By Denise Octavia Smith 

As everyday Americans struggle to balance their budgets and make sense of a world in flux, our national mental health keeps declining. Mental Health America reported that one in five adults experiences mental illness annually and suicide rates remain a top cause of death. Upward trends in depression and substance abuse preceded the pandemic. Youth and young adult depression, psychological distress and suicidal thoughts and attempts rose from the 2010s into the mid 2020s.

Community health workers don’t need a national report to confirm what they already know—although it does help draw attention to the issue. They see it in the clients who used to show up consistently and now don’t. They hear it from community members whose fear, anxiety, and mounting sense of hopelessness are overshadowing management of their diabetes or blood pressure.

While COVID-19 increased the isolation, anxiety and economic strain on children, youth and families, it was not the cause of persistent poverty, the wealth gap, homelessness or rising rates of depression, substance use and suicide—all of which have risen sharply over the last 20 years. As frontline community-rooted professionals, CHWs know that communities aren’t just facing lingering COVID impacts—they are staring down generational structural challenges that the unwinding of the public health emergency cracked open and left exposed. 

This is Mental Health Awareness Month. And we recently observed National Children’s Mental Health Awareness Day. So let me say plainly what CHWs, nonprofits, and community-based organizations have been saying for years: the mental health crisis in the United States is not a post-pandemic phenomenon. It is a pre-existing condition. And the workforce best positioned to address it has been undervalued, underpaid, and largely invisible to the systems that need them most.

That’s starting to change.

The Crisis We’ve Lived in for Generations

When COVID-19 forced the world indoors, at first, many community health workers were laid off. Some CHWs stayed in their jobs but were asked to only do Zoom calls with clients. But CHWs found ways to “pivot, get creative”, and began mobilizing on their own, getting training and coordination from their state Associations or standing up mutual aid. Entering homes when others couldn’t. Building trust with communities with long memories of being failed, experimented on, or simply ignored by institutions that claimed to serve them. As the Inaugural Executive Director of the National Association of community health workers, I heard from my CHW colleagues from across the country about their mental health burdens and the growing mental health challenges in their local communities.

In 2021, I wrote in USA TODAY that CHWs were essential workers, who were not receiving the mental health support they needed. I partnered with Dr. Susan Mayfield Johnson and other CHW researchers to document CHWs’ elevated stress levels and declining self-care routines. I met with dozens of tribal community health representatives serving in rural and frontier communities who have felt isolated and underappreciated long before COVID-19. Years later, this is still true. CHWs are still advocating for respect as professionals who show up everyday with ethics, skill and unique capabilities that bridge siloed systems and deepen community trust and capacity.

The pandemic triggered a 25% increase in global anxiety and depression in its first year alone, according to the World Health Organization. Lockdowns, job losses, grief, and isolation did what years of chronic stress had been building toward: they broke the dam. By the end of 2020, one in five young adults reported a depressive episode, according to a 2020 report by the Centers for Disease Control (CDC).  And as of 2022, the WHO estimated that nearly two-thirds of people with mental health conditions still went untreated.

Since then? Inflation. Interest rate hikes. Social service cuts. Geopolitical anxiety. A 2025 survey of 4,200 adults found 73% are financially stressed—38% describing themselves as “very stressed.” The leading causes: inflation (86%), interest rates (75%), and tariffs (66%).

So yes, there is a mental health crisis in the United States. And no, it is not new.

The Barriers Are the Story

Here is what the data often misses: people aren’t just struggling to get well. They’re struggling to even attempt it.

The average therapy session now costs $178 without insurance, according to Verywell Mind. Even with coverage, one-third of patients canceled therapy sessions in 2024 due to out-of-pocket costs. Another 31% stopped going altogether. Meanwhile, there is roughly one mental health provider for every 340 people in this country, and more than 122 million Americans live in areas with a mental health workforce shortage, according to a 2024 report from Mental Health America. Over 5 million adults with mental illness are uninsured, and 25% of adults with any mental illness (AMI) reported an unmet need for treatment, according to a report. Thirty-eight percent of psychologists report having a waitlist, according to the American Psychological Association. When I ask communities why they don’t seek care, cost and access are part of the answer. But they are not the whole answer.

Trust is the other part, and it is not a small one.

For many people, seeking mental health support isn’t just logistically hard. It is emotionally loaded. There is a question underneath the question: Will this provider understand me? Will they judge me? Will my information be safe? 

Others, such as people who are low-income, have limited English proficiency, who live in rural or frontier regions with provider shortages, or who live on tribal nations, as well as youth and young adults, may face additional barriers.

Access to mental health care isn’t simply a matter of whether services exist. It is a matter of whether people feel safe enough, and seen enough, to use them.

What CHWs Bring That Systems Cannot Replicate

Community health workers can change the equation.

CHWs are not a workaround. We are not a cheaper substitute for clinical care. We are a fundamentally different kind of resource. One that operates from trust rather than transaction.

