general essay synonym

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• 40 Useful Words and Phrases for Top-Notch Essays

To be truly brilliant, an essay needs to utilise the right language. You could make a great point, but if it’s not intelligently articulated, you almost needn’t have bothered.

Developing the language skills to build an argument and to write persuasively is crucial if you’re to write outstanding essays every time. In this article, we’re going to equip you with the words and phrases you need to write a top-notch essay, along with examples of how to utilise them.

It’s by no means an exhaustive list, and there will often be other ways of using the words and phrases we describe that we won’t have room to include, but there should be more than enough below to help you make an instant improvement to your essay-writing skills.

If you’re interested in developing your language and persuasive skills, Oxford Royale offers summer courses at its Oxford Summer School , Cambridge Summer School , London Summer School , San Francisco Summer School and Yale Summer School . You can study courses to learn english , prepare for careers in law , medicine , business , engineering and leadership.

General explaining

Let’s start by looking at language for general explanations of complex points.

1. In order to

Usage: “In order to” can be used to introduce an explanation for the purpose of an argument. Example: “In order to understand X, we need first to understand Y.”

2. In other words

Usage: Use “in other words” when you want to express something in a different way (more simply), to make it easier to understand, or to emphasise or expand on a point. Example: “Frogs are amphibians. In other words, they live on the land and in the water.”

3. To put it another way

Usage: This phrase is another way of saying “in other words”, and can be used in particularly complex points, when you feel that an alternative way of wording a problem may help the reader achieve a better understanding of its significance. Example: “Plants rely on photosynthesis. To put it another way, they will die without the sun.”

4. That is to say

Usage: “That is” and “that is to say” can be used to add further detail to your explanation, or to be more precise. Example: “Whales are mammals. That is to say, they must breathe air.”

5. To that end

Usage: Use “to that end” or “to this end” in a similar way to “in order to” or “so”. Example: “Zoologists have long sought to understand how animals communicate with each other. To that end, a new study has been launched that looks at elephant sounds and their possible meanings.”

Adding additional information to support a point

Students often make the mistake of using synonyms of “and” each time they want to add further information in support of a point they’re making, or to build an argument . Here are some cleverer ways of doing this.

6. Moreover

Usage: Employ “moreover” at the start of a sentence to add extra information in support of a point you’re making. Example: “Moreover, the results of a recent piece of research provide compelling evidence in support of…”

7. Furthermore

Usage:This is also generally used at the start of a sentence, to add extra information. Example: “Furthermore, there is evidence to suggest that…”

8. What’s more

Usage: This is used in the same way as “moreover” and “furthermore”. Example: “What’s more, this isn’t the only evidence that supports this hypothesis.”

9. Likewise

Usage: Use “likewise” when you want to talk about something that agrees with what you’ve just mentioned. Example: “Scholar A believes X. Likewise, Scholar B argues compellingly in favour of this point of view.”

10. Similarly

Usage: Use “similarly” in the same way as “likewise”. Example: “Audiences at the time reacted with shock to Beethoven’s new work, because it was very different to what they were used to. Similarly, we have a tendency to react with surprise to the unfamiliar.”

11. Another key thing to remember

Usage: Use the phrase “another key point to remember” or “another key fact to remember” to introduce additional facts without using the word “also”. Example: “As a Romantic, Blake was a proponent of a closer relationship between humans and nature. Another key point to remember is that Blake was writing during the Industrial Revolution, which had a major impact on the world around him.”

12. As well as

Usage: Use “as well as” instead of “also” or “and”. Example: “Scholar A argued that this was due to X, as well as Y.”

13. Not only… but also

Usage: This wording is used to add an extra piece of information, often something that’s in some way more surprising or unexpected than the first piece of information. Example: “Not only did Edmund Hillary have the honour of being the first to reach the summit of Everest, but he was also appointed Knight Commander of the Order of the British Empire.”

14. Coupled with

Usage: Used when considering two or more arguments at a time. Example: “Coupled with the literary evidence, the statistics paint a compelling view of…”

15. Firstly, secondly, thirdly…

Usage: This can be used to structure an argument, presenting facts clearly one after the other. Example: “There are many points in support of this view. Firstly, X. Secondly, Y. And thirdly, Z.

16. Not to mention/to say nothing of

Usage: “Not to mention” and “to say nothing of” can be used to add extra information with a bit of emphasis. Example: “The war caused unprecedented suffering to millions of people, not to mention its impact on the country’s economy.”

