Speaking on a video call a week later, she elaborated on the overarching impact of what have become untenable demands in music—anxiety, insomnia, fatigue, vertigo, and more—and the overlapping broken systems at their root. “The math does not ever work,” she said, referring not only to the grueling and increasingly unprofitable nature of touring, but to the broader reality for working musicians in an era where music has been devalued by exploitative streaming and ticketing models.

Within her statement, Santigold voiced what has become a central dilemma of musicians in a dysfunctional industry today: At all levels, from DIY acts to established indie icons and festival headliners, artists are suffering from mental health struggles vastly disproportionate from the general public—even in light of the mounting mental health crisis around the world.

For her canceled tour, the inflated price of gas combined with scheduling holes and a flooded market all left her unsure that she’d break even. The unsolvable equation of being a working musician today, she explained, begins with economic dysfunction—“You’re spending a lot of money to make a product that you’re going to give a way for free”—and results in a way of life and a churn of constant productivity that is unsustainable. “You’re supposed to present this version of yourself that’s larger than life, and that’s what people are buying into,” she said. “It’s requiring you to operate at superhuman capacity for extended periods, for years, forever, if you’re going to keep filling the expectations of the industry.”

A 2019 study found that 73 percent of independent music makers experience anxiety and depression in relation to their work. In 2021, the Journal of Psychiatric Research published a peer-reviewed report titled “Mental health issues among international touring professionals in the music industry”—based on a pre-pandemic survey of 1,154 individuals—that showed “greatly elevated” rates of clinical depression and stress in comparison to the general population, and levels of suicidality that are five times the average rate of the U.S. population. Musicians have historically gone widely without health insurance, but as with all of these longstanding problems, more research is needed.

To be a fan of modern music is to see entangled crises of mental health and economic sustainability that are increasingly conspicuous, and, if not new, then no longer possible to ignore. Since 2019, an uptick of non-profit and research-based initiatives have emerged to address the mental health dimension of this sobering reality and to offer more immediate support to musicians and touring crew members. But the dozens of artists and experts interviewed for this story believe that systemic change to both the music industry and to society, including universal healthcare, is what’s needed most.

“Being expected to constantly come up with something from nothing energetically, it becomes a real mental health problem,” Santigold said of her canceled tour. “My body wasn’t getting on that bus. People were like, ‘You need to keep the momentum. You need the social media hits,’ but I was like, ‘I need to stay alive, and my body is telling me that this is dangerous for me.’ There has to be another way, because what I’m not going to do is go out and put myself in a hospital.”

In 2022, there are so many systemic issues at the root of the mental health crisis in music that the conversation begins to feel perilously unwieldy. Streaming has decimated the economy of music, creating financial stress for artists as they’re instructed to relentlessly tour. Corporate consolidation has exacerbated those problems. Self-employed workers face barriers to health insurance across the board in the U.S., with its broken healthcare system. Musicians and therapists alike cite social media as an extenuating factor, eroding boundaries and contorting our senses of self. There are also fraudulent cultural myths about tortured artists, and a need for stronger labor consciousness among working musicians. Meanwhile, the anxiety of pandemic health risks persists.

It can be hard to know where to start, so the conversation stalls, and issues get swept under the rug. At this point, the rug no longer exists. Reality has exposed the mess. The consequences can be life or death.

A Crisis Across Music

Even before the pandemic, it was not uncommon to see artists canceling tours citing mental health concerns. And even before touring became increasingly unprofitable, it was a fraught lifestyle. Despite vast chasms of budget that differentiate the many forms a tour can take, there remains common ground. There are the roller-coaster highs of performance followed by post-show lows. The inescapable presence of alcohol. The stress to relationships back home. Reduced autonomy, but also loneliness, jet lag and disrupted sleep. Pressures from managers and agents who are reliant on an artist’s success. The cumulative effect of such conditions can lead to breaking points and troubling thoughts.

