“Mental health is the defining public health crisis of our time.”
It is difficult to disagree with the quote from Dr. Vivek Murthy above. The facts are overwhelming. In 2024, 23% of U.S. adults struggled with a mental illness and 18% reported having a substance use disorder. Approximately 20% of American youth had at least one major depressive episode, with 13% reporting having seriously considered suicide. Despite the high incidence of mental illness, less than half of youth receive treatment nationwide.
Marblehead and its young people are not immune. An article in this newspaper reporting on the annual Youth Risk Behavioral Survey for high schoolers showed that in 2024, 21% of MHS students reported experiencing meaningful anxiety and 13% reported depression. Eleven percent reported suicidal thoughts. Much of the School Committee discussion on that report focused on student substance use — specifically alcohol — which appeared to be at worrisome levels and has recently been receiving more attention in the town.
Even if there is agreement with Murthy’s comment about the mental health crisis, developing a meaningful response is not easy. With an average of 340 people for every one mental health professional nationally, the mental health provider community is being overwhelmed. Local mental health providers, including the Marblehead Counseling Center, report wait lists for their services.
The Board of Health has a history of involvement with mental health issues. It has been a strong supporter of the Marblehead Counseling Center for many years. During it established the Marblehead Mental Health Task Force to address the behavioral consequences of the pandemic. But as the BoH moves to strengthen its capacity to be a proactive force promoting health and wellness, it needs a more comprehensive strategy for addressing mental health and, perhaps even more significantly, for partnering with others at the mental health interface. The town has functioned fairly well for 376 years with its boards and committees primarily functioning in silos. But mental health issues are sufficiently “public” in consequence, that joint venturing with other town agencies in analyses and solutions may be the better approach in the future.
The new strategy also needs to be realistic and consistent with the nature of public health which is not structured to provide services to individuals via one-on-one treatment, therapy or support. Those efforts remain the sole prerogative of the health care delivery system. Public health focuses on the well-being of populations or groups and should consider how to support actions that foster mental wellness and resilience in the community.
Public health is most effective when it focuses on the root causes in the society or environment which lead to poor health in those groups. It often addresses non-clinical factors, known as social determinants of health, which are defined as “the conditions in the environments where people are born, live, learn, work, play, worship and age that affect a wide range of health, functioning and quality-of-life outcomes and risks.” Many of the mental health issues resulting from SDOH (social determinants of health) risks appear as anxiety, depression and stress-type responses. One relatively new and quite logical approach to dealing with SDOH is known as Public Mental Health. PMH builds on existing or easily generated resources in local communities and describes societal actions designed to:
- Prevent mental health problems from occurring
- Reduce the consequences of existing mental health problems
- Promote mental health wellness and resilience in our communities.
PMH looks at health from a variety of perspectives, including how health occurs across a continuum of people’s lives from prenatal to older adulthood.
If PMH were adopted, the BoH would certainly have to learn how to be a better partner. It can and should provide insight and data for analysis of many problems that arise, but it does not have to “own” everything it considers. Well-intentioned consultants can add great value to projects, and as the BoH anticipates growing to five members next year, this might be a good
time to add helpful consultation to its existing skill sets. Part of that would include learning how to increase awareness among potential partners about the BoH’s willingness to partner and to be comfortable in such a partnership.
Let’s take the excessive alcohol use discussion by the School Committee described above as an example of how PMH might work if it were endorsed by the BoH and community. Once the School Committee recognized its substance use issue, it would almost automatically approach the BoH for assistance in developing a science and data-based root cause analysis and possibly help engage the larger community to assist in the potential responses. The School Committee and BoH would draw on their respective skill sets and work together on dealing with a problem that transcends the boundaries and capabilities of both groups functioning independently. Similar partnerships could be envisioned between the BoH and other groups in the town.
Kristin Erbetta is a faculty member in the School of Social Work at Salem State University.
Thomas A. Massaro is a chair of the Marblehead Board of Health. The opinions here are theirs alone and do not represent the views of their organizations.
***All Marblehead residents 18 and older are urged to take a survey regarding their health and wellness. The confidential assessment run by a team from UMass Boston is part of the Creating a Healthier Marblehead (CAHM) initiative, which is based on the belief that the Board of Health should be more actively involved in improving the wellness of our community.
