As a hands-on leader who combines both a bird’s-eye view and a ground-level approach, Rawle Andrews Jr., Esq., Executive Director of the American Psychiatric Association (APA) Foundation, discusses the urgent need for a whole-of-nation approach to mental health, including a particular focus on the unique challenges faced by the security community.
Rawle brings a wealth of experience across law, non-profit leadership, and public policy, and has been a powerful advocate for improving mental health care across the United States. In our conversation, we dive into the growing youth mental health crisis, explore the mental health needs of veterans and first responders, and discuss innovative solutions like telemedicine and digital mental health tools.
Rawle also shares his perspective on how we can reduce stigma and better support mental health awareness, particularly within the security profession. His insights shed light on how a collaborative approach can help bridge gaps and create lasting change for mental health across the nation. As Rawle puts it in our interview, “Ultimately, no one organization can solve these problems alone. But when we realize that and come together, we can achieve anything.”
Learn more about the APA Foundation: https://www.apaf.org/
For those who prefer to read a condensed transcript of the interview, text is provided below the following video.
Jessica: Hi Rawle, thank you for joining me today. It was such a pleasure to meet you and your colleague, Rudy Scott, at the recent Hero’s Journey Symposium in Washington, D.C. Shout out to the John P. Mayhugh Foundation for organizing the event and their dedication to mental health advocacy over the last decade.
So, as the Executive Director for the APA Foundation, you bring a wealth of knowledge to the table from a variety of fields, including law, non-profit leadership, and public policy. You speak regularly on Capitol Hill, to the media, and at conferences around the country about improving mental health for our nation.
With that in mind, let’s kick off this conversation by taking the broad view. What do you consider the most pressing mental health challenges facing the United States today, and how is the APA Foundation addressing these challenges?
Rawle: The short answer to your question is will. Mental health and substance use issues come down to three main challenges: will, capacity, and communication.
When we talk about “will,” we’re addressing the fear and shame that prevent people from seeking help, even when they know something’s wrong. It’s also about parity—despite laws mandating equal reimbursement for mental and physical health, there's still a gap in what mental health clinicians are paid versus physical health providers.
Then there’s the capacity issue. There’s a growing demand for mental health care, but workforce shortages make it tough to meet that demand. It’s not like you can just walk into an urgent care and get the treatment you need. We’re also facing a shortage of psychiatric beds. While hospitals have many specialties, only a small portion of their beds are dedicated to mental health. And even though we’ve increased the number of residents training to become psychiatrists, we still don’t have enough slots to meet the growing demand.
Finally, communication is a huge challenge. For every good piece of information we share, there's a flood of misinformation and disinformation that makes it harder for people to find the right resources. It’s a constant battle to make sure the truth reaches the right people, despite all the noise.
Jessica: What is a common example of the misinformation or disinformation you’ve witnessed?
Rawle: People often equate mental health with medication, but that’s not always the case. While some treatment plans may include medication, what’s really needed is a proper diagnosis. Many people also think self-care is enough, like using apps to guide things like sleep or nutrition. But when you’re struggling for months—even if you’re following these routines—something’s still missing.
If we treated mental health like any other medical issue—say, with our knee, heart, or shoulder—we wouldn’t hesitate to see a doctor. But for mental health, many people try to “power through” by just shutting down their devices and hoping it’ll get better. Unfortunately, it often doesn’t—and sometimes, it only gets worse.
Jessica: Right, people naturally ask themselves, “Is this something I can take care of myself or do I need help?” I recall at the symposium you mentioned that a lot of mental health cases that enter the system are from people who have reached a more advanced stage and are now more likely to require emergency care. And, as you’ve pointed out, we’re a little stretched thin when it comes to resources to support this emergency care.
Rawle: On average, it takes 10 to 15 years from the onset of a mental illness for someone to actually seek care. That’s a decade or more of struggling before getting help—almost an entire generation. During that time, the person might avoid seeking help due to stigma, fearing the impact on their family.
As life goes on, more problems pile up, and often it’s only after a traumatic event that the need for help becomes undeniable. By then, the condition has progressed, and the treatment needed is more intensive because it's being addressed so much later.
