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• BOOK REVIEW
• 29 March 2024

The great rewiring: is social media really behind an epidemic of teenage mental illness?

• Candice L. Odgers 0

Candice L. Odgers is the associate dean for research and a professor of psychological science and informatics at the University of California, Irvine. She also co-leads international networks on child development for both the Canadian Institute for Advanced Research in Toronto and the Jacobs Foundation based in Zurich, Switzerland.

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Social-media platforms aren’t always social. Credit: Getty

The Anxious Generation: How the Great Rewiring of Childhood is Causing an Epidemic of Mental Illness Jonathan Haidt Allen Lane (2024)

Two things need to be said after reading The Anxious Generation . First, this book is going to sell a lot of copies, because Jonathan Haidt is telling a scary story about children’s development that many parents are primed to believe. Second, the book’s repeated suggestion that digital technologies are rewiring our children’s brains and causing an epidemic of mental illness is not supported by science. Worse, the bold proposal that social media is to blame might distract us from effectively responding to the real causes of the current mental-health crisis in young people.

Haidt asserts that the great rewiring of children’s brains has taken place by “designing a firehose of addictive content that entered through kids’ eyes and ears”. And that “by displacing physical play and in-person socializing, these companies have rewired childhood and changed human development on an almost unimaginable scale”. Such serious claims require serious evidence.

Collection: Promoting youth mental health

Haidt supplies graphs throughout the book showing that digital-technology use and adolescent mental-health problems are rising together. On the first day of the graduate statistics class I teach, I draw similar lines on a board that seem to connect two disparate phenomena, and ask the students what they think is happening. Within minutes, the students usually begin telling elaborate stories about how the two phenomena are related, even describing how one could cause the other. The plots presented throughout this book will be useful in teaching my students the fundamentals of causal inference, and how to avoid making up stories by simply looking at trend lines.

Hundreds of researchers, myself included, have searched for the kind of large effects suggested by Haidt. Our efforts have produced a mix of no, small and mixed associations. Most data are correlative. When associations over time are found, they suggest not that social-media use predicts or causes depression, but that young people who already have mental-health problems use such platforms more often or in different ways from their healthy peers 1 .

These are not just our data or my opinion. Several meta-analyses and systematic reviews converge on the same message 2 – 5 . An analysis done in 72 countries shows no consistent or measurable associations between well-being and the roll-out of social media globally 6 . Moreover, findings from the Adolescent Brain Cognitive Development study, the largest long-term study of adolescent brain development in the United States, has found no evidence of drastic changes associated with digital-technology use 7 . Haidt, a social psychologist at New York University, is a gifted storyteller, but his tale is currently one searching for evidence.

Of course, our current understanding is incomplete, and more research is always needed. As a psychologist who has studied children’s and adolescents’ mental health for the past 20 years and tracked their well-being and digital-technology use, I appreciate the frustration and desire for simple answers. As a parent of adolescents, I would also like to identify a simple source for the sadness and pain that this generation is reporting.

A complex problem

There are, unfortunately, no simple answers. The onset and development of mental disorders, such as anxiety and depression, are driven by a complex set of genetic and environmental factors. Suicide rates among people in most age groups have been increasing steadily for the past 20 years in the United States. Researchers cite access to guns, exposure to violence, structural discrimination and racism, sexism and sexual abuse, the opioid epidemic, economic hardship and social isolation as leading contributors 8 .

How social media affects teen mental health: a missing link

The current generation of adolescents was raised in the aftermath of the great recession of 2008. Haidt suggests that the resulting deprivation cannot be a factor, because unemployment has gone down. But analyses of the differential impacts of economic shocks have shown that families in the bottom 20% of the income distribution continue to experience harm 9 . In the United States, close to one in six children live below the poverty line while also growing up at the time of an opioid crisis, school shootings and increasing unrest because of racial and sexual discrimination and violence.

The good news is that more young people are talking openly about their symptoms and mental-health struggles than ever before. The bad news is that insufficient services are available to address their needs. In the United States, there is, on average, one school psychologist for every 1,119 students 10 .

Haidt’s work on emotion, culture and morality has been influential; and, in fairness, he admits that he is no specialist in clinical psychology, child development or media studies. In previous books, he has used the analogy of an elephant and its rider to argue how our gut reactions (the elephant) can drag along our rational minds (the rider). Subsequent research has shown how easy it is to pick out evidence to support our initial gut reactions to an issue. That we should question assumptions that we think are true carefully is a lesson from Haidt’s own work. Everyone used to ‘know’ that the world was flat. The falsification of previous assumptions by testing them against data can prevent us from being the rider dragged along by the elephant.

A generation in crisis

Two things can be independently true about social media. First, that there is no evidence that using these platforms is rewiring children’s brains or driving an epidemic of mental illness. Second, that considerable reforms to these platforms are required, given how much time young people spend on them. Many of Haidt’s solutions for parents, adolescents, educators and big technology firms are reasonable, including stricter content-moderation policies and requiring companies to take user age into account when designing platforms and algorithms. Others, such as age-based restrictions and bans on mobile devices, are unlikely to be effective in practice — or worse, could backfire given what we know about adolescent behaviour.

A third truth is that we have a generation in crisis and in desperate need of the best of what science and evidence-based solutions can offer. Unfortunately, our time is being spent telling stories that are unsupported by research and that do little to support young people who need, and deserve, more.

Nature 628 , 29-30 (2024)

doi: https://doi.org/10.1038/d41586-024-00902-2

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Vuorre, M. & Przybylski, A. K. R. Sci. Open Sci. 10 , 221451 (2023).

Miller, J., Mills, K. L., Vuorre, M., Orben, A. & Przybylski, A. K. Cortex 169 , 290–308 (2023).

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What Is Mental Disorder? An Essay in Philosophy, Science, and Values

• KENNETH S. KENDLER M.D. ,

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Imagine you are a member of the admissions committee for DSM-V. Your set of applications include night-eating syndrome, hoarding, racism, and Internet addiction. It is your job to decide if these are “real” psychiatric disorders worthy of inclusion in DSM-V. By what criteria would you decide if these applications represent a true mental disorder versus a non-disordered “problem of living” or social deviance?

In this thought-provoking book, clinical psychologist and philosopher Derek Bolton asks whether it is possible to develop a single clear definition of mental disorder to which such a committee could refer. Perhaps surprisingly, he reaches a negative conclusion, writing, “there is no natural, principled boundary between normal and abnormal conditions of suffering” (p. 194).

Much of Bolton’s book critiques the naturalist approach to mental illness. This idea—probably a comfortable one to many readers of this journal—is that there exists in the real world a clear distinction between mental health and disorder. All we have to do is be smart enough to find it and define it clearly. He evaluates several approaches to naturalist definitions of psychiatric disorders. However, he spends the most time on the influential work of Jerry Wakefield, which emphasizes an objective dysfunction of an evolved mental process, the consequences of which cause harm to the individual. At the risk of oversimplification, Bolton suggests that in principle it is just too hard to know what represents a dysfunction of an evolved mental system. Since Homo sapiens evolved in a social milieu, and many of our mental functions develop in an intertwined manner from both genetic and environmental factors, trying to distinguish social from evolutionary dysfunction may be inherently impossible. Problems could also arise when an evolved system is not really dysfunctional, but the environment has changed so dramatically that its impact has become harmful (perhaps an underlying explanation for the obesity epidemic). He argues that Wakefield, rather than trying to make the difficult determination of what functions have evolved for what purpose, actually uses a rough “understandability” measure when, for example, he argues that conduct disorder should not be applied to children growing up in some inner-city neighborhoods where gang membership might be adaptive or that depression should not be diagnosed when it occurs after a major loss. Bolton also examines and rejects the concept that mental disorders represent the breakdown of meaningful connections. With regard to the important issue of the abuse of psychiatry, as occurred in the former Soviet Union, he concludes that is more a task for governments and judicial systems than for psychiatric diagnostic manuals.

Ultimately, Bolton opts for a harm-based approach to defining what should go into our diagnostic manuals. That is the point of greatest consensus for all stakeholders in the business of mental health. He dislikes the term “disorder,” because in many of these syndromes, mental life remains ordered and meaningful.

I suspect most readers, like myself, will find this book a bit disturbing. We would much prefer a comfortable and neat and tidy solution to this boundary problem. Given the current ascendancy of the biological psychiatric paradigm, many of us want to ground ourselves in our physician identity and see ourselves as treating “real” biological disorders that can be cleanly and decisively separated from problems of living and social deviance. Bolton tries hard to puncture this comfortable belief system.

Bolton writes well, with only a modest amount of “philosophy-speak.” My main gripe is the book is not concise. Many of his well-developed arguments are repeated several times in different forms. I also think he underestimates the striking differences across disorders in seeking generic solutions to definitional questions about mental disorders.

I began this book with only a modest knowledge of the relevant literature and a rather naive sense that with a bit of “hard thinking,” we could come up with a clear, defensible definition of mental disorders. Upon completion, I no longer believed as such and have a much deeper appreciation of the subtlety and complexity of this definitional question. Did Bolton convince me the problem is intractable? Not quite, but my naiveté has surely been laid to rest.

Who should read this book? This book will be of most value to those who, because of their clinical or research work (or because they are contributing to current revisions of DSM and ICD manuals), are really interested in the problem of defining the boundaries of psychiatric illness. While it is not the easiest of reads, such individuals will be amply rewarded for their efforts. This book might be of interest to a wider group of individuals, from the fields of both mental health and philosophy, who want to see a good example of analytic philosophy being applied with skill and scholarship to a difficult real-world problem that really matters.

Book review accepted for publication July 2008 (doi: 10.1176/appi.ajp.2008.08060944).

Reprints are not available; however, Book Forum reviews can be downloaded at http://ajp.psychiatryonline.org.

