Mental illnesses are common in the United States. Nearly one in five U.S. adults live with a mental illness (52.9 million in 2020). Mental illnesses include many different conditions that vary in severity, ranging from mild to moderate to severe. Suicidal ideation continues to increase among adults in the U.S. 4.58% of adults report having serious thoughts of suicide, an increase of 664,000 people from last year’s dataset. The national rate of suicidal ideation among adults has increased every year since 2011-2012.

Over half of adults with a mental illness do not receive treatment, totaling over 27 million adults in the U.S. who are going untreated. In Hawaii, the bottom-ranked state, 67% of adults with a mental illness did not receive treatment. Even in Vermont, the top-ranked state in the U.S., 43% of adults experiencing a mental illness were not receiving treatment. This is a massive problem as the percentage of adults with a mental illness reported an unmet need for treatment every year since 2011. In 2019, 24.7% of adults with a mental illness say an unmet need for treatment.

There is mounting evidence that mental health problems have become more common during the pandemic. Millions have lost loved ones, and survivors are at increased risk of post-traumatic stress disorder. Lockdowns have separated people from family, friends, and schools while leaving some trapped in abusive situations or turning to self-destructive behaviors. Many people have lost their jobs or are at risk of failing and face serious financial difficulties.

Both adults and youth in the U.S. continue to lack adequate insurance coverage. 11.1% of Americans with a mental illness are uninsured. There was a 0.3% increase from last year’s dataset, the second year in a row, and this indicator increased since the passage of the Affordable Care Act (ACA). 8.1% of children had private insurance that did not cover mental health services, totaling 950,000 youth.

Psychologists reported the most significant increases in treating anxiety disorders (84%, up from 74%), depressive disorders (72%, up from 60%), and trauma- and stress-related conditions (62%, up from 50%). Other diagnoses with significant increases included sleep-wake disorders, obsessive-compulsive and related disorders, and substance-related and addictive disorders.

While not the right solution for everyone, online therapy is quickly becoming one of the top ways people seek mental health services. Online mental health services can provide interactive solutions to engage young people self-directed and anonymous, thus assisting and supporting overburdened face-to-face services.

Two significant issues when using the web for mental health information are too much information and no quality control. Wading through vast amounts of uncensored information of low quality is time-consuming and frustrating. Focused search engines or edited portal sites maintained by professional societies, professional librarians, or other organizations may help to reduce the volume of information retrieved.

At the same time, there are disadvantages to Internet therapy, including some genuine risks.

Any therapy that is not face to face, such as texting, Emailing, and chat, robs patients of a vitally important means of communication. A large part of what we communicate is from facial expression, tones of voice, body language, and gestures. These do not cover all the ways, both subtle and obvious, that we transmit what we mean when we talk face-to-face and in the same room. Without these dimensions, it is very easy for the client to misunderstand what the therapist is saying and for the therapist to misunderstand what the client is saying.

The other issue is that unless online therapy is encrypted there is a danger that private information can quickly become public. The Federal Government has a list of laws to protect patient privacy. These laws are called HIPPA. Every new doctor and therapist a patient visits must be given a copy of those laws that the patient must read and sign. Without encryption, there is no way anyone can guarantee privacy. It is highly unpleasant to think of very personal information becoming public information available to everyone, including strangers, friends, relatives, and employers.

One country has taken the mental health issue of suicide to the extreme. Switzerland allows anyone, for any reason, to request assisted suicide via a clinic. The Pegasos Swiss Association is a voluntary assisted dying (VAD) organization based in Basel, Switzerland. This, of course, has huge ethical issues, but it acknowledges that some people live in constant mental anguish.

Healthcare in the U.S. is a mess and getting worse. Mental health issues are not likely to get addressed anytime soon because of its stigma. We all need help at some time. The question is can we afford it, and will it be available?