Confronting the Mental Health Crisis: Structural Inequities, Market Pressures, and the Role of Pharmacy Solutions

The US is experiencing a widespread mental health crisis, with over 63% of individuals younger than 50 years reporting some form of mental illness.¹ Depression alone affects approximately 8.5% of adults,¹ and anxiety disorders and substance use further compound psychological distress and worsen clinical patient outcomes.

Among young adults, mental illness is now a leading cause of disability, with anxiety and depression topping concerns for college students.^2,3 The COVID-19 pandemic further exacerbated mental health challenges, particularly for essential workers and minority populations, who reported facing disproportionate barriers, including limited access to care, social isolation, and increased health risks.^4,5

Infrastructure, Innovation, and Industry Response

The rising mental health burden in the US has spurred growth in care infrastructure and pharmaceutical development. By 2025, the mental health services market is projected to reach about $11.82 billion,⁶ with outpatient mental health and substance abuse revenues expected to hit $28 billion in 2024.⁷ In 2023, nearly 8200 facilities offered mental health services, but only 1184 provided inpatient care, highlighting shortages in acute treatment, particularly in rural and underserved areas.⁸ Although more than 59 million adults received mental health treatment in 2023,⁸ access remains inconsistent, and care is fragmented.

In 2021, the number of antidepressant prescriptions in the US surpassed 337 million, primarily driven by the COVID-19 pandemic.⁹ From January 2016 to December 2022, monthly antidepressant fills increased by about 66%, with a notable rise during the pandemic.¹⁰ The number of attention deficit/hyperactivity disorder prescriptions grew from about 55 million in 2012 to 90.9 million in 2023, an approximately 64% increase in 11 years. The worldwide mental health market, which encompasses therapeutics, services, and digital tools, was approximately $396 billion in 2022 and is expected to grow to $560 billion by 2030, with primary drivers being technological innovations (eg, digital therapeutics, artificial intelligence) and psychedelic-assisted therapies, which are in several late-stage trials.¹¹

Despite progress, challenges persist, including overmedicalization, access inequities, and ethical concerns.^1,9 In response, health systems are integrating pharmacists into interdisciplinary teams to improve outcomes and reduce costs.

Barriers to Access and Public Perceptions

Despite the evident and growing demand for mental health services, significant barriers have hindered access to care. A 2023 national survey found that approximately 51% of adults could not afford mental health treatment, and 38.4% were unsure where to seek help.¹ Concerns about law enforcement involvement often deterred individuals from seeking crisis intervention. For example, Statista’s 2024 data showed that 60% of adults feared police involvement during a mental health emergency, whereas 45% felt it was unsafe to call 911 for help.¹²

Public opinion increasingly supports systemic reform. Approximately 88% of Americans believe health insurers should be mandated to cover mental health crisis care comprehensively.³ Similarly, growing attention is being paid to the influence of social media and bullying, particularly among adolescents.

Social determinants of health have played a critical role in shaping mental health outcomes. Poverty, limited educational attainment, unemployment, and unstable housing significantly contribute to psychological distress.^10,13-15 During the COVID-19 pandemic, social isolation emerged as a significant mental health risk, with over 40% of adults reporting increased psychological symptoms linked to isolation and reduced interpersonal interaction.¹⁶

Substance use disorders frequently occur alongside mental health conditions, complicating treatment strategies.¹⁷ In 2023, 25% of US adults with alcohol dependence also had a serious mental illness, and 42.4% of adults with mental illness reported using illicit drugs in the previous year compared with 21% among those without mental illness.^1,8

The Expanding Role of Pharmacists

After completing trainings—such as Mental Health First Aid—pharmacists are emerging as key contributors in mental health care, especially within primary and transitional care settings.^18,19 Through collaborative practice agreements, clinical pharmacists can enhance medication adherence, reduce the likelihood of adverse events, and facilitate deprescribing.²⁰ Behavioral health integration models leverage pharmacists for screening, monitoring, and follow-up of depression, anxiety, and bipolar disorder, improving patient outcomes while easing provider workload.²¹ Some systems employ pharmacists to conduct depression screenings during medication therapy management visits or help initiate psychiatric treatments under collaborative protocols, reducing the burden on mental health teams.²²

Conclusion

The mental health crisis in the US is complex, far-reaching, and deeply influenced by structural inequities and socioeconomic factors, and the lingering effects of the COVID-19 pandemic. Pharmacists are on the front line, with recent years seeing growing awareness of increased investment and promising innovations in care delivery and pharmaceutical development. Despite these improvements, major gaps remain in access, affordability, and care integration, particularly in vulnerable populations.

The health care system must continue evolving toward more equitable and patient-centered approaches, leveraging technology, policy reform, and workforce expansion to meet rising mental health needs. With their accessibility, clinical expertise, and trusted role in communities, pharmacists are uniquely positioned to support these efforts. As the health care landscape continues to adapt, fully integrating pharmacists into mental health strategies will be critical to closing care gaps and supporting long-term recovery for individuals and communities alike.