• Cited by None

• Open access
• Published: 12 December 2023

Examining the role of community resilience and social capital on mental health in public health emergency and disaster response: a scoping review

• C. E. Hall 1 , 2 ,
• H. Wehling 1 ,
• J. Stansfield 3 ,
• J. South 3 ,
• S. K. Brooks 2 ,
• N. Greenberg 2 , 4 ,
• R. Amlôt 1 &
• D. Weston 1  

BMC Public Health volume  23 , Article number:  2482 ( 2023 ) Cite this article

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The ability of the public to remain psychologically resilient in the face of public health emergencies and disasters (such as the COVID-19 pandemic) is a key factor in the effectiveness of a national response to such events. Community resilience and social capital are often perceived as beneficial and ensuring that a community is socially and psychologically resilient may aid emergency response and recovery. This review presents a synthesis of literature which answers the following research questions: How are community resilience and social capital quantified in research?; What is the impact of community resilience on mental wellbeing?; What is the impact of infectious disease outbreaks, disasters and emergencies on community resilience and social capital?; and, What types of interventions enhance community resilience and social capital?

A scoping review procedure was followed. Searches were run across Medline, PsycInfo, and EMBASE, with search terms covering both community resilience and social capital, public health emergencies, and mental health. 26 papers met the inclusion criteria.

The majority of retained papers originated in the USA, used a survey methodology to collect data, and involved a natural disaster. There was no common method for measuring community resilience or social capital. The association between community resilience and social capital with mental health was regarded as positive in most cases. However, we found that community resilience, and social capital, were initially negatively impacted by public health emergencies and enhanced by social group activities.

Several key recommendations are proposed based on the outcomes from the review, which include: the need for a standardised and validated approach to measuring both community resilience and social capital; that there should be enhanced effort to improve preparedness to public health emergencies in communities by gauging current levels of community resilience and social capital; that community resilience and social capital should be bolstered if areas are at risk of disasters or public health emergencies; the need to ensure that suitable short-term support is provided to communities with high resilience in the immediate aftermath of a public health emergency or disaster; the importance of conducting robust evaluation of community resilience initiatives deployed during the COVID-19 pandemic.

Peer Review reports

For the general population, public health emergencies and disasters (e.g., natural disasters; infectious disease outbreaks; Chemical, Biological, Radiological or Nuclear incidents) can give rise to a plethora of negative outcomes relating to both health (e.g. increased mental health problems [ 1 , 2 , 3 , 4 ]) and the economy (e.g., increased unemployment and decreased levels of tourism [ 4 , 5 , 6 ]). COVID-19 is a current, and ongoing, example of a public health emergency which has affected over 421 million individuals worldwide [ 7 ]. The long term implications of COVID-19 are not yet known, but there are likely to be repercussions for physical health, mental health, and other non-health related outcomes for a substantial time to come [ 8 , 9 ]. As a result, it is critical to establish methods which may inform approaches to alleviate the longer-term negative consequences that are likely to emerge in the aftermath of both COVID-19 and any future public health emergency.

The definition of resilience often differs within the literature, but ultimately resilience is considered a dynamic process of adaptation. It is related to processes and capabilities at the individual, community and system level that result in good health and social outcomes, in spite of negative events, serious threats and hazards [ 10 ]. Furthermore, Ziglio [ 10 ] refers to four key types of resilience capacity: adaptive, the ability to withstand and adjust to unfavourable conditions and shocks; absorptive, the ability to withstand but also to recover and manage using available assets and skills; anticipatory, the ability to predict and minimize vulnerability; and transformative, transformative change so that systems better cope with new conditions.

There is no one settled definition of community resilience (CR). However, it generally relates to the ability of a community to withstand, adapt and permit growth in adverse circumstances due to social structures, networks and interdependencies within the community [ 11 ]. Social capital (SC) is considered a major determinant of CR [ 12 , 13 ], and reflects strength of a social network, community reciprocity, and trust in people and institutions [ 14 ]. These aspects of community are usually conceptualised primarily as protective factors that enable communities to cope and adapt collectively to threats. SC is often broken down into further categories [ 15 ], for example: cognitive SC (i.e. perceptions of community relations, such as trust, mutual help and attachment) and structural SC (i.e. what actually happens within the community, such as participation, socialising) [ 16 ]; or, bonding SC (i.e. connections among individuals who are emotionally close, and result in bonds to a particular group [ 17 ]) and bridging SC (i.e. acquaintances or individuals loosely connected that span different social groups [ 18 ]). Generally, CR is perceived to be primarily beneficial for multiple reasons (e.g. increased social support [ 18 , 19 ], protection of mental health [ 20 , 21 ]), and strengthening community resilience is a stated health goal of the World Health Organisation [ 22 ] when aiming to alleviate health inequalities and protect wellbeing. This is also reflected by organisations such as Public Health England (now split into the UK Health Security Agency and the Office for Health Improvement and Disparities) [ 23 ] and more recently, CR has been targeted through the endorsement of Community Champions (who are volunteers trained to support and to help improve health and wellbeing. Community Champions also reflect their local communities in terms of population demographics for example age, ethnicity and gender) as part of the COVID-19 response in the UK (e.g. [ 24 , 25 ]).

Despite the vested interest in bolstering communities, the research base establishing: how to understand and measure CR and SC; the effect of CR and SC, both during and following a public health emergency (such as the COVID-19 pandemic); and which types of CR or SC are the most effective to engage, is relatively small. Given the importance of ensuring resilience against, and swift recovery from, public health emergencies, it is critically important to establish and understand the evidence base for these approaches. As a result, the current review sought to answer the following research questions: (1) How are CR and SC quantified in research?; (2) What is the impact of community resilience on mental wellbeing?; (3) What is the impact of infectious disease outbreaks, disasters and emergencies on community resilience and social capital?; and, (4) What types of interventions enhance community resilience and social capital?

By collating research in order to answer these research questions, the authors have been able to propose several key recommendations that could be used to both enhance and evaluate CR and SC effectively to facilitate the long-term recovery from COVID-19, and also to inform the use of CR and SC in any future public health disasters and emergencies.

A scoping review methodology was followed due to the ease of summarising literature on a given topic for policy makers and practitioners [ 26 ], and is detailed in the following sections.

Identification of relevant studies

An initial search strategy was developed by authors CH and DW and included terms which related to: CR and SC, given the absence of a consistent definition of CR, and the link between CR and SC, the review focuses on both CR and SC to identify as much relevant literature as possible (adapted for purpose from Annex 1: [ 27 ], as well as through consultation with review commissioners); public health emergencies and disasters [ 28 , 29 , 30 , 31 ], and psychological wellbeing and recovery (derived a priori from literature). To ensure a focus on both public health and psychological research, the final search was carried across Medline, PsycInfo, and EMBASE using OVID. The final search took place on the 18th of May 2020, the search strategy used for all three databases can be found in Supplementary file 1 .

Selection criteria

The inclusion and exclusion criteria were developed alongside the search strategy. Initially the criteria were relatively inclusive and were subject to iterative development to reflect the authors’ familiarisation with the literature. For example, the decision was taken to exclude research which focused exclusively on social support and did not mention communities as an initial title/abstract search suggested that the majority of this literature did not meet the requirements of our research question.

The full and final inclusion and exclusion criteria used can be found in Supplementary file 2 . In summary, authors decided to focus on the general population (i.e., non-specialist, e.g. non-healthcare worker or government official) to allow the review to remain community focused. The research must also have assessed the impact of CR and/or SC on mental health and wellbeing, resilience, and recovery during and following public health emergencies and infectious disease outbreaks which affect communities (to ensure the research is relevant to the review aims), have conducted primary research, and have a full text available or provided by the first author when contacted.

Charting the data

All papers were first title and abstract screened by CH or DW. Papers then were full text reviewed by CH to ensure each paper met the required eligibility criteria, if unsure about a paper it was also full text reviewed by DW. All papers that were retained post full-text review were subjected to a standardised data extraction procedure. A table was made for the purpose of extracting the following data: title, authors, origin, year of publication, study design, aim, disaster type, sample size and characteristics, variables examined, results, restrictions/limitations, and recommendations. Supplementary file 3 details the charting the data process.

Analytical method

Data was synthesised using a Framework approach [ 32 ], a common method for analysing qualitative research. This method was chosen as it was originally used for large-scale social policy research [ 33 ] as it seeks to identify: what works, for whom, in what conditions, and why [ 34 ]. This approach is also useful for identifying commonalities and differences in qualitative data and potential relationships between different parts of the data [ 33 ]. An a priori framework was established by CH and DW. Extracted data was synthesised in relation to each research question, and the process was iterative to ensure maximum saturation using the available data.

Study selection

The final search strategy yielded 3584 records. Following the removal of duplicates, 2191 records remained and were included in title and abstract screening. A PRISMA flow diagram is presented in Fig.  1 .

PRISMA flow diagram

At the title and abstract screening stage, the process became more iterative as the inclusion criteria were developed and refined. For the first iteration of screening, CH or DW sorted all records into ‘include,’ ‘exclude,’ and ‘unsure’. All ‘unsure’ papers were re-assessed by CH, and a random selection of ~ 20% of these were also assessed by DW. Where there was disagreement between authors the records were retained, and full text screened. The remaining papers were reviewed by CH, and all records were categorised into ‘include’ and ‘exclude’. Following full-text screening, 26 papers were retained for use in the review.

Study characteristics

This section of the review addresses study characteristics of those which met the inclusion criteria, which comprises: date of publication, country of origin, study design, study location, disaster, and variables examined.

Date of publication

Publication dates across the 26 papers spanned from 2008 to 2020 (see Fig.  2 ). The number of papers published was relatively low and consistent across this timescale (i.e. 1–2 per year, except 2010 and 2013 when none were published) up until 2017 where the number of papers peaked at 5. From 2017 to 2020 there were 15 papers published in total. The amount of papers published in recent years suggests a shift in research and interest towards CR and SC in a disaster/ public health emergency context.

Graph to show retained papers date of publication

Country of origin

The locations of the first authors’ institutes at the time of publication were extracted to provide a geographical spread of the retained papers. The majority originated from the USA [ 35 , 36 , 37 , 38 , 39 , 40 , 41 ], followed by China [ 42 , 43 , 44 , 45 , 46 ], Japan [ 47 , 48 , 49 , 50 ], Australia [ 51 , 52 , 53 ], The Netherlands [ 54 , 55 ], New Zealand [ 56 ], Peru [ 57 ], Iran [ 58 ], Austria [ 59 ], and Croatia [ 60 ].

