This book was not written to start a conversation. There are enough conversations. There are task forces, white papers, listening sessions, strategic plans, congressional hearings, and annual reports. The mental health field has been conversing about the crisis for decades. The conversations have not failed because the participants lacked intelligence or compassion. They have failed because conversations operate at the speed of institutions, and the crisis operates at the speed of neurobiology.
While you read this foreword, approximately five Americans will attempt suicide. By the time you finish this book, several hundred more will have tried. Some will succeed. Their hippocampi were atrophying while the system deliberated. Their amygdalae were kindling while the profession debated scope of practice. Their children's attachment patterns were being shaped by parental depression while Congress allocated funding for another study on the problem everyone already understands.
This book is written with urgency because the situation demands urgency. It is written with bluntness because the situation has survived decades of diplomatic hedging. It is written with specific proposals and specific timelines because the situation cannot survive another decade of "further research is needed."
The argument is straightforward: America's mental health system has collapsed. The collapse is not coming — it has happened. The existing tools — therapy, medication, funding, task-shifting, stepped care, peer support — are all necessary and none are sufficient. People are already migrating to AI for mental health support in the tens of millions, using systems with no clinical validation, no safety architecture, and no outcome measurement. Every month this continues, brains are damaged, lives are lost, and children grow up shaped by treatable suffering that no one treated.
The book makes the case that clinically rigorous AI therapy — not as a replacement for human clinicians but as a necessary component of a comprehensive strategy — must be built, validated, and deployed with the urgency of a public health emergency. Because that is what this is. Not a policy challenge. Not an interesting technology question. A public health emergency with a body count that exceeds most of the emergencies America has mobilized to address.
If you are a clinician, a policymaker, a technologist, an insurer, a parent, or a person who has ever waited three months for a therapy appointment that never came — this book is for you. It is not neutral. It is not balanced in the way that treats inaction and action as equally defensible positions. It takes the position that the evidence demands action, that the tools for action exist, and that the failure to act is a choice with consequences measured in human suffering.
Read it with that understanding. Disagree where the evidence warrants disagreement. But do not mistake the urgency for hysteria. The urgency is proportional to the crisis. If anything, it is insufficient.