Because many CHWs come from the communities they serve, because we share lived experiences with the people we support, we can do what most of the healthcare system doesn’t: show up before someone reaches a crisis point. Our client check-ins not only focus on a person’s diagnosis, but consider the whole person. We ask whether there’s food in the refrigerator, whether the lights are still on, whether the medication is being picked up, and whether someone is actually okay. We help people identify what matters most to them today. What their vision for health is. And we let them know we are here to help.

Mental health does not exist in isolation from housing, food, income, and safety. CHWs have always known this. The research is catching up. The WHO’s 2024 World Health Atlas confirmed that people living with chronic conditions like heart disease are twice as likely to experience depression or anxiety. In the U.S., four chronic diseases (asthma, kidney disease, high cholesterol, and coronary heart disease) are significantly associated with mental health problems. People with diabetes are two to three times more likely to have depression than those without diabetes, according to the CDC.

When a CHW helps a person access a food assistance program, find stable housing, advocate for services, or enroll in Medicaid benefits, they are not just solving a social problem. They are showing compassion and respect while actively supporting that person’s mental health.

Does Medicaid Cover Mental Health? The Answer Is Complicated.

In many states, yes. Medicaid covers a range of behavioral health services. But navigating what’s available, who qualifies, and how to access it is its own barrier.

A 2023 KFF survey found the median number of mental health services covered by state Medicaid programs was 44 out of an identified 55. Ten states, including Florida, Texas, and South Carolina, covered fewer than 41 of the 55 services. Coverage for substance use treatment, outpatient therapy, and community-based services varies widely.

CHWs address access to care gaps by “slaying” mental health stigma, helping clients who are disconnected from care, understand what’s included, and find providers who will actually accept it. For organizations serving Medicaid populations, there’s also a meaningful opportunity: CHW services are increasingly eligible for Medicaid and Medicare reimbursement, creating a sustainable path to scale this work.

Three Ways CHWs Are Filling the Gaps Right Now

1. Identifying Social Drivers Before They Become Mental Health Crises

CHWs assess the full picture—not just the diagnosis, but the conditions surrounding it. Economic instability that leads to anxiety. Food insecurity that leads to missed appointments. Isolation that no clinical intervention can address from behind a desk.

By identifying and addressing social drivers of health early, CHWs help interrupt the cycle before it becomes an acute mental health episode.

2. Connecting Communities to Affordable, Culturally Responsive Care

CHWs are not therapists. But they can make therapy easier to access and more trusted. They connect clients to sliding-scale services, community mental health centers, and nonprofit resources. They provide case management support that improves treatment adherence. And because CHWs are often peers with lived experience in areas such as mental health or substance use or leverage their lived experience, they build trust by sharing their own struggles with social needs, service navigation and care access. They help people take the first step, which is often the hardest one.

For children and adolescents, this role is especially critical during observances, such as National Children’s Mental Health Awareness Day. Young people are less likely to self-advocate and more likely to have their needs go unrecognized. A CHW who knows a family can notice what a provider in a 15-minute appointment might not catch.

3. Bridging the Gap Between Community and Clinical Systems

In clinical settings, CHWs advocate for patients facing language barriers, cultural mismatches, or systems that feel foreign and intimidating. In communities, they provide a stabilizing presence while clients wait, sometimes for months, for formal care. In stepped care models, CHWs also manage lower-acuity needs, freeing licensed providers to focus on higher-risk cases.

During the pandemic, this was a crisis response. Today, it is infrastructure.

Technology That Supports the Human Element

Scaling this work requires more than dedicated people. It requires community-based organizations and other CHW employers to have a suite of tools that reduce the data collection and claims-related administrative burdens while unlocking critical resources to compensate CHWs to sustain their valuable roles in communities.

Care navigation and billing software, such as Pear Suite, allows CHWs to embed social needs, personal goal setting and behavioral health screening into their existing workflows, track mental health trends alongside chronic disease management, and coordinate referrals across systems that don’t effectively talk to each other. 

MECA Therapies, one of Pear Suite’s partners, is already using this approach to support maternal health, behavioral health, and substance use programs across New Mexico, with improved care coordination and stronger closed-loop referrals as a result.

The goal of technology in this space is not to replace the human connection that makes CHW work effective. It is to protect it by taking the documentation, claims, and administrative weight off a CHW’s plate so they can stay focused on the person in front of them.

What This Moment Requires

We are in a month dedicated to mental health awareness. But awareness without action is just noise.

The mental health crisis in the United States will not be solved by awareness campaigns or by waiting for the clinical system to expand fast enough to meet demand. It will be addressed person by person, family by family, community by community by the workforce that has been doing this work all along. Partnering with CHWs and their organizations in your local community is the best way to strengthen trust in systems, increase access to services and break down the silos between social needs and clinical and behavioral health systems so that every person seeking mental health information, interventions and supports can find them.

Community health workers deserve the infrastructure, compensation, and recognition to do it at scale. And the communities they serve deserve nothing less.

Denise Octavia Smith is a Community Health Worker, and Head of Workforce Innovation at Pear Suite. She was the Inaugural Executive Director of the National Association of Community Health Workers and a nationally recognized leader in community health worker policy and workforce development.