America’s mental health moment is finally here

There’s a mental health moment in America, and athletes are leading the way.

On Tuesday, Simone Biles did something revolutionary: She walked away.

“I have to focus on my mental health and not jeopardize my health and well-being,” Biles explained when she pulled out of the women’s team gymnastics final at the Tokyo Olympics. It was a move that surprised fans who had expected the 24-year-old gymnast, widely regarded as the greatest of all time, to lead her team to the gold.

Biles’s decision is part of a larger cultural moment. In recent months, multiple high-profile athletes — many of them young Black women — have been open about prioritizing their mental health over someone else’s definition of success. Before Biles, the most prominent was tennis star Naomi Osaka, who stepped away from press conferences and then from tournaments earlier this year out of a need to protect her mental health. “It’s O.K. to not be O.K., and it’s O.K. to talk about it,” she wrote in a July essay at Time explaining the move.

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Athletes like sprinter Noah Lyle and swimmer Simone Manuel have also spoken publicly about mental health treatment or challenges. So have other public figures like Meghan Markle, who said in an Oprah interview earlier this year that she experienced suicidal thoughts as a result of media scrutiny but was told by the royal family that she couldn’t seek help.

And it’s not just famous people who are done staying silent. Record numbers of workers from retail to restaurants to offices have left their jobs this year, often citing mental health as a factor. In one 2020 survey, 80 percent of workers said they would consider quitting for a role that offered better support for mental well-being.

Some of this new drive to be proactive — and public — about psychological wellness may be a generational shift. Generation Z — the cohort born after 1996 — “is more open than prior generations to both seeking mental health care and disclosing their experiences,” psychologist B. Janet Hibbs told Vox in an email. And some of it may also stem from the pandemic, a time that inspired many Americans to reevaluate their lives and focus on what was really important to them. The events of the last year and a half “allowed people to sit with themselves” and “assess how to make things right in a way that is true to them and not just please everyone else,” Elyse Fox, founder of the mental health nonprofit Sad Girls Club, told Vox.

Whatever the cause, it’s become more mainstream in recent months to prioritize self-care rather than self-denial. For decades, Americans have been laboring under a play-through-the-pain mentality — “there’s this overall sort of ethic in our society around grinning and bearing it, taking it on the chin,” Michael A. Lindsey, the executive director of the NYU McSilver Institute for Poverty Policy and Research, who also studies mental health, told Vox. But in recent months, more and more people have hit their breaking point and are committing to caring for themselves — even if it means stepping away from something as big as the Olympics or the Grand Slam. For Biles and Osaka, “although this was a move for themselves, it’s also a step for the entire world,” Fox said.

Gen Z is taking a lead on mental health

America asks a lot of its athletes. They train, often from very young ages, at sports that risk their health and sometimes their very lives — just prior to the Olympics, Biles completed a vault so dangerous that no other female gymnast had even tried it. They endure constant pressure to win, and constant scrutiny when they falter, even for a moment. They also have to show up at press conferences and be personable and relatable, all while holding themselves to a different standard of behavior than ordinary people — by, for example, never smoking marijuana. During the pandemic, they’ve also had to travel without family and friends and submit to a life in a series of isolated bubbles, making a difficult situation all the more stressful.

And the requirements for Black female athletes, historically, have been even more taxing, with players like Serena Williams subjected to endless body-shaming, racism, and disparate treatment by sports’ governing bodies. These athletes are still expected to be stand-ins for American greatness on a world stage, even when America — from sporting officials to the media — has often been far from great to them. Such factors make it all the more remarkable — or perhaps, all the more overdue — that Black female athletes have been some of the first to stand up on a national stage and say: enough.

In many ways, Osaka jump-started the current national conversation around mental health when she announced in May that she would not participate in mandatory press conferences ahead of the French Open. She later withdrew from the tournament, explaining that “I am not a natural public speaker and get huge waves of anxiety before I speak to the world’s media” and that she had faced “long bouts of depression” since 2018. In order to care for herself, she said, “I’m gonna take some time away from the court now, but when the time is right, I really want to work with the Tour to discuss ways we can make things better for the players, press, and fans.”

While she faced some criticism, she was also met with an outpouring of support, with experts, commentators, and even corporate sponsors praising her honesty. Other athletes have spoken out about mental health in recent months, too, from Lyle, who described taking antidepressants as “one of the best decisions I have made in a while,” to Manuel, who missed three weeks of training earlier this year due to overtraining syndrome, which can cause fatigue and depression. Meanwhile, sprinter Sha’Carri Richardson, who was suspended in June after testing positive for marijuana, said she’d used it to cope with grief after her biological mother’s death. “It sent me into a state of emotional panic,” she said in an NBC interview, “I didn’t know how to control my emotions or deal with my emotions during that time.”

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Then came Biles, who withdrew both from the team final and from the individual all-around competition in Tokyo this week. “This Olympic Games, I wanted it to be for myself when I came in — and I felt like I was still doing it for other people,” she told reporters. “At the end of the day, we’re human too so we have to protect our mind and our body rather than just go out there and do what the world wants us to do.”

The movement among athletes to prioritize caring for their health above competing at all costs — and to share their mental health challenges openly — is emblematic of something bigger, many say. Between athletes like Osaka and Biles and ordinary Americans on social media, we’re seeing “more people speaking openly about mental health issues and how they’re impacting their work,” Betty Lai, a professor of counseling, developmental, and educational psychology at Boston College, told Vox.

