One in nine American adults now takes prescription medication for depression. The United States has among the highest rates of psychiatric drug use in the world, and spending continues to climb. Yet nearly one in four American adults—more than 61 million people—were classified as experiencing mental illness in 2024, according to the most recent federal survey. The U.S. suicide rate has increased roughly one-third since 2000, with nearly 48,800 Americans dying by suicide in 2024 alone.
We are spending more on psychiatric medication than ever before, and we are getting sicker.
The response to the so-called mental health crisis has been to look for better drugs, more precise diagnoses, and expanded access to treatment. These are not unreasonable impulses. But they share an assumption so deeply embedded that it rarely gets examined: that what we are witnessing is primarily a biological problem, best addressed with pharmaceutical solutions.
What if the problem is not that there's something wrong with our heads, but with the systems in which we live? What if the very act of framing distress as disease is part of how these systems sustain themselves? The term "mental health crisis" itself reflects this logic, locating the problem in individuals rather than in the systems giving rise to their distress.
I came to this question through my work as a business school professor. For the first part of my career, I studied businesses and markets using the tools of applied economics. I did reasonably well by the metrics valued by my field. But I felt increasingly disconnected from my work, and it took me a while to understand why: the tools I was trained in could not see past the systems they were built to analyze, and the economic paradigm in which my research was embedded was itself deeply dysfunctional—in ways that my work was inadvertently helping to sustain.
That recognition led me to the field of regenerative economics, which applies the patterns and principles of natural systems to the organization of economic life. And it led me to a question my earlier training would never have produced: what would a mental health system look like if it were designed not to manage symptoms, but to cultivate well-being? This is a more radical question than it might appear. If the system generating distress is itself the disease, then managing symptoms within that system isn't treatment. It's maintenance.
To understand what the alternative might look like, it helps to first understand what the current system actually does, not just clinically, but economically.
When psychiatric drugs were first introduced in the 1950s, mental illness was understood as a condition influenced by both biological and psychosocial factors. Pharmaceutical treatment was one element in a broader web of psychological and social remedies. Over the subsequent decades, the pharmaceutical industry promoted a narrower view: mental disorders as clusters of biologically based symptoms, treatable primarily with medication, in patients conceived as atomized consumers rather than socially embedded human beings. This was not a neutral scientific development. It was enormously profitable, and it reshaped not just clinical practice, but our cultural understanding of what it means to struggle.
The pharmaceutical reconception of mental illness did not occur in a vacuum. It co-evolved with a broader economic worldview, one that treats competition as the natural organizing principle of human life and measures success almost exclusively in financial terms. As this worldview has taken hold, the structure of American communities has changed with it. Americans interact less with friends and family than they did a generation ago. In 2023, the U.S. Surgeon General declared loneliness a public health epidemic, with an estimated 52 million American adults experiencing loneliness daily (according to Gallup). Civic institutions—religious congregations, labor unions, volunteer associations—have thinned dramatically. The systematic erosion of the relational fabric that human beings depend on to thrive has culminated in what has been referred to as a crisis of connection.
Social fragmentation and economic concentration go hand in hand. When a community's social bonds fray and its local economic relationships are displaced by distant ones, the community loses its ability to sustain itself, not because it necessarily lacks resources, but because the relationships through which those resources once circulated have been severed. Money flows outward to distant shareholders rather than circulating locally. Local businesses close, and with them go the ties that once kept wealth, knowledge, and opportunity rooted in place. Decisions that shape daily life are made by corporate managers who have never set foot in the places they affect. What is lost is not just financial capital; it is the capacity of a community to provision its own well-being.
This pattern is not unique to mental healthcare. It is the operating logic of the broader economic system, as visible in how industrial agriculture has displaced local food systems as in the countless other sectors where local relationships have given way to distant ones. Wherever community bonds weaken, resources flow outward and local capacity erodes.
The effects on mental health are not incidental to this dynamic; they reflect it. Social epidemiologists Kate Pickett and Richard Wilkinson have shown that countries with greater income inequality, a marker of the pattern of extraction described above, exhibit higher rates of depression and substance abuse. The broader picture is consistent: severing the bonds between people and extracting resources from communities produces mental distress. The pharmaceutical industry then reframes this distress as a biological problem—and sells us the "cure."
So what would the alternative look like? In nature, healthy systems regenerate themselves through a continual process of replenishment and recirculation. Nutrients and information flow through densely interconnected networks—mycelial webs, root systems, watersheds—supporting the thriving of the whole. What drives the system is not the accumulation of resources by any single element, but its capacity to regenerate itself.
A regenerative economic system follows this same pattern. The resources supporting well-being—human, social, ecological, financial—are continually replenished and recirculated within geographically rooted communities. These communities form the foundation of a thriving economy, just as local ecosystems form the foundation of a healthy biosphere.
The regenerative lens reframed my original question. If individual and collective well-being are intrinsically interdependent—as they are in any healthy ecosystem—then treating people in isolation and returning them to the same disconnected environment that contributed to their distress cannot produce lasting healing. A genuinely regenerative approach to mental healthcare would need to heal communities, not just individuals. That is the idea behind the Pollinator Approach, which I first wrote about in this article.
In practice, the Pollinator Approach means designing treatment sites not as isolated clinical offices, but as community well-being centers: places where people participate in healing and community-building activities together. It means reconnecting people to local social, economic, and ecological systems through group integration, partnerships with local organizations, and nature-based practices. It means consulting with local wisdom keepers—community elders, social workers, spiritual leaders, local business owners—who understand the specific conditions, cultures, and trauma patterns of a place. And it means structuring these organizations so they are owned and governed by the communities they serve, not by remote investors.
The Pollinator Approach draws indirect support from Compassionate Frome, a community health program in a town in Somerset, England. Built on social reconnection, the program saw emergency hospital admissions fall 14% over four years while rising nearly 29% across the surrounding region. Compassionate Frome is not a mental healthcare initiative; it is a primary-care program that treats loneliness as a medical condition, and reconnection as the intervention. Its results illustrate a principle at the heart of the Pollinator Approach: connecting people to community systems cultivates well-being more effectively than treating them as isolated biological cases.
The deeper problem with the current mental health system is not merely that it is ineffective. It actively reinforces the conditions producing the distress it claims to treat. By reframing systemic harm as individual pathology, it enables the expansion of the very market that profits from widespread suffering. Extractive economic patterns produce mental distress, which is reframed as biological illness, which generates pharmaceutical revenues, which fund the lobbying and research that sustain the extractive pattern. Breaking this reinforcing feedback loop requires not just new drugs or expanded access, but a fundamentally different kind of container for delivering care.
The principles behind the Pollinator Approach—recirculating resources locally, strengthening communities as well as individuals, adapting to local conditions, keeping ownership and governance rooted in place—are not limited to healthcare. They describe a way of organizing economic life that follows the pattern of natural systems rather than defying it. In the next essay, I'll ask why simply knowing all of this may not be enough to change it.