Jessica: Speaking of the generational aspect, let’s take a moment to talk about the youth mental health crisis in the country. According to APA Foundation statistics, as of 2021 fifty-percent of adolescents have experienced a mental health condition at some point in their lives and 1 in 5 adolescents have contemplated suicide. Between 2016 to 2020 (note: this is from before the pandemic), the rate of depression among children aged 3 – 17 increased by 27%.
What do you see driving this increasing rate of anxiety, depression, and suicidal ideation among the younger generation today? And if you could speak directly to this generation, what would you say to them?
Rawle: The new generation is open to discussing mental health online, which is a positive shift. However, older generations often struggle with empathy in these conversations. We need to create a new circle of trust where people can openly express that something feels off and ask for help without fear of judgment.
When it comes to mental health issues, anxiety often stems from worry about the future, while depression is linked to unresolved issues from the past. Suicidality, especially post-pandemic, has risen, with over two out of five high school students, particularly young women, contemplating suicide. Women may express their pain through writing or music, while young men often resort to more violent means, leading to tragic outcomes.
In many cases, mental health struggles are clinical—rooted in the system—while others are environmental reactions. We’re seeing an increase in reporting, with bullying, cyberbullying, and the misuse of over-the-counter drugs or “dirty cocktails” being key drivers. These “dirty cocktails” are as dangerous as unsecured guns at home, posing serious risks. Adverse childhood experiences, housing and food insecurity, and early adult responsibilities also contribute to these conditions.
Additionally, the stress of living in a polarizing political climate, constant media exposure, and concerns about issues like climate change leave young people feeling overwhelmed, powerless, and trapped by the state of the world.
Jessica: So obviously it’s not just one driver; there are many drivers. And it sounds like the exposure to negative content through social media and news media is unprecedented and overwhelming to people.
I’m glad you brought up adverse childhood experiences (ACE). This is something that’s definitely relevant to the security community, especially the military. According to a previous interview I conducted with Kate Kuzminski, the Director of the Military, Veterans, and Society Program at the Center for a New American Security (CNAS), compared to when there was a national draft, once we shifted to an all-volunteer military the ACE scores among service members went up.
Meaning, Americans who make the choice to serve are more likely to have ACE scores in their profile than the average population, making their psychological profile a little more complex, especially when it comes to other exposures inside the military.
Rawle: At our foundation, we’re using a federal grant to provide school-based training for all staff—not just teachers. The “Notice, Talk, Act” Program is designed for everyone who interacts with students: coaches, cafeteria workers, custodians, counselors, and more. It teaches staff how to spot signs of distress, engage in active listening, and then take action to connect students with the resources they need, including the 988 helpline.
I can share a story: About a year ago, I was coaching youth basketball, and one of my players, a 13-year-old, was being teased after failing a quiz. He kept saying he was suicidal because of the test score. Twenty years ago, I might have brushed it off as “boys being boys” or good-natured teasing. But because I’m trained in Notice, Talk, Act, I knew I needed to step in.
I pulled him aside, pretending it was to work on his free throws, and we had a good conversation. It turned out he wasn’t suicidal but was deeply disappointed about his grade being exposed to the team. He didn’t like feeling singled out.
That conversation led to a broader team discussion about what being a team really means—not just holding each other accountable but supporting each other when it counts. Notice, Talk, Act empowered me to go to his parents afterward and share my concerns. I didn’t know if there was an issue at home, but I wanted to be proactive. I’d rather be cautious and overstep than regret not acting if something worse happened later.
Jessica: Better safe than sorry. You bring up an important point—whether you're a teacher, parent, or working in security, the power of having a conversation can’t be overstated. I have young kids myself, and I often think about how to frame things for them.
Sometimes, what seems devastating to a child can feel more manageable with the right perspective. A simple conversation can help them see the bigger picture, making challenges feel less overwhelming. It’s about building resilience and giving people the tools to handle tough situations on their own.
Rawle: The power of human connection is crucial. We need to stay connected because isolation makes it incredibly hard to work through our struggles, no matter how strong or independent we are.
Everyone has a breaking point; it’s just part of being human. In the security community, especially, there’s often an expectation to be “superhuman.” We’re asked to do tough things in tough places with no room for vulnerability—just stay hard, adapt, and push through. But when we return and the chaos slows down, the tools we used to cope may no longer work.
