A Letter from 2020: What I Imagine Mental Health will look like in 5 Years
When we launched 7 Cups in July 2013, we started by providing 50 supportive conversations a week with just a handful of active listeners. Now, we provide 130,000 supportive conversations a week and have over 100,000 listeners across 180 countries offering support in 140 languages.
It has been a long and hard road to get here. We learned a lot of hard lessons along the way, with many more to learn. We consulted with lawyers specializing in mental health and technology. We also spoke to leading mental health professionals like John Norcross, Ph.D., ABPP, an internationally recognized expert on behavior change.
The bulk of what we learned, however, did not come from consultation or top-down strategic planning. Rather, it came from staying close and listening to our community.
Many of the lessons learned are counterintuitive, and I want to share them, because I think they point to one possible vision or framework for understanding the future of mental health and potentially all healthcare.
That said, lets pretend its 2020, and Im writing a letter to my friend and colleague, Louis. Youre getting a glimpse into this letters excerpts, in which I made comparisons to the past, including today, 2015.
Heres what I see—and hope:
October 15, 2020
Dear Louis,
How are you? Im sure the boys are quite big now. Amazing how quickly the time goes and how much things change. I wanted to share some thoughts with you comparing 2020 to how things were back in 2015. Would welcome your feedback!
1. Free Basic Mental Health Care for All: Remember in 2015 when so many people struggled and couldnt access mental health care? It wasnt that anyone was deliberately holding back care from people that needed it; it was just that we didnt yet know that we could rearrange some pieces in the puzzle and do things differently. Fortunately, now we do know and, man, what a difference it makes.
2. Peer Support: Its still hard for me to believe that peers, or volunteers, play such a critical role now. Who would have known they would become the foundation of our field? We had some clues of it with NAMI (National Alliance on Mental Illness), AA (Alcoholics Anonymous), but really had no idea of their roles.
AA and NAMI also gave us hints of something else as well: the importance of community, the need for us to be a part of something greater than ourselves, to lean on and be leaned on when others need support. Communities strengthen people and help everyone see that really we are all on the same journey.
3. Emotional Wellness as Enjoyable: Mental health was not seen as a good time in 2015. Perhaps it was the words mental health and the stigma associated with it that made people want to avoid it so much. Or maybe it was our obsession with labels in identifying people as disorders instead of, well, uh, people? What we know now is that emotional wellness is enjoyable. People build great relationships, play therapeutic games, and know that life is comprised of ups and downs. There is a deep joy that can be found in helping another person who might be struggling.
Today, we realize challenging times are just a part of life and nothing to be ashamed of. Im so happy that our field is now seen as hopeful, positive and enriching. Lets never go back to those dark days of 2015.
4. Technology: I think everyone knew that face to face sessions were going to go by the wayside. Everyone had a phone in their pocket, so it wasnt a huge surprise for people to begin to connect with others via the Web and apps. What I remember being more surprising was how our models of support changed. We gradually came to realize that people benefit from continuous support and that the 50 minute hour was just an artifact, an old dusty idea. Man, and remember how clinicians had to struggle to see 30-35 clients in a given week? What a recipe for burnout and frustration. I guess we didnt know any better. Now, through a combination of texting therapy, video chat, and therapeutic games, therapists can track outcomes across a hundred clients a week.
5. Collaboration: Looking back on the mental health world 5 years ago, I think we were all in a sort of collective denial about the economics. Clinicians had already been getting paid less and less each year. Reimbursement rates kept falling. There was growing competition between counselors, psychologists, social workers, and psychiatrists. In retrospect, I dont think we realized that we were all fighting over a pretty small pie. Turns out when everyone gets free access to mental health care, the amount of people that need support from licensed professionals grows 10X. The pie, as they say in the business world, becomes bigger than any of us realized. Now, because demand is so high, we learned that we need to collaborate. Peers see the majority of clients with sub-clinical issues, and this frees up licensed folks to take on the more challenging cases. There also now seems to be less tension around the different roles, because we all realize that each profession plays an important part in the overall field.
5. Outcomes: Today, we have learned that regular assessments and monitoring throughout the course of treatment can allow us to make adjustments where necessary and help us get the person well faster and more efficiently. Previously, some percentage of clinicians used outcome measures regularly, but they were largely administered on paper and stuck in a file cabinet or room somewhere. NHS (National Health Service in the U.K.) was just starting some innovative work in regularly administering assessments and gathering data at scale but, unfortunately, they were still kind of wedded to the clinical hour model. I dont think any of us realized in 2015 that baking in outcome measures right into the normal flow would allow us to learn so much more about treatments that work at a much faster rate.
One last thought: How do you think things will look in 2025? I cant wait to see how things evolve and change. Things changed so much in the last 5 years. Very fun to think about!
Give my regards to Heather and the boys!
Best,
Glen
Ive been thinking about this for several months now and wanted to share it with our community. Would welcome your thoughts and feedback!
This letter has some good things and some bad things. It correctly addresses the beneficial short term issues that online therapy and low level unlicensed volunteers can alleviate effectively and relatively quickly. However, considering that face to face therapy has so many benefits (deep bonds between clients and therapists, conveying tone of voice, reading facial expressions, being mindfukly present amd sitting with another human being etc.) and encourages real world, person to person interaction in a time where technology (including crisis chats, 7cups, video chats, etc.) can encourage isolation, loss of social skills, and a false sense of shallow connectedness to others, it is clear that face to face professional therapy from licensed psychotherapists will never be able to fully be replaced by technological inventions. Instead, I envision a future in 2020 where low level issues are addressed through technology only when the individual is unable to access their therapist, and that real personal interaction with a face to face therapist will remain the ultimate best option to help the individual work on long term issues.
