Healing A Broken Mental Health System: David Stewart Of Alliant International University On 5 Things That Can Be Done To Fix Our Broken Mental Health System

An Interview With Stephanie Greer

Make education, training and pay for behavioral health professionals an incentive to enter the profession. This is a highly rewarding profession but also challenging and our workforce should not be saddled with debt and underpaid.

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 David G. Stewart.

David G. Stewart, Ph.D., ABPP, is a board-certified clinical child and adolescent psychologist and Dean of the California School of Professional Psychology. Dr. Stewart received his Ph.D. in Clinical Psychology from the University of California San Diego and completed his internship and postdoctoral fellowship in Child Community Psychology at the University of Washington, School of Medicine. His previous positions include Chief of Psychology at Cambridge Health Alliance/Harvard Medical School, Professor of Clinical Psychology and Chair of the Ph.D. program at Seattle Pacific University and a faculty appointment at the University of Washington.

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?

While my tendency would be to answer, “I had a normal childhood” I actually experienced what psychologists would call “Adverse Childhood Experiences” or ACES that put me at risk. I was born to an unwed teen mother and spent the first four years of my life in the foster care system. I was exposed to substance use disorder in my home and eventually raised by a single mother and lived for times in relative economic poverty. All this is to say that risks are very much surmountable as I was equally blessed with a loving extended family, was instilled with a love of learning and an expectation of educational excellence. I was engaged in school, church and the community. I came to study psychology after bouncing from an ivy league university to a commuter college and finally finding a subject that spoke to me. Once I figured that out I was quickly through graduate school with my PhD and a desire to help children and adolescents, most of whom, like me, had ACES in their background but needed someone to help them build resiliency.

Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?

I have always loved Gandhi’s quote “Be the change you wish to see in the world” Of course, like many quotes, Gandhi never said it. What he actually said was even more profound “As a (person) changes (their) own nature, so does the attitude of the world change toward (them). This is the divine mystery supreme. A wonderful thing it is and the source of our happiness. We do not need to wait to see what others do.” Both the original quote which is more social justice oriented and the real quote which is more mental health related have been great guidance for me. The action of jumping in to make change without looking to see if everyone else is following is relevant to my work as a social scientist where I push forward with ideas and implement them without always knowing they’ll work. The changing yourself quote is important as it is the essence of what happens in therapy where the work of changing has to start with yourself, the part you can control. This is what I tell adolescents who have been dealt a lousy hand in life, “you are only responsible for what YOU do.”

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?

Our broken mental health system is really simply a matter of access. We have never had better tools for understanding mental illness, how to detect it and treat it. We fail however, to make it accessible across barriers of funding, and support of a workforce large and well-trained enough to meet the vast need. There is also still a matter of stigma where individuals and institutions are still reluctant to ascribe problems of daily living to persistent mental health issues. We’ve come a long way in de-stigmatizing mental health problems where people are now seeking care, recognizing warning signs and open to treatment. The access issue is also not a particularly complex issue. We first need a system that funds mental health treatment with not only parity to all other healthcare, but with priority. The cost of mental health problems are so high in both the personal and social toll that it really is only a deeply dysfunctional political system that can’t figure out how to fund a universal system of care. Beyond destigmatizing, funding and making mental health care accessible, we also need a better system of building a workforce. This includes paying for training and providing salaries that makes behavioral healthcare a sustainable career for young professionals.

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 many bright spots. I mentioned de-stigmatization. We live in a world where people talk openly about their struggles with mental health. This is an amazing development in my lifetime where previously (and still I fear in my generation and above) mental health problems were a shameful secret. I have read complaints about this suggesting that “everyone talking about mental health causes more problems” I think that is nonsense. Bringing mental health out into the light not only helps those suffering understand that they are not alone and points them towards health but it also allows all of us to recognize the signs of distress in others and get them support. To say the recognizing mental health problems leads to mental health problems is like saying understanding that viruses cause illness leads to more illness. The other bright spot I mentioned are advances in treatment efficacy. We are in a great place in Psychiatry, Psychology and other mental health professions in knowing what works in treating mental health conditions. We are better at screening, diagnosing, treating with medicine and therapy than at any time in history so if we can connect people to treatment we have a good chance of success.

