Welcome!
Towards an Abundant Mental Health Future
Welcome to my journey as Senior Fellow for Mental Health and Community Wellness at Sagamore Institute. I’m excited to make this transition after spending five years as Director of the Indiana Division of Mental Health and Addiction, where I made policy for—and led the execution of—an overhaul of Indiana’s behavioral health system.
What is my goal here? After five years of operating within the state system, the freedom to dictate the focus and cadence of my work is simultaneously liberating and terrifying. I learned a lot during my time in charge of Indiana’s mental health system—about incentives, regulation, gatekeeping, politics, policy, funding, best practices, and the opportunities and limits of state government oversight. I learned that a system produces the outcomes that it is designed to produce, and that our mental health system is no different.
I also developed a theory that I am looking forward to testing with this project. I believe that the root cause of many of our systematic problems with mental health and well-being is an attitude of scarcity that drives most decisions and behavior within systems. This mindset is responsible for the protectionism, territoriality, risk-aversion, zero-sum thinking and overall failure of imagination that undermines most mental health system improvement efforts.
The “Abundance Agenda”—a set of policy prescriptions that share the philosophy of solving problems by embracing technology and building—is having a moment. I’m all in on that—my political views are basically “Ezra Klein/Derek Thompson 2028”—but I’m choosing to view abundance as more of a lens through which to evaluate complicated choices rather than a set of specific policies.
The activities that drive the direction of our system—policymaking, regulatory oversight, and decisions about funding and programming—require making tough choices about tradeoffs. I think that erring on the side of innovation and reasonable risk-taking is the right choice for a better systematic approach to mental health and well-being.
Therefore, at a high-level, what I want to do with this project is apply the abundance lens to mental health and well-being. I see this work roughly encompassing three broad categories (although, in true abundance fashion, I reserve the right to explore anything else that could be useful): (1) “More and better”; (2) A holistic approach; and (3) favorable thriving conditions.
“More and Better”
The typical interplay between providers and payors in behavioral health goes like this. The providers say, “give us more, and we’ll do better.” The payors (government and otherwise) retort “do better, and we’ll give you more.” The result is a spirally stalemate of stagnation and inertia that blocks needed policy and programmatic changes.
This is because both parties are correct. There are two distinct types of systematic issues within the behavioral health system and addressing them requires an approach of “more and better.” We need policy improvements to increase the resources within the system and process improvements that promote creativity, efficiency, and innovative use of technology to maximize those resources.
There is also a significant policy dimension to the process improvements. Federal, state, provider, and payer policies add crushing bottlenecks and administrative burdens to the practice of behavioral health, often without any discernable benefits. As we enter a new—likely more challenging—fiscal environment for health and human services, we must put these policies under the microscope.
A holistic approach
The traditional mental health system—largely focused treatment through medication and evidence-based therapy—tends to scoff at more holistic potential interventions—things like nutrition, exercise, sleep, exposure to nature, psychedelics, etc.: “Those things are great, and important, but keep them out of our system, unless you can produce evidence that meets our incredibly rigorous standards that they work.”
Meanwhile, the “holistic” mental health community tends to aggressively dismiss the traditional field as shills for big pharma and other entrenched interests. Even though millions of people benefit from the “therapy + medication” paradigm, the holistic group insists that those interventions are mere band-aids, and that solving mental health issues requires a more holistic approach, ignoring the herculean implementation problems of trying to systematically harness those tools.
To be clear, this is a hyperbolic description of the actual situation. Plenty of people live comfortably with feet in both camps. Traditional practitioners often recommend things like improving nutrition and holistic advocates are generally respectful (if skeptical) of traditional treatment.
What is not hyperbolic, however, are the structural and systematic barriers keeping the full range of tools out of reach for many people. For example, despite mounting and promising evidence, why hasn’t the FDA approved psychedelic assisted therapy? Why can’t we use our health savings accounts to pay for better food or a gym membership? We talk about treating other social problems (like gun violence, or systemic racism) as “public health” issues. Why don’t we do that with sleep, which is as close to miracle cure for better health outcomes that exists?
Most importantly, how do we bridge the gap between these worlds, so all people can access all available tools to live the best possible version of their lives?
Favorable Thriving Conditions
The most common objection I heard during my time at the state was “this is fine, but if you really want to make a dent in mental health, you need to focus on prevention.” When I followed up (because I totally agreed!), people would invariably talk about more education about mental health and drug use. Mental health literacy and common-sense drug education are important components in a comprehensive behavioral health strategy, but they are not prevention. Prevention is about thriving—less childhood trauma, more economic security, and stronger connections with other people and communities.
The conditions that promote thriving are strongly influenced by a staggeringly interconnected web of local, state, and federal policies—housing policy, healthcare policy, environmental policy, employment policy, criminal justice policy and many others. Mental health is no different—any prevention strategy must account for these powerful forces. If our goal is thriving people and communities, we must examine the social, political, and economic factors that play a huge role.
My years in state government taught me a humbling lesson about the limitations of central located institutions—public, private, philanthropic, or academic—to actually engineer “outcomes.” The contours of lives and communities are almost infinitely complicated and trajectories are almost impossible to predict.
Consider another example, however. For the last 20 years, states have aggressively pursued a two-pronged economic development strategy: creating “favorable business conditions” through tax and regulatory reform while providing robust economic incentives to attract good employers. Billions of taxpayer dollars (in the form of incentives and tax breaks) have been spent pursuing this strategy.
What if we used the same approach towards individual and community well-being? Even though we know it is very difficult to engineer outcomes, can we create “favorable thriving conditions” for children and families?
There are no bright-lines between these areas—a key part of a thriving community includes access to traditional and holistic mental health care. My goal is to be open-minded, pragmatic, and unfettered by partisan or philosophical divides.
TLDR: I am interested in one overarching question: “What does it mean to approach mental health and well-being through a framework of abundance, rather than scarcity?” My strategy and approach to this work is simple: I want to talk to people who are smarter and more knowledgeable than I am. Have an idea or strategy that you want to talk about? Please reach out to jay.chaudhary@sagamoreinstitute.org and let’s get to work!