That’s when things like moral injury come into play. In the moment, we don’t think about it, but once we’re back, alone and away from our team, it hits. We’re left with memories and experiences that we feel we can’t share—things we’ve seen or know that others can’t understand.
And without our platoon or brigade, it feels like there’s no way to unpack it, even though we desperately need to.
Jessica: I’ve heard that sentiment from several veterans. Like, when you’re in the heat of moment and you’re pumping adrenaline, you’re okay. It's when you come down from that and have the quiet space to start processing what happened back in the battlefield, then you hit the bumps in the road. That’s when having the right coping techniques and the right community for support is crucial.
On a similar note, veterans often face unique mental health challenges, such as PTSD, depression, struggles with transitions back to the civilian sphere. What specific initiatives is the APA Foundation involved in to address the mental health needs of veterans?
Rawle: Our approach has always been to support where we're invited—whether it's where people live, learn, work, worship, or play. We operate from a "three-legged stool," bringing thought leadership, convening power, and a micro-philanthropy platform.
We’ve focused on supporting veteran-led organizations, often beyond the usual veteran service organizations (VSOs), like the Veterans Mental Health and Wellness Foundation, the John P. Mayhugh Foundation, and Home Base in Boston. These groups address local veteran needs, and we make sure our doctors, especially trainees, are exposed to this work.
Did you know that 60% of psychiatrists in North America have spent time in the VA system? Many have served or continue to serve, and they’re equipped to work with people who’ve faced the unique challenges of military life. Right now, we’re expanding our Mental Health Care Works campaign, which has already reached over 500 million audience impressions in less than 18 months. Our next step is to focus on veterans and military families.
However, we know veterans must lead the conversation. We didn’t rush to create a narrative about their struggles, but instead, we’re collaborating with foundations like Home Base and Mayhugh to amplify their vetted resources. One unique approach we’re using is the “huddle interview.” This format involves a clinician and a group of veterans or former operators discussing challenges and solutions in a casual, roundtable-style conversation. It’s not scripted—just real, honest dialogue.
We’ve found that certain mental health issues like anxiety, depression, addiction, and grief are common in military life, but there isn’t one veteran who can represent the entire community. The huddle approach captures that diversity and strength in numbers. It also helps break down barriers to self-care. In civilian life, taking a sick day is normal, but in the military, skipping training can feel like letting down your team.
The huddle encourages vulnerability and allows veterans to see they’re not alone in needing help, even if they’ve been conditioned to push through.
Jessica: Right. I was talking to a veteran recently who made an interesting point, that certain behaviors can be adaptive in one environment but become maladaptive in another, especially if you don’t know how to transition between them.
Rawle: The Veterans Health and Wellness Foundation and Home Base, which operates at scale nationwide, assists veterans with accessing comprehensive care, counseling, and reentry support. What’s particularly impressive is that Home Base can deploy teams to assist veterans during a two-week program that not only addresses immediate needs but also guides them through a transformative process.
By the end, it’s like graduating from basic training—veterans leave feeling reenergized and ready to reenter civilian life with a fresh perspective.
Jessica: PTSD and TBI (traumatic brain injury) may not be visible on the outside, but they are just as real, making it harder for people to seek help compared to physical wounds. Law enforcement officers and first responders also face significant trauma and stress.
How does the APA Foundation approach the mental health needs of this group, and what steps are being taken to support them?
Rawle: We’re seeing many of the same mental health challenges in first responders that we’ve seen in the military community, such as PTSD and rising suicide rates. To address this, the APA Foundation has partnered with organizations like the National Association of Counties and sheriffs’ departments, including a deep dive with the Alexandria City Sheriff’s Department in Virginia.
Our goal is to help first responders recognize their own needs, much like we do with school staff through the Notice, Talk, Act initiative, but adapted for the workplace. First responders often feel they can’t ask for help for fear of damaging their careers or losing their ability to help others. We’re working to humanize our heroes so they feel empowered to seek support.
One key challenge we face is reaching families early enough to provide assistance before it’s too late. For example, we worked with the widow of a sheriff who tragically took his own life. She had no idea he was struggling, as he had kept his pain to himself. His death was an accumulation of unresolved issues over time, and while we can never say for sure if it would have stopped him, the outpouring of love at his memorial made us wonder if it could have slowed it down, giving him a chance to get help.
