How ‘empathetic engagement’ can increase access to mental health care

The United States is in the midst of a mental health crisis, with increasing rates of anxiety, depression, and other mental health disorders. At the same time, there is a drastic shortage of mental health professionals to address the growing need for care, from psychiatrists to social workers. Put the two together, and the crisis becomes a catastrophe.

Some people experiencing mental health issues need the intensive care that only qualified nurses, doctors, and social workers can provide. But such roles require the huge commitment of time and money to complete necessary training and certification — which is part of the reason for the shortage.

Others seeking mental health care can find it in community-based organizations staffed by people possessing an essential characteristic: empathetic engagement.

Empathetic engagement is a listening and questioning technique that lends itself to a deeper understanding at both an intellectual and emotional level for the individual on the receiving end. It’s active listening with an increased focus on understanding and validating another person’s emotional experience. Anyone who has worked with an effective mental health care provider knows how helpful this skill is. Some people are fortunate to have friends and family who possess this ability.

The ability to listen to others in an emotionally validating way is largely an innate talent, not something that’s easily learned. So one way to expand the pool of potential mental health providers is to recruit people based on their talent for empathetic engagement rather than formal degrees and certifications.

Based on early tests my colleagues and I conducted, it’s an effective approach to alleviating mental health challenges in communities.

In the early days of the pandemic, we sought to test the idea that empathetic engagement could have meaningful effects on the mental health of a community. We and others had been observing many older adults who, already at risk for a range of health conditions due to medical and social drivers, became even more isolated over the course of the pandemic. Our hypothesis was that we could reduce loneliness in these adults with outreach by individuals who were both gifted in empathetic listening and trained to use it effectively.

We hired individuals who were authentic, empathetic, and mission driven at their core. These individuals received a 2-hour mock-call training before reaching out to any people in the community. A sample of what this process looks like was the subject of a New York Times documentary focused on an organization in Montreal using a similar empathetic engagement approach.

Our study took place over the course of one month. It started with 240 participants across central Texas who had been referred to us from Meals on Wheels of Central Texas: 120 individuals in the intervention group and 120 in the control group. At the start of the study, participants in both groups were given the UCLA 3-item loneliness scale and the 8-item Patient Health Questionnaire (PHQ-8) to establish baseline levels of loneliness and depression.

Each participant in the intervention arm received a call once a day for the first week. Those making the calls were asked to prioritize listening and elicit conversation from the participant on topics of their choice. The callers did not use any conversational prompts, so the early calls were sometimes filled with awkward silences. But as participants got more comfortable with the conversations, they shared whatever was top of mind — a neighbor, the price of food, a recent frustration with a daughter or son, or being excited a grandchild was to visit.

Individuals in the control arm did not receive any calls from the study.

While about 60% of the participants chose to keep receiving one call a day, others opted to move to two or three calls a week. The average duration of each call was 10 minutes.

At the end of the month, self-reported loneliness measured on the UCLA 3-Item Loneliness Scale had decreased by 30%, supporting our hypothesis of the value of empathetic listening. Even more notable, however, was that depressive symptoms had decreased by 24% based on the PHQ-8. As these results emerged from a randomized clinical trial, we were able to confirm that the mental health improvements were a result of the empathetic calls, since those who didn’t receive them did not improve.

It’s not new, it just looks different

This approach to addressing workforce challenges in mental health is not new.

Community-based organizations currently provide a large amount of both mental health and logistical support in the lives of their community members. They offer peer-support groups for children in schools, programs for adults with substance-abuse disorders, church programs that match adolescents with seniors, and food pantries, to name a few. What they have in common is that almost all are conducted by volunteers and face fickle funding. Our society values these types of services from a moral standpoint — but not from a financial one.

There is a massive opportunity to not only address a growing mental health crisis but to do so in a way that leverages the innate knowledge and talents of community members who understand empathetic engagement and provides meaningful, flexible, and well-paying jobs. Communities can’t afford to leave the building of these solutions to volunteer-based or poorly subsidized programs. They deserve the financial and logistical support needed to address pressing needs.

To be sure, lay providers are not a stand-in for formally trained and credentialed mental health professionals. But they do represent an effective and accessible approach to alleviating the mental health issues prevalent in every community while allowing formally trained professionals to focus on the individuals most in need of their comprehensive services and skill sets.

It is worth noting that empathetic listening is an existing component of medical training. Current medical education acknowledges that empathetic listening is important in providing care — I just think few realize how important it is. The best part of the approach I’ve outlined here is that it is possible to recruit and train lay providers with innate empathetic talent quickly so communities can get a reprieve from the shortage of mental health care workers now — not years into the future.

Mini Kahlon is a neuroscientist, founding vice dean of Dell Medical School at the University of Texas at Austin, an associate professor in the Department of Population Health, and founder of Factor Health.