“There were times when I was like, ‘I don’t want to do this shit no more,’ mainly because I was working myself to the bone,” said the rapper Denzel Curry, talking about life on the road. When he voiced concerns he felt they often went unheard. “What if I took off one day and said, ‘I don’t give a fuck,’ and sabotaged my career because of this?” Curry added.

Jeff Tweedy is another artist who knows this battle well. Though the Wilco frontman has viewed touring as a comfort over the years, he said he still believes it’s crucial for the music industry to collectively raise its health standards. Two decades ago, he struggled with opioid addiction at home and on the road. He started treatment in 2004, and in the hospital, he realized that he’d suffered from depression and anxiety for his entire life, and that much of his addiction struggles were “maladaptive behaviors to cope” with those mental health issues. “I just thought other people felt better than I did, and I didn’t know why,” he recalled. “In the emergency room, somebody said, ‘You should go to a dual diagnosis facility so you can address your mental illness and your addiction at the same time.’ A lightbulb went off.”

After getting sober, Tweedy still hasn’t been immune to the hurdles that professional musicians face to meet basic human needs. “Even as I’ve become more financially stable, I have not ever been able to get life insurance,” he said. “There are actuary tables saying that it’s not a good bet that somebody in my profession is gonna make it for very long.”

Australian singer-songwriter Courtney Barnett illuminated the ups and downs of the job further in her recent fly-on-the-wall doc, Anonymous Club, which pulls back the curtain on the emotional challenges of touring. It’s a film reflecting the nuances of anxiety on the road, and in one particularly vivid scene, Barnett is backstage warming up for a show, listing off all of the reasons why someone in the crowd could think she’s a fraud. And then she walks out, the image on screen juxtaposing the darkness of the venue to the blinding stage lights, the uneasy pre-show stillness giving way to screams. The exhaustion and adrenaline of touring is laid bare.

The film’s foundation is an archive of voice memos, like a spoken diary, that Barnett recorded and sent to the director, Danny Cohen, who “became like my therapist,” she said. Barnett elliptically voices her feelings of depression and hopelessness, self-doubt, fear of failure, and emptiness, all at the heights of indie success. “That was the stuff I didn’t want to talk to friends and loved ones about because sometimes it feels like a burden,” she added. “It was a sad realization: I felt scared to talk to people.”

Mainstream stars aren’t exempt, either. Back in May, when the R&B singer Jhené Aiko was named a mental health ambassador by the City of Los Angeles, she said that at a peak of her success—after her debut mixtape came out in 2011, and two years later, when she featured on Drake’s “From Time”—she struggled with depression, anxiety, and the alcohol that was handed to her before and during every single show. She had just become a mother, she was struggling with grief from the death of her brother, and she had no room to process her emotions. Aiko added that she was blackout drunk during some of the biggest shows of her career, like her first Coachella. She eventually entered the hospital for gallbladder issues and kidney infections, which she connects to her drinking. “I was self-medicating,” she said, “and really digging myself into a deeper hole of depression and anxiety.”

A Mental Health Resource Hub for Music

In the absence of systemic change, a number of new initiatives have emerged in the U.S. in recent years to address the mental health crisis in music. One is Backline, a non-profit launched in October 2019, which connects artists, touring crew members, and their families with mental healthcare providers. Through a form on the Backline website, musicians can qualify to be paired with a case manager who creates a custom care plan tailored to their needs and finances.

Therapists and treatment centers in Backline’s clinical network are vetted for their understanding of the music industry—they’re attuned to the specific stressors of the road and know the right questions to ask. Or as co-founder Hilary Gleason put it: “One of the main things Backline has tried to remove is having to explain what it means to go on tour.” They can also connect clients through like-minded charitable organizations around the country that exist for the purpose of assisting musicians with mental healthcare, like SMASH (Seattle Musicians Access to Sustainable Healthcare) and the SIMS Foundation in Texas, named after the late Austin musician Sims Ellison, who suffered from depression and died by suicide in 1995. 

