list two or three things about her current job that have a positive impact on her mental health, happiness, and well-being, one female, full-time worker from the South stated:

I have control over my day-to-day activities and can set my own agenda for each day. There is paid sick leave if I need it. There is time off for holidays where I can rest and rejuvenate myself.

In contrast, when asked to list two or three things that have a negative impact on her mental health, happiness, and well-being, one female, full-time worker from the Northeast stated:

No control over schedule. Little to no work-life balance. Poor management.

Certain job characteristics and demographics are associated with work-life harmony

Those who work in hybrid or remote arrangements were more likely to be satisfied with the how, when, and where they do their work (85% and 89%, respectively) than those who work in person (77%). Remote workers reported being slightly more likely to have enough flexibility at work to be able to keep their work life and personal life balance (75%) than hybrid (67%) or in-person workers (66%). Further, those ages 18–25 are more likely to agree that they do not have enough flexibility at work to be able to keep their work life and personal life in balance compared with those in older generations (41% vs. 26% of workers 44–57, 28% of workers 58–64, and 24% of workers 65+).

Other workplace and personal characteristics were also associated with satisfaction with the how, when, and where work is done. For example, office workers were more likely to be satisfied (86%) than those in manual labor (77%) or customer/client/patient service (76%). Those at for-profit organizations were more likely to be satisfied (83%) than those at nonprofit organizations (73%). Those in upper management were more likely to be satisfied (93%) than those in middle management (81%), front-line workers (76%), or individual contributors (78%). Finally, those living with a disability were less likely (77%) than those without a disability (84%) to be satisfied with this aspect of work.

Too many workers experience a lack of respect for their time off

Unfortunately, more than one-quarter (26%) of respondents strongly or somewhat agreed with the statement, “my employer does not respect my personal boundaries.” Further, fewer than half of respondents (40%) reported that their employer offers a culture where time off is respected. Those who do office work were almost twice as likely (48%) than those who do manual labor (25%) to report respect for time off.

Those who work in an organization with racial or ethnic diversity in senior leadership were more likely than those who do not to report respect for time off (42% vs. 34%).

When asked to list the most important things your employer either is doing or should be doing to help protect and foster your emotional and psychological well-being, a male, full-time worker from the South stated:

Respecting boundaries and personal days.

Similarly, a female, part-time employee from the West said:

Respecting my boundaries and not calling me on my two days off to come in to work just because they need a body. I need those two days for personal reasons and will not budge. Also they are flexible if I need time off for doctor appointments and things like that.

Work-life harmony: Key facts and figures

• Eighty-four percent of workers are satisfied with their work schedules (e.g., number of hours worked, flexible scheduling options offered, etc.) and 81% are satisfied with the amount of control they have over how, when, and where they do their work.
• However, about one-third (32%) said they do not have enough flexibility at work to be able to keep their work life and personal life in balance
• Just over one-quarter (26%) said their employer does not respect their personal boundaries.

Finding equilibrium: Tips to achieve work-life harmony

Tammy Allen, PhD, a psychology professor at the University of South Florida in Tampa, offers advice regarding how employees should respond if their employer wants them to check email on their personal time or vacation.

“Expectations should be aligned with the nature of the job and based on a mutual understanding between the employee and the boss. If the understanding is violated (e.g., you’ve agreed upon no emails on Sundays and the boss consistently expects emails to be answered on Sundays), then a discussion about realignment may be needed. You can discuss the importance of establishing boundaries and the importance of detachment from work to enable recovery from work for your health and well-being, which allows you to be at your best for the organization.”

Read more: Workers crave autonomy and flexibility in their jobs

Workers want to matter at work and want their work to have meaning

The surgeon general points out that people want to know they matter to those around them, which includes a sense of dignity and meaning. Indeed, 95% of respondents said that it is somewhat or very important to them to feel respected at work.

Mattering at work and meaningful work are associated with psychological well-being

Fortunately, 78% strongly or somewhat agreed with the statement, “I feel valued at work” and 87% strongly or somewhat agreed with the statement, “the work I do is meaningful.”

Those who reported not having meaningful work were much more likely to report that they were typically tense or stressed out during their workday (71%) than those who reported having meaningful work (45%).

Being micromanaged is associated with tension and stress

Four out of 10 workers (42%) reported feeling micromanaged at work. Those who feel micromanaged are much more likely than those who do not feel micromanaged to also report feeling tense/stressed during their workday (64% vs. 36%, respectively).

When asked what the most important thing is that his employer could do to protect and foster his emotional and psychological well-being, one full-time, male employee from the West stated:

Just not micromanage my time. Give me a job, give me a timeline, and leave me alone unless I ask for assistance.

Similarly, a female, full-time employee from the South said:

Stop micromanagement. It is so stressful to me. Let me do my job as hired to do.

Mattering at work: Key facts and figures

• The overwhelming majority of workers (93%) reported believing it is very (60%) or somewhat (33%) important to have a job where they feel that the work they do has meaning.
• Fortunately, the majority of workers (87%) strongly (48%) or somewhat (40%) agreed that the work they do is meaningful.
• However, more than one-quarter (29%) of workers strongly (10%) or somewhat (19%) agreed that they do not matter to their employer.

Mattering at work: Seven tips to help employees feel they’re making a difference

In the postpandemic era of “quiet quitting,” workers are rethinking their work-life integration and seeking jobs where they feel they can make a positive impact. But it’s hard to feel you’re making a difference if the organization doesn’t have a culture of respect. Fortunately, experts say, there are concrete things organizations and leaders can do to create a culture where every worker matters. Here are seven tips:

• Establish company norms
• Provide objective and subjective resources—e.g., tangible benefits and cultural support
• Make it safe
• Embrace diversity of thought
• Help employees understand how their contribution aids the organization’s mission
• Provide public recognition, being specific in praising achievements
• Say it again—praise employees

Read more: Employees really value making a difference at work

Opportunity for growth

Workers want and need opportunities for growth

This essential from the surgeon general’s framework is based on the human needs for learning and accomplishment. These needs are consistent with the survey results. The overwhelming majority of workers (91%) said it was very or somewhat important to them to have a job where they consistently have opportunities to learn, and 94% said it was very or somewhat important to them to have a job where they get a sense of accomplishment.

Although most workers are satisfied with their opportunities for growth, there is room for improvement

Almost three-quarters of respondents (74%) indicated they are very or somewhat satisfied with the opportunities for growth and development at their place of work. Over three-quarters of respondents (79%) said that they are very or somewhat satisfied with the opportunities they have to be innovative or creative in their work. More than two-thirds (70%) strongly or somewhat agreed with the statement, “I feel I can reach my highest potential at my current place of work.”

Opportunities for growth are associated with psychological well-being

Workers who were somewhat or very satisfied with their opportunities for growth and development more often reported good or excellent mental health (79%) than those who were unsatisfied (52%). Further, workers who lacked opportunities for growth and advancement were also more likely to typically feel tense and stressed out during their workday (66% vs. 42%).

Certain demographic and organizational characteristics associated with satisfaction regarding opportunities for growth and development

Men were more likely to report being satisfied with growth and development opportunities (77%) than women (71%). Higher-income workers ($125,000+) also were more likely to report satisfaction with growth and development opportunities (79%) than workers making less than $50,000 (68%).

Workers in for-profit settings were more likely to report satisfaction with growth and development opportunities (76%) than those in nonprofit organizations (65%). Those who reported working for an organization with equity, diversity, and inclusion policies were more likely to report being satisfied with opportunities for growth and development (78%) than those in organizations without such policies (64%). Those who reported working for an organization with racial or ethnic diversity in senior leadership were more likely to report being satisfied with opportunities for growth and development than those in organizations without such diversity (77% vs. 68%, respectively).

Overall, those who were satisfied with their opportunities for growth and development were far more likely to report being very or somewhat satisfied with their jobs (96%) than those who were not (64%).

Opportunity for growth: Key facts and figures

• About three-quarters (74%) of workers reported being very (34%) or somewhat (40%) satisfied with the opportunities for growth and development at their place of work.
• Most workers (79%) reported being very (36%) or somewhat (43%) satisfied with the opportunities they have to be innovative or creative in their work.
• However, fewer than half (47%) reported that their employer offers educational opportunities.

These growth opportunities help employees advance at work

A 2018 study by Gartner, a research and advisory firm that helps companies develop and implement HR strategies, found that a lack of career opportunities is the main reason employees leave an organization. By investing in employee growth, companies can reduce costly turnover and increase job satisfaction among employees of all ranks. Some key strategies to foster growth include:

• Providing quality training and mentoring
• Establishing pathways for career advancement
• Delivering relevant, reciprocal feedback
• Emphasizing a culture of learning

Read more: Lack of growth opportunities is a big reason why employees leave jobs

Methodology

The research was conducted online in the United States by The Harris Poll on behalf of APA among 2,515 employed adults. The survey was conducted April 17–27, 2023.

Data are weighted where necessary by age, gender, race/ethnicity, region, education, marital status, household size, full-time/part-time employment, employment sector, industry, household income, and propensity to be online to bring them in line with their actual proportions in the population.

Respondents for this survey were selected from among those who have agreed to participate in our surveys. The sampling precision of Harris online polls is measured by using a Bayesian credible interval. For this study, the sample data is accurate to within ±3.1 percentage points using a 95% confidence level. This credible interval will be wider among subsets of the surveyed population of interest.

All sample surveys and polls, whether or not they use probability sampling, are subject to other multiple sources of error which are most often not possible to quantify or estimate, including, but not limited to coverage error, error associated with nonresponse, error associated with question wording and response options, and postsurvey weighting and adjustments.

Survey questions

• 2023 APA Work in America survey questions (PDF, 351KB)
• 2023 APA Work in America survey topline data (PDF, 827KB)

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Mental Health Has Become a Business Imperative

• Workplace, Teams, & Culture
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• Work-Life Balance

Of the many issues we have faced throughout the past two years, perhaps the most surprising but important is mental health. Studies now show that nearly 81% of workers face some form of burnout or mental health issue, and 68% of employees say their daily work has been interrupted by these challenges. 1

Health care is one of many industries, along with retail, transportation, and hospitality, that has been especially affected by burnout and stress as a physically and mentally depleted workforce has faced peaks in demand for services.

Large health care providers like Provident and HCA, among others, have told us that their employees are “undergoing trauma, just like our patients.” This, in turn, is leading to sickness, absenteeism, and staff turnover. There’s a domino effect on remaining teams, too, as these employees are overstretched and unsettled and face high levels of stress in order to meet patient needs with fewer people.

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From our regular discussions with HR leaders around the world, it’s clear that the organizations outperforming their peers are those that have cultivated a strong sense of empathy and flexibility, developed new skills to address workforce needs, and extended holistic mental health support to employees.

Like many of the changes that have come out of the pandemic, this new approach to mental health looks set to be a permanent one. As they begin to see the value in the link between mental health and the well-being and overall performance of a business, leading companies are going the extra mile to understand and respond to the way employees feel day to day.

The CEO of Starbucks has stated publicly that he considers the mental and emotional health of the company’s workers to be its biggest challenge coming out of the pandemic. 2 Morgan Stanley, which employs many people who have advanced degrees and are exceptionally high performers, now has a chief medical officer dedicated to maintaining and improving mental health across the organization.

Within human resources departments, we’re seeing a growing trend of companies promoting new roles focused on measuring and improving mental health at work.

Our research (a study of over 1,000 companies) examined which business and people practices have the most impact on business outcomes, people outcomes, and innovation. This analysis points to the importance of transitioning from the traditional focus on employee benefits to one that encompasses job and work design, management, rewards practices, a demonstrated commitment to psychological safety and fairness, and a culture of employee listening.

This research shows that “healthy” organizations outperform their peers in a range of ways. Rates of absenteeism are almost 11 times more likely to be lower, and these employers are more than three times more likely to retain people. Companies that care about staff well-being are at least twice as likely to delight customers, to be identified as a “great place to work,” and to exceed financial targets. These companies also adapt more readily to change and are more effective at innovating . 3

From HR Issue to Management Priority

We’ve found that within organizations, the higher up that mental health is prioritized, the bigger the impact of any interventions. Until recently, mental health was seen as a benefits problem, relegated to the realm of HR. Companies offered employee assistance programs, for instance, or insurance-provided advice networks to help staffers find a counselor. These programs, while widely available, were rarely used in practice, due to employees’ worries about the stigma of asking for help. Plus, benefits managers were continuously concerned about the programs’ cost.

Now, this equation has changed completely. Mental health is scaling the management agenda, and money is being made available to invest in identifying and addressing issues with positive, proactive, and increasingly creative solutions.

Pioneering companies are creating programs for sabbaticals, time off, child care benefits, and far more flexible work arrangements. Tools like real-time pay systems , regular feedback sessions, the four-day workweek , and far more discussions with leadership are all efforts to make work more humane and healthier for workers. Simple policies like allowing dogs in the office can cost so little yet matter so much to employees.

In many cases, technology platforms and targeted apps are providing some of the answers — from meditation apps geared toward mindfulness to tools that improve the employee experience by helping to alleviate administrative strain. But for maximum and lasting impact on mental health, change needs to happen within the context of culture, where conversations about mental health are encouraged and normalized.

Any good, proactive mental health initiative starts with listening. Most companies, and most business leaders, won’t know how much stress there is in the organization unless employees tell them. Sentiment surveys, open town hall meetings, and exit interviews are all crucial inputs for gathering facts and bringing attention to the issues employees are facing.

The real shift here is that many companies are now removing the stigma attached to talking about matters of mental health. People can say, “I’m not feeling well today,” or “I’m tired,” or “I’m having troubles at home”; that type of feedback is critical.

Monitoring in this way will help senior managers pinpoint any particular hot spots in the business for further investigation.

Innovation in Action

During the pandemic, the leadership team at global telecommunications provider Verizon created a series of biweekly conference calls to help senior managers empathize with the high levels of turnover, stress, and employee burnout in its field force and share ideas on how to address these urgent issues.

JPMorgan Chase implemented a well-being application for all of its employees that asks staff members and leaders to check in regularly to tell the system how they feel that day. HR monitors these signals and data inputs to see whether certain groups are experiencing major changes in stress, enabling HR team members to connect managers and challenged teams with support.

Royal Bank of Canada requested that all managers take a course in mental health, developed by the public mental health council of Canada. This course helps leaders develop skills for recognizing various forms of stress or other illnesses, using the language of mental health.

Airline reservation and technology company Sabre surveyed employees regularly to understand their stress and productivity challenges in the move to remote work. Using this input, the company shifted to a new management model, creating a set of focused tools for managers to diagnose, improve, and continuously monitor employee stress and productivity.

Toward the Genuinely Healthy Organization

Creating a robust and consistent process for monitoring employee well-being allows employers to spot issues before they escalate and to provide timely help. Encouragingly, of the 1,000-plus companies we studied, about 15% now think about overall employee well-being as an integrated part of their strategy .

