Clearer Thinking with Spencer Greenberg Too many mental health challenges and not enough psychiatrists (with Jacob Appel)
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May 21, 2025 
Jacob Appel, a Professor of Psychiatry and Medical Education at Mount Sinai, discusses the daunting mental health crisis exacerbated by social media and the pandemic. He highlights the critical shortage of psychiatrists and the challenges in suicide prevention due to liability concerns. The conversation touches on the ethical implications of genetic medicine and the impact of the Affordable Care Act on healthcare access. Appel also addresses the complexities of patient autonomy in mental health treatment and the need for more comprehensive systems to support mental well-being.
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Causes of Mental Health Crisis
- The mental health crisis is driven by people getting sicker and reduced access to care.
- Social disconnection and fewer psychiatrists worsen this crisis simultaneously.
Psychiatrists Reject Insurance
- Psychiatrists often don't accept insurance due to low reimbursement rates.
- Psychiatry is paid for time spent, unlike procedure-focused specialties with higher payouts.
Better Care for Severe Mental Illness
- Support severe mental illness with scatter-site housing in regular community settings.
- Combine housing with standardized day-treatment programs for best psychiatric outcomes.