photo by: Chris Conde
The World War II Memorial Campanile on the University of Kansas campus is pictured on Jan. 19, 2022.
Mental health concerns have been a constant focus in public health and day-to-day life in the country in recent years — and it is not going away.
Nearly one in five Americans report having or being treated for depression in the first quarter of 2026, according to Gallup polling. The total percentage of 19.1% is up nine percentage points since 2015.
Kelsie Forbush is keenly aware of the increased focus the public has on mental health. Forbush, professor of clinical child psychology at KU, said it is a topic that has touched a lot of people’s lives. But she said the current system that many psychologists and psychiatrists use, the Diagnostic and Statistical Manual of Mental Disorders, or DSM, could use some adjusting to get better results.
“A lot of the traditional system has limitations in use in real world practice,” Forbush said.
Forbush recently published a study of veterans to better understand how different psychological conditions can be connected, but it used a different model, called the Hierarchical Taxonomy Of Psychopathology (HiTOP) to diagnose and treat patients. The study, which appeared in the Journal of Psychopathology and Clinical Science, found success in treating patients using that model.
Forbush hopes the study can provide an example of success in using the HiTOP model with patients that can help create a better system to treat mental health issues in the world.
“If we’re creating systems that are hard to use in the real world, we’ve got to re-tool it,” Forbush said.
photo by: Contributed
Kelsie Forbush, a professor at the University of Kansas and the director of its Center for the Advancement of Research on Eating Behaviors (CARE).
One advantage with the HiTOP system is that it is a hierarchical model. Forbush said the DSM is much more binary — a “yes or no” system. For example, if a patient said they were experiencing five symptoms of depression, they could be diagnosed. But if they have four symptoms, a patient would not be diagnosed with depression — no matter how potentially debilitating those four symptoms are. That one symptom difference can serve as a barrier for someone struggling.
“It can make it harder for people who are experiencing issues but aren’t getting the diagnosis they need to get the care,” Forbush said.
Additionally, the DSM model doesn’t always address the “heterogeneity” of some diagnoses. Forbush compared two clients who were diagnosed with depression. One told her they felt like “the sky was blue and now it’s black and white” but insisted they weren’t depressed. The other right away said “I am so depressed.” Forbush said as a therapist, those patients would have two different treatments just based on their outlooks, and that is one way the hierarchical approach can help.
What makes the HiTOP model unique is that it has “dimensions” of mental health responses in a hierarchy. Forbush said the model includes factors as broad as the “p factor” — the patient’s propensity to experience mental health issues in general — to more narrow focuses. She said one key part of the system is splitting internalizing dimensions, symptoms that get projected inward like negative thoughts, and externalizing dimensions, symptoms that get projected outward like hyperactivity.
This split is useful for clinicians because they can identify clusters of symptoms that fall under one category that can lead to better treatment, Forbush said. For example, if a patient is experiencing internalizing issues like fear or distress, those can lead to disorders like phobia or anxiety or obsessive compulsive disorder. Forbush said someone who might be diagnosed with four different disorders on the DSM could have all those symptoms cluster under one dimension. A therapist could then use a treatment that “goes after the core component holding all the (symptoms) together” to help the patient.
Forbush said therapists she spoke with during the study said they already thought about mental health issues in this way. They don’t see a patient as “four different disorders” but look instead to treat the underlying problems. The therapists felt the HiTOP model “formalizes what (they) actually do in practice,” according to Forbush.
After the recent study, Forbush hopes to continue using the HiTOP model and testing other treatment models based on it. She said she is working on a project with the U.S. Department of Veterans Affairs to use it especially for eating disorders. She also said the group recently got a pilot grant that hopes to use a mobile health treatment based on the model that could be tailored week-to-week based on patients’ responses to “lead to more targeted and effective interventions.”
As researchers and therapists work to improve mental health treatment methods, Forbush said she thinks this model is gaining “a lot of traction.” She said the group that is developing the next DSM has created a “dimensional working group” to add more of the aspects in the HiTOP model in the next edition. Forbush said she thinks that the HiTOP model serves as a “useful bridge” between the science of psychology and the clinical side of it. With the increased attention placed on mental health, she hopes the positive traction to find better treatments continues.
“People are very concerned about mental health issues,” Forbush said. “(We) really need systems that are a better fit.”