What we learned from a massive survey on America’s mental health

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The vast majority of Americans of all ages, races, generations and backgrounds say the US has a mental health crisis.

Nine in 10 Americans in a new survey from CNN and the Kaiser Family Foundation say the country as a whole is facing a crisis on this front and about half of adults say they’ve experienced a severe mental health crisis in their family.

CNN published a series of stories this week based on the poll in conjunction with KFF. Read the main report here. And read this from CNN’s polling team about how the survey was conducted.

There’s also 988 – the three-digit number anyone in crisis can call, but which the survey found few people know about.

For a broader look at the poll’s findings, I talked to Ashley Kirzinger, the director of survey methodology at KFF, by email about what we learned from the project. Our conversation is below.

WHAT MATTERS: It is such a striking headline – 90% of Americans believe the US is facing a mental health crisis. Are there many things that 90% of Americans agree on? Also, can we say definitively that these results suggest a shift? Do more people now say the US is in a mental health crisis?

KIRZINGER: You are absolutely right, normally we talk about how divided the country is and rarely do we have a data point on which such a large majority of adults agree. While we cannot definitively quantify this as a shift because we don’t have an earlier comparison question using the exact wording, other data points show there has clearly been a shift in people’s experiences over the past several years. For example, the share of adults who report symptoms of anxiety or depression in federal survey data has quadrupled during the pandemic. In addition, data from the CDC (US Centers for Disease Control and Prevention) has shown that there has been an increase in the number of both drug overdose deaths and suicide rates. Many of these trends pre-dated the pandemic, and some of them have gotten worse. I think these additional data points help explain why such a large majority are now identifying the current situation as a mental health crisis. People are seeing their friends, family members, neighbors, and in some cases themselves struggling. With more than half of all adults saying they or a family member have experienced a severe mental health crisis, it makes sense why we have nine in 10 saying the US is facing a crisis.

WHAT MATTERS: What led CNN and KFF to undertake this project? What had you been seeing that made you think this was worth doing?

KIRZINGER: During the Covid-19 pandemic, polling from both KFF and CNN had indicated that there were increased concerns around mental health of both adults and children in the US, both in terms of the toll the pandemic had on people’s mental health, but also the barriers for those seeking mental health. Stress and worry around themselves and loved ones getting sick or dying from Covid-19, job losses, loss of childcare for working parents are just a few examples. Starting really in March 2020, we were finding about half of adults saying that worry and stress from the pandemic was having a negative impact on their mental health. And for some groups, such as parents and younger adults, the shares reporting a negative impact were even larger. All of this made both teams at KFF and CNN interested in conducting a project that focused solely on mental health, with some attention being paid to the populations that we know were hit hardest by the pandemic.

WHAT MATTERS: But the pandemic is not an overarching theme in the results. Why is that?

KIRZINGER: When we started this project, it was largely focusing on the specific stresses of the pandemic, but the truth is for many Americans, the pandemic is now in the background and they are dealing with the normal stressors of everyday life. That said, the worry and concerns that arose during the pandemic haven’t faded away and so people are having to balance going back to work, getting their kids back in school while facing many of the mental health issues that arose during the past two years. I think while the survey questions don’t necessarily focus on the pandemic, the experiences and worries from the past two years are definitely influencing how people responded to the survey.

WHAT MATTERS: Is there one detail or number in particular that surprised you?

KIRZINGER: When I started digging into the data, the disproportionate share of young adults who reported negative mental health, anxiety, depression, and difficulty accessing care kept surprising me. I think the most striking data point is that nearly half (47%) of adults under age 30 say there was a time in the past year when they thought they might need mental health services or medication, but they did not get them. This shows that there is still a lot of unmet need out there, even when three in 10 younger adults say that have received mental health care in the past year. And when we ask why they didn’t receive the care or medication they thought they need, the most cited reason among younger adults was the cost of such care.

WHAT MATTERS: There is a real divide in the survey between older and younger Americans. How are younger and older Americans viewing mental health differently?

KIRZINGER: I already talked about how younger adults report more difficulty accessing care; but perceptions of mental health is another difference between younger and older adults. Half of young adults say they have felt anxious either “always” or “often” in the past year (compared to a third of adults overall), one-third describe their mental health or emotional well-being as “only fair” or “poor” (compared to 22% of adults overall), and four in 10 say a doctor or other health care professional has told them that they have a mental health condition such as depression or anxiety. The good news is that majorities of younger adults also report feeling comfortable seeking care for mental health concerns and discussing mental health with their friends or relatives.

WHAT MATTERS: I’m assuming we do not ask children themselves about their mental health, but there is real concern in the results about the mental health of children. Do the results suggest this is more than adults expressing a natural concern for younger people?

KIRZINGER: You are right, this is a poll of adults in the US, but it includes a large sample of parents who we ask to report on their kids’ experiences. And yes, majorities of parents and non-parents are worried about how depression, alcohol or drug use, anxiety, and other mental health struggles are negatively impacting teenagers in the US. But when we also ask about the experiences of children, parents’ concerns around the impact of the Covid-19 pandemic on children and teenagers has been a major theme of a lot of KFF polling during the past two years. Previous surveys we did earlier in the pandemic when many schools were still holding classes virtually suggested that parents whose kids attended online school reported more mental health and behavioral problems in their kids than those who attended in-person school. This new poll finds around half of parents (47%) say the pandemic had a negative impact on their child’s mental health, including 17% who say it had a “major negative impact” and an additional three in 10 saying it had a “minor negative impact.” So I think we do have evidence that this goes beyond a general level of concern and reflects something parents are seeing in their children.

WHAT MATTERS: There’s near unanimity on the existence of a mental health crisis, but a divide on how to deal with it. The country is split on what role government should play. There is a split among adults on whether calling 911 would help in a situation. What pathways does the survey suggest we should take to address this crisis?

KIRZINGER: A quarter of the public say they think calling 911 during a mental health crisis would do more to “hurt” rather than “help” the situation, including three in 10 Black adults and four in 10 LGBT adults. In addition, larger shares of Hispanic adults and uninsured adults report they do not know who to call if there was a mental health crisis and also say they would not know where to find mental health services. However, when told about the new 988 number, a large majority across these demographic groups say they would be likely to call it if they or a loved one were experiencing a mental health crisis. Unfortunately, most adults say they have heard nothing about this new hotline.