Healing A Broken Mental Health System: Wendy Smith On 5 Things That Can Be Done To Fix Our Broken Mental Health System
An Interview With Stephanie Greer
Better training about and more thoughtful use of psychoactive medications, especially with children and adolescents, whose brains are still developing. Children and adolescents should always receive person-to-person therapy in addition to taking psychoactive medications, and sometimes instead of them.
The current state of the mental health system is a conversation that echoes in the halls of policy-making, the corners of social advocacy, and within the private struggles of individuals and families. As we continue to witness an unprecedented need for robust mental health support, the shortcomings of the existing system become more glaring. It is within this backdrop that we seek the insight of those who are at the forefront of behavioral health. In this interview series, we are talking to behavioral health leaders, policymakers, mental health practitioners, advocates, and reformers to share their perspectives on healing our broken mental health system. As a part of this interview series, we had the pleasure of interviewing Wendy Smith.
Wendy Smith, Ph.D., LCSW, is a retired clinical professor of social work and associate dean of curriculum development and assessment at the University of Southern California Suzanne Dworak-Peck School of Social Work. She taught courses on child and adolescent development and social work practice with children, families, and transition age youth. She is a licensed clinical social worker who maintained a private practice in psychotherapy in Los Angeles for 35 years.
Thank you so much for joining us in this interview series. Before we start, our readers would love to “get to know you” a bit better. Can you tell us a bit about your background and your childhood backstory?
I am the child of Jewish refugees from Nazi Germany who escaped the looming Holocaust as young people in the late 1930’s. They met and married in London, where my sister and I were born into a country reeling from the devastation of war. Our family of four emigrated to the United States, leaving behind my mother’s large Orthodox family and the economic depression of post-war England. I grew up in Los Angeles and earned my undergraduate and graduate degrees from the University of California. My career began with clinical social work and later encompassed university teaching and administration.
Most relevant to the topic of this interview is the fact that the history of my parents’ frightening experiences related to Nazism, as well as the losses and psychological disturbance in their own families of origin, set the stage for the serious mental health problems my parents suffered, and which infused my childhood. The impact of their struggles definitely led to my lifelong work in the areas of childhood trauma and mental health.
Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?
There are so many valuable lessons I have learned from others. I have more than one favorite, so I will share one that guides me, in work and in life. Dr. Martin Luther King spoke of the “beloved community,” a community in which everyone is cared for, where there is no poverty, hunger, or hate. That is the community I keep in the front of my mind and hope that I can help create.
Let’s now shift to the main part of our discussion. It is often said that “the mental health system in America is broken”. What does that statement mean to you? From your perspective what is “broken” today?
That is a big question. An important piece of the problem goes back more than 60 years. The closing of long-term-care inpatient facilities (or deinstitutionalization) that began in the 1960s was the beginning of some of the mental health crises we see today. The idea then was that many individuals could do better with community-based care options that were less restrictive. There were two problems with what happened next and since. First, not enough community-based options were created or available, and second, some people need structured inpatient care, but we no longer have enough of these beds.
Another piece is the distance between the public perception of and value placed on mental health as compared with physical health. The amount of research and attention paid to diseases of the body far exceeds that devoted to problems of the mind and emotions. And the more limited health insurance coverage for the latter reflects these perceptions and can prevent people from receiving the treatment they need.
What about any bright spots? Do you think there are any elements that we get right in today’s world that we wouldn’t want to reverse unintentionally?
There are indeed bright spots. There is a much greater understanding of mental illness and of the impact of early trauma not only on mental health, but also on physical health. There is greater integration of treatment in clinic settings, illustrating the growing appreciation that the whole person must be seen and addressed in order to successfully treat emotional or physical problems. The stigma of mental health problems such as depression, anxiety, and post traumatic disorders is decreasing.
In your opinion, what are the 5 most impactful things that could help heal the broken mental health system? These could be on any level including training, workforce, policy, culture, equity etc.
1. If the general public, including legislators, urban planners, school administrators, etc., had a greater appreciation of the importance of the impact of mental health problems and treatment availability for those who struggle with them, it would lead to increased funding for and creation of needed facilities and services.
2. A greater understanding of the time it takes to treat mental health problems could change things. The emphasis is often on short-term treatments, and insurance may cover such a limited number of therapy sessions that the problem is not truly resolved. The disappearance of one symptom can result in a different symptom emerging if the underlying issues have not been addressed. Similarly, we need mental health practitioners to learn and be able to employ greater understanding of some of the social determinants of mental (and physical) health, such as pre-existing trauma, poverty, homelessness, discrimination, and structural racism.