Words and phrases for demonstrating contrast

When you’re developing an argument, you will often need to present contrasting or opposing opinions or evidence – “it could show this, but it could also show this”, or “X says this, but Y disagrees”. This section covers words you can use instead of the “but” in these examples, to make your writing sound more intelligent and interesting.

17. However

Usage: Use “however” to introduce a point that disagrees with what you’ve just said. Example: “Scholar A thinks this. However, Scholar B reached a different conclusion.”

18. On the other hand

Usage: Usage of this phrase includes introducing a contrasting interpretation of the same piece of evidence, a different piece of evidence that suggests something else, or an opposing opinion. Example: “The historical evidence appears to suggest a clear-cut situation. On the other hand, the archaeological evidence presents a somewhat less straightforward picture of what happened that day.”

19. Having said that

Usage: Used in a similar manner to “on the other hand” or “but”. Example: “The historians are unanimous in telling us X, an agreement that suggests that this version of events must be an accurate account. Having said that, the archaeology tells a different story.”

20. By contrast/in comparison

Usage: Use “by contrast” or “in comparison” when you’re comparing and contrasting pieces of evidence. Example: “Scholar A’s opinion, then, is based on insufficient evidence. By contrast, Scholar B’s opinion seems more plausible.”

21. Then again

Usage: Use this to cast doubt on an assertion. Example: “Writer A asserts that this was the reason for what happened. Then again, it’s possible that he was being paid to say this.”

22. That said

Usage: This is used in the same way as “then again”. Example: “The evidence ostensibly appears to point to this conclusion. That said, much of the evidence is unreliable at best.”

Usage: Use this when you want to introduce a contrasting idea. Example: “Much of scholarship has focused on this evidence. Yet not everyone agrees that this is the most important aspect of the situation.”

Adding a proviso or acknowledging reservations

Sometimes, you may need to acknowledge a shortfalling in a piece of evidence, or add a proviso. Here are some ways of doing so.

24. Despite this

Usage: Use “despite this” or “in spite of this” when you want to outline a point that stands regardless of a shortfalling in the evidence. Example: “The sample size was small, but the results were important despite this.”

25. With this in mind

Usage: Use this when you want your reader to consider a point in the knowledge of something else. Example: “We’ve seen that the methods used in the 19th century study did not always live up to the rigorous standards expected in scientific research today, which makes it difficult to draw definite conclusions. With this in mind, let’s look at a more recent study to see how the results compare.”

26. Provided that

Usage: This means “on condition that”. You can also say “providing that” or just “providing” to mean the same thing. Example: “We may use this as evidence to support our argument, provided that we bear in mind the limitations of the methods used to obtain it.”

27. In view of/in light of

Usage: These phrases are used when something has shed light on something else. Example: “In light of the evidence from the 2013 study, we have a better understanding of…”

28. Nonetheless

Usage: This is similar to “despite this”. Example: “The study had its limitations, but it was nonetheless groundbreaking for its day.”

29. Nevertheless

Usage: This is the same as “nonetheless”. Example: “The study was flawed, but it was important nevertheless.”

30. Notwithstanding

Usage: This is another way of saying “nonetheless”. Example: “Notwithstanding the limitations of the methodology used, it was an important study in the development of how we view the workings of the human mind.”

Giving examples

Good essays always back up points with examples, but it’s going to get boring if you use the expression “for example” every time. Here are a couple of other ways of saying the same thing.

31. For instance

Example: “Some birds migrate to avoid harsher winter climates. Swallows, for instance, leave the UK in early winter and fly south…”

32. To give an illustration

Example: “To give an illustration of what I mean, let’s look at the case of…”

Signifying importance

When you want to demonstrate that a point is particularly important, there are several ways of highlighting it as such.

33. Significantly

Usage: Used to introduce a point that is loaded with meaning that might not be immediately apparent. Example: “Significantly, Tacitus omits to tell us the kind of gossip prevalent in Suetonius’ accounts of the same period.”

34. Notably

Usage: This can be used to mean “significantly” (as above), and it can also be used interchangeably with “in particular” (the example below demonstrates the first of these ways of using it). Example: “Actual figures are notably absent from Scholar A’s analysis.”

35. Importantly

Usage: Use “importantly” interchangeably with “significantly”. Example: “Importantly, Scholar A was being employed by X when he wrote this work, and was presumably therefore under pressure to portray the situation more favourably than he perhaps might otherwise have done.”