Most visibly, that change is being driven by Black women in their 20s or younger — Osaka, Biles, Manuel, and Richardson are all under 25. “Black women have always had a sort of leading presence” when it comes to social change “in a way that they have not been historically given credit for,” Lindsey said. The young Olympians speaking out today about their need to care for themselves are “yet another example of how Black women are leading.”

It’s also not surprising that young people are at the forefront of a mental health revolution, since they appear more adept than their elders at recognizing mental health problems. Members of Gen Z in general report worse mental health than their elders, with just 45 percent saying their mental well-being was good or very good in a 2019 survey, compared with 56 percent of millennials. The pandemic has also taken an outsize toll on young people, with 62.9 percent of 18- to 24-year-olds reporting symptoms of anxiety or depression in a 2020 CDC survey, the highest of any age group.

At the same time, people in Gen Z are also more likely than their elders to seek help for mental health problems, with 37 percent saying they had gotten therapy or other professional treatment in a 2019 survey, compared with 35 percent of millennials, 26 percent of Gen-Xers, and 22 percent of boomers.

This is likely because Gen-Zers have been exposed to more outreach on mental health by colleges and universities, as well as more awareness of these issues among parents, than older generations, Hibbs said. “They’ve been encouraged to talk about their feelings more,” she added. “There’s much more self-awareness of what’s going on for you.”

Peers and social media likely play a role, too — mental health has emerged as a popular topic on TikTok, for example, where professionals and ordinary people share experiences and advice. “I learn so much through TikTok,” said Fox, who launched Sad Girls Club as a way to provide mental health resources to underserved communities, especially women of color and young people. The rise of mobile therapy options like Talkspace may also have helped, allowing young people to get help on their phones without going into an office.

Overall, among younger Americans, “everyone’s kind of awakened” when it comes to mental health issues, Fox said. “It’s like, ‘We know this exists. Why are we living like this? We can’t live like this anymore.’”

The pandemic has brought mental health challenges — but also raised awareness

In addition to the influence of high-profile people, the pandemic has sparked a larger interest in mental health across society. In her work with school administrators on supporting students during this time, for example, Lai has noticed that “talking about mental health has really been at the forefront of people’s minds.”

“More people are raising these issues and are raising them earlier,” Lai explained. “Ten years ago, we really had to make the case that we should be thinking about mental health outcomes for kids after disasters.” Today, it’s more of a given.

And that awareness around mental health extends to adults as well, with more people recognizing the importance of caring for themselves during a time that has been traumatic for so many. The pandemic has led many people to reevaluate their lives, which can include prioritizing what’s best for themselves rather than living up to external demands. For some, that can extend to walking away from a job, with many of those quitting as part of the so-called Great Resignation doing so at least in part for their psychological well-being. Twenty-one-year-old Stephanie Becker, for example, told CNBC in June that she left her job at a dog boarding facility after the stress started to make her physically ill. “If [work] is affecting you so much, it’s not worth working yourself so hard and not feeling good that you aren’t able to enjoy yourself at home,” she said.

“This past year was definitely the hardest for so many people, but what’s coming out of it is very beautiful” when it comes to “the voices that are speaking up in support of mental health and taking time,” Fox said.

“I don’t want to be a gymnast,” she added, “but I’m also very inspired by someone actually ditching the biggest game or the biggest thing in their career to focus on their mental health.”

America has a long way to go to support people

Biles’s stepping away is especially inspirational since the stigma around mental health still prevents too many Americans from getting help. “The person who is ‘experiencing a mental health problem’ is sort of cast aside or thought to be different,” Lindsey said, when “the reality is, we all are struggling with mental health issues and challenges in our lives.” Black Americans can experience disproportionate stigma around getting help for mental illness, which may help contribute to the fact that just one in three Black people experiencing mental health problems ever get appropriate treatment. Men can also feel stigma around mental health issues, making them less likely than women to get help.

But even if Americans are ready to prioritize mental health, it does not mean they will come by support easily. As of 2019, 14.5 percent of non-elderly Americans lacked health insurance, and that number has likely risen during the pandemic. Black, Latinx, and Indigenous Americans are disproportionately likely to lack health insurance, as are young adults, making it especially hard for many people in these groups to get treatment for mental health needs.

Even with insurance, therapy can be unaffordable and therapists difficult to find. Moreover, the country needs more culturally competent therapists who understand the needs of people from historically marginalized groups, from Black Americans to LGBTQIA people, Lindsey said. Without such competence, therapy can end up “creating an experience whereby someone feels further villainized or marginalized because of how they identify.”

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Meanwhile, companies aren’t always understanding about their employees’ psychological well-being. “I’ve done a lot of consulting with brands and companies” whose employees’ mental health is suffering — “but then they have a full-on campaign on World Mental Health Day,” Fox said. It’s not enough just to talk about the issue on corporate social media channels. Companies need to let workers know that “there are no repercussions if you need a mental health break,” Fox said. That’s especially important since many workers today say they don’t feel comfortable asking for a mental health day.

And if people do decide to leave a job to care for their psychological well-being, there’s not always a safety net to help them. With health insurance tied to a job, many Americans risk losing access to therapy if they quit. Many say that bigger systemic changes, such as a universal basic income and universal health care, are needed to truly decouple people’s well-being from their jobs.

These are big asks for a country more accustomed to telling people to pull themselves up by their bootstraps no matter how bad they’re feeling. But the time may be ripe for a revolution in American mental health and greater well-being — and the generation represented by Biles and Osaka may be the best one to push for it. Young people today have “a more balanced ability to use the leverage of their generation to ask for changes,” Hibbs said, “and I think that will be healthier for an entire generation.”