There were multiple methodological approaches carried out across retained papers. The most common formats included surveys or questionnaires [ 36 , 37 , 38 , 42 , 46 , 47 , 48 , 49 , 50 , 53 , 54 , 55 , 57 , 59 ], followed by interviews [ 39 , 40 , 43 , 51 , 52 , 60 ]. Four papers used both surveys and interviews [ 35 , 41 , 45 , 58 ], and two papers conducted data analysis (one using open access data from a Social Survey [ 44 ] and one using a Primary Health Organisations Register [ 56 ]).

Study location

The majority of the studies were carried out in Japan [ 36 , 42 , 44 , 47 , 48 , 49 , 50 ], followed by the USA [ 35 , 37 , 38 , 39 , 40 , 41 ], China [ 43 , 45 , 46 , 53 ], Australia [ 51 , 52 ], and the UK [ 54 , 55 ]. The remaining studies were carried out in Croatia [ 60 ], Peru [ 57 ], Austria [ 59 ], New Zealand [ 56 ] and Iran [ 58 ].

Multiple different types of disaster were researched across the retained papers. Earthquakes were the most common type of disaster examined [ 45 , 47 , 49 , 50 , 53 , 56 , 57 , 58 ], followed by research which assessed the impact of two disastrous events which had happened in the same area (e.g. Hurricane Katrina and the Deepwater Horizon oil spill in Mississippi, and the Great East Japan earthquake and Tsunami; [ 36 , 37 , 38 , 42 , 44 , 48 ]). Other disaster types included: flooding [ 51 , 54 , 55 , 59 , 60 ], hurricanes [ 35 , 39 , 41 ], infectious disease outbreaks [ 43 , 46 ], oil spillage [ 40 ], and drought [ 52 ].

Variables of interest examined

Across the 26 retained papers: eight referred to examining the impact of SC [ 35 , 37 , 39 , 41 , 46 , 49 , 55 , 60 ]; eight examined the impact of cognitive and structural SC as separate entities [ 40 , 42 , 45 , 48 , 50 , 54 , 57 , 59 ]; one examined bridging and bonding SC as separate entities [ 58 ]; two examined the impact of CR [ 38 , 56 ]; and two employed a qualitative methodology but drew findings in relation to bonding and bridging SC, and SC generally [ 51 , 52 ]. Additionally, five papers examined the impact of the following variables: ‘community social cohesion’ [ 36 ], ‘neighbourhood connectedness’ [ 44 ], ‘social support at the community level’ [ 47 ], ‘community connectedness’ [ 43 ] and ‘sense of community’ [ 53 ]. Table  1 provides additional details on this.

How is CR and SC measured or quantified in research?

The measures used to examine CR and SC are presented Table  1 . It is apparent that there is no uniformity in how SC or CR is measured across the research. Multiple measures are used throughout the retained studies, and nearly all are unique. Additionally, SC was examined at multiple different levels (e.g. cognitive and structural, bonding and bridging), and in multiple different forms (e.g. community connectedness, community cohesion).

What is the association between CR and SC on mental wellbeing?

To best compare research, the following section reports on CR, and facets of SC separately. Please see Supplementary file 4  for additional information on retained papers methods of measuring mental wellbeing.

• Community resilience

CR relates to the ability of a community to withstand, adapt and permit growth in adverse circumstances due to social structures, networks and interdependencies within the community [ 11 ].

The impact of CR on mental wellbeing was consistently positive. For example, research indicated that there was a positive association between CR and number of common mental health (i.e. anxiety and mood) treatments post-disaster [ 56 ]. Similarly, other research suggests that CR is positively related to psychological resilience, which is inversely related to depressive symptoms) [ 37 ]. The same research also concluded that CR is protective of psychological resilience and is therefore protective of depressive symptoms [ 37 ].

• Social capital

SC reflects the strength of a social network, community reciprocity, and trust in people and institutions [ 14 ]. These aspects of community are usually conceptualised primarily as protective factors that enable communities to cope and adapt collectively to threats.

There were inconsistencies across research which examined the impact of abstract SC (i.e. not refined into bonding/bridging or structural/cognitive) on mental wellbeing. However, for the majority of cases, research deems SC to be beneficial. For example, research has concluded that, SC is protective against post-traumatic stress disorder [ 55 ], anxiety [ 46 ], psychological distress [ 50 ], and stress [ 46 ]. Additionally, SC has been found to facilitate post-traumatic growth [ 38 ], and also to be useful to be drawn upon in times of stress [ 52 ], both of which could be protective of mental health. Similarly, research has also found that emotional recovery following a disaster is more difficult for those who report to have low levels of SC [ 51 ].

Conversely, however, research has also concluded that when other situational factors (e.g. personal resources) were controlled for, a positive relationship between community resources and life satisfaction was no longer significant [ 60 ]. Furthermore, some research has concluded that a high level of SC can result in a community facing greater stress immediately post disaster. Indeed, one retained paper found that high levels of SC correlate with higher levels of post-traumatic stress immediately following a disaster [ 39 ]. However, in the later stages following a disaster, this relationship can reverse, with SC subsequently providing an aid to recovery [ 41 ]. By way of explanation, some researchers have suggested that communities with stronger SC carry the greatest load in terms of helping others (i.e. family, friends and neighbours) as well as themselves immediately following the disaster, but then as time passes the communities recover at a faster rate as they are able to rely on their social networks for support [ 41 ].

Cognitive and structural social capital

Cognitive SC refers to perceptions of community relations, such as trust, mutual help and attachment, and structural SC refers to what actually happens within the community, such as participation, socialising [ 16 ].

Cognitive SC has been found to be protective [ 49 ] against PTSD [ 54 , 57 ], depression [ 40 , 54 ]) mild mood disorder; [ 48 ]), anxiety [ 48 , 54 ] and increase self-efficacy [ 59 ].

For structural SC, research is again inconsistent. On the one hand, structural SC has been found to: increase perceived self-efficacy, be protective of depression [ 40 ], buffer the impact of housing damage on cognitive decline [ 42 ] and provide support during disasters and over the recovery period [ 59 ]. However, on the other hand, it has been found to have no association with PTSD [ 54 , 57 ] or depression, and is also associated with a higher prevalence of anxiety [ 54 ]. Similarly, it is also suggested by additional research that structural SC can harm women’s mental health, either due to the pressure of expectations to help and support others or feelings of isolation [ 49 ].

Bonding and bridging social capital

Bonding SC refers to connections among individuals who are emotionally close, and result in bonds to a particular group [ 17 ], and bridging SC refers to acquaintances or individuals loosely connected that span different social groups [ 18 ].

One research study concluded that both bonding and bridging SC were protective against post-traumatic stress disorder symptoms [ 58 ]. Bridging capital was deemed to be around twice as effective in buffering against post-traumatic stress disorder than bonding SC [ 58 ].

Other community variables

Community social cohesion was significantly associated with a lower risk of post-traumatic stress disorder symptom development [ 35 ], and this was apparent even whilst controlling for depressive symptoms at baseline and disaster impact variables (e.g. loss of family member or housing damage) [ 36 ]. Similarly, sense of community, community connectedness, social support at the community level and neighbourhood connectedness all provided protective benefits for a range of mental health, wellbeing and recovery variables, including: depression [ 53 ], subjective wellbeing (in older adults only) [ 43 ], psychological distress [ 47 ], happiness [ 44 ] and life satisfaction [ 53 ].

Research has also concluded that community level social support is protective against mild mood and anxiety disorder, but only for individuals who have had no previous disaster experience [ 48 ]. Additionally, a study which separated SC into social cohesion and social participation concluded that at a community level, social cohesion is protective against depression [ 49 ] whereas social participation at community level is associated with an increased risk of depression amongst women [ 49 ].

What is the impact of Infectious disease outbreaks / disasters and emergencies on community resilience?

From a cross-sectional perspective, research has indicated that disasters and emergencies can have a negative effect on certain types of SC. Specifically, cognitive SC has been found to be impacted by disaster impact, whereas structural SC has gone unaffected [ 45 ]. Disaster impact has also been shown to have a negative effect on community relationships more generally [ 52 ].

Additionally, of the eight studies which collected data at multiple time points [ 35 , 36 , 41 , 42 , 47 , 49 , 56 , 60 ], three reported the effect of a disaster on the level of SC within a community [ 40 , 42 , 49 ]. All three of these studies concluded that disasters may have a negative impact on the levels of SC within a community. The first study found that the Deepwater Horizon oil spill had a negative effect on SC and social support, and this in turn explained an overall increase in the levels of depression within the community [ 40 ]. A possible explanation for the negative effect lays in ‘corrosive communities’, known for increased social conflict and reduced social support, that are sometimes created following oil spills [ 40 ]. It is proposed that corrosive communities often emerge due to a loss of natural resources that bring social groups together (e.g., for recreational activities), as well as social disparity (e.g., due to unequal distribution of economic impact) becoming apparent in the community following disaster [ 40 ]. The second study found that SC (in the form of social cohesion, informal socialising and social participation) decreased after the 2011 earthquake and tsunami in Japan; it was suggested that this change correlated with incidence of cognitive decline [ 42 ]. However, the third study reported more mixed effects based on physical circumstances of the communities’ natural environment: Following an earthquake, those who lived in mountainous areas with an initial high level of pre-community SC saw a decrease in SC post disaster [ 49 ]. However, communities in flat areas (which were home to younger residents and had a higher population density) saw an increase in SC [ 49 ]. It was proposed that this difference could be due to the need for those who lived in mountainous areas to seek prolonged refuge due to subsequent landslides [ 49 ].

What types of intervention enhance CR and SC and protect survivors?