Related Articles

This has implications for leaders’ skill sets and personal attributes, too, which over time will have a bearing on who is promoted into senior roles. I believe very strongly in human-centered leadership — the idea of putting your people first and prioritizing their health. Managers or team leaders have to keep in mind that people’s sense of safety and security is the most important thing. Once that’s in place, you can talk about everything else. But if that isn’t there, everything else you’re working toward will suffer.

Now more than ever, it’s time to think about the employee experience more holistically. It isn’t just my own work that’s highlighting this. Study after study shows that mental health is the top-rated benefit requested by workers. In response, leaders, managers, and employees at all levels must advocate for a proactive approach to mental health. It’s both the right thing to do and a solid business strategy.

About the Author

Josh Bersin ( @josh_bersin ) is a global industry analyst covering HR, talent, and leadership and is the founder of the Josh Bersin Academy.

1. “ Employer Support Has a Direct Impact on the Health and Resilience of Employees, According to a Mercer Survey ,” Mercer, Sept. 13, 2021, www.mercer.com; “American Worker in Crisis: Understanding Employee Mental Health in Unprecedented Times,” PDF file (Burlingame, California: Lyra Health, July 2020), https://get.lyrahealth.com; and “ Edelman Trust Barometer 2022 ,” PDF file (Chicago: Edelman, January 2022), www.edelman.com.

2. A.R. Sorkin, “ Howard Schultz: Starbucks Is Battling for the ‘Hearts and Minds’ of Workers ,” The New York Times, June 11, 2022, www.nytimes.com.

3. J. Bersin, “ The Healthy Organization: Next Big Thing in Employee Wellbeing ,” Josh Bersin (blog), Oct. 27, 2021, https://joshbersin.com.

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Opening up About Mental Health at Work

Last summer, American gymnast Simon Biles won the admiration of many when she withdrew from several Olympic events for mental health reasons. Biles is one of a growing number of high-profile individuals who have recently shared personal mental health struggles. Olympic swimmer Michael Phelps. Superstar Lady Gaga. Prince Harry. All have used their platforms to bring mental health issues to the fore.

When celebrities voice concern about their mental health, they raise public awareness and help reduce stigma. But how does this heightened attention to mental health affect the workplace?

The numbers are telling Mind Share Partners is a nonprofit organization focused on mental health at work. In the spring of 2021, they conducted a survey of full-time employees in the United States. Their findings, revealed in Mind Share Partners’ 2021 Mental Health at Work Report in Partnership with Qualtrics & ServiceNow , are eye-opening.

Over three-quarters (76%) of respondents indicated that they experienced at least one symptom associated with a mental health condition in the past year. This was up from the already significant percentage (59%) found in a similar 2019 Mind Share Partners survey. The most frequently reported symptoms were burnout, depression, and anxiety, and these challenges aren’t fleeting. For more than one-third (36%) of those surveyed, symptoms persisted from five months to a year. Employees at all levels experienced mental health symptoms, with slightly greater instances reported by executives (82%) and C-level professionals (78%).

Mental health challenges have a profound impact on an organization. One-sixth (17%) of respondents said that they missed more than 10 days of work in the past year because of mental health challenges. Further, 77% experienced a decline in productivity due to mental health. And an astonishing one-half of those surveyed said that, at some point during their career, they left a job due to mental health concerns.

Absenteeism. Productivity. Retention. It’s no wonder that organizations are beginning to pay serious attention to mental health. “Mental health challenges,” as the Mind Share report’s authors wrote, “are [now] the norm.” Other global research confirms the Mind Share Partner findings.

Deloitte conducts an annual survey of millennials (and now, Gen Z as well) to identify trends involving the digital natives who are rapidly coming to dominate the workplace. Deloitte’s 2021 Global Millennial Survey Report noted that nearly one-third of respondents said they’ve taken time off work “due to stress and anxiety caused by the pandemic.” Among those who didn’t take time off, 40% indicated that, even though they chose to go to work, they were “stressed all the time.“

Why now? What’s causing unprecedented levels of mental health issues in the workplace? As Deloitte found, the pandemic is a significant driver. But it’s not the only factor. There are myriad other factors that combine to exert pressures that affect our mental health. Globally, there is political unrest and significant polarization. Environmental concerns including climate change weigh heavily on people’s minds, especially among those in the rising generations. There are heightened concerns over the growing wealth gap, over racism, over diversity and inclusion of populations that have long been marginalized. And, on top of all these issues, they’re also stressed about the need to find purpose and do meaningful work.

Organizations respond to mental health concerns Fortunately, as employees increasingly become more transparent about their mental health challenges, organizations are stepping up to help address them. In many cases, the pandemic gave businesses the immediate need – and the opportunity – to tackle issues around workplace flexibility. Senior leaders, experiencing mental health challenges of their own, are reaching out to employees with greater authenticity. They’re hearing and acting on concerns about diversity, equity, and inclusion, and about purposeful work. And they’re acknowledging that a focus on mental health is no longer a ‘nice to have’ but a necessity in the 21st century workplace.

Let’s talk

Change isn’t easy, but we can help. Together we’ll create informed and inspired leaders ready to shape the future of your business.

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Livestream Event: Suicide Prevention in Health Care Settings

September 11, 2024

STEPHEN O’CONNOR : Hello. Welcome, everyone. Thank you for joining us today. September is National Suicide Prevention Month. And for our discussion today, we're focusing on suicide prevention in healthcare settings. I'm Dr. Stephen O'Connor, chief of the suicide prevention research program at the National Institute of Mental Health or NIMH for short. NIMH has partnered with the Substance Abuse and Mental Health Services Administration to host today's event. I'm joined by Dr. Richard McKeon, a senior advisor for the 988 in behavioral health crisis office at SAMHSA. Richard is part of the team that led the creation of 988, the new and simplified nationwide three-digit voice and text hotline, providing counselors 24/7 for suicide, mental health, and substance use crises. Richard.

RICHARD MCKEON : Thank you. And so let me just mention and we'll be talking more about 988   , which is available to anyone who is having suicidal thoughts or experiencing a behavioral health crisis of any sort. You certainly don't have to be thinking of suicide in order to call and to get help. But today, we won't be making any specific medical or treatment recommendations for anyone or any diagnostic recommendations. But you should be aware there's also a resource in order to find treatment that SAMHSA supports. And it can be found at findtreatment.gov  . You see the URL there at the bottom of your screen. So we wanted you to be aware of that. Thanks.

STEPHEN O’CONNOR : Okay. Great. Thank you, Richard. So we'll also use a few minutes of our chat today to answer some of your questions. So please enter them as comments under the live stream on either Facebook or YouTube. And we'll do our best to answer as many of those as we can in the time that we have. I'd also like to introduce Dr. Brian Ahmedani, who's the director of the center for health policy and health services research at Henry Ford Health. We're going to hear from Brian just a little bit about some of the really great work that he's been leading. So suicide is a major cause of death in the United States, and many people at risk don't get the mental healthcare that they need. In many cases, people see a healthcare provider in the weeks or months before they make suicide attempts. And that makes settings like emergency departments or doctor's offices key points for prevention and intervention. So NIMH and SAMHSA provide funding for research and programming that's aimed at enhancing suicide prevention efforts, particularly within healthcare settings. This work focuses on improving identification, intervention, and treatment strategies to reduce suicide risk among individuals receiving healthcare services. So NIMH and SAMHSA have supported Dr. Ahmedani's efforts in these areas over the years. So we're really glad to have him join the discussion today. One of the ways that NIMH and SAMHSA have supported work to advance suicide prevention in healthcare settings is through a learning healthcare approach that's known as zero suicide. So Brian, would you describe how it originated, what's involved, and the types of projects that you've been working on?

BRIAN AHMEDANI : Yes, thanks so much, Stephen. Overall, the goal of zero suicide is that instead of thinking that suicide is inevitable like we used to, we're now thinking that suicide is preventable and that healthcare systems have a responsibility to try and prevent every single suicide possible. The zero suicide approach focuses on improving practices within healthcare settings to better identify and support individuals at risk for suicide. Our goal with the zero-suicide model at Henry Ford is to achieve zero suicides among those who receive healthcare in our system and then go even further to partner with others to eliminate suicide throughout our communities. So the key areas of the framework, zero suicide, are screening and assessment. Here, we emphasize the importance of routine screening for suicide risk and behavioral health in primary care and in many other medical settings like the emergency department. We advocate for the use of standard and universal tools to identify individuals who might be at risk even if they are not presenting with obvious mental health or suicide risk issues. With universal screening tools, it really helps clinicians discern when patients might be at risk. The next step is really engagement and treatment. When someone discloses having suicidal thoughts, we engage them into creating a safety plan to help manage suicide intensity and stay safe. We also emphasize the use of empirically supported treatments for suicide prevention like cognitive behavioral therapy for suicide prevention and dialectical behavior therapy. We leveraged supportive care coordination, improved access, 988 crisis lines like Richard was already referencing, and other local resources to provide comprehensive services aimed at delivery of care, where and when the patient needs it.

BRIAN AHMEDANI : So the next step is follow-up and continuity of care. This approach also highlights the need for effective follow-up procedures for individuals at risk for suicide. This includes ensuring patients receive ongoing support after the initial assessment and intervention. Transitions in care can be really difficult, especially when people have more acute settings and return home. So it's important to stay connected and provide support while they establish and return to care with their outpatient team of providers. Also, training and education, really important. Training of healthcare providers to recognize and address suicide risk is really important. This includes enhancing their ability to communicate with patients about suicidal thoughts and providing appropriate referrals and support. And finally, one of my favorite topics, data and outcomes. I often use data and driven approaches to evaluate the effectiveness of suicide prevention strategies in our healthcare systems. And our research team includes analyzing outcomes related to the implementation of screening programs and interventions. So those are the most common areas of zero suicide. Overall, we've got a lot of data that show that this model works, not only at Henry Ford but at many other different kinds of healthcare systems. The zero-suicide model originally was developed in 2001 at Henry Ford Health and has showed immediate progress. The system, our health system, Henry Ford, measures suicide rates within one year of a patient visit, and we began experiencing up to 70 to 80 percent reductions in our suicide deaths in the years that followed implementation.

BRIAN AHMEDANI : In our recent NIMH-funded research study, we also found that implementing the zero-suicide model across six different healthcare systems across the country, serving more than 10 million patients per year, was associated with significant reductions in suicide attempts and deaths in behavioral health clinics. Importantly, and also as part of this study, Dr. Julie Richards at Kaiser Permanente in Washington also led a systematic implementation of our zero-suicide model in 22 different primary care clinics. The implementation was linked with up to a 25% reduction in suicide attempts in that setting. These encouraging data have now supported larger-scale efforts and approaches, such as our My Mind program, which is a partnership between provider organizations and Blue Cross Blue Shield to implement the zero-suicide model in all of the primary care and behavioral health settings across Michigan. In addition, through support from SAMHSA, we have also developed innovative zero-suicide models stemming from the emergency department. We are also further studying ways to link community organizations and partners with healthcare settings to reach individuals at risk in those areas as well. This includes our state-funded refugee pilot program and our NIMH-funded suicide prevention center called NCHATS, which is studying ways to link the criminal legal setting with our healthcare systems for cross-sector suicide prevention, consistent with one of the primary goals of our recently released national strategy on suicide prevention. As the new leader of Zero Suicide International, our team at Henry Ford is partnering with leaders from over 20 countries around the world to work on strategies to prevent suicide globally.

STEPHEN O’CONNOR : Wow. Very busy making a huge impact in doing really rigorous science in order to inform what the most effective ways to implement this are. And so we can't thank you enough for the work that you do and making a huge impact and really starting to see partnerships all around the globe. So really exciting to see that. And I'm glad that you brought up the center that you co-lead. And I would just mention to people that that was an effort by NIMH to accelerate research that can really have a near-term impact on reducing suicide risk in the country. So those are called practice-based suicide prevention research centers . And the aim there is to use clinical practice settings as real-world laboratories where multidisciplinary research teams can work together, they can develop, they can test, and they can refine their approaches, and they can figure out in partnership with these practice partners what can actually be implemented and scaled up and sustained over time. And they're really focusing on groups that have traditionally had disproportionately high risks of suicide, or maybe in more recent years, there's been a disproportionate increase in their risk over time that really places them at an elevated level compared to other groups. And so in line with NIMH's commitment to addressing mental health disparities, those centers are really kind of focused on those groups and wanting to understand what's going to work best for those communities of practice, what really resonates with the people who are receiving the services because we really want that to fit. We don't want to just try and plug and play things, and then they're not going to be acceptable or sustainable. So we're talking about health services. And certainly, those learning healthcare approaches are important.

STEPHEN O’CONNOR : Richard was also talking about SAMHSA's lead role in developing 988 and really, I think, changing the vision of the role that crisis services play as part of the network of healthcare. So we really wanted to spend some time talking about that expansion as well. So Richard, could you talk a little bit more-- a little bit more about 988 and how the Lifeline came about? SAMHSA is the lead agency in operating and developing this. So really interested to hear about that from you.

RICHARD MCKEON : Sure. Thank you, Stephen. I'm glad to be able to talk to people today about 988. And it's a fascinating story in terms of how it came about. The United States has had a national hotline network focused on suicide prevention and mental health crises for a significant period of time, and it's called the National Suicide Prevention Lifeline. It was launched in 2005. Both SAMHSA and NIMH did evaluation and research studies that demonstrated its effectiveness. But the way to access it was through a 10-digit number, which was at the time, 1-800-273-8255. But the issue was that a 10-digit number is a difficult thing to remember in the middle of a suicidal crisis, right, by contrast. And SAMHSA in our report to the Federal Communications Commission, first recommending a three-digit number, made the point that if somebody was experiencing severe chest pains and was with a family member, it's likely both the person and the family member is going to remember the number 911. But in a suicidal crisis, it was unlikely that either the person or the family member was going to remember 1-800-273-8255. So our feeling was that a three-digit number would be easier to remember and would lead more people to be able to access when they were in crisis and that that would help us save lives.

RICHARD MCKEON : So 988 was launched in July of '22. And in the little over two years since that launch, we have responded to over 10 million people who contacted us by phone, by chat, or by text. And 988 is also available by text as well as by calling. Both of those were by order of the Federal Communications Commission. And so we are very pleased that we have been able to accomplish this, but we have additional goals as well, Stephen.

STEPHEN O’CONNOR : Yeah. Tell me a little bit more about that. Thank you. I understand there are these three broad horizons with the vrisis services network in 988. Could you kind of speak to those a little bit and what the timeframe is for those?

RICHARD MCKEON : Yes. We were hoping when 988 was launched that a three-digit number could play a transformative role in behavioral health crisis services in much the same way that over a half a century 911 became a catalyst for the development of emergency medical services in the United States. And the way that we framed our goals has been in to have someone to talk to, and that's what 988 provides 24 hours a day, 7 days a week, 365 days a year. But also, someone who can respond, such as a mobile crisis team that can respond to where the person is, and that can go without the police, unless there's a specific reason that an ambulance or police would be necessary such as a suicide attempt in progress. And a safe place to go for help. And one of the things that we wanted to accomplish was to reduce the burden on emergency departments. We know too many emergency departments across the country have experienced significant emergency room boarding. And so that people may be in an emergency department but not able to get the help that they need. So crisis stabilization units outside of hospitals and similar programs can be safe places for help. So that is kind of the three-part stool. Not that there aren't other very important services. But those are the three key services that SAMHSA identified in our national guidelines for behavioral health crisis services.