Summarising

You’ve almost made it to the end of the essay, but your work isn’t over yet. You need to end by wrapping up everything you’ve talked about, showing that you’ve considered the arguments on both sides and reached the most likely conclusion. Here are some words and phrases to help you.

36. In conclusion

Usage: Typically used to introduce the concluding paragraph or sentence of an essay, summarising what you’ve discussed in a broad overview. Example: “In conclusion, the evidence points almost exclusively to Argument A.”

37. Above all

Usage: Used to signify what you believe to be the most significant point, and the main takeaway from the essay. Example: “Above all, it seems pertinent to remember that…”

38. Persuasive

Usage: This is a useful word to use when summarising which argument you find most convincing. Example: “Scholar A’s point – that Constanze Mozart was motivated by financial gain – seems to me to be the most persuasive argument for her actions following Mozart’s death.”

39. Compelling

Usage: Use in the same way as “persuasive” above. Example: “The most compelling argument is presented by Scholar A.”

40. All things considered

Usage: This means “taking everything into account”. Example: “All things considered, it seems reasonable to assume that…”

How many of these words and phrases will you get into your next essay? And are any of your favourite essay terms missing from our list? Let us know in the comments below, or get in touch here to find out more about courses that can help you with your essays.

At Oxford Royale Academy, we offer a number of  summer school courses for young people who are keen to improve their essay writing skills. Click here to apply for one of our courses today, including law , business , medicine  and engineering .

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100+ Useful Words and Phrases to Write a Great Essay

By: Author Sophia

Posted on Last updated: October 25, 2023

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How to Write a Great Essay in English! This lesson provides 100+ useful words, transition words and expressions used in writing an essay. Let’s take a look!

The secret to a successful essay doesn’t just lie in the clever things you talk about and the way you structure your points.

Useful Words and Phrases to Write a Great Essay

Overview of an essay.

Useful Phrases for Proficiency Essays

Developing the argument

• The first aspect to point out is that…
• Let us start by considering the facts.
• The novel portrays, deals with, revolves around…
• Central to the novel is…
• The character of xxx embodies/ epitomizes…

The other side of the argument

• It would also be interesting to see…
• One should, nevertheless, consider the problem from another angle.
• Equally relevant to the issue are the questions of…
• The arguments we have presented… suggest that…/ prove that…/ would indicate that…
• From these arguments one must…/ could…/ might… conclude that…
• All of this points to the conclusion that…
• To conclude…

Ordering elements

• Firstly,…/ Secondly,…/ Finally,… (note the comma after all these introductory words.)
• As a final point…
• On the one hand, …. on the other hand…
• If on the one hand it can be said that… the same is not true for…
• The first argument suggests that… whilst the second suggests that…
• There are at least xxx points to highlight.

Adding elements

• Furthermore, one should not forget that…
• In addition to…
• Moreover…
• It is important to add that…

Accepting other points of view

• Nevertheless, one should accept that…
• However, we also agree that…

Personal opinion

• We/I personally believe that…
• Our/My own point of view is that…
• It is my contention that…
• I am convinced that…
• My own opinion is…

Others’ opinions

• According to some critics… Critics:
• believe that
• suggest that
• are convinced that
• point out that
• emphasize that
• contend that
• go as far as to say that
• argue for this

Introducing examples

• For example…
• For instance…
• To illustrate this point…

Introducing facts

• It is… true that…/ clear that…/ noticeable that…
• One should note here that…

Saying what you think is true

• This leads us to believe that…
• It is very possible that…
• In view of these facts, it is quite likely that…
• Doubtless,…
• One cannot deny that…
• It is (very) clear from these observations that…
• All the same, it is possible that…
• It is difficult to believe that…

Accepting other points to a certain degree

• One can agree up to a certain point with…
• Certainly,… However,…
• It cannot be denied that…

Emphasizing particular points

• The last example highlights the fact that…
• Not only… but also…
• We would even go so far as to say that…

Moderating, agreeing, disagreeing

• By and large…
• Perhaps we should also point out the fact that…
• It would be unfair not to mention the fact that…
• One must admit that…
• We cannot ignore the fact that…
• One cannot possibly accept the fact that…

