Focused Futures: Exploring the Future of Mental Health from AI to Psychedelics

‍This Week's Feature: From AI to Psychedelics, What’s the Future of Mental Health in America     ‍

In this episode of Focused Futures we’re thrilled to welcome Dr. Christopher Vaughan, he's a leading psychotherapist with over 30 years’ experience. He is a graduate of both the University of Maryland (MSW) and Smith College School of Social Work (PhD) specializing in psychodynamic psychotherapy, he maintains a private practice working with a broad spectrum of clients. Dr. Vaughan also integrates the impact of the existential threat of climate collapse, COVID-19, and political divides on individuals and communities into his clinical work. He is an adjunct professor at the Smith College School for Social Work focusing on clinical supervision and advising both MSW and PhD students. Dr. Vaughn discusses both the current climate of the mental health industry in America; from the impacts on society to how technology is changing the field. 

Q: How would you describe the current state of the mental health industry from a practitioner’s perspective? Is it facing challenges, evolving? 

A: Since Covid, the awareness and value of mental health treatment has expanded significantly. No where was this more true than in addressing the exponentially growing need for emergent adolescent mental health treatment. In addition, while the appreciation for quality mental health services grew, the availability of affordable treatment did not at the same rate. This has exposed a crisis in our system of accessibility. Recent years have seen an increase in the enrollment in graduate programs for social work, psychology, and professional counseling. However, it takes years for this cohort to graduate and then do post graduate training. At the same time, as with other healthcare fields, Covid also saw an increase in seasoned clinicians retiring. So while the industry is seeing an increased need and valuation, it is also experiencing a crisis in the availability of experienced clinicians to address this need. Interestingly, while those in private practice have grown, reimbursement rates, length of treatment protocols, and included insurance benefits have not. As with physical healthcare, this is creating a two tiered ‘have and have-not’ system. 

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Q: In your opinion Is the mental health need growing in America or is it just more awareness and acceptance for seeking it out?   

The need has always been there. The lowering stigma associated with mental illnesses, spurred on not just by Covid but also by other issues adjacent to mental illness. These are not limited to but include those experiencing housing insecurity, political tensions, the increased understanding of racial and economic tensions in our society. The list goes on. In addition, the growing understanding of trauma-what constitutes it, the effects on physical health, as well as the increasing modes of treating trauma have helped many in this country understand the importance of mental health. I would add that the role of mindfulness, the practice of attending to our internal state, has greatly influenced people’s understanding and awareness of the importance of daily maintenance of one’s emotional and psychological health.    

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Q: Do you see any difference in how various generations view or approach mental health? 

I am less familiar with generational differences in accessing and utilizing mental health treatment. I do know that socioeconomic status and race play huge roles in who accesses and how they access these services. Obviously, private practice is much more likely to be more expensive and for a select group, open-ended in length of treatment. For this reason this is more likely to be for those with good insurance reimbursement rates, disposable income. To the extent that younger people are not as economically stable, they will likely access community mental health services, college counseling, low cost or medicaid accessible practices and agencies. There is no data suggesting these have lower quality services. Racial differences mirror the above with some notable exceptions: The last decade is seeing a real shift in who is entering graduate clinical programs and they have been addressing some of the structural elements that have disenfranchised students of color. This is leading to more treatment protocols by clinicians of color for clients of color. This is a challenging but exciting development in clinical practice across all professions.

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Q: Its clear technology has made a big push into the world of mental health, what are the biggest changes you’ve seen both good and bad?  

Without a doubt the most obvious development is with the use of remote-based treatment. Zoom-like spaces exploded in the pandemic and have not gone away. While the number of clinicians practicing exclusively this way has lessened, the role of remote-based treatment is here to stay. In some ways, this allows people greater accessibility-people in rural areas have the potential to be better served. But many report they have a strong preference for in-person or at least a hybrid approach to treatment. I’m not sure anyone has a strong handle on what the future will bring on this way of practicing. 