STEPHEN O’CONNOR : Okay, great. Thanks. And you mentioned the impact that you've been seeing in terms of the uptake and increasing and reaching people in response. Are there any innovations that have come about with the crisis line or any of the other work that you were mentioning?

RICHARD MCKEON : Yes. Absolutely. And both the chat and the tech services are relatively recent innovations. And Dr. Madelyn Gould from Columbia has published on the effectiveness of the Lifeline chat service. And she's also published on text outcome data from the crisis text line. And one of the things that we know is that young people are more likely to text than to call, and they are also more likely to have current suicidal ideation. So those are really important. But there are other additions that we've made. For a long time, we have had a connection to the veterans' crisis line   , a press one option, as well as a Spanish-language subnetwork when you can press two. But we have added, since July '22, several additions. While we had a Spanish language subnetwork for phone, there is now Spanish language chat and text. There is also now a national press three option for LGBTQI+ youth as well as chat and text that go along with that. We have added a video phone for those who are deaf and hard of hearing and who need that to facilitate their access. And in the state of Washington, they've even added a press four option to allow connection to a program called Native and Strong, a hotline affiliated with one of our centers where the entire staff is American Indian and are able to provide those kinds of culturally specific and competent services.

STEPHEN O’CONNOR : Yeah. Okay. It's just really impressive about trying to deliver the best option that's going to be the best fit for different groups of people to make sure that we can really help them be as effective as possible. So I love hearing about that. If someone is watching today and they're saying, "Okay, I don't work in one of these crisis centers. I'm not a trained provider," what would I do if someone I knew loved was having suicide experiences? What could I do that would be helpful, protective for them? Do you have any recommendations that you'd cheer?

RICHARD MCKEON : Yeah. So I would mention a couple of things, if you're worried about someone, first off, don't be afraid to ask the question, "Are you thinking about suicide?" It's not an easy question in the sense people are often anxious because they don't know what to do if the answer should be yes. But sometimes people are very isolated with their suicidal thoughts and won't bring it up themselves but may very well acknowledge that they're thinking about suicide if asked. And then being aware that 988 exists. Letting people know that it's there for them. And if somebody's unsure about a situation, 988 can be called by family members or friends if you're worried about someone else. You're not sure how to handle a situation, 988 is there. But one of the things that's really important regarding to ask the question is that one of the most important things someone can do is really to be there with the person, right, so that they are not isolated with their suicidal thoughts, that someone doesn't panic when they hear that but to express the caring and concern. And it's useful to have information about what kind of help is available. 988 is one, but of course, also accessing mental health services, talking to your primary care provider is there. Now, another important piece to be aware of is the importance of keeping people safe, particularly during the interim if they're having suicidal thoughts. And that means that paying attention to the issue of whether the person has access to lethal means, right?

RICHARD MCKEON : In the United States, about 54% of suicides are by firearms. And so safe storage of firearms is an important suicide prevention measure. But there are also maybe other things to pay attention to in terms of medications. We also have looked at the importance of various kinds of barriers to jumping. For a long time, people are familiar with the story of the Golden Gate Bridge, where they're now finally working on building a barrier there. So anything that can reduce access to lethal means, even sometimes for a short period of time, can be instrumental in saving a life. And then following up with a person. We would all wish that if you got through a terrible moment or the worst day of your life, that everything would be fine. But sometimes suicidal thoughts might recur. And so following up with people staying connected and helping to connect the person to care. We used to think on the hotlines that it was like a one-and-done intervention. Now we really promote follow-up after the call, staying in contact until the person is connected to a health or mental health provider.

STEPHEN O’CONNOR : Okay. Well, thank you. So one of the take-home messages there is that you don't have to be perfect. It is good to know in advance, just some really fundamental things that you can do that could help that person in that moment. You don't have to fix all the problems. But I think being calm, kind of knowing what your plan is, there are things that you can do that can help instill some hope and help convey to that person that they're not alone, and you're going to be with them as they kind of go through that dark moment, and it's something that you want to do. You're choosing to do that. So thanks for describing that. I think the last thing I wanted to touch upon with you I was hoping that you would be able to talk about was ways that healthcare providers can take care of themselves as well. Thinking about people who are working in the crisis call centers, thinking about first responders. Do you have any tips for people about how they can attend to their own mental health as they're helping other people?

RICHARD MCKEON : I think that's a really important point, Stephen. It's very important for healthcare providers, behavioral healthcare providers, and crisis workers, whether it's on the lines, on mobile teams, to be aware of the impact on their own mental health of what they experience. And repeated exposure to people who are thinking about suicide, but also people who have made a suicide attempt and, of course, death by suicide, has a powerful impact. And it's very important that people are aware of that impact and get the support they need, which can be through supervision. It can be peer supervision or with your direct supervisor. It's very important for crisis services to have a defined approach to supporting the wellness of the people working with them. So on the Lifeline on 988, there is support that is provided through our administrator, Vibrant, to call centers when there has been exposure, particularly to a death by suicide. And this is really important.

RICHARD MCKEON : We know, for example, that if you look at one type of first responder police officers, police officers have a really significant exposure, repeated exposure to deaths by suicide. But also, other healthcare providers and behavioral healthcare providers have heightened exposure. And we know that we need to pay attention to their behavioral health because repeated exposure to suicide can increase one's own suicide risk. So it's really important to pay attention to it and for organizations that provide crisis services or behavioral health or healthcare in general to provide to the needs of their workforce.

STEPHEN O’CONNOR : Okay. Yeah. Thank you. We've got some really great questions here. So we only have so much time. Brian, I'd love to hear your take on this. It's about training the workforce. And in real-world health settings, emergency departments, specialty clinics, what approaches do you take to ensure that the healthcare providers are competent, they're skilled, they're ready to help the people that come in with suicide intensity?

BRIAN AHMEDANI : Yeah, it's so important. What a good question. This is tough. It's not easy to do because we're all so busy with making sure we see patients and a healthcare system is really busy. But you have to prioritize it to make sure people are delivering effective care. So one strategy is to make sure everybody has training when they come in through orientation. Another thing I really highly recommend is that we really choose consistent approaches that are really pragmatic. And that's why really simple screening tools, really simple brief interventions, and really structured protocols so people know exactly what they're supposed to do when they're supposed to do it. It can be really effective and easy brief ways to train your staff in your healthcare system. But we have to be creative. All of our healthcare providers also have to get continuing education credits so we can leverage that to try and make sure we can offer solutions that are both effective care options but also meet the demands of continuing education for our providers. And we can use creative strategies to arrange trainings on times that work best for our healthcare systems and delivery of care so we can make sure to get patients the care that they need when they need it.

STEPHEN O’CONNOR : Okay. I mean, this is a huge focus, Richard, for SAMHSA too is ensuring that there's a workforce that is ready to deliver equitable suicide prevention care. Any thoughts that you have to say about that as well?

RICHARD MCKEON : Just that I agree entirely, right? And one of the things that we've been focusing on is that there is a workforce for crisis services and that people are aware early in their career that it can be a career trajectory for folks. Most of us who have spent many years in crisis services didn't start off planning that as a career. So we're really working on trying to help develop the pipeline for that, as well as to improve training in healthcare professions for suicide prevention more generally and for behavioral. It's been part of several of the U.S. national strategies, including the most recent one released this past April. The importance of training in suicide prevention. I often tell the story that when I was in my training, I was only exposed to one lecture on suicide. The irony was the one lecture that I was exposed to was the one that I gave because our teacher said, "Pick a topic and present to the class," and I picked suicide. But literally, that was the only class on suicide that I got during my graduate training or during my internship, even though in both, I was seeing suicidal people. And of course, we talked about it in supervision, but it's a really important area to enhance training.

STEPHEN O’CONNOR : Yeah. Okay. And I think we're out of time here. I'm sorry. We're going to answer more of the questions later on. But I would say that NIMH shares the prioritization of training. We had a workshop a couple of years ago that was completely devoted to training the clinical care workforce in suicide prevention best practices. And we also have active notices of funding opportunity announcement to help support research to build up the foundation of science in crisis care services. Things are moving really quickly, but there's still this really great opportunity to conduct rigorous research that's going to inform clinical practice in the future. You can reach out to me if you have an interest in learning more about that notice of funding opportunity announcement or any other research that you're interested in conducting that NIMH might be able to fund. So we've reached the end of our discussion today, and I really appreciate you spending time with us, submitting thoughtful questions. Again, if you know someone or if you were in crisis, please call or text the 988 Suicide & Crisis Lifeline   at 988. You can visit 988lifeline.org   for help and information. And I appreciate Richard and Brian for joining us, sharing their expertise. And I look forward to seeing you all again in the future. So thank you all very much.

RICHARD MCKEON : Thank you, Stephen.

BRIAN AHMEDANI : Thank you.

Brain & Behavior Research Foundation Announces $10.4 Million in Young Investigator Grants to 150 Mental Health Scientists Worldwide

New York, Sept. 10, 2024 (GLOBE NEWSWIRE) -- The Brain & Behavior Research Foundation (BBRF) today announced it is awarding $10.4 million in Young Investigator Grants to 150 promising early career scientists who are conducting neurobiological and psychiatric research to identify causes, improve treatments, and develop methods of prevention for mental illnesses. 

The 2024 Young Investigators are focused on a broad range of psychiatric illnesses that impact millions of people in the United States and around the world. More than half of the projects are relevant to the study or treatment of depression and schizophrenia. Addiction/substance-use disorders, anxiety, and PTSD, as well as the prevention of suicide are also the focus of many of the 2024 projects. Attention to these areas indicates the prevalence of these disorders in the population and the urgent need for new and improved treatments.

Reflecting the fact that many psychiatric illnesses begin to display symptoms in the years before adulthood, and that in many cases, biological factors that give rise to these symptoms have their roots in early life, before birth and/or in the childhood and adolescent years, BBRF has specific categories for Young Investigator projects that are pertinent to the early years of life – children and adolescence and prenatal brain development.

“BBRF Young Investigators represent a new generation of researchers who will pioneer breakthroughs in mental health research. They are at the cutting edge of progress in brain and psychiatric research,” said Dr. Jeffrey Borenstein, President & CEO of the Brain & Behavior Research Foundation. “We are excited to be able to support the work of these young scientists who will apply powerful new technologies and insights to understanding, treating, and curing mental illness.” The 2024 Young Investigator recipients were selected by the Foundation’s Scientific Council , comprised of 195 prominent scientists with expertise in every area of brain research. This year the Scientific Council reviewed more than 700 applications. Of the 150 award recipients, 74 percent of grantees are from the United States (111 grantees). Twenty-six percent of grantees come from 14 other countries (39 grantees): Australia, Austria, Belgium, Brazil, Canada, France, Germany, Ireland, The Netherlands, Singapore, Spain, Sweden, Uganda, and the United Kingdom. “BBRF Young Investigator grants fund groundbreaking research aimed at reducing suffering in people with mental illness,” said Dr. Judith Ford, President of the BBRF Scientific Council and Co-Chair of the Young Investigator Grant Selection Committee. “These early-career scientists are pushing the boundaries in basic and clinical research to establish new approaches to early prediction, prevention, and intervention, and to develop next-generation therapies that offer hope for those with brain and behavior illnesses.” For detailed information about the Young Investigator Grant recipients and their projects, click HERE.

About Brain & Behavior Research Foundation The Brain & Behavior Research Foundation awards research grants to develop improved treatments, cures, and methods of prevention for mental illness. These illnesses include addiction, ADHD, anxiety, autism, bipolar disorder, borderline personality disorder, depression, eating disorders, OCD, PTSD, and schizophrenia, as well as research on suicide prevention. Since 1987, the Foundation has awarded more than $461 million to fund more than 5,600 leading scientists around the world. 100% of every dollar donated for research is invested in research. BBRF operating expenses are covered by separate foundation grants. BBRF is the producer of the Emmy® nominated public television series Healthy Minds with Dr. Jeffrey Borenstein , which aims to remove the stigma of mental illness and demonstrate that with help, there is hope.

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The figure is a stacked line graph, conveying cumulative visit rates and spend rates across mental health diagnoses.

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Kalmin MM , Cantor JH , Bravata DM , Ho P , Whaley C , McBain RK. Utilization and Spending on Mental Health Services Among Children and Youths With Commercial Insurance. JAMA Netw Open. 2023;6(10):e2336979. doi:10.1001/jamanetworkopen.2023.36979

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Utilization and Spending on Mental Health Services Among Children and Youths With Commercial Insurance

• 1 RAND Corporation, Santa Monica, California
• 2 Castlight Health, San Francisco, California
• 3 Stanford University, Palo Alto, California
• 4 RAND Corporation, Arlington, Virginia

The COVID-19 pandemic severely tested the mental health of children and youths due to unprecedented school closures, social isolation and distancing, and COVID-19–related mortality among family. 1 , 2 In response, health systems offered telehealth to increase access to pediatric mental health care. 3 However, the extent to which telehealth availability led to greater pediatric mental health service utilization and spending is largely unknown. In this study, we examined telehealth, in-person, and overall pediatric mental health service utilization and spending rates from January 2019 through August 2022.

In this cross-sectional study among children and youths (aged <19 years) receiving services for the most common pediatric mental health diagnoses (anxiety disorders, adjustment disorder, attention-deficit/hyperactivity disorder [ADHD], major depressive disorder, and conduct disorder), we quantified diagnosis-specific and overall trends and changes in monthly utilization (mental health diagnosis codes used as proxy) and spending rates between 3 phases related to SARS-CoV-2: (1) prepandemic, before the national public health emergency declaration (January 1, 2019, to March 12, 2020); (2) acute, before vaccine availability (March 13 to December 17, 2020); and (3) postacute (December 18, 2020, to August 31, 2022). Monthly medical claims data (categorized by International Statistical Classification of Diseases and Related Health Problems, Tenth Revision [ICD-10] diagnostic codes 4 ) provided by Castlight Health were used to measure trends in utilization per 1000 beneficiaries and spending (accounting for inflation by indexing 2020 to 2022 rates to 2019) per 10 000 beneficiaries among approximately 1.9 million children and youths with commercial insurance throughout the US (eAppendix in Supplement 1 ). The RAND institutional review board deemed this study exempt and waived informed consent because deidentified claims data were used. We followed the STROBE reporting guideline.

We estimated longitudinal, fixed-effects regressions segmented by each period for each diagnosis and overall. Fixed effects were included for US state and patient biological sex to account for associated variability. Standard errors were clustered at the state level to account for multiple facilities within each state. Precision estimates were reported using 2-sided 95% CIs. Analyses were conducted with Stata version 16.0 (StataCorp) from April to May 2023.

