The Real Truth About American Mental Health

A long-form investigation from someone who has lived it.

Published on December 8, 2025

The Real Truth About American Mental Health

A long-form investigation from someone who has lived it.

I have been fighting the same disorders for more than thirty years. Depression that hums like an electrical fault deep under the ribcage. Anxiety that steals the breath. Panic attacks that hit without warning. Medications that work for a few weeks and then dissolve into nothing. The slow grind of hopelessness that sets in after the tenth or fifteenth failed prescription.

I have lived this story for decades; from SSRIs to mood stabilizers to benzodiazepines to experimental pathways that barely existed when I was a teenager. I am also a veteran; part of a population that the United States publicly claims to support but privately fails in measurable, catastrophic ways.

This is not a memoir. It is an indictment of a healthcare system that places paperwork over people, profit over outcomes and delay over life. If America truly wants to address mental health, prevent suicide and reduce suffering, it has to understand how the system actually works. Because the real story is not about drugs or diagnoses. It is about barriers.

The American Suicide Crisis

Mental illness is not fringe. It is not rare. It is not something other people deal with. It is central to the American public health landscape.

The CDC reports that suicide rates rose roughly 37 percent between 2000 and 2018, dipped briefly and then surged back to record levels by 2022.[1] In 2022 alone, nearly 49,500 Americans died by suicide.[2] In 2023, the number remained staggeringly high at 49,300.[3]

These are not statistics from a country in control of its mental health. These are statistics from a country losing the battle.

Veterans: A Crisis Within A Crisis

Although veterans make up about 7.6 percent of the U.S. adult population, they account for nearly 14 percent of adult suicides.[4] According to RAND, the veteran suicide rate reached 34.7 per 100,000 in 2022, compared to 17.1 per 100,000 among nonveterans.[5] In raw numbers, that was 6,407 veterans and 41,484 nonveteran adults that year.[6]

A JAMA analysis confirmed the pattern. Between 2017 and 2020, the suicide rate for veterans remained between 1.57 and 1.66 times higher than for nonveterans, even after adjusting for age and sex.[7]

People often say mental health matters. These numbers prove the opposite: as a nation, we are failing.

My History in the System: A Case Study in How People Get Lost

Across three decades of seeking treatment, I have been prescribed nearly every category of medication that conventional psychiatry offers.

  • SSRIs: Prozac, Celexa, Paxil, Zoloft, Brintellix, Lexapro
  • SNRIs: Effexor, Cymbalta
  • Mood stabilizers: Lithium, Depakote
  • Antipsychotics for anxiety: Seroquel
  • Benzodiazepines: Klonopin, Ativan, Valium

Some sedated me. Some flattened emotion. Some created new problems, like weight gain or withdrawal. One doctor prescribed an opioid, Nucynta, for generalized pain; I spent years fighting my way out of that dependency because pharmacies often did not have it in stock, which forced withdrawal more often than any medical professional would consider safe.

This is not unusual. This is what treatment looks like for many Americans. A cycle of trial, failure, substitution and resignation.

But the last decade has brought new science; treatments that do not depend on serotonin but instead on glutamate signaling, neuroplasticity and the restoration of damaged or atrophied networks in the medial prefrontal cortex and hippocampus. There is genuine promise. Ketamine therapies; sigma-1 receptor modulation; NMDA and AMPA pathway interventions. These are not fringe. They are peer-reviewed, evidence-driven developments that offer hope to people who have exhausted the old playbook.

Which raises the question: if the science exists, why is it so hard to access?

The Structural Barrier: Prior Authorization

Most Americans have never heard the term prior authorization until the day it denies them care. It sounds administrative; harmless; like a clerical step. In practice, it is one of the most effective tools insurers use to restrict access to treatment.

Prior authorization requires that a clinician request insurer approval before prescribing or providing certain treatments. The insurer, not the doctor, decides whether the treatment is “medically necessary.” That decision can take days, weeks or longer. For mental health, delay is not a minor inconvenience. It is a risk factor.

The Data Behind the Delays

  • In 2023, qualified health plans on HealthCare.gov denied 19 percent of in-network claims and 37 percent of out-of-network claims.[8]
  • Across insurers, denial rates ranged from 1 percent to 54 percent, depending on the company.[9]
  • About 9 percent of denials cited failure to obtain prior authorization or referral; 34 percent cited administrative or contractual reasons.[10]
  • Medicare Advantage plans processed almost 50 million prior authorization requests in 2023; they denied 3.2 million, or 6.4 percent, in part or in full.[11]

From the patient perspective, denials mean cost, delay or both. According to a national physician survey, 79 percent of doctors reported that prior authorization delays or denials frequently lead patients to pay full cost out of pocket or abandon treatment.[12]

Psychiatrists report even worse bottlenecks. For medications considered “specialty” drugs, denial rates are substantially higher. Many insurers demand documented failure of multiple inexpensive medications before approving a newer therapy, even when the patient has a decades-long medical record showing that those drugs do not work.

This is simply cost engineering.

The Cost of Mental Health Care in America

It would be one thing if care were accessible once authorized. It is not.

  • In 2023, 28 percent of U.S. adults reported delaying or skipping medical, mental health, dental or prescription care because of cost.[13]
  • Between 6 and 7 percent specifically skipped mental health care due to cost, even when they believed they needed it.[14]
  • About 8 percent rationed or skipped prescription medications due to cost.[15]

Insurance does not guarantee access. It mostly guarantees paperwork.