The other dynamic that we are in the nacency phase of is the use of Artificial Intelligence. I think this has the potential to bring some exciting aspects to clinical practice as well as some alarming elements. We know some people are receiving mental health treatment from AI programs. We have almost no data on outcome in these situations and nearly no regulatory guidance. Obviously the ethical and clinical implications of this are daunting and the potential for abuse, the quality assurance issues, and need for oversight could make one’s head spin. I know all professional organizations in the clinical arena are scrambling to develop policy guidelines, standards of care, and have a voice in the governmental response to this rapidly growing area. 

One other area I want to mention, but is almost the opposite of technology is the role of psychedelics in clinical treatment. There are very real legal and ethical issues associated with the use of these drugs (psilocybin, MDMA, Ketamine, etc…) and to make matters more complicated, states are increasingly lowering the criminality of these drugs for the purposes of mental health treatment. At the same time, NO change has been made at the Federal level. What individuals need to know is that there is a rapidly growing body of evidence suggesting the positive impact these drugs have in the treatment of depression and anxiety (and related disorders: OCD, eating disorders, addition, trauma healing, etc…) We really are just at the beginning of our understanding of not just whether these treatments work but WHY they do and for some, why they are so much more effective than traditional psychopharmaceutical interventions. As one might imagine, the use of psychedelics is highly controversial and clinicians are strongly divided as to their use. So on the one hand, we have AI clinicians and at the other end, we are returning to traditional forms of healing. We truly live in exciting times!

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Q: What are the biggest challenges in the coming future for the mental health industry in your opinion? 

As I stated above, accessibility will continue to be an issue. As more people enter professions that provide mental health services, quality control and oversight will be something to keep an eye on. Reimbursement issues will only increase in importance and it is difficult to know how this will play out. Although congress passed the mental health parity act years ago (stating mental disorders must be reimbursed at equitable rates comparable to physical disorders), this has failed to materialize in any meaningful or consistent fashion. What we know is ameliorative in treatment, across all modalities, is the relationship the therapist develops with their client. If issues of trust, rapport, sense of being cared about are of paramount importance to healing, how does authorization for only six sessions help in this process? 

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Q: Social media is regularly cited as a factor in the overall mental health of America, how big of a role do you see it playing and is there a course correction needed in your opinion? 

I liken this to the town square. Just as community can be a powerful factor in developing a sense of belonging, or not, so too can social media act as a powerful tool in shaping one's' sense of well being. I think we will continue to see growing tension between the highly valued right to free expression and the need to protect the most vulnerable in our society. Fore example, we know the impact of public shaming/bullying has on pre and pubescent girls and it’s not good. How do we both allow for the right to free speech and protect those at risk? I suspect we will see a rise in prosocial aspects of social media. For example, “Rooms” where young girls can receive affirmative support and affiliation to counter some of the more isolating and negative elements of social media. This is just one area of concern. What to do with the role of dis- and misinformation in the political arena and the deleterious impact on individuals’ mental health? Performative masculinity is having a huge impact on boys who get almost all of their social interaction through the “manosphere”.  This is troubling and I don’t think the profession has a viable response to these issues at this time. 

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Q: Are there lesser-known factors that are affecting society at large today that you don't feel are getting the same attention as social media or other more obvious influences?  

I think the subtle but powerful shift in wealth redistribution is having a profound effect on our culture’s sense of collective well being. Across the political divide is a strong belief that something is wrong and increasingly out of our control. Feelings of helplessness and despair are at all time highs among people under 30. Adding to this is the existential threat posed by climate change. As therapists, we have to be willing to address these issues, both in our communities as well as in our offices. Allowing for intense differences between ourselves and our clients is paramount to doing what our profession mandates we do: to name the unnamable and speak to the unspeakable. This is much easier said than done. 

For many students that I teach, they are entering the field with great ambivalence. If therapists are here to help individuals adjust to the demands of a modern world, how do we do this in good conscience when we ourselves see the modern world as maladjusted?

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Q: As the future continues to evolve in front of us, many challenges are brewing but what are the positive changes that technology can possibly bring to mental health in years to come?  

As EM Forrester implored us to do at the beginning to Howard’s End, “Only Connect”. In a world that has so much potential to bring us together, it is the conundrum that we appear to be so far divided. Tribalism on the internet. While the risk is great, I do have hope that we will use our very complicated levels of technology as tools to connect rather than be controlled by them to be divided and “otherize” those who appear to be different from us. The risks are great. But the potential is greater still.

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