There were mixed effects across the 26 retained papers when examining the effect of CR and SC on mental wellbeing. However, there is evidence that an increase in SC [ 56 , 57 ], with a focus on cognitive SC [ 57 ], namely by: building social networks [ 45 , 51 , 53 ], enhancing feelings of social cohesion [ 35 , 36 ] and promoting a sense of community [ 53 ], can result in an increase in CR and potentially protect survivors’ wellbeing and mental health following a disaster. An increase in SC may also aid in decreasing the need for individual psychological interventions in the aftermath of a disaster [ 55 ]. As a result, recommendations and suggested methods to bolster CR and SC from the retained papers have been extracted and separated into general methods, preparedness and policy level implementation.

General methods

Suggested methods to build SC included organising recreational activity-based groups [ 44 ] to broaden [ 51 , 53 ] and preserve current social networks [ 42 ], introducing initiatives to increase social cohesion and trust [ 51 ], and volunteering to increase the number of social ties between residents [ 59 ]. Research also notes that it is important to take a ‘no one left behind approach’ when organising recreational and social community events, as failure to do so could induce feelings of isolation for some members of the community [ 49 ]. Furthermore, gender differences should also be considered as research indicates that males and females may react differently to community level SC (as evidence suggests males are instead more impacted by individual level SC; in comparison to women who have larger and more diverse social networks [ 49 ]). Therefore, interventions which aim to raise community level social participation, with the aim of expanding social connections and gaining support, may be beneficial [ 42 , 47 ].

Preparedness

In order to prepare for disasters, it may be beneficial to introduce community-targeted methods or interventions to increase levels of SC and CR as these may aid in ameliorating the consequences of a public health emergency or disaster [ 57 ]. To indicate which communities have low levels of SC, one study suggests implementing a 3-item scale of social cohesion to map areas and target interventions [ 42 ].

It is important to consider that communities with a high level of SC may have a lower level of risk perception, due to the established connections and supportive network they have with those around them [ 61 ]. However, for the purpose of preparedness, this is not ideal as perception of risk is a key factor when seeking to encourage behavioural adherence. This could be overcome by introducing communication strategies which emphasise the necessity of social support, but also highlights the need for additional measures to reduce residual risk [ 59 ]. Furthermore, support in the form of financial assistance to foster current community initiatives may prove beneficial to rural areas, for example through the use of an asset-based community development framework [ 52 ].

Policy level

At a policy level, the included papers suggest a range of ways that CR and SC could be bolstered and used. These include: providing financial support for community initiatives and collective coping strategies, (e.g. using asset-based community development [ 52 ]); ensuring policies for long-term recovery focus on community sustainable development (e.g. community festival and community centre activities) [ 44 ]; and development of a network amongst cooperative corporations formed for reconstruction and to organise self-help recovery sessions among residents of adjacent areas [ 58 ].

This scoping review sought to synthesise literature concerning the role of SC and CR during public health emergencies and disasters. Specifically, in this review we have examined: the methods used to measure CR and SC; the impact of CR and SC on mental wellbeing during disasters and emergencies; the impact of disasters and emergencies on CR and SC; and the types of interventions which can be used to enhance CR. To do this, data was extracted from 26 peer-reviewed journal articles. From this synthesis, several key themes have been identified, which can be used to develop guidelines and recommendations for deploying CR and SC in a public health emergency or disaster context. These key themes and resulting recommendations are summarised below.

Firstly, this review established that there is no consistent or standardised approach to measuring CR or SC within the general population. This finding is consistent with a review conducted by the World Health Organization which concludes that despite there being a number of frameworks that contain indicators across different determinants of health, there is a lack of consensus on priority areas for measurement and no widely accepted indicator [ 27 ]. As a result, there are many measures of CR and SC apparent within the literature (e.g., [ 62 , 63 ]), an example of a developed and validated measure is provided by Sherrieb, Norris and Galea [ 64 ]. Similarly, the definitions of CR and SC differ widely between researchers, which created a barrier to comparing and summarising information. Therefore, future research could seek to compare various interpretations of CR and to identify any overlapping concepts. However, a previous systemic review conducted by Patel et al. (2017) concludes that there are nine core elements of CR (local knowledge, community networks and relationships, communication, health, governance and leadership, resources, economic investment, preparedness, and mental outlook), with 19 further sub-elements therein [ 30 ]. Therefore, as CR is a multi-dimensional construct, the implications from the findings are that multiple aspects of social infrastructure may need to be considered.

Secondly, our synthesis of research concerning the role of CR and SC for ensuring mental health and wellbeing during, or following, a public health emergency or disaster revealed mixed effects. Much of the research indicates either a generally protective effect on mental health and wellbeing, or no effect; however, the literature demonstrates some potential for a high level of CR/SC to backfire and result in a negative effect for populations during, or following, a public health emergency or disaster. Considered together, our synthesis indicates that cognitive SC is the only facet of SC which was perceived as universally protective across all retained papers. This is consistent with a systematic review which also concludes that: (a) community level cognitive SC is associated with a lower risk of common mental disorders, while; (b) community level structural SC had inconsistent effects [ 65 ].

Further examination of additional data extracted from studies which found that CR/SC had a negative effect on mental health and wellbeing revealed no commonalities that might explain these effects (Please see Supplementary file 5 for additional information)

One potential explanation may come from a retained paper which found that high levels of SC result in an increase in stress level immediately post disaster [ 41 ]. This was suggested to be due to individuals having greater burdens due to wishing to help and support their wide networks as well as themselves. However, as time passes the levels of SC allow the community to come together and recover at a faster rate [ 41 ]. As this was the only retained paper which produced this finding, it would be beneficial for future research to examine boundary conditions for the positive effects of CR/SC; that is, to explore circumstances under which CR/SC may be more likely to put communities at greater risk. This further research should also include additional longitudinal research to validate the conclusions drawn by [ 41 ] as resilience is a dynamic process of adaption.

Thirdly, disasters and emergencies were generally found to have a negative effect on levels of SC. One retained paper found a mixed effect of SC in relation to an earthquake, however this paper separated participants by area in which they lived (i.e., mountainous vs. flat), which explains this inconsistent effect [ 49 ]. Dangerous areas (i.e. mountainous) saw a decrease in community SC in comparison to safer areas following the earthquake (an effect the authors attributed to the need to seek prolonged refuge), whereas participants from the safer areas (which are home to younger residents with a higher population density) saw an increase in SC [ 49 ]. This is consistent with the idea that being able to participate socially is a key element of SC [ 12 ]. Overall, however, this was the only retained paper which produced a variable finding in relation to the effect of disaster on levels of CR/SC.

Finally, research identified through our synthesis promotes the idea of bolstering SC (particularly cognitive SC) and cohesion in communities likely to be affected by disaster to improve levels of CR. This finding provides further understanding of the relationship between CR and SC; an association that has been reported in various articles seeking to provide conceptual frameworks (e.g., [ 66 , 67 ]) as well as indicator/measurement frameworks [ 27 ]. Therefore, this could be done by creating and promoting initiatives which foster SC and create bonds within the community. Papers included in the current review suggest that recreational-based activity groups and volunteering are potential methods for fostering SC and creating community bonds [ 44 , 51 , 59 ]. Similarly, further research demonstrates that feelings of social cohesion are enhanced by general social activities (e.g. fairs and parades [ 18 ]). Also, actively encouraging activities, programs and interventions which enhance connectedness and SC have been reported to be desirable to increase CR [ 68 ]. This suggestion is supported by a recent scoping review of literature [ 67 ] examined community champion approaches for the COVID-19 pandemic response and recovery and established that creating and promoting SC focused initiatives within the community during pandemic response is highly beneficial [ 67 ]. In terms of preparedness, research states that it may be beneficial for levels of SC and CR in communities at risk to be assessed, to allow targeted interventions where the population may be at most risk following an incident [ 42 , 44 ]. Additionally, from a more critical perspective, we acknowledge that ‘resilience’ can often be perceived as a focus on individual capacity to adapt to adversity rather than changing or mitigating the causes of adverse conditions [ 69 , 70 ]. Therefore, CR requires an integrated system approach across individual, community and structural levels [ 17 ]. Also, it is important that community members are engaged in defining and agreeing how community resilience is measured [ 27 ] rather than it being imposed by system leads or decision-makers.

In the aftermath of the pandemic, is it expected that there will be long-term repercussions both from an economic [ 8 ] and a mental health perspective [ 71 ]. Furthermore, the findings from this review suggest that although those in areas with high levels of SC may be negatively affected in the acute stage, as time passes, they have potential to rebound at a faster rate than those with lower levels of SC. Ongoing evaluation of the effectiveness of current initiatives as the COVID-19 pandemic progresses into a recovery phase will be invaluable for supplementing the evidence base identified through this review.

• Recommendations

As a result of this review, a number of recommendations are suggested for policy and practice during public health emergencies and recovery.

Future research should seek to establish a standardised and validated approach to measuring and defining CR and SC within communities. There are ongoing efforts in this area, for example [ 72 ]. Additionally, community members should be involved in the process of defining how CR is measured.

There should be an enhanced effort to improve preparedness for public health emergencies and disasters in local communities by gauging current levels of SC and CR within communities using a standardised measure. This approach could support specific targeting of populations with low levels of CR/SC in case of a disaster or public health emergency, whilst also allowing for consideration of support for those with high levels of CR (as these populations can be heavily impacted initially following a disaster). By distinguishing levels of SC and CR, tailored community-centred approaches could be implemented, such as those listed in a guide released by PHE in 2015 [ 73 ].

CR and SC (specifically cognitive SC) should be bolstered if communities are at risk of experiencing a disaster or public health emergency. This can be achieved by using interventions which aim to increase a sense of community and create new social ties (e.g., recreational group activities, volunteering). Additionally, when aiming to achieve this, it is important to be mindful of the risk of increased levels of CR/SC to backfire, as well as seeking to advocate an integrated system approach across individual, community and structural levels.

It is necessary to be aware that although communities with high existing levels of resilience / SC may experience short-term negative consequences following a disaster, over time these communities might be able to recover at a faster rate. It is therefore important to ensure that suitable short-term support is provided to these communities in the immediate aftermath of a public health emergency or disaster.