Gleason has worked in the nonprofit sector for over a decade, and sees Backline as a mental health resource hub for music. She helped start the organization in the summer of 2019, after two musicians in her community took their own lives. Given her professional experience and her social circle—she dated a touring musician for four-and-a-half years and had been vocal about mental health online—Gleason soon found herself on the receiving end of urgent phone calls. Peers turned to her, asking: Why are our friends slipping through the cracks?

Citing the 2018 deaths of the chart-topping rapper Mac Miller, from an overdose, and the EDM star Avicii, by suicide, Gleason says, “In that moment I recognized that I was not the only person in the music industry getting those calls.”

Gleason helped initiate an emergency conference call that included representatives of organizations like MusiCares and the Sweet Relief Musicians Fund, which both provide financial assistance to career musicians in health crises. Gleason invited 50 people to participate in the call; over 150 joined. “We decided to explore what it really looked like when somebody was struggling with mental health,” Gleason recalled. “Where are people going? What were the resources they were able to turn to? How did they find out about them?” They were questions without definite answers.

What began to emerge was the need to streamline and demystify mental healthcare for U.S. musicians—as well as for agents, managers, venue staff, security, tour bus drivers, plus all of their family members—amplifying available resources and offering ways around the confusing bureaucracy of accessing them. “When things were really hard, and people needed help, they were running a Google search and getting a page for something they might not be eligible for—and that is a door that is closed in your face,” Gleason said. “It can feel like a huge roadblock.” Breaking down those barriers became Backline’s mission.

Backline’s resources currently include a clinical network of over 365 providers, spanning therapists, psychiatrists, psychologists, social workers, and life coaches, many of whom offer sliding scale or pro bono rates. To qualify for Backline assistance, applicants must have made at least half of their income off music for at least two years. (This requirement can still pose a barrier for some, and Rachel Brown, of the burgeoning indie rock duo Water From Your Eyes, hopes that an organization like Backline might, in the future, also benefit still-rising artists with demonstrated commitment to their work. “How can you prove that you make half of your income on music if you’re getting paid in drink tickets?” they said.)

The Backline network was initially assembled by L.A.-based therapist Zack Borer, who was a musician and songwriter in New York for a decade before training as a therapist. Borer is now focused on a new mental health consulting firm called Borer Newman, which offers its services to festivals and tours—like the Newport Festivals Foundation and CID Presents, the organization behind destination jam bonanzas for the likes of Dead & Company—who hire the company to provide mental health support. That might mean creating psychoeducational workshops at festivals for artists and crew, or having therapists available on the ground.

Borer’s partner in his new company, Chayim Newman, is a co-founder of the Tour Health Research Initiative (THRIV), which produced the aforementioned peer-reviewed paper on mental health and touring in the Journal of Psychiatric Research last year. Borer and Newman also wrote a related white paper of their own, analyzing the research, in 2021. The current data on touring health “paints a disturbing picture,” they write. Also disturbing are anecdotes shared in the paper of unnamed industry executives who referred to artists and crew members as “‘cannon fodder’ to be pushed through unsustainable touring itineraries and demanding schedules in order to deliver creative output and profit lines.” The paper goes on to note, “With minimal mental health support, when burnout or worse occurs, artists and crew are then quickly replaced by the next eager individual.”

Newman and Borer outline their ideas for possible solutions, including support facilitated by management companies, record labels, and tour promoters. Their paper also considers Live Nation, which both owns Ticketmaster and serves as the biggest concert promoter in the world. “Since 2019, in the aftermath of the suicides of several high-profile touring artists, companies such as Live Nation have attempted to better support touring mental health by investing in several small initiatives,” the paper reads. “While this is a major step forward […] these initiatives are extremely limited in scope and incommensurate with the extent of the mental health crisis and the organizations’ footprints in the industry.” (Live Nation has since become the subject of a federal antitrust investigation. When reached for comment for this story, a Live Nation representative shared that the company has begun making the same mindfulness meditation resources it offers to its employees available to crews backstage at its venues.)