Among approximately 1.9 million claims for children and youths with commercial insurance, utilization and spending trends were generally consistent across pediatric mental health diagnoses ( Figure ), allowing for collapsing of estimates. Compared with prepandemic, in-person pediatric mental health services declined by 42% during the pandemic’s acute phase, while pediatric telehealth services increased 30-fold (3027%), representing a 13% relative increase in overall utilization. By August 2022, in-person services returned to 75% of prepandemic levels and tele–mental health utilization was 2300% higher than prepandemic levels. During the postacute period, we observed a gradual increase in spending rates compared with prepandemic for in-person, telehealth, and total visits. From January 2019 to August 2022, mental health service utilization increased by 21.7%, while mental health spending rates increased by 26.1%.

The Table shows the diagnosis-specific and overall results of the longitudinal, fixed-effects segmented regressions for utilization and spending accounting for state and patient sex among in-person and telehealth visits. For each diagnosis and overall, there was at least 1 statistically significant difference between 2 consecutive periods (intercept term) and at least 1 statistically significant change within each period (slope) for both utilization and spending.

After comparing mental health care service utilization and spending rates for children and youths with commercial insurance across 3 periods, we found differences between periods as well as different rates of change within each period for both visit types, even after accounting for state and patient sex. Utilization and spending increased over the entire timeframe. ADHD, anxiety disorders, and adjustment disorder accounted for most visits and spending in all phases.

The study has limitations. First, these data represent only children and youths with commercial insurance. Utilization patterns, care needs, and spending may differ for other pediatric patient populations such as Children’s Health Insurance Program recipients or children and youths lacking health insurance. Additionally, we did not have available data to distinguish between new and existing pediatric patients, and thus cannot specify whether increases result from an overall population increase in mental health diagnoses or a utilization increase among existing patients.

Our findings indicate that pediatric telehealth care for mental health needs filled a critical deficit in the immediate period following the emergence of COVID-19 and continues to account for a substantial proportion of pediatric mental health service utilization and spending. Supported by evidence that telehealth can effectively deliver mental health treatment for children and youths, 5 , 6 these findings have important implications for telehealth sustainability beyond the effects of COVID-19.

Accepted for Publication: August 29, 2023.

Published: October 3, 2023. doi:10.1001/jamanetworkopen.2023.36979

Open Access: This is an open access article distributed under the terms of the CC-BY License . © 2023 Kalmin MM et al. JAMA Network Open .

Corresponding Author: Mariah M. Kalmin, PhD, RAND Corporation, 1776 Main St, Santa Monica, CA 90401 ( [email protected] ).

Author Contributions: Drs Cantor and Whaley had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Kalmin, Cantor, Whaley, McBain.

Acquisition, analysis, or interpretation of data: Kalmin, Bravata, Ho, Whaley, McBain.

Drafting of the manuscript: Kalmin, Bravata, McBain.

Critical review of the manuscript for important intellectual content: Cantor, Bravata, Ho, Whaley, McBain.

Statistical analysis: Cantor, Whaley.

Obtained funding: Cantor, Bravata, McBain.

Administrative, technical, or material support: All authors.

Supervision: Bravata, Whaley, McBain.

Conflict of Interest Disclosures: Dr Cantor reported receiving grants from the National Institute of Mental Health during the conduct of the study and from the National Institute on Aging outside the submitted work. Dr Bravata reported receiving personal fees from Castlight Health during the conduct of the study. Dr Whaley reported receiving personal fees from Castlight Health outside the submitted work. No other disclosures were reported.

Funding/Support: This study was funded by grants from the National Institute of Mental Health (R21MH126150) and the National Institute on Aging (K01AG061274 and R01AG073286).

Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Data Sharing Statement: See Supplement 2 .

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Mental Health

Native-led suicide prevention program focuses on building community strengths.

Brandon Kapelow

Indigenous researchers in Alaska try a new approach to prevent suicides

Sunrise view from the cemetery in Mountain Village, a community in Alaska’s Yukon-Kuskokwim Delta, the morning after Drake “Clayton” Wilde’s burial. Wilde was only 19 years old when he died by suicide, following a number of local teens who have taken their lives in recent years. Brandon Kapelow hide caption

Alaska’s Yukon-Kuskokwim Delta is one of the nation’s most remote regions , stretching across 75,000 square miles of mountains, tundra and coastal wetlands along the Bering Sea. The U.S. Census counts the population at roughly 27,000 – the majority of whom are Alaska Natives of Yup’ik and Athabascan descent – placing the region among the most sparsely populated areas in the United States. There are no roads connecting the Delta’s 50 villages to the national system. It’s also home to the nation’s highest rates of suicide.

Since the 1950s , mental health experts say that suicide prevention models have largely been designed to identify and mitigate risk through an individualized approach, treating symptoms like anxiety or suicidal ideation through therapy or counseling. But as suicide rates have steadily risen over the past few decades, a group of Indigenous researchers at the Center for Alaska Native Health Research (CANHR) have been developing a new approach across the villages of the Y-K Delta.

Over several decades, CANHR has designed programs that aim to build up a community’s endemic strengths, rather than solely treating the risks facing individuals within that community. By providing support and resources that enable access to Alaska Native cultural activities, they hope to strengthen social bonds that build resilience. Their approach has shown such promise that it’s now being piloted in Alaska’s military population – another demographic highly impacted by suicide – with hopes that the model could scale both nationally and abroad.

Thomas Rivers with a seal harpoon he made with his brothers. They learned traditional crafting skills through one of CANHR’s programs. Rivers has found it difficult to open up to adults about his struggles with suicidal ideation. “I’ve been depressed since I was about 10. All I'm really good at is hiding it,” he explained. After losing two uncles and several friends to suicide, Rivers found refuge in his relationships with his siblings. He credits those bonds as his reasons for being alive. Brandon Kapelow hide caption

‘A People in Peril’

For decades, it’s been common to see headlines that highlight the wide spectrum of challenges confronting the Y-K Delta: the lingering psychological impacts of residential boarding schools ; high rates of substance use and sexual violence stemming from generational trauma ; dwindling salmon runs that limit food and livelihood; and a changing climate that is threatening low-lying village communities along the coast with flooding and erosion .

But the researchers at CANHR, who work out of the University of Alaska Fairbanks, believe that all this focus on risks might actually be part of the problem. They say that as a result, these communities are often viewed solely through the prism of their challenges, while funders and research groups across the field of suicide prevention have dedicated too little attention and resources towards approaches that emphasize their inherent strengths. “We’ve been trying risk reduction approaches for nearly half a century,” says Stacy Rasmus, the director at CANHR. “And we are not moving the needle with those approaches.”

Remnants of the St. Mary's Mission Boarding School, which was built in 1894 and ceased operations in 1987 after a string of suicides. Brandon Kapelow hide caption

The origins of CANHR’s innovative prevention efforts can be traced, in part, to the conversations that emerged in response to intense media coverage of the problems confronting the communities of the Y-K Delta. In the 1980s, the Anchorage Daily News published a Pulitzer Prize-winning series called “A People in Peril,” which described a burgeoning crisis of suicide and substance use in Alaska’s Bush villages. “ The Alaska Federation of Natives came out after that and said, ‘yes, that’s a reality, but that’s not who we are,’” says Rasmus.

Sebastian Cowboy is one of the few remaining Elders in St. Mary's to have attended the Mission school, where he saw one of his peers take their own life in the dormitory. That trauma came flooding back decades later when he lost his oldest son to suicide. “I think I was in a coma for three days. I didn’t know where I was,” he recalls. For Cowboy, healing came through finding ways to share his grief with his community. “I’d been holding it too long. It needs to come out.” Brandon Kapelow hide caption

Rasmus – who is Indigenous – says those articles failed to capture the positives that also exist in village communities. “We need our young people to know that they’re not vanishing, they’re not all drowning in ‘ a river of booze ’. That was literally a title of one of the ‘People in Peril’ articles,” says Rasmus. “Actually, the large majority of Alaska Native people are living their ancestral ways of life. Indigenous people are here, and have these strengths.”

Subsequently, a group of leaders from Alakanuk – one of the villages named in the article – approached CANHR to collaborate on an action plan that would focus on building up the community strengths that already existed in the local Yup’ik culture, rather than treating the individual risks identified by the series – like substance use and depression.

Implementing a community-based program required a break from decades of common practice in suicide prevention, which has historically tended towards an individualized, medical approach, often in a clinical setting. As a former village clinician in the Y-K Delta, Rasmus had seen firsthand the need for a different strategy. “I went and lived out in Emmonak for three years before realizing that a clinician’s toolkit wasn’t gonna help.”

During her tenure in the village, as an unlicensed clinician fresh out of graduate school, Rasmus was immediately confronted by eight consecutive youth suicides. Rasmus found herself facing a lot of difficult questions from the community: “What’s going on with our young people? What can we do? You’re a mental health clinician – fix it.”

But Rasmus struggled to get her young patients to open up. She remembers one young man who “walked in, took his hoodie strings, put his head down, and tightened it up. And that was it. This young man was never going say one word to me.”

Panik John (right) teaches her granddaughter Bernadette Wiseman (left) how to process a baby seal using a traditional Uluaq knife at their home in Toksook Bay, Alaska. Panik and her husband Simeon lead CANHR’s programs and research projects in Toksook Bay, including Qungasvik. Brandon Kapelow hide caption

In search of a more effective approach, CANHR embarked on a research project that would come to span decades, traveling to seven different villages across the Y-K Delta to meet and collaborate with Elders and local leadership. Through interviews and conversations, they identified positive qualities within communities that are protective against suicide, such as the cultural traditions surrounding Alaska Native food, hunting, music and storytelling. These ‘protective factors’ would prove foundational to more than a dozen studies that followed, funded by the National Institutes of Health (NIH) and the Substance Abuse and Mental Health Service Administration’s (SAMHSA) Native Connections Program .

The culmination of these efforts was a flagship program called Qungasvik , a Yup’ik word meaning ‘toolkit,’ which aims to reduce suicide risk by providing youth with culturally grounded activities and learning.

Rasmus has been helping oversee Qungasvik for the last fifteen years. “In a Yup’ik worldview, suicide is not a mental health disorder, and it’s not an individual affliction, it’s a disruption of the collective,” she says. “And so the solution to suicide needs to be at the community level.”

Simeon John speaks about Qungasvik with a group of students at the Lower Kuskokwim Dance Festival in Tununak, Alaska. “I don’t like to think of it as a program. A program is something that has an ending,” he explains. “I want to say Yuuyaraq [a Yup’ik way of life].” Brandon Kapelow hide caption

‘Tools for Life’

Every week in the coastal village of Hooper Bay, a local dance group gets together for practice in the tribal council building. In this village of roughly 1,300 people in Alaska’s Y-K Delta, public spaces are scarce, so the room gets used for council meetings during the day and events at night. Tables and bingo machines have been swept to the side, and rows of folding chairs are laid out facing a small stage where a group of about 20 locals are gathered. A row of drummers plays in the front, while Elders teach the youth to dance. People of all ages shuffle in and out of the door in heavy winter clothes.

Gideon Green is one of the regulars. “Doing our Eskimo dances and drumming, it takes your stress away,” says Green. “It takes my depression away when I’m hitting the drum. It just takes out all the anger.”

At the Lower Kuskokwim Dance Festival in Tununak, students are given opportunities to learn about mental health programs alongside a range of cultural activities such as Yup’ik singing and dancing. Brandon Kapelow hide caption

Back in 2015, a string of youth suicides rocked Hooper Bay. Many of those who died were among Green’s peers. “We had three suicides in less than a week,” he reflects. Young Alaska Native men are among the nation’s most disproportionately impacted demographics for suicide risk.

Many village residents, including Green, pointed to a lack of healthy options for how young people could spend their time outside of school. “We have to start doing our cultural activities,” he recalls telling friends. So when he saw CANHR volunteers recruiting for Qungasvik, it felt like a natural fit. “They got us some stuff so we could start with the youth group Eskimo dance practice,” he says. That’s the dance practice that’s still going on today in the tribal council building. It’s one of many activities – like beadwork or seal hunting – that have been supported by the program.

The thought behind these activities is threefold: first, it helps to address a lack of options for how young people spend their idle time outside of school. Next, it provides a context for trained community volunteers to help instill healthy behaviors, while fostering social connection, and a sense of shared purpose that research has shown protects against suicidal behavior. Finally, it provides a bridge for youth to reconnect with aspects of their cultural traditions that were eroded during the forced assimilation of residential schools during their parents’ generations.

Gideon Green (center) sings with a group of drummers at a Yup’ik dance practice in Hooper Bay that’s been supported by Qungasvik. For Green, who has lost several close friends to suicide, the group has proven integral to his healing. Brandon Kapelow hide caption

In the eyes of Yup’ik leaders, subsistence living provides valuable life skills for survival, connection and self-worth. During interviews and conversations, village Elders repeatedly told researchers from CANHR that facilitating opportunities for young people to spend time on the land was essential to supporting mental health. “Our Elders tell us that nature is our medicine,” says Simeon John, one of CANHR’s local program coordinators. “We’re spiritually connected to everything – the land, air, water, the plants. When you’re out berry picking or hunting, you can let go of what’s bothering you.” Youth are required to give away their first kill to Elders and vulnerable members of the community, which John says provides young hunters with a direct and tangible sense of purpose.

For Jerome Nukusuk, a high school student in Hooper Bay, spending time on the land serves as a reprieve from the challenges of the village. “I feel at peace, just hearing birds and enjoying nature,” he says. At seventeen, Nukusuk has already lost four friends to suicide. “When my closest friend passed in 2020, I didn’t eat for three days, and I didn’t go to school for two weeks.” Nukusuk was only thirteen at the time, but when he saw CANHR staff recruiting for Qungasvik at school, he signed up. “It really opened my eyes to a lot of opportunities,” he recalls. The program gave Nukusuk the opportunity to learn new skills, like making harpoons or fishing nets that he could use while out on the water. “That really helped me through a lot of my suicide problems, just keeping my hands busy.”

James Joseph (left) and Albert Simon (right) scout for game on an ice floe several miles offshore of Hooper Bay, Alaska. Both have lost close friends to suicide. Despite seal hunting being identified by CANHR as a protective activity they’d like to support, the organization has had trouble getting funding for it over liability concerns. Brandon Kapelow hide caption

Promising results, uncertain funding

Since the outset of the program, CANHR has been able to successfully identify and prescribe a robust series of activities. For some – like beading, or dancing – it’s been easier to get the necessary funding and approvals. But when it comes to activities like hunting that many communities identified as being essential, CANHR has faced greater challenges. And complicated funding mechanisms have also made it hard to consistently implement a broad array of programs.

Over the years, subsistence activities have become increasingly reliant on the cost of key supplies like fuel and ammunition. This can present obstacles for many remote communities, where the added expense of air deliveries mean that common goods can cost more than five times the national average . For a region living on a median household income of roughly $42,000 per year these costs can be prohibitive.

A river bisects the village of Nunapitchuk in Alaska’s Yukon-Kuskokwim Delta. Located along the Bering Sea, the Y-K Delta has the highest rates of suicide in the United States. It is one of the country’s most remote regions, with no physical infrastructure connecting its villages to the national road system. Brandon Kapelow hide caption

CANHR has tried to address that barrier by providing villages with access to vehicles and supplies. But the University of Alaska Fairbanks wouldn’t let the program fund activities involving minors, firearms and boating in the Arctic due to liability concerns. “People from the western world try to come in and imply what works for them, and demand that this is a model that you’re going to use. But a lot of the time it doesn’t apply to us, because we do things differently out here,” says Simeon John.