Robust evaluation of the community resilience initiatives deployed during the COVID-19 pandemic response is essential to inform the evidence base concerning the effectiveness of CR/ SC. These evaluations should continue through the response phase and into the recovery phase to help develop our understanding of the long-term consequences of such interventions.

Limitations

Despite this review being the first in this specific topic area, there are limitations that must be considered. Firstly, it is necessary to note that communities are generally highly diverse and the term ‘community’ in academic literature is a subject of much debate (see: [ 74 ]), therefore this must be considered when comparing and collating research involving communities. Additionally, the measures of CR and SC differ substantially across research, including across the 26 retained papers used in the current review. This makes the act of comparing and collating research findings very difficult. This issue is highlighted as a key outcome from this review, and suggestions for how to overcome this in future research are provided. Additionally, we acknowledge that there will be a relationship between CR & SC even where studies measure only at individual or community level. A review [ 75 ] on articulating a hypothesis of the link to health inequalities suggests that wider structural determinants of health need to be accounted for. Secondly, despite the final search strategy encompassing terms for both CR and SC, only one retained paper directly measured CR; thus, making the research findings more relevant to SC. Future research could seek to focus on CR to allow for a comparison of findings. Thirdly, the review was conducted early in the COVID-19 pandemic and so does not include more recent publications focusing on resilience specifically in the context of COVID-19. Regardless of this fact, the synthesis of, and recommendations drawn from, the reviewed studies are agnostic to time and specific incident and contain critical elements necessary to address as the pandemic moves from response to recovery. Further research should review the effectiveness of specific interventions during the COVID-19 pandemic for collation in a subsequent update to this current paper. Fourthly, the current review synthesises findings from countries with individualistic and collectivistic cultures, which may account for some variation in the findings. Lastly, despite choosing a scoping review method for ease of synthesising a wide literature base for use by public health emergency researchers in a relatively tight timeframe, there are disadvantages of a scoping review approach to consider: (1) quality appraisal of retained studies was not carried out; (2) due to the broad nature of a scoping review, more refined and targeted reviews of literature (e.g., systematic reviews) may be able to provide more detailed research outcomes. Therefore, future research should seek to use alternative methods (e.g., empirical research, systematic reviews of literature) to add to the evidence base on CR and SC impact and use in public health practice.

This review sought to establish: (1) How CR and SC are quantified in research?; (2) The impact of community resilience on mental wellbeing?; (3) The impact of infectious disease outbreaks, disasters and emergencies on community resilience and social capital?; and, (4) What types of interventions enhance community resilience and social capital?. The chosen search strategy yielded 26 relevant papers from which we were able extract information relating to the aims of this review.

Results from the review revealed that CR and SC are not measured consistently across research. The impact of CR / SC on mental health and wellbeing during emergencies and disasters is mixed (with some potential for backlash), however the literature does identify cognitive SC as particularly protective. Although only a small number of papers compared CR or SC before and after a disaster, the findings were relatively consistent: SC or CR is negatively impacted by a disaster. Methods suggested to bolster SC in communities were centred around social activities, such as recreational group activities and volunteering. Recommendations for both research and practice (with a particular focus on the ongoing COVID-19 pandemic) are also presented.

Availability of data and materials

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Abbreviations

Social Capital

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Acknowledgements

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This study was supported by the National Institute for Health Research Research Unit (NIHR HPRU) in Emergency Preparedness and Response, a partnership between Public Health England, King’s College London and the University of East Anglia. The views expressed are those of the author(s) and not necessarily those of the NIHR, Public Health England, the UK Health Security Agency or the Department of Health and Social Care [Grant number: NIHR20008900]. Part of this work has been funded by the Office for Health Improvement and Disparities, Department of Health and Social Care, as part of a Collaborative Agreement with Leeds Beckett University.

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C. E. Hall, H. Wehling, R. Amlôt & D. Weston

Health Protection Research Unit, Institute of Psychology, Psychiatry and Neuroscience, King’s College London, 10 Cutcombe Road, London, SE5 9RJ, UK

C. E. Hall, S. K. Brooks & N. Greenberg

School of Health and Community Studies, Leeds Beckett University, Portland Building, PD519, Portland Place, Leeds, LS1 3HE, UK

J. Stansfield & J. South

King’s Centre for Military Health Research, Institute of Psychology, Psychiatry and Neuroscience, King’s College London, 10 Cutcombe Road, London, SE5 9RJ, UK

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DW, JSo and JSt had the main idea for the review. The search strategy and eligibility criteria were devised by CH, DW, JSo and JSt. CH conducted the database searches. CH and DW conducted duplicate, title and abstract and full text screening in accordance with inclusion criteria. CH conducted data extraction, CH and DW carried out the analysis and drafted the initial manuscript. All authors provided critical revision of intellectual content. All authors approved the final manuscript.

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Hall, C.E., Wehling, H., Stansfield, J. et al. Examining the role of community resilience and social capital on mental health in public health emergency and disaster response: a scoping review. BMC Public Health 23 , 2482 (2023). https://doi.org/10.1186/s12889-023-17242-x

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Published : 12 December 2023

DOI : https://doi.org/10.1186/s12889-023-17242-x

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Essay on Mental Health

Mental health is as crucial as physical health, forming an essential aspect of overall well-being. It encompasses our emotional, psychological, and social well-being, impacting how we think, feel, and act. It determines our handling of stress, decision-making, and interpersonal relationships. This essay delves into the various aspects of mental health, underscoring its importance, exploring the challenges faced, and discussing ways to maintain and enhance mental well-being.

Understanding Mental Health

Mental health refers to our emotional, psychological, and social well-being. It affects our thoughts, feelings, behaviors, and our ability to handle stress, interact with others, and make choices. Good mental health enables individuals to realize their potential, cope with life’s stresses, work productively, and contribute meaningfully to their communities. It is a state of balance, both within and with the environment, where one can face life’s challenges with resilience.

The Importance of Mental Health

Mental health is a critical component of overall well-being and profoundly impacts various aspects of life. It goes beyond the absence of mental illnesses and encompasses a state of emotional, psychological, and social wellness. Understanding the importance of mental health is vital for individuals and communities alike. This section explores the multiple reasons why mental health is crucial.

• Foundation for Emotional Well-being: Mental health is essential for emotional balance and stability. It allows individuals to experience and express a range of emotions appropriately, cope with life’s challenges, and enjoy fulfilling relationships. Emotional well-being contributes to a sense of contentment and life satisfaction.
• Impact on Physical Health: There is a strong link between mental and physical health. Poor mental health can lead to an increased risk of physical health problems. Conversely, chronic physical conditions can significantly affect a person’s mental health, increasing the risk of depression and anxiety.
• Influences Behavior and Decision-making: Mental health influences our behavior and decision-making process. It affects how we handle stress, relate to others, and make choices. Good mental health enables individuals to make decisions that positively impact their lives and the lives of those around them.
• Enhances Productivity and Performance: Good mental health is crucial for productivity and performance, both in personal and professional settings. It enables individuals to concentrate, focus, and engage in productive activities. Employers increasingly recognize the importance of mental health in the workplace, as it directly influences work efficiency and output quality.
• Promotes Educational Success: For students, mental health is key to academic success. It affects cognitive functions such as concentration, memory, and the ability to learn. Good mental health supports educational engagement and achievement, essential for future opportunities and career development.
• Contributes to Social Cohesion and Community Resilience: Mental health is important for social cohesion and community resilience. It enables individuals to contribute to their community, engage in meaningful social interactions, and foster supportive networks. Communities with strong mental health awareness and support systems are better equipped to face collective challenges.
• Economic Impact: Mental health issues can have a significant economic impact, including healthcare costs, lost productivity, and the impact on families and carers. Investing in mental health support and services not only helps individuals but also benefits the economy.
• Reduces Stigma and Discrimination: Recognizing the importance of mental health helps in reducing stigma and discrimination against those who experience mental health issues. It encourages a more understanding and supportive society where individuals feel more comfortable seeking help.
• Facilitates a Fulfilling Life: Ultimately, good mental health is key to living a fulfilling and rewarding life. It enables individuals to pursue their goals, experience joy, and navigate life’s ups and downs with resilience.

Common Mental Health Disorders

Common mental health disorders include depression, anxiety disorders, schizophrenia, eating disorders, and addictive behaviors. These conditions, affecting millions globally, can be chronic and incapacitating, influencing every life aspect from personal relationships to professional performance. They often co-exist with other health problems, causing a complex interplay of physical and mental health challenges.

Causes and Risk Factors for Mental Health Issues

Understanding the causes and risk factors for mental health issues is crucial for prevention, early intervention, and effective treatment. Mental health disorders arise from a complex interaction of various factors. Here, we explore the primary causes and risk factors that contribute to mental health issues.

• Genetic Factors: Genetics can play a significant role in mental health. Individuals with a family history of mental health disorders such as depression, bipolar disorder, or schizophrenia may have a higher risk of developing these conditions.
• Biological Factors: Biological factors, including brain chemistry imbalances and hormonal imbalances, can influence mental health. Neurotransmitters, the chemicals in the brain that transmit messages between neurons, are often implicated in mental health conditions.
• Life Experiences: Traumatic life experiences, such as abuse, neglect, the loss of a loved one, or experiencing a traumatic event, significantly increase the risk of mental health issues. Post-Traumatic Stress Disorder (PTSD) is a common condition that arises from traumatic experiences.
• Early Childhood Development: Adverse experiences in early childhood, such as emotional, physical, or sexual abuse, can have long-lasting effects on mental health. The early environment, including exposure to stress or parental neglect, plays a critical role in shaping emotional and psychological development.
• Socioeconomic Factors: Socioeconomic factors, including poverty, unemployment, or living in a disadvantaged or violent community, can increase the risk of mental health problems. Financial stress, in particular, is a significant trigger for conditions like depression and anxiety.
• Chronic Physical Health Conditions: Having a chronic physical health condition, such as diabetes, heart disease, or cancer, can lead to mental health issues, particularly if the condition causes pain, disability, or social isolation.
• Substance Abuse: Substance abuse can both be a cause and a result of mental health issues. The use of drugs and alcohol can alter brain chemistry and lead to conditions like depression, anxiety, or paranoia.
• Stress: Prolonged or intense stress, whether from work, relationships, or other sources, can lead to mental health problems. Stress can trigger conditions like anxiety disorders and depression.
• Personality Traits: Certain personality traits, such as perfectionism or low self-esteem, can make individuals more susceptible to mental health issues like depression and anxiety.
• Social Isolation and Loneliness: Lack of social support, isolation, and feelings of loneliness can significantly impact mental health, increasing the risk of conditions like depression.
• Cultural and Social Norms: Societal expectations and cultural norms can also contribute to mental health conditions. For instance, stigma surrounding mental health can prevent individuals from seeking help.