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. Integrate screening and access to treatment throughout all human and medical services. There should be “no wrong door” to accessing mental health care. Schools, employers, doctors’ offices, churches, law enforcement/justice, and government social services offices should all have the capacity to recognize and provide a “warm handoff” to a mental health professional
2. Mental health treatment should be high quality, evidence-based and culturally competent. The training and licensing of mental health professionals and the funding of services should be closely linked to providing care that works.
3. De-stigmatize mental health problems and treatment so that the phrase “I need time off for therapy” would be no different than saying “I have a medical appointment” Privacy and confidentiality are still critical in all of healthcare but shame and secrecy are not.
4. Make sure that solutions to crime, substance use, homelessness and even political division and unrest consider mental health. We often overlook the mental health component of social problems as we plan and argue how to solve them. Often the solutions are the ones we are talking about here.
5. Make education, training and pay for behavioral health professionals an incentive to enter the profession. This is a highly rewarding profession but also challenging and our workforce should not be saddled with debt and underpaid.

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 would hope to see a reduction in the number of people who are “lost” to mental health problems. Many families and communities are broken by loved ones who succumb to mental health problems by suicide, gun violence, overdose or homelessness. We, in some ways, have normalized this suffering as part of the fabric of our lives. In a healthier system these drastic and tragic outcomes would be rare and mental health problems would be like any other health problem that we learn to live with.

What is a project you or others are working on today that gives you hope? How can our readers learn more about this work?

I have been fortunate to be funded for my work on integrating mental health care into school, juvenile justice and medical systems by the Substance Abuse and Mental Health Services Administration https://www.samhsa.gov to provide screening, implement intervention programs and increase the workforce with training grants. They also provide incredibly helpful guidance on topics of mental health and treatment to the general public. It is a great example of excellent federal leadership on topics of mental health.

How do you see technology shaping the future of mental health care and its accessibility?

I very clearly remember my first Telemental health session on March 20, 2020. I became a telehealth provider overnight and was amazed that my clients showed up and that treatment continued. What was once a niche therapy modality became universal in 2020 and I think the opportunity to increase access to mental health care through telehealth is here to stay. I also think we will make use of the tools of AI in the future to help in our efforts to screen and detect mental health problems. I also think technology can help us match people to effective treatment. I don’t think AI can treat mental illness as the human relationship is still key in our work. Especially the ability to understand what is NOT being said in therapy which by definition a chat bot doesn’t have access to.

In your view, how do social factors like poverty, education, and culture affect mental health care and its effectiveness?

I started this interview talking about ACES (adverse childhood experiences). We know a lot about the risk factors and how to intervene early and often to ameliorate them. It is a feedback loop, the more we improve social conditions, and eliminate poverty, discrimination in all of its forms and improve educational opportunities the more we improve mental health. At the same time, the more we improve mental health, the more we reduce the causes of many social problems.

In light of the growing mental health crisis among young people, what innovative approaches or interventions have proven most successful for children and adolescents?

I am a board-certified child and adolescent clinical psychologist so I could fill volumes on this one. I have been involved in school-based mental health for children and adolescents both in terms of universal screening for mental health problems in middle schools and intervention programs in teen health centers in high schools. I am big on having services where kids spend a chunk of their time and exhibit many of the early signs of problems. I am also impressed with universal interventions that teach problem solving and emotional intelligence skills to kids in elementary school. Not mental health treatment but tools that lead to mental health. Finally, when you study treatments that work to prevent mental health problems, some of the most effective and long lasting are early childhood interventions that identify children at risk of ACES and intervene as early as birth to three. This is intervention for the caregivers, obviously, and among the most successful and innovative things we can do.

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?

I remember being so proud of Simone Biles in the summer of 2020 when she, the gymnastics GOAT, stepped back from the Olympics and cited the mental component of her sport and mental health in general as reasons. She took a lot of heat and criticism and was an incredible role model for all of us. I would love to talk with her about her impact on the kids I work with and the rest of us.

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.