A new vision rooted in abundance, not scarcity.
Meet Adam.
Adam was 14 when something started to shift.
It wasn’t dramatic—just a quiet sense that things were off. He spent more time alone. Drifted from his friends. His grades were fine. He was polite, responsive, even cheerful when adults asked how he was doing. There was no clear signal, no obvious distress.
So nothing happened.
Because the system didn’t see it.
Because the system, as it’s currently built, can only react when things get bad enough to reach a “diagnosis” or disease threshold.
By 17, the disconnection ran deeper. He wasn’t in overt crisis. He still showed up, still passed his classes. But he felt increasingly hollow. He googled things like “Am I depressed?” but told no one. Therapy seemed like something for people who were worse off than he was.
Still, nothing happened.
Because the system can only react.
In college, things got harder. Adam struggled to connect with peers. He found it difficult to build meaningful relationships, to feel rooted in anything. He knew something wasn’t right, but the options in front of him didn’t feel accessible. He tried therapy once—waited weeks for an appointment, didn’t feel a connection with the provider, and couldn’t afford to keep going. So he gave up.
No follow-up. No support system. No early intervention.
Because the system can only react.
By his mid-20s, Adam was unraveling. Chronic anxiety, panic attacks, fatigue, isolation. The disconnection that had followed him for a decade had hardened into crisis. Now, finally, the system responded. He qualified for treatment. He got referrals. But by then, he was deep into a kind of suffering that might have been avoided—or at least softened—if help had come earlier.
Whew. Finally. Adam can get what he needs…but what if…we had the infrastructure built to prevent his devolution into crisis in the first place?
A System Designed to Miss the Moment
Adam’s story isn’t unusual. It’s typical. Not because something slipped through the cracks—but because the cracks are the system.
What we call mental healthcare is mostly a crisis-response model—not a health-building model. It waits until pain reaches a threshold, until a diagnosis can be coded, until reimbursement can be justified.
But Adam didn’t need a billing code at 14. He needed tools. Support. Connection. Skills. A way to understand what he was feeling and what to do with it.
And the system couldn’t offer that. Because that’s not what it was built to do.
It wasn’t built for prevention.
It wasn’t built for whole-person flourishing.
It was built for disease management.
The Tail Wagging the Dog
This isn’t just a clinical design problem—it’s a financial one.
Payer systems and reimbursement codes have quietly become the architecture of care. They shape what services exist, how they’re delivered, and who gets access. The result is a system where clinicians must diagnose in order to provide care, where “treatable conditions” take precedence over early warning signs, and where anything proactive, relational, or preventative is considered out of scope.
Care doesn’t follow people—it follows paperwork.
Therapists are forced to work inside structures that reward what can be billed, not what actually helps. And even that narrow model is under strain. There aren’t enough providers. Waitlists stretch for months. People like Adam are left waiting not because we don’t know what to do, but because the system can’t deliver it.
Scarcity Thinking, Everywhere
In Abundance, Ezra Klein and Derek Thompson explain that many of America’s greatest systemic failures aren’t the result of material shortages—but of a failure to build. We’ve been living in self-imposed scarcity, operating under constraints we created and then forgot how to challenge (Klein & Thompson, 2024).
Mental healthcare is steeped in that same mindset.
We tell ourselves that:
- Quality care can’t be scaled.
- Mental health support must be complex, expensive, and slow.
- Prevention is idealistic, not practical.
But those beliefs aren’t truths. They’re beliefs built on ingrained assumptions—ingrained patterns of thinking that reinforce a system already misaligned with what people need.
When Rigor Becomes a Barrier
As a clinician and researcher, I’ve seen how our reverence for gold-standard models can quietly become a barrier. We have fetishized procedure and process. Randomized controlled trials, fidelity protocols, structured delivery frameworks—these were all created to ensure quality. But too often, they’ve become gatekeepers, preventing creative and scalable designs, excluding any intervention that doesn’t match their format.
We’ve built interventions that look great in journals but are nearly impossible to access in everyday life:
- Delivered only by highly trained specialists,
- During weekday office hours,
- In locations many people can’t reach,
- At costs most can’t afford.
