It's Time for Routine and Recurring Therapy for All

(Reprinted from Psychology Today, December 12, 2024)

Distinct energy and excitement are emerging around Medicine 3.0, a nascent movement focused more on prevention and maintenance, and less on late-stage interventions and pharmaceuticals. In a country where rates of heart disease, cancer, and obesity are statistically through the roof, an ounce of prevention sounds like more than just a novel idea, but an imperative. Most med students have nary a class extolling the game-changing health benefits of sleep, nutrition, or exercise, but instead have an overabundance of classes focused on pharmacology. Even though it’s clear that healthy lifestyle choices can significantly reduce the rates of what most commonly kills us (many cancers, heart disease, and neurodegenerative diseases), prevention is often a mere afterthought.

How about the American mental health system? Well—how do I say this nicely—we aren't exactly crushing the mental health game. Sure, everyone is more open about their mental health these days. From celebs to CEOs, parents to kids—everyone is shamelessly sharing their mental and emotional vulnerabilities. Don’t get me wrong, openness is a good thing, and certainly far better than the alternative. But the idea that we’ve reached some grand societal milestone is a testament to just how backward we’ve been for generations.

On the heels of Medicine 3.0, America needs Mental Health 3.0, stat.

We need to operate from a new paradigm, one where going to therapy is as commonplace as going to the gym or engaging in daily exercise. Mental Health 3.0 means going to therapy before you’re clinically depressed, anxious, dejected, and weak. Mental Health 3.0 means going to therapy when it isn’t medically necessary at all.

But the reality is that many Americans go to therapy only when their symptoms have gotten so unbearable that they can barely think, leave the house, hold a job, or maintain healthy relationships. By the time they finally do get help, the proverbial hemorrhaging is so bad that pharmaceuticals are the first line of defense: anti-depressants, anti-anxieties, anti-psychotics, and more.

Health insurance companies are to blame, and the crux of the problem? The words "medically necessary."

Health insurance companies offer coverage only for those treatments they deem to be medically necessary. So in order to get treatment covered, there needs to be a diagnosis made in the very first intake session (such as an anxiety disorder, depressive disorders, OCD, PTSD, etc.). Anyone who falls short of meeting the criteria as outlined in the DSM-5 will be told their treatment isn't "medically necessary" and will not be covered. The net effect is that people who should be seen are turned away, and their situations devolve and get worse as a result.

This mentality of waiting for psychological treatment until your life is a three-alarm fire (i.e., meeting criteria for a diagnosis) incorrectly pathologizes the normal and typical ups and downs of life. If someone feels shaky and needs reassurance, if someone feels sad because they're lonely, if someone feels anxious about an upcoming life event—there is no diagnosis for these feelings. They are simply a part of being alive, of being a human with a heart and a mind. And seeing a therapist for normal life things should be not only allowed but wholeheartedly encouraged.

What’s the fix to America’s ailing mental health care system? Here’s Mental Health 3.0 in a nutshell:

• Routine and recurring psychotherapy begins in adolescence, when a good percentage of emotional and mental maladies first present.

• Routine and recurring psychotherapy would continue through early adulthood to adulthood, and extend into the sunset years (people 60 and older account for more than 25 percent of all suicides).

• Along with talk therapy (and psychiatry when needed), there would be an emphasis on evidence-based lifestyle adaptations that build mental and emotional strength (social connectedness, regular exercise, proper sleep hygiene, and conscious nutrition, to name a few).

Mental Health 3.0 means going to therapy when you’re happy, fine, strong, creative, resilient, and high-functioning. This sounds absurd to most people because we're so accustomed to believing that therapy is only for times of crisis. Mental Health 3.0 is based on the premise that maintaining emotional and mental clarity during the good times results in making the inevitable hard times easier to handle (aka nurturing and growing your resiliency). This just makes sense (unless you're an insurance company).

Can America afford to do this? My belief is that America can't afford not to do this. We're in crisis, and it’s time to change the paradigm, starting with federal subsidies that make this coverage available to all, and/or health insurance companies completely throwing out their "medical necessity" policy.

Go to therapy when you’re happy. Go to therapy when you're sad. Just go—it's strength training for your mind. Embrace the practice of routine and regular psychotherapy, and you’ll see profound benefits in you, in those around you, and in America as a whole.