This underscores the critical importance of communications, support networks, and proactive mental health care for first responders and their families.
Jessica: People working in the security field sometimes consider taking their life because they fear they won’t be able to continue in a job that’s become their identity. Their mission, their calling—it’s not just a job. The fear of losing that role, combined with the hesitation to ask for help, can feel overwhelming.
One important message I always try to emphasize is that if you’ve made it as far as you have in this field, you’re talented, and you’ll find another mission that suits you. It might not be the same, but it will be something that doesn’t compromise your mental health. You don’t have to stay in a situation that’s causing you harm. There’s always a path forward.
Rawle: Absolutely. Pain is real, and it’s important to understand that the body often responds to what the mind is telling it. When someone feels overwhelmed, the mind searches for a solution, and sometimes the answer it finds is not the one we hope for.
Suicide is always a tragedy, and there's no judgment. Often, people feel like there’s no tomorrow or that others would be better off without them. But the person they believe would be better off is usually the one who loves them the most.
Jessica: Exactly, it’s a sad irony, and it highlights just how crucial early intervention is. Training from the start is key. Many fields—whether it’s law enforcement, intelligence, or the military—are also exploring new tools.
So, how do you see technology, like telemedicine and digital mental health tools, shaping the future of mental health care, especially for veterans and security professionals?
Rawle: Telemedicine is absolutely essential, and psychiatrists are leading the way in adopting these tools, even more so after the pandemic. It’s significantly reduced wait times for care and, importantly, helps remove some of the stigma. I’ve had people hesitate to visit psychiatric buildings, even in Washington, because of how it looks, but with telemedicine, you can access care privately from your phone or laptop—no one needs to know.
The tech space is growing rapidly, with innovations like digital visors, apps, and wearables being showcased at the Behavioral Health Tech Conference in Phoenix. While we need regulation to prevent misuse, the truth is treatments that didn’t exist just a few years ago are now available.
We’re also encouraging other healthcare providers to be more aware of emotional and psychological health. For example, when you visit a gynecologist or pediatrician, they should ask a few more questions beyond the usual check-up, to better understand your mental well-being.
Ultimately, we're moving toward a more holistic approach to care, where physical and mental health are treated together—what we call the “collaborative care model.” We want to ensure that people are as whole and well as possible, not just physically, but emotionally too.
Jessica: Part of tackling the stigma, as you're pointing out, is tackling the taboo around it. And when you see somebody that you respect shoving that taboo to the side, it’s encouraging. The hope is that encourages others to do so as well.
Looking toward the future, how can organizations better support mental health awareness and reduce stigma within the security profession?
Rawle: We need to be more enlightened and sensitive to the unique needs of the veteran community. It’s easy to forget that less than 1% of Americans have served, yet we ask a lot of them. We owe them, and if we truly do, we must do more. That means reaching out and finding their trusted voices.
I had the privilege of meeting General Greg Martin earlier this year, and his story is powerful. He shares how his struggles with bipolar disorder didn’t start until he was home, sitting at a desk after years of being in the field. His experience shows that even the most highly decorated veterans need help, and his willingness to speak openly about it is crucial.
* Author’s note: To view my previous interview with General Greg Martin on The (In)Security Blog, check out “Leading With Courage: A General’s Battle With Bipolar Disorder.”
But it’s not just about generals. I’ve spoken with enlisted veterans, and their challenges can differ from officers’. We’ve even had feedback that our campaigns seemed to focus on high-ranking officers, leaving out non-commissioned personnel. We’ve learned that every veteran, every service member, and their families need support, not just those in leadership roles.
This same blind spot exists in other communities, too. Metta World Peace shared with me that while athletes get resources, their families are often overlooked. We need to care for the entire village—the service members, their families, and everyone supporting them.
Ultimately, no one organization can solve these problems alone. But when we realize that and come together, we can achieve anything.
* * *
About Jessica Lauren Walton: Jessica is a communications strategist, video producer, and writer in the U.S. defense sector. She has written articles on a range of security and mental health topics and conducted interviews with military leadership, CIA officers, law enforcement, psychologists, filmmakers, and more. Jessica recently completed her memoir about her experience as an American woman struggling with mental illness while trying to get into Israeli intelligence.
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