3. A range of kinds of treatment facilities is needed, one in which a person can graduate from acute treatment or hospitalization into community-based care. Some people will require long-term inpatient treatment, and there should be spaces to accommodate them.
4. Better training about and more thoughtful use of psychoactive medications, especially with children and adolescents, whose brains are still developing. Children and adolescents should always receive person-to-person therapy in addition to taking psychoactive medications, and sometimes instead of them.
5. Ideally, mental health practitioners would be trained to provide a range of psychotherapeutic approaches, so that treatment can be tailored to the needs of the individual, rather than to the therapist’s preferred theory or model.
If all of the items on your list were magically implemented tomorrow, what change might we see in the world? What are the signs (big and small) that would show us that the system is being healed?
I believe we would see a physically and mentally healthier world. I believe we would have less crime, including juvenile crime, less addiction, fewer gun deaths (suicides or homicides) and fewer chronic diseases. People would be getting the help they need.
What is a project you or others are working on today that gives you hope? How can our readers learn more about this work?
The research I have been doing regarding childhood trauma in the lives of juvenile offenders, and the book I am writing about it, give me hope that understanding of the pernicious effects of early adverse experiences will be clearer and more widely known. The broader use (in medical settings and social service agencies) and understanding of Adverse Childhood Experiences (ACEs) is a positive development and a reason to be hopeful.
How do you see technology shaping the future of mental health care and its accessibility?
Technology has already changed the accessibility and reach of mental health care. The ability to conduct virtual interventions has allowed individuals who might otherwise have no access to therapy to be treated.
Technology permits a more immediate response in crisis situations and the ability to see a person, in addition to hearing them, allows for better assessments of the person’s mental health status. That said, there are times and situations that require a face-to-face meeting to be able to truly see and feel what is happening, and to provide the help that is needed.
Technology can be invaluable in providing education and guidance regarding mental health, and can be an important part of training practitioners.
In your view, how do social factors like poverty, education, and culture affect mental health care and its effectiveness?
These factors are powerful determinants not only of mental health care, but also of mental health itself. Many studies point to the differences in accessibility and nature of mental health treatment provided to people of color and to those living in poverty.
There are also widely varying cultural norms about mental health and about seeking care. Opinions differ as to whether the person offering treatment and the person receiving it do better if they are of the same cultural background, but many people feel much more comfortable when they can identify with the person providing treatment. Personal bias, whether conscious or unconscious, of both patients and practitioners can come into play with negative effects. Quality mental health care can be effective regardless of the level of education of the person receiving it. The provider’s sensitivity, knowledge, competence, understanding, and ability to communicate are far more important than what level of school a patient attended.
In light of the growing mental health crisis among young people, what innovative approaches or interventions have proven most successful for children and adolescents?
That depends very much on the age and developmental status and social factors in the individual case. A careful assessment of those dimensions is key to successful intervention. For example, for some young people, a group intervention with other kids with similar issues is more engaging and allows more risk-taking in opening up. For others, the privacy of individual interventions will be more comfortable.
Children communicate via play, so for younger kids, a provider trained in play therapy will be more successful. Innovative therapies, for example, equine therapy and therapies that utilize internet platforms, have been found to be successful with traumatized adolescents.
We are very blessed that some very prominent names in Business, VC funding, Sports, and Entertainment read this column. Is there a person in the world, or in the US with whom you would love to have a private breakfast or lunch, and why? He or she might just see this if we tag them. 🙂
I would love to sit down with Michelle Obama to discuss her ideas about improving child and adolescent mental health. Her attention to childhood nutrition and physical activity tells me that she cares a great deal about healthy development.
How can our readers further follow your work online?
I don’t engage in social media, but I can be reached via email at wsmith@wendybsmithphd.net.
Thank you for your time and thoughtful answers. I know many people will gain so much from hearing this.
About The Interviewer: Stephanie Greer, PhD is the Co-founder and CEO of Akin Mental Health — a company dedicated to guiding families on their journey supporting a loved one with mental health challenges like bipolar disorder, schizophrenia and severe depression. Stephanie is passionate about this topic from her own personal experience growing up with a mother who struggled with bipolar 1 disorder and found a path forward to overcome the obstacles and live well. Stephanie’s professional experience includes a doctorate in neuroscience as well as design research roles at Hopelab and Apple. Stephanie brings this personal passion together with her world-class science and technology background to support families across the US in their personal journeys supporting loved ones with mental illness. To learn more about Akin Mental Health and join our community, visit us at akinmh.com.
Healing A Broken Mental Health System: Wendy Smith On 5 Things That Can Be Done To Fix Our Broken… was originally published in Authority Magazine on Medium, where people are continuing the conversation by highlighting and responding to this story.