Sustainability is also a big challenge. Qungasvik receives federal grants that are typically funded on 3-5 year cycles. This can be a problem for programs that seek to address complex, longstanding issues like suicide. Holly Wilcox, a national suicide prevention researcher and professor at Johns Hopkins University, says that this is a recurring issue for prevention programs across the country. “It could be that you're just finally making momentum and able to do things at high quality, and then the grant ends.”

CANHR lead investigator and Qungasvik community organizer Simeon John goes to collect water outside his Maqi (steam house) near his home in Toksook Bay, Alaska. Historically, he says that the steam bath has played an important role in mental wellness within the community by providing neighbors with spaces to gather and share their concerns. Brandon Kapelow hide caption

CANHR has assisted regional tribal entities in applying for their own grants to continue funding the program locally, but this piecemeal approach has, at times, yielded uneven results. Such was the case in Hooper Bay, whose Qungasvik program was temporarily halted despite widespread popularity after their Native Connections grant expired in September of last year. CANHR was able to assist the village in securing a new grant through the NIH in March, effectively resuming the program after a six month pause in services.

These short funding cycles, along with working among small populations, make it hard to measure whether the program has caused a drop in suicide deaths. But in two outcome papers , published in 2017 and 2022, respectively, CANHR was able to show that the program did help improve factors that reduced suicide risk over two-year study periods.

Additionally, other Native groups across the country like the White Mountain Apache tribe , who have run similar community prevention programs, have been able to demonstrate a reduction in suicide rates as much as 38.3% over six years.

These promising results have left Rasmus and her colleagues feeling optimistic that their community-centric approach could be applied in other contexts.

A group of soldiers from the 1st Brigade Combat Infantry Division march in formation outside Bassett Military Hospital at Fort Wainwright in Fairbanks. In 2021 there were 17 suicides in the Division, giving it one of the highest rates among a military unit nationwide. Brandon Kapelow hide caption

Purpose, identity and grit

Through their work in the villages of the Y-K Delta, CANHR felt they had developed a process for identifying community strengths that could be used as a model elsewhere. Through interviews and collaboration with local leaders to identify cultural strengths, researchers felt they could design new programs and activities that help to reinforce a strong sense of purpose. And in 2021, CANHR had their first opportunity to demonstrate their approach in a totally different group: the U.S. military.

“The universality of the Yup’ik approach, it’s really a protective factors approach,” says Rasmus. “Every community and culture has protective factors.”

In the late 2010’s, deep within the Alaskan interior, military service members were killing themselves at astonishingly high rates. Suicide rates for military servicemembers are roughly double that of their civilian peers, and among military populations over the last five years, Alaska’s suicide rate was more than triple the national average. Despite persistent attention and investment, the problem wasn’t getting better.

“I think about it every day, every time my phone rings,” says Command Sgt. Maj. Joe Gaskin of the U.S. Army’s 11th Airborne Division. “We’re devastated every time these things happen.”

Command Sgt. Maj. Joe Gaskin, of the 1st Brigade, 11th Airborne Division at Fort Wainwright in Fairbanks. Gaskin was no stranger to suicide when he arrived in Alaska, having experienced three suicides within his brigade during his tenure at Fort Carson, Colorado. There have been seven confirmed suicides within his brigade since his arrival. Brandon Kapelow hide caption

In 2022, Alaska Sens Lisa Murkowski and Dan Sullivan successfully lobbied for additional funding to allocate toward military suicide prevention. Congress also directed the Department of Defense to investigate the high occurrence of suicides on remote, rural military installations like those in Alaska. These actions laid the groundwork for CANHR to receive their first grant in 2022 to start working with the 11th Airborne Division, and begin to adapt the model they’d developed through Qungasvik within the military.

The 11th Airborne Division’s 1st Brigade is housed at Ft. Wainwright in Fairbanks, just down the road from CANHR’s offices at the University of Alaska. Sticking with their philosophy of working in partnership with communities, CANHR staffed their internal team with military officers and worked closely with their Army counterparts to develop an approach.

They started by identifying the challenges the group was facing. Military leaders said the unit suffered from a lack of identity. “When I first got here, it was like mass triage,” says Maj. General Brian Eifler, the unit’s top commander. “The worst thing you can have are people that don’t know their purpose.” He said years of fighting in desert wars left recruits wondering why they were going to such extreme lengths to train in Arctic combat. Soldiers felt isolated from their families in the lower 48 and were struggling to connect with their mission.

What was needed – the military leaders felt – was a rebranding of sorts. Concurrent to CANHR’s partnership, the Army unified its Alaska forces under the banner of the 11th Airborne Division and invested in building their identity as Arctic warfare specialists.

First Sgt. Heather Thomas was one of the senior military officials who collaborated with CANHR to help design a training program for young leaders in the 11th Airborne Division. “Nobody really teaches you how to have those hard conversations, or what's going to help prevent people from hurting themselves,” she says. Brandon Kapelow hide caption

CANHR worked with their military counterparts to design a new program. They started by interviewing Division leadership to define the cultural strengths within the organization, and quickly honed in on three themes; purpose, identity and grit. Gaskin, who helps to oversee the program, explains, “if you fill soldiers’ lives with purpose and identity, those corrosive behaviors like suicide and alcohol abuse start to delete themselves naturally.”

Next, they developed a series of training programs designed to empower junior leaders with the skills to help their soldiers connect with those core principles. The implementation of that training started to roll out this spring, allowing those trainees to start applying their newly developed skills within their units.

Finally, they participated in community-building activities, like lessons in preparing wild salmon, and polar plunges, that provide a context in which those skills could be applied. Those activities also helped leaders connect soldiers with their peers, and to build a sense of shared purpose.

Soldiers from the 11th Airborne Division examine a jar of smoked salmon during a class at a local folk school in Fairbanks. These community outings are designed to help young soldiers build connections with their peers and their cultural surroundings in Alaska. Brandon Kapelow hide caption

During a recent such community outing at a folk school in Fairbanks, soldiers learned to smoke salmon while volunteer leaders encouraged the privates to get to know one another. An officer asked the assembled group, “why did y’all join the army?” Part of the thinking behind these activities is to create opportunities for conversations around topics like identity, or the deeper meaning of serving in the Armed Forces. “Mostly because of family, and to expand my reach as well,” one of the soldiers replied. “To become a stronger person, mentally,” said another.

As the program continues, CANHR will gather data from participants and leaders that will help to further refine their approach and measure its effectiveness. They received their second grant in February to expand their research to include the Alaska National Guard and U.S. Coast Guard . As they continue to collect and analyze the data from the study’s initial phases, their aim is to present a model to the Department of Defense by the end of 2025 that could be used across the military.

Gaskin says he thinks it’s all making a difference. “I lose sleep every night thinking about these kids that we've lost along the way. I think about their parents, their families…” he pauses for a moment. “We’ve got to protect what's left.”

A new paradigm

In the latest iteration of the National Suicide Prevention Strategy published by the U.S. Department of Health and Human Services in April, community-based suicide prevention was designated as the top strategic priority. Last year, U.S. Surgeon General Vivek Murthy released an advisory warning about “our epidemic of loneliness and isolation,” both of which are considered key risk factors for suicide. Within the 82-page treatise, Dr. Murthy praised “the healing effects of social connection and community,” as a potential antidote.

To Holly Wilcox and her professional peers, the federal government’s emphasis on community prevention feels like a signal of a new paradigm. “I actually think it’s been long overdue,” she says. “We really need to be focusing more on upstream, community-based, public health approaches to this major and leading cause of death.”

Freshly painted headstone markers sit onstage at the Paimiut Tribal Council building in Hooper Bay, Alaska. In February, two young people in the village died consecutively by suicide. The tribal council building hosts a weekly practice for a traditional Yup’ik dance group - one of many activities supported by the Qungasvik program that experts believe help bolster community mental health. Brandon Kapelow hide caption

In addition to its other strengths, Wilcox feels that programs like Qungasvik, which leverage peers and paraprofessionals from within local communities, may offer a potential blueprint to address the shortfalls in the mental healthcare workforce that have been a persistent problem nationwide . “Many of us are thinking, can we engage people with lived experience that we can train?” she asks. “They're from the same neighborhoods. They know the lay of the land in terms of the resources and the supports that are most engaging and effective in their own community. And they can develop rapport with folks because they've walked in their shoes.”

As the president of the International Academy of Suicide Research, Wilcox sees the greater potential for this emergent model. Outside the U.S., CANHR has collaborated with Indigenous groups from Canada, Greenland, Norway and Siberia – the circumpolar nations that represent some of the world’s highest rates of suicide.

Dominic Hunt holds a catch from a blackfish trap on the Yukon River near Emmonak, Alaska. Dominic and his wife Lala are community volunteers with Qungasvik who help organize traditional subsistence activities like ice fishing and tool crafting. “Growing up, I rarely heard about suicide”, says Hunt, reflecting a view that’s echoed by many Elders who were alive prior to the era of residential boarding schools. It wasn’t until his own brother died by suicide that Hunt was first confronted by the issue head-on. Brandon Kapelow hide caption

But according to Wilcox, a number of barriers still stand in the way of widespread implementation of this new approach. She says that research organizations and the government agencies that fund prevention programs often operate in silos. So while research might support a certain model, it might not be prioritized by funders or decision makers. Wilcox also feels that sustainable funding streams for community-based prevention programs will be necessary to establish momentum and longevity for local efforts. “Funding streams that are not reliant on grants and contracts, but are more part of the background infrastructure, are ideal,” she says.

Wilcox wants to see more groups around the country seize the opportunity to deliver programs that follow this approach. With the increased attention from the federal government, she’s feeling more hopeful that they might.

If you or someone you know may be considering suicide or is in crisis, contact the 988 Suicide & Crisis Lifeline by dialing 9-8-8, or the Crisis Text Line by texting HOME to 741741.

Support for this reporting was provided by Stanford University's Bill Lane Center for the American West.

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Social Media and Mental Health: Benefits, Risks, and Opportunities for Research and Practice

John a. naslund.

a Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA

Ameya Bondre

b CareNX Innovations, Mumbai, India

John Torous

c Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA

Kelly A. Aschbrenner

d Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH

Social media platforms are popular venues for sharing personal experiences, seeking information, and offering peer-to-peer support among individuals living with mental illness. With significant shortfalls in the availability, quality, and reach of evidence-based mental health services across the United States and globally, social media platforms may afford new opportunities to bridge this gap. However, caution is warranted, as numerous studies highlight risks of social media use for mental health. In this commentary, we consider the role of social media as a potentially viable intervention platform for offering support to persons with mental disorders, promoting engagement and retention in care, and enhancing existing mental health services. Specifically, we summarize current research on the use of social media among mental health service users, and early efforts using social media for the delivery of evidence-based programs. We also review the risks, potential harms, and necessary safety precautions with using social media for mental health. To conclude, we explore opportunities using data science and machine learning, for example by leveraging social media for detecting mental disorders and developing predictive models aimed at characterizing the aetiology and progression of mental disorders. These various efforts using social media, as summarized in this commentary, hold promise for improving the lives of individuals living with mental disorders.

Introduction

Social media has become a prominent fixture in the lives of many individuals facing the challenges of mental illness. Social media refers broadly to web and mobile platforms that allow individuals to connect with others within a virtual network (such as Facebook, Twitter, Instagram, Snapchat, or LinkedIn), where they can share, co-create, or exchange various forms of digital content, including information, messages, photos, or videos ( Ahmed, Ahmad, Ahmad, & Zakaria, 2019 ). Studies have reported that individuals living with a range of mental disorders, including depression, psychotic disorders, or other severe mental illnesses, use social media platforms at comparable rates as the general population, with use ranging from about 70% among middle-age and older individuals, to upwards of 97% among younger individuals ( Aschbrenner, Naslund, Grinley, et al., 2018 ; M. L. Birnbaum, Rizvi, Correll, Kane, & Confino, 2017 ; Brunette et al., 2019 ; Naslund, Aschbrenner, & Bartels, 2016 ). Other exploratory studies have found that many of these individuals with mental illness appear to turn to social media to share their personal experiences, seek information about their mental health and treatment options, and give and receive support from others facing similar mental health challenges ( Bucci, Schwannauer, & Berry, 2019 ; Naslund, Aschbrenner, Marsch, & Bartels, 2016b ).

Across the United States and globally, very few people living with mental illness have access to adequate mental health services ( Patel et al., 2018 ). The wide reach and near ubiquitous use of social media platforms may afford novel opportunities to address these shortfalls in existing mental health care, by enhancing the quality, availability, and reach of services. Recent studies have explored patterns of social media use, impact of social media use on mental health and wellbeing, and the potential to leverage the popularity and interactive features of social media to enhance the delivery of interventions. However, there remains uncertainty regarding the risks and potential harms of social media for mental health ( Orben & Przybylski, 2019 ), and how best to weigh these concerns against potential benefits.

In this commentary, we summarized current research on the use of social media among individuals with mental illness, with consideration of the impact of social media on mental wellbeing, as well as early efforts using social media for delivery of evidence-based programs for addressing mental health problems. We searched for recent peer reviewed publications in Medline and Google Scholar using the search terms “mental health” or “mental illness” and “social media”, and searched the reference lists of recent reviews and other relevant studies. We reviewed the risks, potential harms, and necessary safety precautions with using social media for mental health. Overall, our goal was to consider the role of social media as a potentially viable intervention platform for offering support to persons with mental disorders, promoting engagement and retention in care, and enhancing existing mental health services, while balancing the need for safety. Given this broad objective, we did not perform a systematic search of the literature and we did not apply specific inclusion criteria based on study design or type of mental disorder.

Social Media Use and Mental Health

In 2020, there are an estimated 3.8 billion social media users worldwide, representing half the global population ( We Are Social, 2020 ). Recent studies have shown that individuals with mental disorders are increasingly gaining access to and using mobile devices, such as smartphones ( Firth et al., 2015 ; Glick, Druss, Pina, Lally, & Conde, 2016 ; Torous, Chan, et al., 2014 ; Torous, Friedman, & Keshavan, 2014 ). Similarly, there is mounting evidence showing high rates of social media use among individuals with mental disorders, including studies looking at engagement with these popular platforms across diverse settings and disorder types. Initial studies from 2015 found that nearly half of a sample of psychiatric patients were social media users, with greater use among younger individuals ( Trefflich, Kalckreuth, Mergl, & Rummel-Kluge, 2015 ), while 47% of inpatients and outpatients with schizophrenia reported using social media, of which 79% reported at least once-a-week usage of social media websites ( Miller, Stewart, Schrimsher, Peeples, & Buckley, 2015 ). Rates of social media use among psychiatric populations have increased in recent years, as reflected in a study with data from 2017 showing comparable rates of social media use (approximately 70%) among individuals with serious mental illness in treatment as compared to low-income groups from the general population ( Brunette et al., 2019 ).

