Mental Health and the Next Generation

Panel Overview & Context

• Host Lynn Goldman (Dean, Milken Institute School of Public Health) framed the session by highlighting the scale of the mental health crisis:
  • One in five US adults experience a mental health condition at some point in their lives.
  • Approximately one in ten youth currently suffer from depression.
  • In 2017, 50% of Americans with a mental illness did not receive treatment.
  • The US has only one mental health professional for every 1,000 people (including psychiatrists, psychologists, and social workers).
  • 57,000 people with mental health conditions are incarcerated, a statistic highlighted as a systemic failure.
• The panel defined mental health as emotional, psychological, and social well-being affecting how individuals think, feel, and act, noting that illness involves biology, genetics, brain chemistry, life experiences, and trauma.

Organizational Innovations & Models

• 33 Foundation (Cindy Citrone):
  • Launched the "Play It Forward" initiative to integrate stress tolerance skills into the general public, aiming to teach resilience rather than just treating illness.
  • Successfully mobilized three major Pittsburgh sports franchises (Steelers, Penguins, Pirates) to deliver unified messaging on organ donation, a model now being replicated for mental health.
  • Plan to launch the mental health campaign in early 2019 correlated with the sports season, utilizing influencers like Ben Roethlisberger to normalize failure and resilience.
  • Goal is to hand over assets and resources to the city after the initial campaign to ensure sustainability.
• Talkspace (Oren Frank):
  • Founded to democratize therapy, currently serving over 1 million users.
  • 70% of users are in their first therapy experience, having never accessed mental health care previously.
  • The average user engages for over six months, compared to a mode number of one session in traditional care, leading to improved clinical outcomes.
  • Utilizes a proprietary data science platform to provide decision support tools for therapists, optimizing treatment without selling data to pharma or advertisers.
  • Identifies major barriers to traditional care: high cost (average $150/session), lack of time/attendance flexibility, stigma, and poor therapist-patient matching.
• Crisis Text Line (Alana Jacobs/Kaner):
  • Provides free, 24/7 text-based crisis counseling, processing 67 million messages to date with 4,000 trained volunteer counselors.
  • 65% of texters share something for the first time with a counselor, indicating a high level of trust and reach.
  • Achieved product-market fit in every US area code within four months of launch; consistent satisfaction ratings of ~85%.
  • Currently expanding internationally, including Canada and the UK, with a goal to reach 15 markets in the next four years.
  • Executes approximately 12,000 active emergency rescues; estimated 40,000 high-risk individuals were de-escalated without emergency dispatch.
  • Uses machine learning to triage risk, serving high-risk texts in under 39 seconds.
• Active Minds (Allison Malman):
  • Mobilizes young adults to change the mental health conversation, operating 450+ student-led chapters on college and high school campuses.
  • Driven by the founder's personal loss of her brother to suicide while he was a successful Ivy League student struggling in silence.
  • Data indicates 67% of suicidal students tell a friend before anyone else, necessitating peer-led intervention.
  • The presence of an Active Minds chapter increases help-seeking behavior for the entire campus population, not just chapter members.
  • Organized a partnership with the NFL Players Association to distribute "The World Needs You Here" bracelets during Suicide Prevention Month.

Key Barriers & Policy Obstacles

• Licensing Restrictions:
  • Current laws require therapists to hold specific state licenses, preventing cross-border care (e.g., a Texas-licensed therapist cannot treat a New Mexico patient remotely).
  • This reduces efficiency and access, particularly in states with provider shortages like New Mexico, where the supply of licensed therapists is in the dozens.
  • Talkspace is currently "hacking" the system by training therapists in states with high supply to obtain specific state licenses to serve out-of-state patients.
• FCC Regulations:
  • Crisis Text Line faces bureaucratic delays in being classified as an emergency service provider, hindering the ability to dispatch emergency care to texters in imminent risk.
  • The rollout of E911/Text-911 capabilities is inconsistent across states, limiting the integration of location data for crisis intervention.
• Funding & Parity:
  • Significant underfunding of mental health compared to physical health, with "atrocious" insurance parity preventing equitable coverage.
  • Corporate philanthropy toward mental health remains scarce due to stigma; few companies are willing to direct resources to the sector.
  • Mental health education is often missing or minimal in high school health curricula and college orientation programs.

Strategic Needs & Calls to Action

• Integration & Data:
  • Call for a "Human Genome Project" for mental health to integrate data from psychiatrists, psychologists, neuroscientists, and geneticists to better understand behavior and illness drivers.
  • Crisis Text Line seeks to partner with international affiliates to build holistic, integrated datasets to break down silos and identify geographic trends.
  • Talkspace emphasizes the need to merge verticals of science through machine learning to decipher patterns previously invisible to single disciplines.
• Technology Partnerships:
  • Crisis Text Line is actively partnering with social media platforms (Facebook, YouTube, Snapchat, After School) to embed crisis services directly where young people communicate.
• Public Engagement & Education:
  • Recommendation to integrate mental health skills (stress tolerance, resilience) into daily education, replacing or supplementing traditional academic tasks like calculus problems.
  • Advocacy for mandatory mental health units in health education classes and screening for mental health risks in pediatric offices starting at age eight.
  • Call to action for parents to discuss feelings openly starting in nursery school to reduce future stigma.
  • Encouragement for individuals to share personal stories of struggle and recovery to normalize mental illness and encourage help-seeking.

Audience Interaction & Specific Issues

• Physician Burnout:
  • Talkspace noted that young physicians are a high-intensity user group, often self-selecting into their service due to the difficulty of scheduling traditional appointments.
• Parental Engagement:
  • Parents are identified as the critical gatekeepers; reducing stigma requires parents to model vulnerability and discuss mental health early to prevent children from feeling isolated.
  • Suggestions include working with principals to update health curricula and ensuring pediatricians screen for mental health alongside vision and hearing.
• Digital Health:
  • Host and panelists noted the double-edged nature of technology, warning that social media can act as "digital tobacco" but must also be leveraged as a force for good through crisis intervention tools.