The Stigma Surrounding Mental Health

Stigma, prejudice, and discrimination against those with mental health issues are widespread, often leading to exacerbation of conditions and reluctance in seeking help. It creates barriers to social, educational, and occupational opportunities and prevents individuals from accessing the support they need. Combating stigma is essential to create an inclusive society where mental health issues are treated with the same urgency as physical health issues.

Maintaining and Improving Mental Health

• Regular Exercise
• Balanced Diet
• Adequate Sleep
• Stress Management
• Building Strong Relationships
• Pursuing Hobbies and Interests
• Mindfulness and Meditation
• Setting Realistic Goals
• Limiting Alcohol and Avoiding Drugs
• Continuous Learning and Personal Growth
• Community Involvement

Access to Mental Health Services

Accessible mental health services are critical for early detection and treatment of mental health issues. However, access to these services is often limited by lack of resources, geographical barriers, and social stigma. Expanding access to mental health care through policy, education, and community outreach is essential. Telehealth and digital platforms are emerging as vital tools in providing wider access and overcoming traditional barriers to mental health care.

Mental health, an integral part of our overall health, profoundly impacts our life quality. Recognizing its importance, addressing the common disorders, and understanding how to maintain and enhance mental health are crucial for a healthy society. Breaking the stigma surrounding mental health, ensuring access to mental health services, and fostering environments that support mental health are vital steps towards this goal. We must remember that mental health is not a destination, but a journey of self-care, support, and continuous growth.

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Sample Essay Mental Health

2019, Positive thinking

Positive thinking contribute to your mental health; Improving feelings of happiness as well as wellbeing; positive thinking supports mental health by eliciting positive emotions, enhancing the coping process, and developing a supportive network.

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Career Services Guide: Supporting People Affected by Mental Health Issues free download at ceric.ca/mentalhealth Employment is a cornerstone of social inclusion, yet people living with mental health problems face the highest unemployment rate of any disability group. Although people want to and are able to work, employment for many remains an illusive goal. People living with mental illness are capable of making an important contribution in the workforce, and do NOT need to be symptom-free to be successful. At the same time, career service workers report more people are disclosing mental health problems as a factor in their employment journey. They feel challenged to support these clients due to a lack of knowledge about mental health and a lack of tools and resources to move clients forward effectively. This Career Services Guide offers a new lens for understanding people affected by mental illness and practical strategies for engaging them in supportive ways. When properly trained, career service workers play a critical role in helping clients to meet their full employment potential. Available for free download: http://ceric.ca/?q=en/node/1062

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The rise of mental health problems such as depression cannot be understood in narrowly medical terms, but instead needs to be understood in its political-economic context. An economy driven by debt (and prone to problem debt at the level of households) will have a predisposition towards rising rates of depression.

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This paper will consider religion and spirituality through the lens of responses to two of the most striking features of the last century: the medicalisation of emotion, and the re-imagining of non-western ideas by the West for therapeutic purposes. Because the medicalisation of emotion is a pervasive aspect of western culture, much discussion in the last century has concerned whether religion and spirituality complement, challenge or conflict with medical approaches to emotion. I will begin by discussing the backlash against the Freudian-influenced negative assessment of religion which is evident in the increasingly numerous studies of whether religion and spirituality are beneficial for mental health, pointing to how attention to a more diverse range of religions and to religions in context might nuance our understanding of the relationships between religion and mental health. Having considered ways in which religion and spirituality have been thought both to conflict with and to complement mental health, I will turn to ways in which religions and spirituality have been re-imagined for emotional healing, initially in 'alternative' but increasingly in mainstream popular and medical cultures. I will argue that at the heart of the re-imagining of spiritual resources by western consumers are not only practical, therapeutic concerns but also some important philosophical concerns to do with the mind and emotion: the relationship between the body and the mind, between the human person and the larger world (or the nature of consciousness), the nature of human wellbeing and its relationship to experiences of suffering, and the nature, value, importance and role of emotion. While therefore in some ways sympathetic to these re-imaginings, however, I will point to some important concerns raised by religious practitioners and by religious studies scholars about the appropriation of religious and spiritual traditions for therapeutic ends, focusing on issues of misrepresentation. As with the religion and mental health literature discussed earlier in the paper, I will argue that increased attention to the religious traditions in question is needed, and that this should be combined with a more respectful attitude towards them.

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This article presents the results of a questionnaire-based survey of the perceived effects of metal detecting among British Armed Forces veterans with PTSD (Post Traumatic Stress Disorder) and/or other diagnosed or undiagnosed psychological disorders. Although the qualitative analysis presented here is only a first step towards understanding its beneficial effects, the authors conclude that archaeological metal detecting can be regarded as having the potential to positively influence well-being and happiness for people suffering from mental health problems. The findings suggest that practitioners feel that metal detecting has a significantly positive and lasting effect on their health and well-being. A significant number of respondents feel that metal detecting has alleviated specific symptoms of their mental disorders (PTSD, depression, anxiety disorders). The key factors for the beneficial effect of metal detecting appear to be of a mental, sensory, physical and social nature. First and foremost, however, its beneficial effect seems to be deeply rooted in the fact that the participants interact with archaeological heritage.

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What is Mental Disorder? An essay in philosophy, science, and values

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• Mental Health Essay

Essay on Mental Health

According to WHO, there is no single 'official' definition of mental health. Mental health refers to a person's psychological, emotional, and social well-being; it influences what they feel and how they think, and behave. The state of cognitive and behavioural well-being is referred to as mental health. The term 'mental health' is also used to refer to the absence of mental disease. 

Mental health means keeping our minds healthy. Mankind generally is more focused on keeping their physical body healthy. People tend to ignore the state of their minds. Human superiority over other animals lies in his superior mind. Man has been able to control life due to his highly developed brain. So, it becomes very important for a man to keep both his body and mind fit and healthy. Both physical and mental health are equally important for better performance and results.

Importance of Mental Health 

An emotionally fit and stable person always feels vibrant and truly alive and can easily manage emotionally difficult situations. To be emotionally strong, one has to be physically fit too. Although mental health is a personal issue, what affects one person may or may not affect another; yet, several key elements lead to mental health issues.

Many emotional factors have a significant effect on our fitness level like depression, aggression, negative thinking, frustration, and fear, etc. A physically fit person is always in a good mood and can easily cope up with situations of distress and depression resulting in regular training contributing to a good physical fitness standard. 

Mental fitness implies a state of psychological well-being. It denotes having a positive sense of how we feel, think, and act, which improves one’s ability to enjoy life. It contributes to one’s inner ability to be self-determined. It is a proactive, positive term and forsakes negative thoughts that may come to mind. The term mental fitness is increasingly being used by psychologists, mental health practitioners, schools, organisations, and the general population to denote logical thinking, clear comprehension, and reasoning ability.

 Negative Impact of Mental Health

The way we physically fall sick, we can also fall sick mentally. Mental illness is the instability of one’s health, which includes changes in emotion, thinking, and behaviour. Mental illness can be caused due to stress or reaction to a certain incident. It could also arise due to genetic factors, biochemical imbalances, child abuse or trauma, social disadvantage, poor physical health condition, etc. Mental illness is curable. One can seek help from the experts in this particular area or can overcome this illness by positive thinking and changing their lifestyle.

Regular fitness exercises like morning walks, yoga, and meditation have proved to be great medicine for curing mental health. Besides this, it is imperative to have a good diet and enough sleep. A person needs 7 to 9 hours of sleep every night on average. When someone is tired yet still can't sleep, it's a symptom that their mental health is unstable. Overworking oneself can sometimes result in not just physical tiredness but also significant mental exhaustion. As a result, people get insomnia (the inability to fall asleep). Anxiety is another indicator. 

There are many symptoms of mental health issues that differ from person to person and among the different kinds of issues as well. For instance, panic attacks and racing thoughts are common side effects. As a result of this mental strain, a person may experience chest aches and breathing difficulties. Another sign of poor mental health is a lack of focus. It occurs when you have too much going on in your life at once, and you begin to make thoughtless mistakes, resulting in a loss of capacity to focus effectively. Another element is being on edge all of the time.

It's noticeable when you're quickly irritated by minor events or statements, become offended, and argue with your family, friends, or co-workers. It occurs as a result of a build-up of internal irritation. A sense of alienation from your loved ones might have a negative influence on your mental health. It makes you feel lonely and might even put you in a state of despair. You can prevent mental illness by taking care of yourself like calming your mind by listening to soft music, being more social, setting realistic goals for yourself, and taking care of your body. 

Surround yourself with individuals who understand your circumstances and respect you as the unique individual that you are. This practice will assist you in dealing with the sickness successfully.  Improve your mental health knowledge to receive the help you need to deal with the problem. To gain emotional support, connect with other people, family, and friends.  Always remember to be grateful in life.  Pursue a hobby or any other creative activity that you enjoy.

What does Experts say

Many health experts have stated that mental, social, and emotional health is an important part of overall fitness. Physical fitness is a combination of physical, emotional, and mental fitness. Emotional fitness has been recognized as the state in which the mind is capable of staying away from negative thoughts and can focus on creative and constructive tasks. 