Consequences

• From these facts, one may conclude that…
• That is why, in our opinion, …
• Which seems to confirm the idea that…
• Thus,…/ Therefore,…
• Some critics suggest…, whereas others…
• Compared to…
• On the one hand, there is the firm belief that… On the other hand, many people are convinced that…

How to Write a Great Essay | Image 1

How to Write a Great Essay | Image 2

Phrases For Balanced Arguments

Introduction

• It is often said that…
• It is undeniable that…
• It is a well-known fact that…
• One of the most striking features of this text is…
• The first thing that needs to be said is…
• First of all, let us try to analyze…
• One argument in support of…
• We must distinguish carefully between…
• The second reason for…
• An important aspect of the text is…
• It is worth stating at this point that…
• On the other hand, we can observe that…
• The other side of the coin is, however, that…
• Another way of looking at this question is to…
• What conclusions can be drawn from all this?
• The most satisfactory conclusion that we can come to is…
• To sum up… we are convinced that…/ …we believe that…/ …we have to accept that…

How to Write a Great Essay | Image 3

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Synonyms for “Essay”

The term “Essay” is deeply rooted in the literary and academic arena, often denoting a short piece of writing on a particular subject. Originating from the French word ‘essayer’, meaning ‘to try’ or ‘to attempt’, an essay is an endeavor to express thoughts, arguments, or narratives in a structured manner. Over time, it has evolved into a popular form of writing, with several synonymous terms and types.

General Synonyms for “Essay”

Beyond academic precincts, the word essay resonates with various undertones depending on the context:

• Composition

Synonyms for “Essay” in Academic Writing

In academia, essays are a staple, reflecting deep introspection, research, or exploration:

• Dissertation

Detailed Synonyms: Definitions and Examples

Delving deeper, let’s explore these synonyms, accentuated with definitions and illustrative examples:

“The essay is a literary device for saying almost everything about almost anything.” – Aldous Huxley

The “Essay”, with its myriad forms and connotations, remains a primary medium for individuals to articulate, elucidate, and convey their thoughts. Ranging from personal narratives to critical analyses, essays facilitate the seamless flow of ideas, fostering deeper understanding and appreciation of myriad subjects.

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Expository Essay Vocab List for General Paper

In General Paper , there's a need to also work on providing felicitous language expressions and wide-ranging vocabulary (refer to the syllabus rubrics ). Examiners will differentiate your language bands based on whether your choice of vocabulary is apt, and sophisticated and appropriate to the essay task.

As such, one way to enhance the language in your essay is to utilise vocabulary which are loaded vocabulary words with complex meanings. Note however, that you should not be looking to inundate the essay with complex words which makes it difficult to use , but instead, appropriately and aptly to provide a deeper nuance to your writing.

This will also be in parallel to what you will see in certain language questions for Paper 2 Short Answer Questions, where loaded languages are used! In tutorials, we will be adapting and seeing how these vocabulary can fit into your essays better too 🙂

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Overall Synonyms: List of 25 Examples

Krystal N. Craiker

Overall means to take all parts into account or to look at something as a whole.

In essays and business writing in particular, it is an overused word. Luckily, there are many synonyms for overall that you can use.

For the purpose of this article, we are not talking about the loose protective coverall clothing item called overalls. Instead, we are talking about the adjective and adverb overall .

We have curated a list of 25 words you can use in lieu of overall .

Overall Synonyms in Emails

Overall synonyms in creative writing, overall synonyms in essay writing, final thoughts.

Business emails and other business communications use the word overall to mean “in general.” But there are many related words you can use instead.

Here are some overall synonyms for business writing:

• Principal/principally
• All things considered
• Comprehensive
• Across-the-board

Let’s look at a couple of these synonyms for overall in example sentences.

Original: Overall , the report shows promising results. With a synonym: As a whole , the report shows promising results.

Original: Our overall growth this quarter trended upward. With a synonym: Our across-the-board growth this quarter trended upward.

Overall isn’t as commonly used in creative writing, but it can become a crutch word, which is a word a writer overuses and leans on too heavily.

Creative writers should aim for a more vivid description rather than using a vague adverb or adjective like overall .

If you do need some synonyms for overall in your fiction or creative writing, here are some you could use:

• A great degree
• Collective/collectively
• All-embracing

Here’s an example of how you might use an overall synonym in your creative writing.

Original: The pirates were overall brave and passionate. With a synonym: The pirates were collectively brave and passionate.