A Handbook in Every Venue

Tamsin Embleton had been working in the music industry for years—primarily booking shows, working with the likes of the xx, Spiritualized, and Fucked Up—when she found herself in Leipzig, Germany, eating Chinese food with Nick Cave. It was 2010, and Embleton, at the time a tour manager and longtime Bad Seeds fan, was bonding with Cave, then on the road with his band Grinderman, over their shared experiences in therapy. “A little while later I realized that someone out there was Nick Cave’s therapist,” Embleton said.

So Embleton retrained as a psychotherapist, a decision tethered to music. “I was a troubled kid who became a troubled adult,” she said. “I could mask it fairly well within the music industry, like many people do, but there came a time when I couldn’t outrun what I was struggling with—I had to turn and face it.” 

While continuing to work as a booker on a smaller scale, she switched careers, and in 2018, completed a master’s thesis on the psychological impact of touring. That work became the basis of a 624-page book called Touring and Mental Health: The Music Industry Manual—edited by Embleton and featuring contributions by therapists, psychologists, performance coaches, dieticians, and experts on sleep, sexual health and addiction, among others—to be published this March.

With other like-minded therapists in the UK, U.S., and Europe, Embleton helped form the Music Industry Therapists Collective, and many of its members contributed to the manual. Artists interviewed for the book include Radiohead’s Philip Selway, Four Tet’s Kieran Hebden, and Chic’s Nile Rodgers. “The life of a musical artist can be a magnificent thing when you’re on stage,” Rodgers says in promotional materials for the book. “There are, however, another 22-and-a-half hours in the day.”

Embleton hopes the book will be concretely useful to production managers and crew, explaining how to identify and cope with various psychological difficulties, as well as offering in-the-moment strategies. She also wants it to provoke broader conversations around doing things differently. Chapters of the book will be turned into online courses, and a global database of services will live on a website as well.

In September 2019, when Embleton was beginning to crowdfund the book’s projected budget of about $28,000, she quickly received an email from Michael Rapino, CEO of Live Nation, the biggest concert promoter in the world and current subject of a federal antitrust investigation, who offered to help pay. “Within about a week, the amount we were aiming to raise, plus a bit more, was sent to my account,” Embleton said, adding that Rapino also pre-ordered 3,000 copies.

When I mentioned these pro-bono therapy and publishing initiatives to Santigold, she was encouraged—it was her own experiences in therapy, after all, that equipped her with the ability to create boundaries: “That’s what helped me arrive at canceling a tour,” she said. But she still adamantly favored a focus on systemic change surrounding streaming deals and governmental support in order to foster artists’ wellbeing.

“I love that people are starting to recognize the need to come up with solutions,” she said. “But we need to focus our energy on forcing these bigger companies to make a change. Say there’s a really dangerous hole in the street and people keep falling in the hole. And instead of fixing the hole, they’re like, ‘If you fall in the hole, we’ll give you a Band-Aid, but we’re not going to fix the hole.’ That doesn’t make sense. We need to fix the problem.”

How Labels Can Help

Given the documented need for immediate support—and the current absence of socialized medicine—the question recurs: Who should foot the bill for musicians’ healthcare? It’s unlikely that there will ever be a one-size-fits-all answer. But one recurring idea, from therapists and artists, is that those labels with the resources to help should step up.

Right before the pandemic, Denzel Curry spoke out in support of label-funded mental healthcare. Curry himself had signed up for therapy a year prior, after a period of severe depression. “I thought I was dealing with my problems through music, but I wasn’t really confronting them for real,” he said. “When I went to therapy, I was able to confront them.” Speaking from his home in Los Angeles in August, Curry remained a strong supporter of therapy, which he said helped him tremendously—so much so that his 2022 album, Melt My Eyez See Your Future, is grounded in his therapeutic process. “Therapy taught me how to really feel. It changed my music because I don’t just run through one or two emotions, I run through all of them.”

