What are mental health deserts? You’re probably familiar with the concept of food deserts right? Large swaths of the country where it is impossible to find healthy, affordable, produce for example. The corollary impact on people’s health – obesity, diabetes, heart disease, etc — is another kind of national health crisis.

Recently I heard the term “mental health deserts” for the first time and it immediately made sense. As National Geographic writes, “Across much of rural America, demand has long outpaced the availability of these services, leading to what is known as ‘mental health care deserts.’ In some areas, the closest provider might be hours away, a problem for people living in poverty when every gallon of gas counts.” This has of course been exacerbated by the Pandemic, which has led to a tsunami of mental health distress. Humans are social animals. We’re crushed by isolation. Add the loss of loved ones, financial stress, uncertainty, and fear to this mix, and it’s a recipe for disaster.

And then we have these mental health deserts.

I spoke with my teacher, colleague, and friend Dr James Phelps author of Why Am I still Depressed and A Spectrum Approach to Mood Disorders yesterday. Dr Phelps, who goes by Jim is a global authority on the Bipolar Spectrum. (If you didn’t know there’s a bipolar spectrum you’re not alone.) I have a brain on that spectrum known as bipolar II which I’ve chronicled in detail in my new memoir BrainStorm: From Broken to Blessed on the Bipolar Spectrum. Jim has dedicated the good part of his career, several decades now, seeking to educate people on the facts: there is a bipolar spectrum, correct diagnosis is rare and essential, and there are treatments that work. Every time I talk with Jim it’s a huge education. Here’s what he said yesterday related to mental health deserts.

Well, before giving Jim’s answer, let me pose this to you first to you as a question. If you think about what kind of specialist doctor writes prescriptions for the ubiquitous anti-depressant drug Prozac, who comes to your mind? Quick? 

Psychiatrists right? 


Phelps explains, “70% of all prescriptions for Prozac, 70!, are written by primary care practitioners. Your family doctor. Indeed more than half of all psychotherapeutic care begins in your doctor’s office.”

Outside of cities there are vast deserts lacking psychiatrists. psychotherapists, social workers or any other kind of therapeutic helper. And here comes the pandemic’s mental health tsunami. Where do people get help?

Even in urban areas, capable therapists are drowning in this wave. There’s just nowhere near enough of them to meet the current seemingly endless need. My kids in college report that their CAPS (counselling and psychological services) on campus can’t begin to keep up. They’re seeing students in 15 minute increments and can’t commit to ongoing therapeutic relationship. There are just too many kids in need.

As the National Geographic article continues, “That scarcity isn’t something the nation can solve overnight. ‘It takes eight years to make a social worker,’ says Ken Duckworth, the chief medical information officer for the National Alliance on Mental Illness.”

The nation he says… I wonder if other countries have a better handle on this. A model we can learn from. I don’t know, but I imagine there’s someplace that does not have the same stigma that Americans have traditionally placed on “mental illness.” As if there’s something wrong with someone suffering from a broken brain. Blame the victim and in our country in many cases, that means throwing them in jail. (Instead of offering the quality care that they need and deserve.) Lifting the stigma might lead to better research right? And it also might encourage more people to go into psychotherapeutic professions in the first place. Take the stigma off that too.

“According to the Merritt Hawkins report, a healthcare industry research and consulting outfit, there are about 28,250 psychiatrists in active practice in the U.S.” If I do the math, that’s about 1 for every 12,000 of us. But it’s worse than that because, “They are unevenly distributed across the country, with the most doctors practicing in California, New York, Texas, Pennsylvania and Florida.” Unsurprisingly mostly on the coasts. With a vast swath of the middle of the country not served at all.  In a quick google search, I found many articles exploring the root causes of why there is such a shortage of psychiatrists. Diving into those is a task for another day. Suffice for now that it all adds up to a big mental health desert crisis in America.

If you’ve ever suffered from a brain breakdown, as I have due to my bipolar brain, you have a visceral sense of the tragedy of this. If you’ve never experienced this first-hand, just imagine millions of people unable to get help for the torture inside their minds. With this number growing exponentially due to the pandemic. 

According to Johns Hopkins, approximately one in four Americans over 18 last year — that’s like 64 million people, not all living in New York or CA –experienced some mental health issue last year. And it’s getting worse among our young people who perhaps suffer the most from Covid isolation. Teenagers crave contact right?  Last year the surgeon general did something unprecedented: he declared official mental health emergency among our youth. According to the associated report, “depressive and anxiety symptoms doubled during the pandemic, with 25% of youth experiencing depressive symptoms and 20% experiencing anxiety symptoms.”  That’s close to one in two teens!  Further, the report continues, “In early 2021, emergency department visits in the United States for suspected suicide attempts were 51% higher for adolescent girls than the previous year.”

Yikes. Now you’re depressed, right?

So what are we supposed to do about this heartbreaking current reality? That’s gotta be the topic for next week’s blog. Please think about it in the meantime. We need all the help we can get.