Academic writing is another place that overall shows up frequently. It’s often used to make sweeping observations about data or other information.

Freshen up your essays and academic writing by using synonyms for overall . Let’s check out a few general synonyms you can use:

• A large extent
• A wide scope
• For the most part
• Global/globally
• Universal/universally
• Generally speaking
• Predominantly

Here is how using a synonym for overall might look in an essay.

Original: Early literacy skills show an overall positive effect on communication skills. With a synonym: Early literacy skills show a predominantly positive effect on communication skills.

You can use any of the synonyms in this article in any situation where they are appropriate. Sometimes, it might be beneficial to rearrange a sentence to avoid using overall altogether.

ProWritingAid can help you with overused words like overall . Simply click on the Overused Report to see which words you use too often.

You can also use our in-tool thesaurus by double-clicking on a word to see synonym suggestions.

Take your writing to the next level:

20 Editing Tips from Professional Writers

Whether you are writing a novel, essay, article, or email, good writing is an essential part of communicating your ideas., this guide contains the 20 most important writing tips and techniques from a wide range of professional writers..

Be confident about grammar

Check every email, essay, or story for grammar mistakes. Fix them before you press send.

Krystal N. Craiker is the Writing Pirate, an indie romance author and blog manager at ProWritingAid. She sails the seven internet seas, breaking tropes and bending genres. She has a background in anthropology and education, which brings fresh perspectives to her romance novels. When she’s not daydreaming about her next book or article, you can find her cooking gourmet gluten-free cuisine, laughing at memes, and playing board games. Krystal lives in Dallas, Texas with her husband, child, and basset hound.

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Synonyms of 'in general' in British English

Additional synonyms, browse alphabetically in general.

• in full swing
• in good faith
• in good part
• in good time
• All ENGLISH synonyms that begin with 'I'

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• How long is an essay? Guidelines for different types of essay

How Long is an Essay? Guidelines for Different Types of Essay

Published on January 28, 2019 by Shona McCombes . Revised on July 23, 2023.

The length of an academic essay varies depending on your level and subject of study, departmental guidelines, and specific course requirements. In general, an essay is a shorter piece of writing than a research paper  or thesis .

In most cases, your assignment will include clear guidelines on the number of words or pages you are expected to write. Often this will be a range rather than an exact number (for example, 2500–3000 words, or 10–12 pages). If you’re not sure, always check with your instructor.

In this article you’ll find some general guidelines for the length of different types of essay. But keep in mind that quality is more important than quantity – focus on making a strong argument or analysis, not on hitting a specific word count.

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Table of contents

Essay length guidelines, how long is each part of an essay, using length as a guide to topic and complexity, can i go under the suggested length, can i go over the suggested length, other interesting articles, here's why students love scribbr's proofreading services.

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In an academic essay, the main body should always take up the most space. This is where you make your arguments, give your evidence, and develop your ideas.

The introduction should be proportional to the essay’s length. In an essay under 3000 words, the introduction is usually just one paragraph. In longer and more complex essays, you might need to lay out the background and introduce your argument over two or three paragraphs.

The conclusion of an essay is often a single paragraph, even in longer essays. It doesn’t have to summarize every step of your essay, but should tie together your main points in a concise, convincing way.

The suggested word count doesn’t only tell you how long your essay should be – it also helps you work out how much information and complexity you can fit into the given space. This should guide the development of your thesis statement , which identifies the main topic of your essay and sets the boundaries of your overall argument.

A short essay will need a focused, specific topic and a clear, straightforward line of argument. A longer essay should still be focused, but it might call for a broader approach to the topic or a more complex, ambitious argument.

As you make an outline of your essay , make sure you have a clear idea of how much evidence, detail and argumentation will be needed to support your thesis. If you find that you don’t have enough ideas to fill out the word count, or that you need more space to make a convincing case, then consider revising your thesis to be more general or more specific.

The length of the essay also influences how much time you will need to spend on editing and proofreading .

You should always aim to meet the minimum length given in your assignment. If you are struggling to reach the word count:

• Add more evidence and examples to each paragraph to clarify or strengthen your points.
• Make sure you have fully explained or analyzed each example, and try to develop your points in more detail.
• Address a different aspect of your topic in a new paragraph. This might involve revising your thesis statement to make a more ambitious argument.
• Don’t use filler. Adding unnecessary words or complicated sentences will make your essay weaker and your argument less clear.
• Don’t fixate on an exact number. Your marker probably won’t care about 50 or 100 words – it’s more important that your argument is convincing and adequately developed for an essay of the suggested length.