In 2022, though, he was less hopeful that labels would ever actually provide this resource for artists on their dime. “I know they’re not going to pay for it,” he said. “Artists are dying every day. Labels know that shit sells high-key. They don’t give a damn about that. They’ll think about the next release of that dead artist before they think about mental health.” (Curry was clear that he did not include his own label, Loma Visa, in his broader critique.) 

He continued, “Labels profit off Black trauma. To them, it sells more records. They don’t care if you die, because they own you. Why do you think most rappers have posthumous albums, and [the labels] keep rehashing them, remastering them, putting them back out, adding people to it? They’re just profiting off people who died because of the stuff we were supposed to get therapy for.”

If it currently seems unlikely that labels—especially already-stretched-thin independent ones—would cover a musician’s health bills, one L.A.-based therapist is hoping to shift this paradigm. Syreeta Butler had been a therapist for the better part of a decade when, around 2015, she started to envision the possibility that a record label could have a specialized mental health and wellness department. “It was gnawing at me, but there was no real blueprint,” Butler said. “I mean, there still isn’t—this blueprint is continuously being created.”

Music was foundational for Butler—she was even named after the singer Syreeta Wright—and her interest in bringing her expertise to labels intensified following the deaths of heroes like Whitney Houston and Amy Winehouse. “My inquisitive mind was like: What’s going on here? How does that happen? It did not compute.” The idea kept her up at night, so she eventually began approaching labels with her plan. “I got a lot of no’s,” she said, “until I got a yes.”

That yes came from Atlanta’s Love Renaissance (LVRN), which is distributed by Interscope and currently home to R&B stars including Summer Walker and 6lack. (LVRN have chosen to be public about this program, creating space for Butler to publicly discuss it, too.) To maintain the integrity of her therapeutic relationships, Butler is abundantly clear that she and her firm, Just B. Consulting, are not employees of LVRN, and the label has no bearing on the outcomes of her work with artists. “When you work for someone, there’s a commitment you have to the organization, and that doesn’t align with my value set,” she said. She’s paid by the label on contract according to how many artists use her services, and each artist is assigned a number ID to insure confidentiality. “I’m a partner,” she added, “but I’m a partner supporting whomever is in front of me at the moment.”

All of this has meant she’s had a therapy career like none other. “I’ve done therapy at a strip club, I’ve done therapy on a tour bus,” Butler said. Her previous jobs in community mental health taught her that often, for therapeutic work to be effective, “you are meeting the person where they are,” which can vary day-to-day in music. She focuses on “creating an intensive amount of trust” with clients to accommodate a nontraditional approach. “What I learned during my time in community mental health is that healing isn’t linear, and support isn’t linear. It can look like one-on-one talk therapy weekly. Or it can look like pulling up to the studio like, ‘Yo whatchu cookin?’ If we are going to imagine a world that holds space for this work, I have to be willing and able to adapt.”

Butler hopes to set a precedent in the music industry that will impact not only artists, but listeners too. “Supporting musicians has ripple effects,” Butler said. “It’s not just about getting over your anxiety, but asking: How can we support you in being the best version of yourself? How does that impact not only your well being, but the music and art you create? And from that, how are the people consuming your art changed in their own lives from what you have created?” If therapy could change an individual musician’s interior landscape, she suggested, maybe it could enlighten the music and message they communicate, and even the world it reaches. “Once I was able to unlock those ideas,” Butler added, “the work took on a different life.”

Organizing Music

Within the so-called mental health space, the music industry is often discussed in broad strokes, like a monolithic entity. But there are as many ways to forge a life in music as there are styles of playing it. Some people create music as a hobby, or for its inherently therapeutic qualities; some prioritize their values and communities while keeping money out of the equation; others play music as a career, or try to. Touring also takes radically different forms—DIY bands in minivans are working within markedly different conditions than artists in fancy buses, or DJs who travel alone and work until dawn.