Network Availability: A Hidden Barrier

A large study of mental health provider networks found:

  • Only 42.7 percent of psychiatrists participated in any given network.[16]
  • Only 19.3 percent of nonphysician mental health providers participated.
  • On average, plans included just 11.3 percent of mental health providers in a given state-level market.[17]

If you have insurance but cannot find a psychiatrist who takes it, the coverage is meaningless. This is common and systemic.

Pharmaceutical and Insurance Profits: The Part Nobody Likes to Talk About

This section is not ideological (unless you’re beyond rich and own stock, in which case it’s an indictment on your own humanity).

While Americans face record suicide rates, rising costs and record claim denials, the financial performance of major pharmaceutical and insurance companies has been robust. Public filings show that between 2020 and 2024, most major companies in these sectors reported substantial revenue growth and high profitability. The exact figures vary by company, but the trend is unmistakable: increasing margins while patients face increasing barriers.

Bare facts:

  • The companies that profit from illness have been doing extremely well.
  • The people living with illness have not.

VA Funding and Access: A Mixed Picture

The Department of Veterans Affairs invests heavily in mental health services, yet still faces significant gaps.

Recent VA Suicide Prevention Annual Reports indicate:

  • The VA has increased mental health spending steadily over the past decade, but demand continues to outpace capacity.
  • Wait times for psychiatric appointments remain inconsistent across regions. Some veterans receive care quickly; others wait weeks or months.
  • Veterans not enrolled in VA health care have substantially higher suicide rates than those who are. VA engagement reduces risk but does not eliminate it.

The VA is not the primary villain in this story. But it operates within the same larger healthcare ecosystem, constrained by the same national trends: provider shortages, rising complexity, bottlenecked access and inconsistent regional support.

The Science Is Advancing. The System Is Not.

The last decade has produced real breakthroughs in understanding depression, anhedonia and treatment resistance. Ketamine, esketamine, glutamate modulation, sigma-1 receptor pathways, AMPA activation, MM120, neuroplasticity restoration. These are not buzzwords. They are measurable effects on synaptic growth, dendritic connectivity and functional networks in brain regions tied to mood, motivation and reward.

For patients whose suffering does not respond to serotonin modulation, these breakthroughs feel like the first real promise in decades, yet access to them is blocked not by science but by cost structures.

Prior authorization. Restricted networks. High out-of-pocket costs. Denials. Delays. The entire ecosystem is designed to ration hope, and deny it.

This Is the Uprising

There is no way to soften this. We are not dealing with unfortunate administrative friction. We are dealing with a structural system that has aligned incentives to restrict access, maximize revenue and limit cost. The suffering of millions is not a bug in that system; it is a byproduct.

Mental health is treated as a cost center, not a mandate. Insurers profit by limiting care. Pharmaceutical companies profit by prolonging medication cycles. Providers are squeezed by reimbursement pressures that make psychiatric practice unattractive. Patients become data points.

A society that genuinely wanted to reduce suicide, improve mental health and create a humane healthcare landscape would not tolerate this structure.

What Must Change

  1. Mental health parity must be enforced, not suggested.
  2. Prior authorization for mental health conditions must be severely limited or abolished.
  3. Insurance networks must include sufficient mental health providers.
  4. Newer evidence-based therapies must be accessible, not reserved for the wealthy.
  5. Cost transparency must be mandated.
  6. Insurers must publish denial rates, approval times and prior authorization data for mental health treatments.

If the United States is serious about mental health, it cannot maintain a system where help is available in theory but inaccessible in practice.

Conclusion: A Personal Statement

I am tired. I have lived through the carousel of failed medications, side effects, dismissals, delays and paperwork. I am not unique. I am not rare. I am one voice in a nation of millions who live with mental illness every single day.

We do not need platitudes. We do not need slogans, rewards cards, or minimal discounts on cosmetic drugs designed to pacify a political base while lining the pockets of those we elected. We deserve access to care without barriers. We deserve a system designed to help us live, not a system designed to make us wait, or worse, sedate us until we simply stop caring.

Change the outcome, change the structure. A healthy society is a productive society, and unless AI powered robots are the sole future workforce, we need to begin with acknowledging the truth: the American mental health system needs a reckoning.

References

[1] CDC Suicide Facts: https://www.cdc.gov/suicide/facts/data.html
[2] AP News on 2022 Suicide Records: https://apnews.com/article/c57bb0852adfb4d85b3670d465a8b890
[3] AP News 2023 Suicide Data: https://apnews.com/article/c57bb0852adfb4d85b3670d465a8b890
[4] JAMA Network 2023 Veteran Suicide Analysis: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2813418
[5] RAND Veteran Suicide Rates 2022: https://www.rand.org/pubs/perspectives/PEA1363-1-v2.html
[6] RAND Raw Numbers 2022: same as above
[7] JAMA Veteran Suicide Rate Ratios: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2807380
[8] KFF Claim Denials 2023: https://www.kff.org/private-insurance/claims-denials-and-appeals-in-aca-marketplace-plans-in-2023
[9] Same source
[10] Same source
[11] KFF Prior Authorization in Medicare Advantage: https://www.kff.org/medicare/nearly-50-million-prior-authorization-requests-were-sent-to-medicare-advantage-insurers-in-2023
[12] AMA Prior Authorization Findings: https://www.ama-assn.org/practice-management/prior-authorization/prior-authorization-delays-care-and-increases-health-care
[13] Health System Tracker, Cost Barriers: https://www.healthsystemtracker.org/chart-collection/cost-affect-access-care
[14] Same source
[15] Same source
[16] American Progress Network Adequacy Study: https://www.americanprogress.org/article/the-behavioral-health-care-affordability-problem
[17] Same source