He should not overreact to situations. He should not get upset or disturbed by setbacks, which are parts of life. Those who do so are not emotionally fit though they may be physically strong and healthy. There are no gyms to set this right but yoga, meditation, and reading books, which tell us how to be emotionally strong, help to acquire emotional fitness. 

Stress and depression can lead to a variety of serious health problems, including suicide in extreme situations. Being mentally healthy extends your life by allowing you to experience more joy and happiness. Mental health also improves our ability to think clearly and boosts our self-esteem. We may also connect spiritually with ourselves and serve as role models for others. We'd also be able to serve people without being a mental drain on them. 

Mental sickness is becoming a growing issue in the 21st century. Not everyone receives the help that they need. Even though mental illness is common these days and can affect anyone, there is still a stigma attached to it. People are still reluctant to accept the illness of mind because of this stigma. They feel shame to acknowledge it and seek help from the doctors. It's important to remember that "mental health" and "mental sickness" are not interchangeable.

Mental health and mental illness are inextricably linked. Individuals with good mental health can develop mental illness, while those with no mental disease can have poor mental health. Mental illness does not imply that someone is insane, and it is not anything to be embarrassed by. Our society's perception of mental disease or disorder must shift. Mental health cannot be separated from physical health. They both are equally important for a person. 

Our society needs to change its perception of mental illness or disorder. People have to remove the stigma attached to this illness and educate themselves about it. Only about 20% of adolescents and children with diagnosable mental health issues receive the therapy they need. 

According to research conducted on adults, mental illness affects 19% of the adult population. Nearly one in every five children and adolescents on the globe has a mental illness. Depression, which affects 246 million people worldwide, is one of the leading causes of disability. If  mental illness is not treated at the correct time then the consequences can be grave.

One of the essential roles of school and education is to protect boys’ and girls' mental health as teenagers are at a high risk of mental health issues. It can also impair the proper growth and development of various emotional and social skills in teenagers. Many factors can cause such problems in children. Feelings of inferiority and insecurity are the two key factors that have the greatest impact. As a result, they lose their independence and confidence, which can be avoided by encouraging the children to believe in themselves at all times. 

To make people more aware of mental health, 10th October is observed as World Mental Health. The object of this day is to spread awareness about mental health issues around the world and make all efforts in the support of mental health.

The mind is one of the most powerful organs in the body, regulating the functioning of all other organs. When our minds are unstable, they affect the whole functioning of our bodies. Being both physically and emotionally fit is the key to success in all aspects of life. People should be aware of the consequences of mental illness and must give utmost importance to keeping the mind healthy like the way the physical body is kept healthy. Mental and physical health cannot be separated from each other. And only when both are balanced can we call a person perfectly healthy and well. So, it is crucial for everyone to work towards achieving a balance between mental and physical wellbeing and get the necessary help when either of them falters.

Expository Essay on Mental Health

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Every year the World Mental Health Day is celebrated on October 10. It was established as an annual work by the international mental health organization by the then UNO secretary-general. Mental health services vary significantly from country to country. At the same time, developed countries in western countries provide mental health programs for all age groups. Also, third-world countries are struggling to meet the basic needs of families. Therefore, it is prudent to focus on the importance of mental health for one day. A mental health article is about understanding the importance of mental health to everyone’s life.

Mental Health

In terrible years, this did not have a specific theme. The primary purpose was to motivate and represent the community on important issues. Also, for the first three years, one of the essential activities done to make this day special was a 2-hour television broadcast by a US information agency satellite system.

Mental health is not just a matter of mental and emotional health. Instead, it is a state of mental and emotional health where a person can use their perceptive powers and emotions to meet everyday needs and activities in society. According to the WHO, there is no single ‘official’ definition of mental health.

Thus, there are many factors such as cultural differences, competing professional theories, and independent evaluation of how mental health is defined. Also, many experts agree that mental disorder and mental illness are not adjectives. So, in other words, when perceived mental disorders are not present, they are not a sign of mental health.

One way to think about mental health is to look at how a person performs successfully and effectively. As a result, elements like feeling competent, knowledgeable, managing typical amounts of stress, keeping good relationships, and living an autonomous life are essential. Also, this includes recovery from difficult situations and the ability to recover.

Significant Benefits of Good Mental Health

Mental health is related to the overall personality of the person. Therefore, the essential function of school and education is to protect the mental health of boys and girls. Physical active body and its fitness is not the only measure of good health. Instead, it is simply a way to improve a child’s mental and moral health. Two significant factors that contribute to feelings of low self-esteem are low self-esteem. Thus, it significantly affects the child. As a result, they lose their self-esteem and confidence. This should be avoided, and children should always be encouraged to believe in them.

Mental Illness

The way we are physically ill, we can also be mentally ill. Mental illness is a disorder of the human body, including mood, thinking, and behaviour changes. Mental illness can be caused by stress or a reaction to an event. It can also raise genetic factors, biological imbalances, child abuse or trauma, social degradation, poor physical health etc. Mental illness is treatable. You can seek professional help in this area or overcome the disease with good thinking and change your lifestyle.

Regular exercise such as morning walks, yoga, and meditation is an excellent treatment for mental health. It is also essential to eat a healthy diet and get enough sleep. You can prevent mental illness by taking care of yourself, such as calming your mind by listening to fantastic music, socializing, setting realistic goals and taking care of your body.

Experts say….

Many health experts have noted that mental, social, and emotional health are essential components of a healthy body. Physical fitness is a combination of physical, emotional, and mental strength. Emotional fitness has been recognized as a condition in which the mind can stay away from negative thoughts and focus on artistic and creative works. It means that the person should not be too sensitive. He should not find himself filled with stories, which are not very important. He should not overreact to situations, should not get upset or distracted, which is part of life. Those who do so are not healthy, although they may be physically fit and in good health. There are no gyms to do that properly, but yoga, meditation, and reading a book, which tells us how to be emotionally intense, help us find strength.

Mental illness is a growing phenomenon in the 21st century. Not everyone gets the help they need. Although mental illness is common and can affect anyone, there is still widespread prejudice. People are still reluctant to accept mental illness because of this stigma. They are embarrassed to admit it and seek medical attention. Physical and psychological health are inextricably linked. Both are equally important to a person.

Our society needs to change its mind about mental illness or disorder. People should get rid of the stigma associated with the disease and educate themselves about it. If mental illness is not treated in time, the consequences can be devastating.

October 10 is considered World Mental Health to create more awareness about mental health. The goal of this day is to raise global awareness about mental health issues and make every effort to promote mental health.

Physical and emotional well-being are the keys to success in all aspects of life. People should be aware of the effects of mental illness and should give greater importance to keeping the mind healthy the way the physical body is kept healthy. Psychological and physical health cannot be separated from one another.

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My Health My Right Essay in English – Download Free PDF

Published by team sy on april 7, 2024 april 7, 2024.

My Health My Right Essay: Each year, the World Health Organization commemorates World Health Day on April 7th, drawing global attention to a crucial public health issue. This year’s theme, “My Health, My Right,” powerfully asserts that access to quality healthcare is a fundamental human right that must be upheld and realized for people of all backgrounds.

Attempt World Health Day Quiz Now!

My Health My Right Essay in English – Sample 1

The World Health Day, observed every April 7th, serves as a global reminder of the importance of health and well-being. This year’s theme, “My Health, My Right,” underscores the fundamental human right to access quality healthcare, education, and information.

Healthcare is not just a privilege; it is a basic human right. Every individual deserves access to quality healthcare services without discrimination or barriers. Whether it’s preventive care, treatment for illnesses, or support for mental health, everyone should have the right to seek and receive the care they need to live a fulfilling life.

Education and information play crucial roles in promoting good health practices and preventing diseases. People need access to accurate and reliable health information to make informed decisions about their well-being. By empowering individuals with knowledge about healthy lifestyles, disease prevention, and treatment options, we can enable them to take control of their health and lead healthier lives.

Unfortunately, many individuals around the world still face barriers to accessing healthcare services and information. Factors such as poverty, inequality, geographic location, and social stigma can hinder people from receiving the care they need. It is essential to address these disparities and work towards achieving universal health coverage, where everyone, regardless of their background or circumstances, can access essential health services without financial hardship.

As we commemorate World Health Day and reflect on the theme “My Health, My Right,” let us reaffirm our commitment to promoting health equity and ensuring that every individual has the opportunity to enjoy the highest attainable standard of health. By advocating for the right to health for all, we can build healthier, more resilient communities and contribute to a brighter, more equitable future for generations to come.

My Health My Right Essay in English – Sample 2

The World Health Day, celebrated annually on April 7, is a global initiative to raise awareness towards the importance of health and wellbeing. This year’s theme, “My Health, My Right,” highlights a fundamental human right to access quality health care, education, and information. This essay will explore the significance of this theme and the importance of promoting health as a basic human right. Health is a crucial aspect of human life, and access to quality health care is essential for maintaining good health. However, many people around the world do not have access to basic health care services, and this is a violation of their fundamental human rights. The theme “My Health, My Right” emphasizes the importance of ensuring that everyone has access to quality health care, regardless of their social, economic, or geographic background.

Access to quality health care is not just a matter of individual well-being, but it is also a matter of social justice. A healthy population is essential for the overall development and prosperity of a society. When people have access to quality health care, they are better equipped to contribute to their communities and the economy. Therefore, promoting health as a human right is not just a moral imperative, but it is also a practical necessity.

Education and information play a vital role in promoting health as a human right. People need to be aware of their health rights and the available health care services to make informed decisions about their health. Education and information can also help to combat misinformation and myths about health, which can prevent people from seeking necessary medical care.

The theme “My Health, My Right” also highlights the importance of addressing the social determinants of health. These are the conditions in which people are born, grow, live, work, and age, which can impact their health outcomes. Factors such as poverty, education, housing, and employment can all affect a person’s health, and addressing these social determinants is essential for promoting health as a human right.

In conclusion, the theme “My Health, My Right” is a powerful reminder of the importance of promoting health as a fundamental human right. Access to quality health care, education, and information is essential for maintaining good health and promoting social justice. By addressing the social determinants of health, we can ensure that everyone has the opportunity to live a healthy and fulfilling life. Let us all work together to promote health as a human right and create a healthier and more equitable world.