In March, 25-year-old singer and songwriter Rachel Brown was halfway through their first proper tour, a 18-date trek from New York down to Austin and then up the West Coast. Brown is one half of the Brooklyn art-pop duo Water From Your Eyes, whose profile within the world of indie rock has steadily risen over the past few years. But by the time they reached Los Angeles by car this spring, Brown needed out. “I had a full-blown panic attack,” they recalled. 

The financial burden of the tour, which Brown essentially self-funded with money from their work as a production assistant on film and television sets, was wearing on them. They took an overnight bus to their brother’s home in San Francisco. “I was like, ‘I can’t be trapped in this car. I need to just not be on this tour for a day to feel like a person again.’”

Speaking over FaceTime two months later from another tour stop in Edinburgh, Scotland, Brown said they could see how they had been seriously unprepared for the confluence of stressors that come with life on the road: the lack of sleep, nutrients, and space took a toll as they juggled the work of a tour manager in addition to performing. Brown has been clinically depressed since they were 14, and they struggle with anxiety, which they processed in their earliest songs. “I hadn’t really been in a good place before that tour started, and it was like a hellish intersection of things,” Brown said. “People really glamorize the idea of being a musician, and forget that it’s a lot of work. When you’re stressed about surviving, you can’t think about anything else.”

Weeks after their mid-tour panic attack, in April, Brown released a spare, lucid solo recording on Bandcamp, titled “plagiarizer,” delineating, in a quiet rush, that shared dilemma of modern musicians:

I need healthcare
I need friends
I need to pay my therapist

Musicians at the start of their careers are faced with especially unforgiving circumstances, yet they aren’t often given a voice in the conversation surrounding mental health, or taken seriously when they speak up. Case in point: In March, when the young rock band Wednesday wrote on social media about their financial losses at Austin’s SXSW festival, fans and others responded saying the group should just tough it out and sleep in their van. The Twitter thread went viral, sparking a discourse within independent music about how much artists are asked to bear in order to sustain, or attempt to sustain, careers as musicians.

Among the most pointed responses came from Zachary Cole Smith, the 37-year-old guitarist and frontman of the indie band DIIV, who has been touring since he was 23 and has also been organizing with the Union of Musicians and Allied Workers (UMAW) since its inception in the pandemic spring of 2020. “Our labor is around making + playing music,” Smith posted, “not fulfilling some quota of suffering for a bunch of fucking morons.”

Smith, who is now five years sober, has been candid in the past about his struggles with addiction and mental health. Over the years, he’s come to see how the false myths we are so often told about artists contribute to the worsening of those struggles. “We grow up seeing the pitfalls of the tragic musician who we all love,” Smith said, describing the fraudulent myth of the tortured artist, the historically perpetuated archetype of musicians sacrificing themselves to art without regard for health or financial stability. “That’s what I was conditioned under: This idea that we’re supposed to suffer. It was a very long time before I realized it doesn’t have to be like this.”

For Smith, part of shifting the conversation about artists has been getting involved with UMAW, where musicians are organizing for a fairer industry. “The music industry pits us against each other,” Smith said. “So being able to build a coalition is really important.” The union’s website poses vital questions: “If we can be part of the movement for healthcare for all and also find ways of taking care of our members, we could make a real impact. How can we plug into broader organizing that’s already happening around healthcare? What’s the leverage we have as musicians?”

UMAW believes that improving material conditions for artists overall, including increasing streaming royalty rates, is essential to improved mental health conditions. “Streaming does not pay artists,” Smith emphatically reiterated, which is another reason why, in addition to universal healthcare, he’s in favor of a universal basic income and government subsidies for artists. “During the pandemic, artists were living off of unemployment, if they were able to access it, which functioned like a universal basic income—and it really kept musicians alive, even for a band that is relatively successful like us,” he added.

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