Don’t wait for a diagnosis: Early mental health and wellbeing starts now

Updated on October 29, 2023

The veil of stigma around mental health and wellness is finally beginning to lift, signaling that now we collectively recognize the widespread mental health crisis we’re facing here in the U.S. and – perhaps more importantly – that we’re ready to address it. And it’s not a moment too soon. 

If you look at nearly any mental health statistic in the U.S., it’s grim. For young people, it’s downright heartbreaking. The Centers for Disease Control and Prevention (CDC) recently released statistics that are harrowing, both from the young people’s perspectives and from their parents. Twenty-two percent of high school students seriously considered suicide in the past year, 57% of teen girls feel “persistently sad or hopeless” and 40% of parents are “very or extremely worried” about the mental health of their children, according to the CDC. 

We have a responsibility to these young people to address this crisis now and with better approaches than in the past.  We can no longer be reactive to mental healthcare, but instead be proactive. Arguably, our entire healthcare system in the U.S. is too reactive, but we simply can’t afford to continue on this paradigm when it comes to the mental health and well-being of young people. 

If we don’t act now – and act earlier in young people’s lives – the toll on their mental health compounds, as does the cost to our healthcare system. We know that 75% of lifetime mental health problems are established by age 24, yet more than 90% of healthcare is spent on acute care for adults, not on early intervention. According to the National Alliance on Mental Illness (NAMI), the average delay between the onset of mental illness symptoms and treatment is 11 years, further exacerbating the problem. 

Reactive options are also more costly than addressing mental health issues earlier. Both direct and indirect costs impact these skyrocketing numbers. According to NAMI, serious mental illness costs the U.S. economy $193.2 billion in lost earnings. Globally, depression and anxiety disorders are responsible for $1 trillion in lost productivity, according to NAMI. 

Further compounding the cost is that we’re also in the midst of a historic clinician shortage. This shortage has impacted healthcare delivery in every field, but it’s particularly difficult for those seeking mental healthcare. There are simply not enough mental health professionals practicing today to address the need adequately. Not even close, in fact. 

The solution is upstream 

We have to start earlier.  When I say earlier, I mean both earlier in a young person’s life, and earlier in the onset of a possible disease –  even before a diagnosis. Every young person deserves access to quality, timely healthcare, but what about early, preventative healthcare, specifically mental healthcare? Imagine the impact we can make if we offered mental health services to young people, to give them the tools to build resiliency all while reaching them exactly where they feel comfortable. 

Current modalities don’t meet young people where they are. Access is limited by geography, transportation, stigma, and even a lack of awareness of mental health tools and solutions. To increase equity of access, we have to first focus on equity of awareness. We can do this by meeting young people where they are, which, for the most part, is through technology. 

A case study: Reaching the “missing middle” through PA schools

At Kooth Digital Health, for example, we know we cannot singlehandedly solve what has historically been a trillion-dollar problem. We chose instead to focus on what we recognize as the massive “missive middle” – the majority of young people who do not have a mental health diagnosis and who are not facing an immediate crisis, but those who are struggling with pre-clinical emotional, social, and mental health challenges. Not only does the proper pre-clinical support improve health and wellness outcomes exponentially for young people, but it potentially staves off bigger and more complex treatment needs in the future, also potentially saving billions in direct and indirect costs. 

We believe one of the primary ways to reach this broad swath of the “missing middle” is through public-private partnerships, specifically through schools. In Pennsylvania, for example, 150,000 students have access to Kooth through a partnership with the state that’s rolled out in school districts across the state. 

We have a variety of digital modules that empower young people with a variety of proven tools and techniques to address stress, anxiety, sleep, relationships, self-esteem, trauma and more. This is done through self-therapy (self-journeys through therapeutic content and tools), peer support (safe community spaces moderated by licensed clinicians) and professional support (synchronous messaging, drop-in chats, and structured ongoing counseling and coaching). 

After just one year, results demonstrate the impact of reaching students in Pennsylvania where they are: 

  • 21% of students presented with a severe level of psychological distress, 24% presented with self-harm issues, and 59% presented with anxiety/stress
  • Though 65% of students feel like they need professional support, 63% do not feel comfortable speaking to friends or family about their mental wellbeing
  • 86% of students found Kooth’s content helpful

We have to start now. We cannot wait any longer. Early mental health and well-being programs can save billions – if not trillions – of dollars to our overburdened, understaffed healthcare system. But more importantly, all young people deserve healthy, fulfilling lives. And they all deserve access to the tools that can help them achieve it. We can help forge a resilient and psychologically flexible generation that values mental health and well-being. 

Bob McCullough
Bob McCullough

Bob McCullough, PhD, is the Vice President of Clinical Strategy for Kooth Digital Health. An associate professor of psychology at Missouri Baptist University and a licensed clinical social worker, Bob has extensive leadership experience in healthcare organizations including Cigna and Magellan Health, and behavioral health strategy experience at SilverCloud and ComPsych. He holds a master's degree in social work from Washington University in St. Louis and a doctorate of philosophy from Newburgh Theological Seminary.