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Matt and Helen Perry at their home in Yulee, Fla.

When Matt and Helen Perry first met in 2010, he had been a U.S. Marine long enough to form two strong opinions. He didn't like the U.S. Army, and he didn't like officers — which he told her on their first date.

"And I was, you know, an Army medical officer," Helen recalls.

They got married anyhow, and Matt went on the last of his four combat deployments while Helen worked at Walter Reed National Military Medical Center outside Washington, D.C. Her worst fear — that she'd see Matt come in on a medevac — never came to pass. She did start to worry though, about the military medical system that was treating troops and their families. In 2013 the Perrys were stationed at Fort Stewart, Ga.

U.S. Marine Sgt. Matt Perry on deployment in Djibouti, 2012 Matt and Helen Perry hide caption

"They were looking at closing Winn Army Medical Community Medical Hospital," says Perry.

Winn Hospital cares for tens of thousands of troops and more than twice that many family members and military retirees living near Fort Stewart. But the Pentagon was abuzz with plans to cut military medical costs, especially on families and retirees, by outsourcing them to local private health care — much to the chagrin of local providers, Helen Perry recalls.

"I vividly remember them putting out an article in the newspaper that was like ... 'We cannot absorb your obstetrical care. We can't absorb your inpatient care. We do not have the resources to absorb the amount of care that you would then be pushing out into the community,'" says Perry.

Obstetrics may not spring to mind when people think about military medicine, but troops get to have families. With the Pentagon pushing them off base to find care, the military hospitals lost the patient base they needed to justify keeping specialty clinicians. It didn't make sense to Perry.

"I was saying, well, why don't we just get the services? Why don't we get cardiology? We had it at one time, why did we lose it? Oh, well, we weren't seeing enough patients," she says.

The business end of cost-cutting

To Perry it looked like a death spiral — downsizing to the point where the military hospital is no longer viable . She even suspected some of the hospitals were attempting to avoid closure by keeping hold of patients they couldn't actually treat, to keep up numbers and justify staying open. When Perry asked questions, as a critical care nurse and junior officer, no one wanted to hear it.

"It's like, 'Lt. Perry, that's beyond you. Do your job. Stay quiet,'" she says.

She wasn't wrong though. She was just on the business end of a decades-long realignment, where the four branches of the military combined their medical services under one health agency and tried to cut costs. This year the Department of Defense has finally admitted that it's not going as planned.

"All these challenges and changes have created and affected our ability to generate and sustain a medically ready force and a ready medical force," says Dr. David Smith, deputy assistant secretary of Defense for health.

Army Capt. and critical care nurse Helen Perry at the Combat Support Hospital in Fort Eisenhower, Ga., in 2018. Matt and Helen Perry hide caption

Army Capt. and critical care nurse Helen Perry at the Combat Support Hospital in Fort Eisenhower, Ga., in 2018.

Smith is talking about two of the three missions of military health. A "medically ready force" means keeping the country's army in good health. A "ready medical force" means training up enough doctors and nurses to keep that army healthy and treat the wounds of war. There's a third part though: taking care of all the military family members who get dragged across the country every time a service member gets ordered to a new base.

The Pentagon has been trying to outsource the less war-related parts, says John Whitley, former acting secretary of the Army.

"We don't want to go back to the days of ... not having the trauma surgeons, the emergency medicine physicians, the critical care physicians we need, and instead having a force of pediatricians and obstetricians and family practice docs," he told NPR.

Of course, troops might not agree that keeping their families healthy is a lower priority.

"As if it doesn't matter to the war fighter whether or not their family members can access quality care," says Karen Ruedisueli with the Military Officers Association of America.

National Security

The self-proclaimed 'bipolar general' is waging war on the stigma of mental illness.

"If they're hearing from the family back home that they're struggling to get medical care, they can't focus on the mission," she says.

"And then my husband started having seizures"

Americans join the military for patriotic, but also practical, reasons and the quality of health care affects recruiting. In recent years, surveys show that health care is a growing concern for active duty families and also retirees as Helen and Matt Perry soon discovered.

"I stayed for two years at Fort Stewart, and I was seeing the results of families not having good access to care. And then my husband started having seizures," she says.

Matt's seizures hit in July of 2014, six years after a series of blast injuries in Afghanistan had left him with a traumatic brain injury.

"We knew he had a TBI. He got blown up three times in Afghanistan in 2008, like big booms. And we knew things were a little bit harder to learn for him after that. He was a little bit more forgetful. I mean, he had all of the classic sort of early TBI stuff that we see from, from most of our guys who've been blown up, but we just didn't know how bad it was," she says.

His first seizure lasted several minutes and he stopped breathing. A few hours later, he seized again and Helen took him to the nearest emergency room.

"He woke up in the ICU. He didn't know me, didn't know his name, didn't know anything," she says.

"We were not at a military facility. So they kept asking me like, did he ever have infantile seizures as a child? I would say, he got blown up really bad. And they would say, you know, all those explosions you see on television, that's not really how it happens," she says.

Matt's debilitating injuries sent the Perrys on a painful odyssey of seeking care within the military, trying to get Helen's Army superiors to assign her near the Marine base where Matt could get treated, and finally getting Matt the right medical discharge and the benefits he'd earned. Helen eventually left active duty and became his full-time caregiver.

"That's where we started to kind of find out all of the challenges with Tricare," she says.

Tricare is the military health care program for troops, families and retirees - which used to mean just going to almost any doctor and Tricare paid for it. In recent years the cost to military families has shot up , and millions of troops rely on Medicaid in addition to Tricare. And as the Perrys discovered, it's gotten harder to find doctors who accept it. They moved to Daytona Beach for a nursing job Helen landed, but it didn't work for Matt's care, or Helen's, or their newly arrived baby boy in 2021.

"We could not find anyone to accept Tricare, period. I work in health care so I knew all the people, so I was calling around trying to find a primary care provider," says Helen.

But the answer was consistent.

" 'Sorry, we don't take Tricare.' 'Sorry, we're not open to new patients.' We couldn't find a pediatrician for our son. Same thing — 'Sorry, we don't take Tricare,' " she says.

Not only is there a nationwide shortage of health care professionals after that pandemic, but, like Medicaid, Tricare reimburses at a lower rate than private health insurance. Helen says doctors told her they just couldn't afford to take Tricare patients. And she was hearing the same thing from other military caregivers nationwide.

"I got onto our little online forum, and I said, is anybody else having problems finding providers accepting Tricare?"

The replies came in a tidal wave.

"Can't find anybody to take us, we're commuting two hours, we're commuting five hours," she says.

The Perrys moved to the Jacksonville area in large part because that's where they found providers. In the meantime though, Helen was making lists of military communities where people can't find care, including many bases located in federally designated health care shortage areas.

NPR contacted a dozen families with similar complaints. Notably, the majority declined to be interviewed on the record, out of concern they'd get in trouble with their command. They told the same stories: They can't get care on base, and they can't find Tricare appointments in town. A Pentagon Inspector General Report echoed their complaints.

"Well, you can't get care at the military, so now you're gonna get care through Tricare. When they both fail, which is what they're currently doing, where are service members expected to go?" says Helen Perry.

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Pentagon about-face on private care.

David Smith, the deputy assistant secretary of Defense, says the Pentagon has realized the private sector doesn't have any extra capacity to lean on, and after a decade of pushing private care, the Pentagon will now do the opposite.

"We're having difficulties with access across the system. And so what we've concluded is bringing more into our system will actually have the best benefit. I think that's part of the epiphany," he told NPR.

That epiphany took the form of a recent DOD internal memo titled " Stabilizing and Improving the Military Health System ." The memo looks back at a decade's worth of downsizing and outsourcing and concludes, "This has resulted in increasing overall health care costs for the Department and missing readiness opportunities for the Force."

The memo calls on the Military Health System to grow and attract more patients back on to base for their health care. Smith says the Pentagon will train or hire more doctors and nurses to re-fill its clinics. The memo directs the Pentagon to review all medical staffing levels by June 30th. It may be the start of another long and monumental attempt to change military health care.

New memories

Helen Perry is glad to hear a fix is coming, but she hasn't seen any sign of that memo in action yet. Matt is making new memories with their son and now a baby daughter. He's seems at peace with the memories that he's lost.

"Stuff from way, way back there, that's kind of wiped clean. That hard drive's gone," he says.

Helen and Matt Perry at Helen's promotion to captain in July 2015, at San Antonio Military Medical Center, Texas. Matt and Helen Perry hide caption

Helen and Matt Perry at Helen's promotion to captain in July 2015, at San Antonio Military Medical Center, Texas.

That's a blessing in one way. Matt doesn't remember his time at war, so he doesn't have PTSD. When he gets frustrated, he calls one of his Marine battle-buddies. They remember.

"When I get a lot of anxiety or I just need to get away, I talk to them. I used to see a ... therapist. And that was OK, but they don't understand what I went through. Once I started talking to my buddies, man, that is the best therapy you can have right there. And it's free," says Matt.

Matt knows his biggest champion is Helen. Now retired from the reserves, she does aid work in conflict zones, like Ukraine, as a critical care nurse. Still, Matt worries that he's holding her back.

"There's a lot of stuff I wish was different. Like I know she wanted to become a doctor. I know she wants to do a lot more humanitarian work, but ... there's always that worry that something happens to me while she's gone," he says.

They juggle their two young kids between them, but being Matt's caregiver can be a full-time job. That, along with having been an Army nurse and a Tricare patient gives Helen some expertise she thinks the Pentagon and Congress might lack.

"I can speak to it from an active duty officer, from a reserve officer ... I can speak to it as a medical provider currently working in the health care system, and as a caregiver. I can speak to it from every angle, and I want to know that they know because I don't think that they do. Because I think if they did, they would be doing different things," she says.

Recently, Matt's condition has gotten unstable again. That means they are looking, again, for a new medical team that accepts Tricare.

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