REFERENCES

1. Mental illness. National Institute of Mental Health. Updated September 2024. Accessed June 24, 2025. https://www.nimh.nih.gov/health/statistics/mental-illness

2. Protecting Youth Mental Health: The US Surgeon General’s Advisory. US Department of Health and Human Services; 2021. Accessed June 24, 2025. https://www.hhs.gov/surgeongeneral/reports-and-publications/youth-mental-health/index.html

3. Pedrelli P, Nyer M, Yeung A, Zulauf C, Wilens T. College students: mental health problems and treatment considerations. Acad Psychiatry. 2015;39(5):503-511. doi:10.1007/s40596-014-0205-9

4. Czeisler MÉ, Lane RI, Petrosky E, et al. Mental health, substance use, and suicidal ideation among US adults during the COVID-19 pandemic — United States, June 24-30, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(32):1049-1057. doi:10.15585/mmwr.mm6932a1

5. 2022 National Survey on Drug Use and Health (NSDUH). Substance Abuse and Mental Health Services Administration; 2023. Accessed June 24, 2025. https://www.samhsa.gov/data/data-we-collect/nsduh-national-survey-drug-use-and-health

6. Mental health – United States. Statista. 2025. Accessed June 24, 2025. https://www.statista.com/outlook/hmo/mental-health/united-states

7. Mental Health & Substance Abuse Centers in the US – Market Research Report (2015-2030). IBISWorld. Updated June 2025. Accessed June 24, 2025. https://www.ibisworld.com/united-states/market-research-reports/outpatient-mental-health-substance-abuse-centers-industry/

8. Mental Health America. The State of Mental Health in America. Accessed June 24, 2025. https://mhanational.org/issues/state-mental-health-america

9. Buntz B. The pandemic is fueling the demand for natural alternatives to antidepressants. Drug Discovery and Development. July 19, 2022. Accessed June 25, 2025. https://www.drugdiscoverytrends.com/the-pandemic-is-fueling-the-demand-for-natural-alternatives-to-antidepressants/

10. Mischoulon D. Update and critique of natural remedies as antidepressant treatments. Obstet Gynecol Clin North Am. 2009;36(4):789-807. doi:10.1016/j.ogc.2009.10.005

11. Kimble C, Coustasse A. The promise of psilocybin assisted therapy for opioid use disorder. Pharmacy Times. May 15, 2025. Accessed June 25, 2025. https://www.pharmacytimes.com/view/the-promise-of-psilocybin-assisted-therapy-for-opioid-use-disorder

12. National Alliance on Mental Illness. Distribution of agreement with the following statements regarding a mental health crisis in the US as of 2023. Statista. July 13, 2023. Accessed June 24, 2025. https://www.statista.com/statistics/1417462/views-on-managing-a-mental-health-crisis-in-the-us/

13. Social Determinants of Mental Health. World Health Organization; 2025. Accessed June 24, 2025. https://www.who.int/publications/i/item/9789241506809

14. The 2023 Annual Homeless Assessment Report (AHAR) to Congress. US Department of Housing and Urban Development; 2023. Accessed June 24, 2025. https://www.huduser.gov/portal/sites/default/files/pdf/2023-AHAR-Part-1.pdf

15. Journal of the American Medical Association. Percentage of select US demographic groups who reported symptoms of serious psychological distress in 2018 and during COVID-19 pandemic*. Statista. June 3, 2020. Accessed June 24, 2025. https://www.statista.com/statistics/1174188/covid-psychological-distress-us-and-covid-impact-by-group/

16. National Institute for Health and Welfare. Share of people with significant psychological distress according to the MHI-5 scales* in Finland in 2018, by level of education. Statista. May 14, 2019. Accessed June 24, 2025. https://www.statista.com/statistics/1022631/share-people-significant-psychological-distress-mhi-5-scale-education-level-finland/

17. Czeisler MÉ, Lane RI, Petrosky E, et al. Mental health, substance use, and suicidal ideation during the COVID-19 pandemic – United States, June 24-30, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(32):1049-1057. doi:10.15585/mmwr.mm6932a1

18. El-Den S, Collins JC, Chen TF, O’Reilly C. Pharmacists’ roles in mental healthcare: past, present and future. Pharm Pract (Granada). 2021;19(3):2545. doi:10.18549/PharmPract.2021.3.2545

19. Finley PR, Crismon ML, Rush AJ. Evaluating the impact of pharmacists in mental health: a systematic review. Pharmacotherapy. 2003;23(12):1634-1644. doi:10.1592/phco.23.15.1634.31952

20. Trenaman SC, Kennie-Kaulbach N, d’Entremont-MacVicar E, et al. Implementation of pharmacist-led deprescribing in collaborative primary care settings. Int J Clin Pharm. 2022;44:1216-1221. doi:10.1007/s11096-022-01449-w

21. Rubio-Valera M, Chen TF, O’Reilly CL. New roles for pharmacists in community mental health care: a narrative review. Int J Environ Res Public Health. 2014;11(10):10967-10990. doi:10.3390/ijerph111010967

22. Crespo-Gonzalez C, Dineen-Griffin S, Rae J, Hill R. Mental health training programs for community pharmacists, pharmacy staff and students: a systematic review. Res Social Adm Pharm. 2022;18(11):3895-3910. doi:10.1016/j.sapharm.2022.06.006