News & Comment

COVID-19 exposed issues in our mental health system, prompting an emergency advisory from the Surgeon General on youth mental health. This Comment offers two lessons drawn from empirically supported aspects of a public health model to guide a transformation of youth mental health services: (1) the importance of recruiting local community members (peer support specialists [PSSs]) with lived experiences to promote engagement in services and (2) the necessity of expanding services to natural settings to enhance access and uptake. Examples of service models applying these lessons and illustrating how they are interrelated are provided. These initiatives are overdue in response to persistent disparities and the need to provide services across the prevention to intervention continuum.

Community health workers (CHWs) have demonstrated effectiveness in delivering EBTs; however, the integration of CHWs in the U.S. mental health system remains limited. This Comment presents key recommendations for optimizing CHW integration into the mental health spectrum of care to better meet the needs of youth. We discuss necessary advancements across domains of practice, research, and policy to support the sustainability of these models.

Given the renewed interest in the use of psychedelics for the treatment of mental and substance use disorders in recent decades, there has also been renewed discussion and debate about whether it is necessary or beneficial for those who study and deliver psychedelic-assisted psychotherapy (PAP) to have had personal experience of using psychedelics. This paper provides a brief history of this debate and brings a disability-rights perspective to the discussion, given increasing efforts to dismantle ableism in medical training, practice, and research. Many psychiatric conditions and psychotropic medications, including ones as commonly prescribed as antidepressants, may preclude one from being able to safely and/or effectively use psychedelics. As such, we argue explicitly mandating or even implying the necessity of experiential training for psychedelic researchers and clinicians can perpetuate ableism in medicine by excluding those who cannot safely use psychedelics because of their personal medical histories. As PAP research and practice rapidly grow, we must ensure the field grows with disability inclusion amongst researchers and clinicians.

Mental health and substance use parity provides a rhetorical device and policy strategy for achieving more equitable financing of mental health and substance use services, which the U.S. has pursued as a lead policy approach for improving access to mental healthcare. Parity implementation in the U.S. has improved access to care for children, but implementation challenges remain, leading to persistent treatment gaps and disparities, workforce shortages, and variable care quality. In the U.S., a recent policy change required health insurers to make available all of the data on their coverage and reimbursement practices for all health conditions. This new data enables a more detailed conceptualization of what parity means in children’s mental health and how it should be implemented and overseen. Researchers, clinicians, and advocates across the globe can use this data to build the case and the policy approach for parity, supporting more equitable financing of children’s mental health and substance use care and promoting families’ access to evidence-based care.

There have been considerable advancements in artificial intelligence (AI), specifically with generative AI (GAI) models. GAI is a class of algorithms designed to create new data, such as text, images, and audio, that resembles the data on which they have been trained. These models have been recently investigated in medicine, yet the opportunity and utility of GAI in behavioral health are relatively underexplored. In this commentary, we explore the potential uses of GAI in the field of behavioral health, specifically focusing on image generation. We propose the application of GAI for creating personalized and contextually relevant therapeutic interventions and emphasize the need to integrate human feedback into the AI-assisted therapeutics and decision-making process. We report the use of GAI with a case study of behavioral therapy on emotional recognition and management with a three-step process. We illustrate image generation-specific GAI to recognize, express, and manage emotions, featuring personalized content and interactive experiences. Furthermore, we highlighted limitations, challenges, and considerations, including the elements of human emotions, the need for human-AI collaboration, transparency and accountability, potential bias, security, privacy and ethical issues, and operational considerations. Our commentary serves as a guide for practitioners and developers to envision the future of behavioral therapies and consider the benefits and limitations of GAI in improving behavioral health practices and patient outcomes.

Virtual reality has been found effective for some mental disorders, while for many others weak methodology prevents conclusive evidence. Similar to other digital technologies, the field has particular demands for conducting clinical research which currently remain poorly addressed. In this commentary, we discuss the unique issues associated with the incorporation of virtual reality in clinical research. In addition, we elaborate on the possibility that these challenges may also be consequences of current funding and publication schemes, and speculate on specific improvement approaches that might be more compatible with the characteristics of clinical virtual reality research.

Microdosing psychedelics is a growing practice among recreational users, claimed to improve several aspects of mental health, with little supporting empirical research. In this comment, we highlight the potential role of expectations and confirmation bias underlying therapeutic effects of microdosing, and suggest future avenues of research to address this concern.

Youth in the United States are facing an unprecedented mental health crisis. Yet, brick-and-mortar mental healthcare, such as face-to-face therapy, is overwhelmingly inaccessible to youth despite research advances in youth mental health. Digital Mental Health tools (DMH), the use of technologies to deliver mental health assessments and interventions, may help to increase mental healthcare accessibility. However, for a variety of reasons, evidence-based DMH have not been successful in reaching youth in real-world settings, particularly those who are most encumbered with access barriers to mental healthcare. This Comment therefore focuses on increasing DMH reach and uptake by young people, particularly among minoritized youth, by engaging in community-based youth partnerships. This idea recognizes and grows from decades’ worth of community-based participatory research and youth partnerships successfully conducted by other disciplines (e.g., social work, public health, urban planning, education). Increasing uptake and engagement is an issue that is unlikely to be solved by adult-driven theory and design. As such, we emphasize the necessity of reframing youth input into DMH design and deployment from one-time participants to integral community-based partners. Indeed, recognizing and valuing their expertise to equitably address DMH implementation challenges, youth should help to pose the very questions that they will help to answer throughout the design and implementation planning for DMH moving forward.

Age is the main risk factor of neurodegenerative diseases, but environmental exposure and lifestyle are important candidates for understanding their etiology. Accumulating evidence suggests that “exposome”, described as the totality of human environmental exposures from conception onwards, represents major modifiable risk factors for most neurodegenerative diseases and dementia. In this commentary, we discuss and provide our opinion about the urgent need for a constructive dialog between political stakeholders, researchers, and physicians to implement specific strategies to counteract and reduce the onset of neurodegenerative diseases.