Similarly, among individuals with serious mental illness receiving community-based mental health services, a recent study found equivalent rates of social media use as the general population, even exceeding 70% of participants ( Naslund, Aschbrenner, & Bartels, 2016 ). Comparable findings were demonstrated among middle-age and older individuals with mental illness accessing services at peer support agencies, where 72% of respondents reported using social media ( Aschbrenner, Naslund, Grinley, et al., 2018 ). Similar results, with 68% of those with first episode psychosis using social media daily were reported in another study ( Abdel-Baki, Lal, D.-Charron, Stip, & Kara, 2017 ).

Individuals who self-identified as having a schizophrenia spectrum disorder responded to a survey shared through the National Alliance of Mental Illness (NAMI), and reported that visiting social media sites was one of their most common activities when using digital devices, taking up roughly 2 hours each day ( Gay, Torous, Joseph, Pandya, & Duckworth, 2016 ). For adolescents and young adults ages 12 to 21 with psychotic disorders and mood disorders, over 97% reported using social media, with average use exceeding 2.5 hours per day ( M. L. Birnbaum et al., 2017 ). Similarly, in a sample of adolescents ages 13-18 recruited from community mental health centers, 98% reported using social media, with YouTube as the most popular platform, followed by Instagram and Snapchat ( Aschbrenner et al., 2019 ).

Research has also explored the motivations for using social media as well as the perceived benefits of interacting on these platforms among individuals with mental illness. In the sections that follow (see Table 1 for a summary), we consider three potentially unique features of interacting and connecting with others on social media that may offer benefits for individuals living with mental illness. These include: 1) Facilitate social interaction; 2) Access to a peer support network; and 3) Promote engagement and retention in services.

Summary of potential benefits and challenges with social media for mental health

Facilitate Social Interaction

Social media platforms offer near continuous opportunities to connect and interact with others, regardless of time of day or geographic location. This on demand ease of communication may be especially important for facilitating social interaction among individuals with mental disorders experiencing difficulties interacting in face-to-face settings. For example, impaired social functioning is a common deficit in schizophrenia spectrum disorders, and social media may facilitate communication and interacting with others for these individuals ( Torous & Keshavan, 2016 ). This was suggested in one study where participants with schizophrenia indicated that social media helped them to interact and socialize more easily ( Miller et al., 2015 ). Like other online communication, the ability to connect with others anonymously may be an important feature of social media, especially for individuals living with highly stigmatizing health conditions ( Berger, Wagner, & Baker, 2005 ), such as serious mental disorders ( Highton-Williamson, Priebe, & Giacco, 2015 ).

Studies have found that individuals with serious mental disorders ( Spinzy, Nitzan, Becker, Bloch, & Fennig, 2012 ) as well as young adults with mental illness ( Gowen, Deschaine, Gruttadara, & Markey, 2012 ) appear to form online relationships and connect with others on social media as often as social media users from the general population. This is an important observation because individuals living with serious mental disorders typically have few social contacts in the offline world, and also experience high rates of loneliness ( Badcock et al., 2015 ; Giacco, Palumbo, Strappelli, Catapano, & Priebe, 2016 ). Among individuals receiving publicly funded mental health services who use social media, nearly half (47%) reported using these platforms at least weekly to feel less alone ( Brusilovskiy, Townley, Snethen, & Salzer, 2016 ). In another study of young adults with serious mental illness, most indicated that they used social media to help feel less isolated ( Gowen et al., 2012 ). Interestingly, more frequent use of social media among a sample of individuals with serious mental illness was associated with greater community participation, measured as participation in shopping, work, religious activities or visiting friends and family, as well as greater civic engagement, reflected as voting in local elections ( Brusilovskiy et al., 2016 ).

Emerging research also shows that young people with moderate to severe depressive symptoms appear to prefer communicating on social media rather than in-person ( Rideout & Fox, 2018 ), while other studies have found that some individuals may prefer to seek help for mental health concerns online rather than through in-person encounters ( Batterham & Calear, 2017 ). In a qualitative study, participants with schizophrenia described greater anonymity, the ability to discover that other people have experienced similar health challenges, and reducing fears through greater access to information as important motivations for using the Internet to seek mental health information ( Schrank, Sibitz, Unger, & Amering, 2010 ). Because social media does not require the immediate responses necessary in face-to-face communication, it may overcome deficits with social interaction due to psychotic symptoms that typically adversely affect face-to-face conversations ( Docherty et al., 1996 ). Online social interactions may not require the use of non-verbal cues, particularly in the initial stages of interaction ( Kiesler, Siegel, & McGuire, 1984 ), with interactions being more fluid, and within the control of users, thereby overcoming possible social anxieties linked to in-person interaction ( Indian & Grieve, 2014 ). Furthermore, many individuals with serious mental disorders can experience symptoms including passive social withdrawal, blunted affect and attentional impairment, as well as active social avoidance due to hallucinations or other concerns ( Hansen, Torgalsbøen, Melle, & Bell, 2009 ); thus, potentially reinforcing the relative advantage, as perceived by users, of using social media over in person conversations.

Access to a Peer Support Network

There is growing recognition about the role that social media channels could play in enabling peer support ( Bucci et al., 2019 ; Naslund, Aschbrenner, et al., 2016b ), referred to as a system of mutual giving and receiving where individuals who have endured the difficulties of mental illness can offer hope, friendship, and support to others facing similar challenges ( Davidson, Chinman, Sells, & Rowe, 2006 ; Mead, Hilton, & Curtis, 2001 ). Initial studies exploring use of online self-help forums among individuals with serious mental illnesses have found that individuals with schizophrenia appeared to use these forums for self-disclosure, and sharing personal experiences, in addition to providing or requesting information, describing symptoms, or discussing medication ( Haker, Lauber, & Rössler, 2005 ), while users with bipolar disorder reported using these forums to ask for help from others about their illness ( Vayreda & Antaki, 2009 ). More recently, in a review of online social networking in people with psychosis, Highton-Williamson et al (2015) highlight that an important purpose of such online connections was to establish new friendships, pursue romantic relationships, maintain existing relationships or reconnect with people, and seek online peer support from others with lived experience ( Highton-Williamson et al., 2015 ).

Online peer support among individuals with mental illness has been further elaborated in various studies. In a content analysis of comments posted to YouTube by individuals who self-identified as having a serious mental illness, there appeared to be opportunities to feel less alone, provide hope, find support and learn through mutual reciprocity, and share coping strategies for day-to-day challenges of living with a mental illness ( Naslund, Grande, Aschbrenner, & Elwyn, 2014 ). In another study, Chang (2009) delineated various communication patterns in an online psychosis peer-support group ( Chang, 2009 ). Specifically, different forms of support emerged, including ‘informational support’ about medication use or contacting mental health providers, ‘esteem support’ involving positive comments for encouragement, ‘network support’ for sharing similar experiences, and ‘emotional support’ to express understanding of a peer’s situation and offer hope or confidence ( Chang, 2009 ). Bauer et al. (2013) reported that the main interest in online self-help forums for patients with bipolar disorder was to share emotions with others, allow exchange of information, and benefit by being part of an online social group ( Bauer, Bauer, Spiessl, & Kagerbauer, 2013 ).

For individuals who openly discuss mental health problems on Twitter, a study by Berry et al. (2017) found that this served as an important opportunity to seek support and to hear about the experiences of others ( Berry et al., 2017 ). In a survey of social media users with mental illness, respondents reported that sharing personal experiences about living with mental illness and opportunities to learn about strategies for coping with mental illness from others were important reasons for using social media ( Naslund et al., 2017 ). A computational study of mental health awareness campaigns on Twitter provides further support with inspirational posts and tips being the most shared ( Saha et al., 2019 ). Taken together, these studies offer insights about the potential for social media to facilitate access to an informal peer support network, though more research is necessary to examine how these online interactions may impact intentions to seek care, illness self-management, and clinically meaningful outcomes in offline contexts.

Promote Engagement and Retention in Services

Many individuals living with mental disorders have expressed interest in using social media platforms for seeking mental health information ( Lal, Nguyen, & Theriault, 2018 ), connecting with mental health providers ( M. L. Birnbaum et al., 2017 ), and accessing evidence-based mental health services delivered over social media specifically for coping with mental health symptoms or for promoting overall health and wellbeing ( Naslund et al., 2017 ). With the widespread use of social media among individuals living with mental illness combined with the potential to facilitate social interaction and connect with supportive peers, as summarized above, it may be possible to leverage the popular features of social media to enhance existing mental health programs and services. A recent review by Biagianti et al (2018) found that peer-to-peer support appeared to offer feasible and acceptable ways to augment digital mental health interventions for individuals with psychotic disorders by specifically improving engagement, compliance, and adherence to the interventions, and may also improve perceived social support ( Biagianti, Quraishi, & Schlosser, 2018 ).

Among digital programs that have incorporated peer-to-peer social networking consistent with popular features on social media platforms, a pilot study of the HORYZONS online psychosocial intervention demonstrated significant reductions in depression among patients with first episode psychosis ( Alvarez-Jimenez et al., 2013 ). Importantly, the majority of participants (95%) in this study engaged with the peer-to-peer networking feature of the program, with many reporting increases in perceived social connectedness and empowerment in their recovery process ( Alvarez-Jimenez et al., 2013 ). This moderated online social therapy program is now being evaluated as part of a large randomized controlled trial for maintaining treatment effects from first episode psychosis services ( Alvarez-Jimenez et al., 2019 ).

Other early efforts have demonstrated that use of digital environments with the interactive peer-to-peer features of social media can enhance social functioning and wellbeing in young people at high risk of psychosis ( Alvarez-Jimenez et al., 2018 ). There has also been a recent emergence of several mobile apps to support symptom monitoring and relapse prevention in psychotic disorders. Among these apps, the development of PRIME (Personalized Real-time Intervention for Motivational Enhancement) has involved working closely with young people with schizophrenia to ensure that the design of the app has the look and feel of mainstream social media platforms, as opposed to existing clinical tools ( Schlosser et al., 2016 ). This unique approach to the design of the app is aimed at promoting engagement, and ensuring that the app can effectively improve motivation and functioning through goal setting and promoting better quality of life of users with schizophrenia ( Schlosser et al., 2018 ).

Social media platforms could also be used to promote engagement and participation in in-person services delivered through community mental health settings. For example, the peer-based lifestyle intervention called PeerFIT targets weight loss and improved fitness among individuals living with serious mental illness through a combination of in-person lifestyle classes, exercise groups, and use of digital technologies ( Aschbrenner, Naslund, Shevenell, Kinney, & Bartels, 2016 ; Aschbrenner, Naslund, Shevenell, Mueser, & Bartels, 2016 ). The intervention holds tremendous promise as lack of support is one of the largest barriers toward exercise in patients with serious mental illness ( Firth et al., 2016 ) and it is now possible to use social media to counter such. Specifically, in PeerFIT, a private Facebook group is closely integrated into the program to offer a closed platform where participants can connect with the lifestyle coaches, access intervention content, and support or encourage each other as they work towards their lifestyle goals ( Aschbrenner, Naslund, & Bartels, 2016 ; Naslund, Aschbrenner, Marsch, & Bartels, 2016a ). To date, this program has demonstrate preliminary effectiveness for meaningfully reducing cardiovascular risk factors that contribute to early mortality in this patient group ( Aschbrenner, Naslund, Shevenell, Kinney, et al., 2016 ), while the Facebook component appears to have increased engagement in the program, while allowing participants who were unable to attend in-person sessions due to other health concerns or competing demands to remain connected with the program ( Naslund, Aschbrenner, Marsch, McHugo, & Bartels, 2018 ). This lifestyle intervention is currently being evaluated in a randomized controlled trial enrolling young adults with serious mental illness from a variety of real world community mental health services settings ( Aschbrenner, Naslund, Gorin, et al., 2018 ).

These examples highlight the promise of incorporating the features of popular social media into existing programs, which may offer opportunities to safely promote engagement and program retention, while achieving improved clinical outcomes. This is an emerging area of research, as evidenced by several important effectiveness trials underway ( Alvarez-Jimenez et al., 2019 ; Aschbrenner, Naslund, Gorin, et al., 2018 ), including efforts to leverage online social networking to support family caregivers of individuals receiving first episode psychosis services ( Gleeson et al., 2017 ).

Challenges with Social Media for Mental Health

The science on the role of social media for engaging persons with mental disorders needs a cautionary note on the effects of social media usage on mental health and well being, particularly in adolescents and young adults. While the risks and harms of social media are frequently covered in the popular press and mainstream news reports, careful consideration of the research in this area is necessary. In a review of 43 studies in young people, many benefits of social media were cited, including increased self-esteem, and opportunities for self-disclosure ( Best, Manktelow, & Taylor, 2014 ). Yet, reported negative effects were an increased exposure to harm, social isolation, depressive symptoms and bullying ( Best et al., 2014 ). In the sections that follow (see Table 1 for a summary), we consider three major categories of risk related to use of social media and mental health. These include: 1) Impact on symptoms; 2) Facing hostile interactions; and 3) Consequences for daily life.

Impact on Symptoms

Studies consistently highlight that use of social media, especially heavy use and prolonged time spent on social media platforms, appears to contribute to increased risk for a variety of mental health symptoms and poor wellbeing, especially among young people ( Andreassen et al., 2016 ; Kross et al., 2013 ; Woods & Scott, 2016 ). This may partly be driven by the detrimental effects of screen time on mental health, including increased severity of anxiety and depressive symptoms, which have been well documented ( Stiglic & Viner, 2019 ). Recent studies have reported negative effects of social media use on mental health of young people, including social comparison pressure with others and greater feeling of social isolation after being rejected by others on social media ( Rideout & Fox, 2018 ). In a study of young adults, it was found that negative comparisons with others on Facebook contributed to risk of rumination and subsequent increases in depression symptoms ( Feinstein et al., 2013 ). Still, the cross sectional nature of many screen time and mental health studies makes it challenging to reach causal inferences ( Orben & Przybylski, 2019 ).

Quantity of social media use is also an important factor, as highlighted in a survey of young adults ages 19 to 32, where more frequent visits to social media platforms each week were correlated with greater depressive symptoms ( Lin et al., 2016 ). More time spent using social media is also associated with greater symptoms of anxiety ( Vannucci, Flannery, & Ohannessian, 2017 ). The actual number of platforms accessed also appears to contribute to risk as reflected in another national survey of young adults where use of a large number of social media platforms was associated with negative impact on mental health ( Primack et al., 2017 ). Among survey respondents using between 7 and 11 different social media platforms compared to respondents using only 2 or fewer platforms, there was a 3 times greater odds of having high levels of depressive symptoms and a 3.2 times greater odds of having high levels of anxiety symptoms ( Primack et al., 2017 ).