This isn’t just a quality assurance problem—it’s a structural inaccessibility problem. The evidence may be sound. But if people like Adam can’t access it, what are we actually building?
Our Funding Bias: Towards the Familiar Instead of the Revolutionary
The scarcity mindset shows up in funding, too. Institutions like NIH say they want innovation—but most dollars go toward incremental iterations of existing models. Grants are awarded to senior researchers refining old protocols, not to bold thinkers building something new.
As we wrote in “Why Haven’t We Done Better to Improve Authentic Social Connection?”, we’ve known for decades that social connection is one of the strongest predictors of physical and mental well-being. But we haven’t invested in making that science practical, scalable, or actionable.
We’ve funded what’s familiar—not what’s needed.
What If We Had Met Adam in His Journey Sooner?
Imagine a system that met Adam at 14—not with a diagnosis, but with tools.
Not with a referral form, but with practical support for building connection, resilience, and purpose.
Imagine a model that offered:
- Values-based behavioral activation,
- Guidance for cultivating meaningful social bonds,
- Progress tracking tied to relationships and values—not just symptoms,
- AI-guided coaching, accessible anytime, without gatekeeping.
That’s what we’re building at Rewire Wellness. A digital infrastructure rooted in real human needs—not reimbursement protocols.
In our published outcomes study (Journal of Contextual Behavioral Science, 2023), even a brief six-session intervention produced:
- Large improvements in quality of life (Cohen’s d = 1.05),
- Reductions in trauma symptoms and loneliness,
- Meaningful gains in perceived closeness and relational support.
This is what happens when care is designed for accessibility, scalability, and impact—not just academic rigor.
Better, More Accessible Infrastructure Reduces our Reactive Reliance on Crisis Response
Adam didn’t just need a crisis intervention at 25—he absolutely did need that…
But he also needed a system that could have supported him a decade earlier that would have prevented his crisis altogether. That would have given him the foundation and skills to understand himself and build the kinds of social networks that could bring him meaning and life.
The truth is, when we invest in infrastructure that builds resilience and life skills—connection, emotional regulation, values-aligned behavior—we reduce our reliance on emergency interventions.
Acute care that is reactive to crisis will always have a role. But it shouldn’t be the main point of entry for help.
It should be the safety net—not the only thing people can access.
Better infrastructure won’t eliminate crisis.
But it makes crisis care the exception, not the default.
And we can build that kind of system—if we choose to.
References (APA Style)
- Berkman, L. F., & Glass, T. (2000). Social integration, social networks, social support, and health. Social Epidemiology, 1, 137–173.
- Cohen, S., Doyle, W. J., Skoner, D. P., Rabin, B. S., & Gwaltney, J. M. (1997). Social ties and susceptibility to the common cold. JAMA, 277(24), 1940–1944.
- DiMatteo, M. R. (2004). Social support and patient adherence to medical treatment: A meta-analysis. Health Psychology, 23(2), 207–218. https://doi.org/10.1037/0278-6133.23.2.207
- Haider, A. H., et al. (2020). Disparities in trauma care and outcomes in the United States: A systematic review and meta-analysis. The Journal of Trauma and Acute Care Surgery, 89(3), 555–564.
- Holt-Lunstad, J. (2021). Social connection as a public health issue: The evidence and a systemic framework for prioritizing the “social” in social determinants of health. Annual Review of Public Health, 43, 193–213. https://doi.org/10.1146/annurev-publhealth-052020-110732
- Klein, E., & Thompson, D. (2024). Abundance: How America Can Build a Better Future. Crown Publishing Group.
- Smith, A. J., Pincus, D., & Ricca, B. P. (2023). Targeting social connection in the context of trauma: Functional outcomes and mechanisms of change. Journal of Contextual Behavioral Science, 28, 300–309. https://doi.org/10.1016/j.jcbs.2023.04.008
- Uchino, B. N., Bowen, K., Carlisle, M., & Birmingham, W. (2018). Psychological pathways linking social support to health outcomes. Social Science & Medicine, 224, 1–7. https://doi.org/10.1016/j.socscimed.2018.05.015