@MaddieDancer sorry for the typos!
@MaddieDancer - I'm surprised you read this letter and took away from it a prediction about the end of face-to-face interaction. I read it as talking about a reshuffling of the peices to meet more needs with a more flexible range of interventions and therapies.
The either/or, defensive response is part of what jumping ahead several years gives us a chance to look past.
@KrinkTheMellowUnicorn He did say that face to face therapy would fall by the wayside, so I think I have a right to address that.
@MaddieDancer
I reread that point and I agree. There are various methods when it comes to staying healthy. I think traditional therapy is a part of that.
I'm confused about the 50 min thing, is that standard? The only health related thing I can think of that was 50 minutes were certain exercise classes.
@AffyAvo yes, typically fifty minutes is standard for therapy sessions. I'm glad you agree that traditional therapy isn't going to be dead or useless!
I love this! Also, ''Let
I agree with the people who are pointing out the benefits and setbacks of therapy as compared to online chat here. With online chat, you can never truly replace a hug at the end of a session or the family-like feel to rapport after a decade of therapy with a client. However, the expansive attentions afforded when a global community supports your journey also cannot be understated.
Two points to add---@GlenM you contradicted yourself a little bit...
"Peers see the majority of clients with sub-clinical issues, and this frees up licensed folks to take on the more challenging cases. "
and
"Man, and remember how clinicians had to struggle to see 30-35 clients in a given week? What a recipe for burnout and frustration. I guess we didnt know any better. Now, through a combination of texting therapy, video chat, and therapeutic games, therapists can track outcomes across a hundred clients a week."
I don't know about you but this sounds like following the current trend of putting an even bigger responsibility on clinicians (increasing from 30-35/wk to 100/wk) while simultaneously "freeing us up to take on the "more challenging cases."
A much more senior clinician than me once told me--at the end of the day, you have to take home the feel good cases because if all you ever see are the horrible or heartbreaking cases, you will burn out very quickly. And indeed my subfield of counseling IS seeing this with legislative changes that are causing our caseloads to increase, our data tracking to increase, and due to a slightly better economy, the few easy cases ("respite cases" IMO) are gone.
If all I deal with each day are the victims of domestic violence, the addicts, the criminals, the very needy, the scammers, the cruel/vicious, and the otherwise "challenging" cases, then you will see another trend emerge yet more noticeably: the only providers left will, for the most part, not be the ones with high levels of compassion.
[Side note: I realize that when I phrase things like "the addicts" it sounds offensive and stigmatizing but that's part of my point. If we get so bombarded with negative interactions, we stop seeing people as "someone who is really struggling and needs help" and start seeing them as "oh my bog---just go away already!" and unfairly compartmentalize people to be able to cope. My "easy" cases are often people who truly benefit from treatment and make my job worth doing even when all of my other cases are deciding to jump headlong into an abyss and then later blaming me for "causing them to slip through the cracks." We all need something pleasant from time to time. Even superheroes need a break sometimes!]
Instead, here's how I see it: 7C and sites like it afford a sense of community and attention that reward wellness instead of promoting a culture of disorders. People who feel badly can reach out and gain attention without attention-seeking being seen as a bad thing. People who tend to act cruelly will be given a chance to become a volunteer "provider" and will learn the social skills to improve their real life interactions. By these two things combined, I will come to work and find my email less flooded, my voicemail less full, my paperwork queue less plentiful, and my appointments much more collaborative and beneficial. D
emand will stay stable, especially if therapy is financially accessible (but that still doesn't truly deter demand even if it's not financially accessible). However, the general populace will become calmer, kinder, and more driven to pursue change within themselves by embracing community and treatment alike.
Mental Heath is often regarded as unimportant and less important than physical Heath one day I hope it is equal to all health types and has no stigma
@understandingLemon7281 I so look forward to no more stigma.
I think that when I'm running for Mayor in 2020, mental health will be viewed differently. ADHD will be acknowledged as rare, which will lead to a substantial decrease in those of us who suffer from Bipolar disorder. I think we'll have better ways to treat mental issues, but dyslexia (Technically a mental disorder) will still most likely dominate the world of mental illness. Otherwise, we'll have better ways to diagnose and treat mental problems. People will view it as a striking issue, but will be eclipsed by a problem that is small or may not even exist yet.
@katman I like the letter a lot though.
I am blessed to have an amazing counselor. I see her twice a week. When things are tight she doesn't charge. We email and text to save time during sessions for really important issues or if I need additional support. We have done 2 - 5 hour sessions and accomplished a great deal. Even kindness of one of us bringing coffee and doughnuts. Yes I am truly blessed and will thank her more often. Your letter reminded me if how blessed I am. Thank you.
@mutter3 I'm also blesssed. I see my therapist once every 2 weeks, but i check in weekly via email and if I ever need I can email her, so i feel I do have that contact outside of the session. I can't see myself ever being solely helped on technology! Hope you have a great day!
I find your letter to be very interesting. I see 2020 almost ideal to what you have described. Technology will definitely set breakthroughs in mental health care. Let's be honest in many thing there will breakthroughs because of technology. We should embrace and try to understand it that way we are better prepared. One thing I will Take with me from your letter is writing myself how my 2020 will be. Thank you for sharing..