Many researchers have postulated that worsening mental health attributed to social media use may be because social media replaces face-to-face interactions for young people ( Twenge & Campbell, 2018 ), and may contribute to greater loneliness ( Bucci et al., 2019 ), and negative effects on other aspects of health and wellbeing ( Woods & Scott, 2016 ). One nationally representative survey of US adolescents found that among respondents who reported more time accessing media such as social media platforms or smartphone devices, there was significantly greater depressive symptoms and increased risk of suicide when compared to adolescents who reported spending more time on non-screen activities, such as in-person social interaction or sports and recreation activities ( Twenge, Joiner, Rogers, & Martin, 2018 ). For individuals living with more severe mental illnesses, the effects of social media on psychiatric symptoms have received less attention. One study found that participation in chat rooms may contribute to worsening symptoms in young people with psychotic disorders ( Mittal, Tessner, & Walker, 2007 ), while another study of patients with psychosis found that social media use appeared to predict low mood ( Berry, Emsley, Lobban, & Bucci, 2018 ). These studies highlight a clear relationship between social media use and mental health that may not be present in general population studies ( Orben & Przybylski, 2019 ), and emphasize the need to explore how social media may contribute to symptom severity and whether protective factors may be identified to mitigate these risks.

Facing Hostile Interactions

Popular social media platforms can create potential situations where individuals may be victimized by negative comments or posts. Cyberbullying represents a form of online aggression directed towards specific individuals, such as peers or acquaintances, which is perceived to be most harmful when compared to random hostile comments posted online ( Hamm et al., 2015 ). Importantly, cyberbullying on social media consistently shows harmful impact on mental health in the form of increased depressive symptoms as well as worsening of anxiety symptoms, as evidenced in a review of 36 studies among children and young people ( Hamm et al., 2015 ). Furthermore, cyberbullying disproportionately impacts females as reflected in a national survey of adolescents in the United States, where females were twice as likely to be victims of cyberbullying compared to males ( Alhajji, Bass, & Dai, 2019 ). Most studies report cross-sectional associations between cyberbullying and symptoms of depression or anxiety ( Hamm et al., 2015 ), though one longitudinal study in Switzerland found that cyberbullying contributed to significantly greater depression over time ( Machmutow, Perren, Sticca, & Alsaker, 2012 ).

For youth ages 10 to 17 who reported major depressive symptomatology, there was over 3 times greater odds of facing online harassment in the last year compared to youth who reported mild or no depressive symptoms ( Ybarra, 2004 ). Similarly, in a 2018 national survey of young people, respondents ages 14 to 22 with moderate to severe depressive symptoms were more likely to have had negative experiences when using social media, and in particular, were more likely to report having faced hostile comments, or being “trolled”, from others when compared to respondents without depressive symptoms (31% vs. 14%) ( Rideout & Fox, 2018 ). As these studies depict risks for victimization on social media and the correlation with poor mental health, it is possible that individuals living with mental illness may also experience greater hostility online compared to individuals without mental illness. This would be consistent with research showing greater risk of hostility, including increased violence and discrimination, directed towards individuals living with mental illness in in-person contexts, especially targeted at those with severe mental illnesses ( Goodman et al., 1999 ).

A computational study of mental health awareness campaigns on Twitter reported that while stigmatizing content was rare, it was actually the most spread (re-tweeted) demonstrating that harmful content can travel quickly on social media ( Saha et al., 2019 ). Another study was able to map the spread of social media posts about the Blue Whale Challenge, an alleged game promoting suicide, over Twitter, YouTube, Reddit, Tumblr and other forums across 127 countries ( Sumner et al., 2019 ). These findings show that it is critical to monitor the actual content of social media posts, such as determining whether content is hostile or promotes harm to self or others. This is pertinent because existing research looking at duration of exposure cannot account for the impact of specific types of content on mental health and is insufficient to fully understand the effects of using these platforms on mental health.

Consequences for Daily Life

The ways in which individuals use social media can also impact their offline relationships and everyday activities. To date, reports have described risks of social media use pertaining to privacy, confidentiality, and unintended consequences of disclosing personal health information online ( Torous & Keshavan, 2016 ). Additionally, concerns have been raised about poor quality or misleading health information shared on social media, and that social media users may not be aware of misleading information or conflicts of interest especially when the platforms promote popular content regardless of whether it is from a trustworthy source ( Moorhead et al., 2013 ; Ventola, 2014 ). For persons living with mental illness there may be additional risks from using social media. A recent study that specifically explored the perspectives of social media users with serious mental illnesses, including participants with schizophrenia spectrum disorders, bipolar disorder, or major depression, found that over one third of participants expressed concerns about privacy when using social media ( Naslund & Aschbrenner, 2019 ). The reported risks of social media use were directly related to many aspects of everyday life, including concerns about threats to employment, fear of stigma and being judged, impact on personal relationships, and facing hostility or being hurt ( Naslund & Aschbrenner, 2019 ). While few studies have specifically explored the dangers of social media use from the perspectives of individuals living with mental illness, it is important to recognize that use of these platforms may contribute to risks that extend beyond worsening symptoms and that can affect different aspects of daily life.

In this commentary we considered ways in which social media may yield benefits for individuals living with mental illness, while contrasting these with the possible harms. Studies reporting on the threats of social media for individuals with mental illness are mostly cross-sectional, making it difficult to draw conclusions about direction of causation. However, the risks are potentially serious. These risks should be carefully considered in discussions pertaining to use of social media and the broader use of digital mental health technologies, as avenues for mental health promotion, or for supporting access to evidence-based programs or mental health services. At this point, it would be premature to view the benefits of social media as outweighing the possible harms, when it is clear from the studies summarized here that social media use can have negative effects on mental health symptoms, can potentially expose individuals to hurtful content and hostile interactions, and can result in serious consequences for daily life, including threats to employment and personal relationships. Despite these risks, it is also necessary to recognize that individuals with mental illness will continue to use social media given the ease of accessing these platforms and the immense popularity of online social networking. With this in mind, it may be ideal to raise awareness about these possible risks so that individuals can implement necessary safeguards, while also highlighting that there could also be benefits. For individuals with mental illness who use social media, being aware of the risks is an essential first step, and then highlighting ways that use of these popular platforms could also contribute to some benefits, ranging from finding meaningful interactions with others, engaging with peer support networks, and accessing information and services.

To capitalize on the widespread use of social media, and to achieve the promise that these platforms may hold for supporting the delivery of targeted mental health interventions, there is need for continued research to better understand how individuals living with mental illness use social media. Such efforts could inform safety measures and also encourage use of social media in ways that maximize potential benefits while minimizing risk of harm. It will be important to recognize how gender and race contribute to differences in use of social media for seeking mental health information or accessing interventions, as well as differences in how social media might impact mental wellbeing. For example, a national survey of 14- to 22-year olds in the United States found that female respondents were more likely to search online for information about depression or anxiety, and to try to connect with other people online who share similar mental health concerns, when compared to male respondents ( Rideout & Fox, 2018 ). In the same survey, there did not appear to be any differences between racial or ethnic groups in social media use for seeking mental health information ( Rideout & Fox, 2018 ). Social media use also appears to have a differential impact on mental health and emotional wellbeing between females and males ( Booker, Kelly, & Sacker, 2018 ), highlighting the need to explore unique experiences between gender groups to inform tailored programs and services. Research shows that lesbian, gay, bisexual or transgender individuals frequently use social media for searching for health information and may be more likely compared to heterosexual individuals to share their own personal health experiences with others online ( Rideout & Fox, 2018 ). Less is known about use of social media for seeking support for mental health concerns among gender minorities, though this is an important area for further investigation as these individuals are more likely to experience mental health problems and more likely to experience online victimization when compared to heterosexual individuals ( Mereish, Sheskier, Hawthorne, & Goldbach, 2019 ).

Similarly, efforts are needed to explore the relationship between social media use and mental health among ethnic and racial minorities. A recent study found that exposure to traumatic online content on social media showing violence or hateful posts directed at racial minorities contributed to increases in psychological distress, PTSD symptoms, and depression among African American and Latinx adolescents in the United States ( Tynes, Willis, Stewart, & Hamilton, 2019 ). These concerns are contrasted by growing interest in the potential for new technologies including social media to expand the reach of services to underrepresented minority groups ( Schueller, Hunter, Figueroa, & Aguilera, 2019 ). Therefore, greater attention is needed to understanding the perspectives of ethnic and racial minorities to inform effective and safe use of social media for mental health promotion efforts.

Research has found that individuals living with mental illness have expressed interest in accessing mental health services through social media platforms. A survey of social media users with mental illness found that most respondents were interested in accessing programs for mental health on social media targeting symptom management, health promotion, and support for communicating with health care providers and interacting with the health system ( Naslund et al., 2017 ). Importantly, individuals with serious mental illness have also emphasized that any mental health intervention on social media would need to be moderated by someone with adequate training and credentials, would need to have ground rules and ways to promote safety and minimize risks, and importantly, would need to be free and easy to access.

An important strength with this commentary is that it combines a range of studies broadly covering the topic of social media and mental health. We have provided a summary of recent evidence in a rapidly advancing field with the goal of presenting unique ways that social media could offer benefits for individuals with mental illness, while also acknowledging the potentially serious risks and the need for further investigation. There are also several limitations with this commentary that warrant consideration. Importantly, as we aimed to address this broad objective, we did not conduct a systematic review of the literature. Therefore, the studies reported here are not exhaustive, and there may be additional relevant studies that were not included. Additionally, we only summarized published studies, and as a result, any reports from the private sector or websites from different organizations using social media or other apps containing social media-like features would have been omitted. Though it is difficult to rigorously summarize work from the private sector, sometimes referred to as “gray literature”, because many of these projects are unpublished and are likely selective in their reporting of findings given the target audience may be shareholders or consumers.

Another notable limitation is that we did not assess risk of bias in the studies summarized in this commentary. We found many studies that highlighted risks associated with social media use for individuals living with mental illness; however, few studies of programs or interventions reported negative findings, suggesting the possibility that negative findings may go unpublished. This concern highlights the need for a future more rigorous review of the literature with careful consideration of bias and an accompanying quality assessment. Most of the studies that we described were from the United States, as well as from other higher income settings such as Australia or the United Kingdom. Despite the global reach of social media platforms, there is a dearth of research on the impact of these platforms on the mental health of individuals in diverse settings, as well as the ways in which social media could support mental health services in lower income countries where there is virtually no access to mental health providers. Future research is necessary to explore the opportunities and risks for social media to support mental health promotion in low-income and middle-income countries, especially as these countries face a disproportionate share of the global burden of mental disorders, yet account for the majority of social media users worldwide ( Naslund et al., 2019 ).

Future Directions for Social Media and Mental Health

As we consider future research directions, the near ubiquitous social media use also yields new opportunities to study the onset and manifestation of mental health symptoms and illness severity earlier than traditional clinical assessments. There is an emerging field of research referred to as ‘digital phenotyping’ aimed at capturing how individuals interact with their digital devices, including social media platforms, in order to study patterns of illness and identify optimal time points for intervention ( Jain, Powers, Hawkins, & Brownstein, 2015 ; Onnela & Rauch, 2016 ). Given that most people access social media via mobile devices, digital phenotyping and social media are closely related ( Torous et al., 2019 ). To date, the emergence of machine learning, a powerful computational method involving statistical and mathematical algorithms ( Shatte, Hutchinson, & Teague, 2019 ), has made it possible to study large quantities of data captured from popular social media platforms such as Twitter or Instagram to illuminate various features of mental health ( Manikonda & De Choudhury, 2017 ; Reece et al., 2017 ). Specifically, conversations on Twitter have been analyzed to characterize the onset of depression ( De Choudhury, Gamon, Counts, & Horvitz, 2013 ) as well as detecting users’ mood and affective states ( De Choudhury, Gamon, & Counts, 2012 ), while photos posted to Instagram can yield insights for predicting depression ( Reece & Danforth, 2017 ). The intersection of social media and digital phenotyping will likely add new levels of context to social media use in the near future.

Several studies have also demonstrated that when compared to a control group, Twitter users with a self-disclosed diagnosis of schizophrenia show unique online communication patterns ( Michael L Birnbaum, Ernala, Rizvi, De Choudhury, & Kane, 2017 ), including more frequent discussion of tobacco use ( Hswen et al., 2017 ), symptoms of depression and anxiety ( Hswen, Naslund, Brownstein, & Hawkins, 2018b ), and suicide ( Hswen, Naslund, Brownstein, & Hawkins, 2018a ). Another study found that online disclosures about mental illness appeared beneficial as reflected by fewer posts about symptoms following self-disclosure (Ernala, Rizvi, Birnbaum, Kane, & De Choudhury, 2017). Each of these examples offers early insights into the potential to leverage widely available online data for better understanding the onset and course of mental illness. It is possible that social media data could be used to supplement additional digital data, such as continuous monitoring using smartphone apps or smart watches, to generate a more comprehensive ‘digital phenotype’ to predict relapse and identify high-risk health behaviors among individuals living with mental illness ( Torous et al., 2019 ).

With research increasingly showing the valuable insights that social media data can yield about mental health states, greater attention to the ethical concerns with using individual data in this way is necessary ( Chancellor, Birnbaum, Caine, Silenzio, & De Choudhury, 2019 ). For instance, data is typically captured from social media platforms without the consent or awareness of users ( Bidargaddi et al., 2017 ), which is especially crucial when the data relates to a socially stigmatizing health condition such as mental illness ( Guntuku, Yaden, Kern, Ungar, & Eichstaedt, 2017 ). Precautions are needed to ensure that data is not made identifiable in ways that were not originally intended by the user who posted the content, as this could place an individual at risk of harm or divulge sensitive health information ( Webb et al., 2017 ; Williams, Burnap, & Sloan, 2017 ). Promising approaches for minimizing these risks include supporting the participation of individuals with expertise in privacy, clinicians, as well as the target individuals with mental illness throughout the collection of data, development of predictive algorithms, and interpretation of findings ( Chancellor et al., 2019 ).

In recognizing that many individuals living with mental illness use social media to search for information about their mental health, it is possible that they may also want to ask their clinicians about what they find online to check if the information is reliable and trustworthy. Alternatively, many individuals may feel embarrassed or reluctant to talk to their clinicians about using social media to find mental health information out of concerns of being judged or dismissed. Therefore, mental health clinicians may be ideally positioned to talk with their patients about using social media, and offer recommendations to promote safe use of these sites, while also respecting their patients’ autonomy and personal motivations for using these popular platforms. Given the gap in clinical knowledge about the impact of social media on mental health, clinicians should be aware of the many potential risks so that they can inform their patients, while remaining open to the possibility that their patients may also experience benefits through use of these platforms. As awareness of these risks grows, it may be possible that new protections will be put in place by industry or through new policies that will make the social media environment safer. It is hard to estimate a number needed to treat or harm today given the nascent state of research, which means the patient and clinician need to weigh the choice on a personal level. Thus offering education and information is an important first step in that process. As patients increasingly show interest in accessing mental health information or services through social media, it will be necessary for health systems to recognize social media as a potential avenue for reaching or offering support to patients. This aligns with growing emphasis on the need for greater integration of digital psychiatry, including apps, smartphones, or wearable devices, into patient care and clinical services through institution-wide initiatives and training clinical providers ( Hilty, Chan, Torous, Luo, & Boland, 2019 ). Within a learning healthcare environment where research and care are tightly intertwined and feedback between both is rapid, the integration of digital technologies into services may create new opportunities for advancing use of social media for mental health.

As highlighted in this commentary, social media has become an important part of the lives of many individuals living with mental disorders. Many of these individuals use social media to share their lived experiences with mental illness, to seek support from others, and to search for information about treatment recommendations, accessing mental health services, and coping with symptoms ( Bucci et al., 2019 ; Highton-Williamson et al., 2015 ; Naslund, Aschbrenner, et al., 2016b ). As the field of digital mental health advances, the wide reach, ease of access, and popularity of social media platforms could be used to allow individuals in need of mental health services or facing challenges of mental illness to access evidence-based treatment and support. To achieve this end and to explore whether social media platforms can advance efforts to close the gap in available mental health services in the United States and globally, it will be essential for researchers to work closely with clinicians and with those affected by mental illness to ensure that possible benefits of using social media are carefully weighed against anticipated risks.

Acknowledgements

Dr. Naslund is supported by a grant from the National Institute of Mental Health (U19MH113211). Dr. Aschbrenner is supported by a grant from the National Institute of Mental Health (1R01MH110965-01).

Publisher's Disclaimer: This Author Accepted Manuscript is a PDF file of a an unedited peer-reviewed manuscript that has been accepted for publication but has not been copyedited or corrected. The official version of record that is published in the journal is kept up to date and so may therefore differ from this version.

Conflict of Interest

The authors have nothing to disclose.

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Early Life and Infant Mental Health Research Group

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Department of Psychiatry 

​research - research units .

​To create a research hub for Early Life and Infant Mental Health at Stellenbosch University that focuses on culturally relevant and contextually sensitive research with infants and their caregivers, support and health care systems from pre-conception through the first 1000 days of life.

​To  create a space that will focus on early development and infant mental health (IMH), guided by the realities/needs of the Southern African context. 

Education progr​​​ammes

• ​ MPhil IMH degree : applications closed for 2025​.​
• IMH  online short course: enquire about future offerings.

​ Collaborators

• ​​ Prof Michelle Pentecost ​ , Department of Global Health & Social Medicine, King's College London
• Prof Fiona Ross ​ , Department of ​Social Anthropology & Gender Studies
• Dr Tracey Smythe ​ , Department of Population Health, London School of Hygiene & Tropical Medicine and the Division of Physiotherapy, Stellenbosch University

Publications​ (updates in progress)

• Lachman A, Gerber B, Bornman J, Smythe T. Opportunities to accelerate progress in infant mental health. Lancet Child Adolesc Health. 2024;8(8):551-552. doi:10.1016/S2352-4642(24)00131-7
• Mpongwana-Ncetani S, Roomaney R, Lachman A . Experiences of Xhosa women providing Kangaroo mother care in a tertiary hospital in the Western Cape, South Africa. South African Journal of Psychology. 2023;53(4):497-508. doi:10.1177/00812463231193167
• Suresh S, Kannenberg SM, Lachman A . Assessing the impact paediatric atopic dermatitis has on the mental health and quality of life of caregivers attending a tertiary hospital in Cape Town, South Africa. Current Allergy & Clinical Immunology. 2023;36(2):2-7.  https://hdl.handle.net/10520/ejc-caci-v36-n2-a9
• Whittaker T, Lachman A . Using technology to impact maternal and perinatal mental healthcare service delivery in South Africa. Africa Journal of Nursing and Midwifery. 2023;25(2):#13655. https://doi.org/10.25159/2520-5293/13655
• Armstrong KJ, Berg A ,  Lachman A . Nannies or creche: exploring child carers’ knowledge of the first 1000 days and their perception of the significance of their role as carers. Early Child Development and Care. 2022;193(6),754–766. https://doi.org/10.1080/03004430.2022.2154760
• Lachman A , Jordaan ER, Stern M, Donald KA, Hoffman N, Lake MT, Zar HJ, Niehaus DJH, Puura K, Stein DJ. The Shared Pleasure Paradigm: A study in an observational birth cohort in South Africa. Arch Womens Ment Health. 2022;25(1):227-235. doi:10.1007/s00737-021-01199-0
• ​ World Association for Infant Mental Health (WAIM)
• The International Marcé Society for Perinatal Mental Health ​ ​
• South African Society of Psychiatrists ​   (SASOP)​
• South African Association for Infant Mental Health (ZA-AIMH)​
• South African Parenting Programme Implementers Network (SAP PI​ N)
• ​ The Handbook of DOHaD and Society ​ - Past, Present, and Future Directions of Biosocial Collaboration​
• WAIMH Handbook of Infant and Early Childhood Mental Health ​ - Cultural Context, Prevention, Intervention, and Treatment (Vol II)
• Developing Culturally Sound Infant Mental Health Practice for the South African Context
• ​ Understanding the Uniqueness and Diversity in Child and Adolescent Mental Health
• Infant Mental Health in Africa: Embracing Cultural Diversity ​ ​

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• Undergraduate

Psychology Capstone

• Field Experience
• Careers in Psychology

The Psychology Capstone Experience is intended to provide the psychology student with an intensive exploration into an aspect (e.g., teaching, service, research) and area (e.g., clinical, developmental, behavior analysis, behavioral neuroscience) of psychology as a means for enhancing learning and integrating the knowledge and experiences acquired as a psychology major.

Experiential learning experiences are critically important for baccalaureate graduates of Psychology to be competitive for graduate or professional programs or to seek employment. One goal of the Capstone requirement is that the student will become well-rounded professionally.  

The capstone must be completed within the 12 months prior to graduation.

There are 5 types of Psychology Capstone courses.

• Teaching Practicum - PSYC 490A
• Professional Field Experience Capstone - PSYC 491A
• Behavior Analysis Field Experience Capstone – PSYC 486
• Behavior Analysis Research Experience – PSYC 487
• Independent Study (Research) - PSYC 495A, PSYC 498A, or PSYC 487: Research and PSYC 498A: Honors Thesis

Selecting a Capstone

Start with what you want to do after you graduate. Your capstone can be used to help you develop the valued skills necessary for that next step related to your career path.

Mental Health

Students interested in an applied area of mental health, like Counseling or Social Work, should prioritize a PSYC 491A capstone.

Research or Medicine

Students interested in careers involving research or medicine should plan on completing several semesters of research with a faculty member, culminating in a PSYC 495A, PSYC 498A, or PSYC 487 capstone.

Behavior Analysis

Students interested in careers in Behavior Analysis, and all those pursuing the undergraduate Certificate in Behavior Analysis should complete a PSYC 486 or PSYC 487 capstone.

Human Resources or Business

Students interested in careers in Human Resources or Business should consider a PSYC 491A capstone.

Students planning to pursue a career in education should complete with a PSYC 490A or PSYC 491A capstone.

Capstone Requirements

Students must have completed PSYC 204 – Research Methods and Analysis II and be in their last year of study before they will be allowed to register for a capstone experience.

Credits: Capstone courses are necessarily 3 credits. Each credit will equate to 3 hours a week of activity in Fall or Spring semesters. Therefore, students should expect to complete 9 hours of activity a week during their capstone semester. If a student is completing a capstone over the 12-week summer session, they should expect to spend at least 12 hours a week engaged in their capstone work.

Project: As a requirement of their Capstone Experience, students complete a capstone project. The nature of the project will vary based on the type of capstone. For example, a PSYC 491A capstone project might be a case study of a particular child or adult at your site. A PSYC 495A capstone project would be completing a research study under the supervision of their faculty supervisor. The project will culminate in a 10-page paper and presentation of a professional paper at the department Capstone Poster Session.

Poster: At the end of the fall and spring semesters, the Department of Psychology hosts a Capstone Poster Session. At this event, all students completing their capstone requirements will produce a professional poster, with the supervision of their supervising faculty, and have their poster evaluated by members of the Department of Psychology. This is one of the most exciting and fun events of the semester. Students in their earlier years are encouraged to attend this poster session. Some PSYC courses may offer extra credit for attending this event.

ACAT: Around mid-semester, all Capstone students must complete the ACAT, a standardized assessment of psychology content.

PSYC 490A: Teaching Capstone

Students completing the PSYC 490A capstone will be involved in proctoring, tutoring, and depending on the course, lecturing or leading in-class activities and discussions. Students will complete a research or equivalent study on issues related to teaching/pedagogy.

This capstone can benefit those students who want to develop their presentational skills, tutoring skills, and are interested in examining topics related to pedagogy, student success, or other topics.

To arrange a PSYC 490A experience, email course supervisors for PSYC 101, PSYC 241, PSYC 251, or another course 1) that you find interesting and 2) in which you earned an A. Find out if that faculty has GPA requirements for their Teaching Practicum students. Some students will reach out a year in advance to secure their spot as a Teaching Practicum student with a faculty. These opportunities can be limited. Once approved to set up a PSYC 490A, you and the faculty member fill out a contract and once this is done, you will send this contract to our Undergraduate Records Assistant. After that, you will be allowed to register for the course.

PSYC 491: Field Experience

Please review the PSYC 491 page for more information about field experience options. 

Student completing the PSYC 491A capstone option will be expected to work at a site for 9 hours a week in Fall or Spring semesters or 12 hours a week if completed over the summer session. Sites can be related to treatment of addictions, persons with autism spectrum disorders or neurodivergence, human resources, psychological testing, and many other areas of interest to students. Students will also meet weekly with their PSYC 491A faculty and GTA to complete work on eCampus.

Most Psychology majors complete this capstone option. It is beneficial for allowing students to gain practical experiences and develop skills valued by employers and many graduate programs. This is a popular capstone choice for students considering careers in Counseling or Clinical Mental Health.

Plan this at least year in advance . Check the due dates for the application and related forms. The application is usually due by the 4 th week of the previous semester. The steps setting up a Professional Field Experience will also include having a background check completed before a student can register for credits. 

PSYC 486: Behavior Analysis Field Experience

Like PSYC 491A, student completing the PSYC 486 capstone option will be expected to work at a site for 9 hours a week in Fall or Spring semesters or 12 hours a week if completed over the summer session. The difference is that the site will be specifically focus on applications of behavior analysis, allowing students to use the PSYC 486 course to meet the experiential requirements for the undergraduate Certificate in Behavior Analysis as well as the Psychology major capstone.

Contact Dr. Brennan Armshaw ( [email protected]  ) well in advance of the semester in which you wish to enroll. Spaces in PSYC 487 are limited.

PSYC 495A, PSYC 498A, or PSYC 487: Research

Students completing a research capstone are typically completing advanced research training in a faculty research lab within the Department of Psychology. Students may have already developed foundational skills in that faculty research lab from previously completing PSYC 497 or PSYC 487 credits. Students may be involved in recruiting, collecting data or coding data, running additional analyses, and assisting in manuscript writing.

PSYC 495A is a research capstone. PSYC 498A is an Honor’s thesis. PSYC 487 involves research in behavior analysis.

Students will develop important research skills and may engage in professional experiences, such as presenting research at colloquia and professional meetings. Students will be working with graduate students and often enjoy important mentoring as they prepare for jobs or graduate programs after they graduate.

Contact faculty members whose research interests you (using the Faculty Directory or Research page as a resource) to learn more about that person’s specific requirements.

PSYC 498A: Honors Thesis

This program is distinct from the Honors College. Students do not need to be members of the Honors College to engage in this capstone option.

Completing a PSYC 498A Honors Thesis generally requires 2 semesters. During the first semester, students typically register for the non-capstone section of PSYC 498. Then during the second semester, students will register for the Capstone section of PSYC 498A. Faculty often require that the student work in their lab for PSYC 497 credit previously. PSYC 498 positions are primarily available in the fall and spring semesters. However, some faculty members will work with students completing a PSYC 498A Capstone Experience during the summer.

In this option, students create a 3-person Honors Thesis committee, usually made up of their supervising faculty member, a second faculty member from outside the lab, and a graduate student. Honors Thesis students develop their own study, propose the study to their Honors Thesis committee, carry out the study, write up their findings, and then defend their study to their committee at the conclusion. As with other capstone students, Honors Thesis students will write a research paper and present their poster at the Department of Psychology Senior Poster Session. Most Honors Thesis papers are “manuscript quality,” that is, the student and the faculty may plan to submit the paper to a professional journal.

With the experience of forming a committee, proposing and defending the research, presenting the research and perhaps seeking a publication, students completing this capstone option are developing skills and experiences that will allow them to be competitive at the highest levels.

Students interested in the PSYC 498A Honors Capstone Experience should discuss this with their research faculty supervisor and their major advisor. A completed and approved PSYC 498 Application, an overall GPA of 3.4 and a Psychology GPA of at least 3.5 are required to apply for the Honors Capstone. Related application and contract forms are provided by the student’s major advisor.  

Setting up a Capstone course will require the approval of the application, completion of a contract (and any other related materials) and submitting form(s) to the Undergraduate Student Records Administrator, Vee Lewis ( [email protected] ). Vee Lewis will lift the departmental approval restriction to allow students to enroll in their experiential course.

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Research: More People Use Mental Health Benefits When They Hear That Colleagues Use Them Too

• Laura M. Giurge,
• Lauren C. Howe,
• Zsofia Belovai,
• Guusje Lindemann,
• Sharon O’Connor

A study of 2,400 Novartis employees around the world found that simply hearing about others’ struggles can normalize accessing support at work.

Novartis has trained more than 1,000 employees as Mental Health First Aiders to offer peer-to-peer support for their colleagues. While employees were eager for the training, uptake of the program remains low. To understand why, a team of researchers conducted a randomized controlled trial with 2,400 Novartis employees who worked in the UK, Ireland, India, and Malaysia. Employees were shown one of six framings that were designed to overcome two key barriers: privacy concerns and usage concerns. They found that employees who read a story about their colleague using the service were more likely to sign up to learn more about the program, and that emphasizing the anonymity of the program did not seem to have an impact. Their findings suggest that one way to encourage employees to make use of existing mental health resources is by creating a supportive culture that embraces sharing about mental health challenges at work.

“I almost scheduled an appointment about a dozen times. But no, in the end I never went. I just wasn’t sure if my problems were big enough to warrant help and I didn’t want to take up someone else’s time unnecessarily.”

• Laura M. Giurge is an assistant professor at the London School of Economics, and a faculty affiliate at London Business School. Her research focuses on time and boundaries in organizations, workplace well-being, and the future of work. She is also passionate about translating research to the broader public through interactive and creative keynote talks, workshops, and coaching. Follow her on LinkedIn  here .
• Lauren C. Howe is an Associate Professor in Management at the University of Zurich. As a member of the Center for Leadership in the Future of Work , she focuses on how human aspects, such as mindsets, socioemotional skills, and social relationships play a role in the changing world of work.
• Zsofia Belovai is a behavioral-science lead for the organizational-performance research practice at MoreThanNow.
• Guusje Lindemann is a senior behavioral scientist at MoreThanNow, in the social impact and organizational performance practices, working on making the workplace better for all.
• Sharon O’Connor is the global employee wellbeing lead at Novartis. She is a founding member of the Wellbeing Executives Council of The Conference Board, and a guest lecturer on the Workplace Wellness postgraduate certificate at Trinity College Dublin.

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