In some cases, you are allowed to exceed the upper word limit by 10% – so for an assignment of 2500–3000 words, you could write an absolute maximum of 3300 words. However, the rules depend on your course and institution, so always check with your instructor if you’re unsure.

Only exceed the word count if it’s really necessary to complete your argument. Longer essays take longer to grade, so avoid annoying your marker with extra work! If you are struggling to edit down:

• Check that every paragraph is relevant to your argument, and cut out irrelevant or out-of-place information.
• Make sure each paragraph focuses on one point and doesn’t meander.
• Cut out filler words and make sure each sentence is clear, concise, and related to the paragraph’s point.
• Don’t cut anything that is necessary to the logic of your argument. If you remove a paragraph, make sure to revise your transitions and fit all your points together.
• Don’t sacrifice the introduction or conclusion . These paragraphs are crucial to an effective essay –make sure you leave enough space to thoroughly introduce your topic and decisively wrap up your argument.

If you want to know more about AI tools , college essays , or fallacies make sure to check out some of our other articles with explanations and examples or go directly to our tools!

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adverb as in chiefly

Strongest matches

• essentially
• predominantly
• principally

Strong matches

Weak matches

• in the first place
• in the main
• on the whole

adverb as in mainly

• first and foremost
• most of all
• substantially
• to the greatest extent

adverb as in ordinarily

• customarily

determiner as in any

• each and every

preposition as in about

Strong match

• approximately
• in the ball park
• in the neighborhood
• practically
• pretty nearly

Discover More

Related words.

Words related to in general are not direct synonyms, but are associated with the word in general . Browse related words to learn more about word associations.

preposition as in near an amount, quantity

determiner as in one, some; unspecified, indiscriminate

adverb as in most importantly

adverb as in for the most part

adverb as in usually

Example Sentences

Betsey Lane had spent most of her life as aid-in-general to the respected household of old General Thornton.

Hence we have an unlimited supply of reformers, philanthropists, humanitarians, and would-be managers-in-general of society.

She believed that details could excitingly be altered, but that things-in-general were comely and kind and immutable.

Gypsy installed herself as housekeeper-in-general, and she and Sarah lost no time in unpacking the cake and bread and butter.

So I only ask as a student of the great nothing-in-general, which men call the universe.'

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On this page you'll find 71 synonyms, antonyms, and words related to in general, such as: especially, essentially, largely, mostly, predominantly, and principally.

From Roget's 21st Century Thesaurus, Third Edition Copyright © 2013 by the Philip Lief Group.

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Synonyms of in general

• as in mostly
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Thesaurus Definition of in general

Synonyms & Similar Words

• predominantly
• principally
• substantially
• by and large
• more or less
• practically
• plus or minus
• approximately
• on the whole
• well - nigh
• incompletely

Antonyms & Near Antonyms

• categorically
• unqualifiedly

Thesaurus Entries Near in general

Cite this entry.

“In general.” Merriam-Webster.com Thesaurus , Merriam-Webster, https://www.merriam-webster.com/thesaurus/in%20general. Accessed 6 Apr. 2024.

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Mental health care is hard to find, especially for people with Medicare or Medicaid

Rhitu Chatterjee

With rates of suicide and opioid deaths rising in the past decade and children's mental health declared a national emergency , the United States faces an unprecedented mental health crisis. But access to mental health care for a significant portion of Americans — including some of the most vulnerable populations — is extremely limited, according to a new government report released Wednesday.

The report, from the Department of Health and Human Services' Office of Inspector General, finds that Medicare and Medicaid have a dire shortage of mental health care providers.

The report looked at 20 counties with people on Medicaid, traditional Medicare and Medicare Advantage plans, which together serve more than 130 million enrollees — more than 40% of the U.S. population, says Meridith Seife , the deputy regional inspector general and the lead author of the report.

Medicaid serves people on low incomes, and Medicare is mainly for people 65 years or older and those who are younger with chronic disabilities.

The report found fewer than five active mental health care providers for every 1,000 enrollees. On average, Medicare Advantage has 4.7 providers per 1,000 enrollees, whereas traditional Medicare has 2.9 providers and Medicaid has 3.1 providers for the same number of enrollees. Some counties fare even worse, with not even a single provider for every 1,000 enrollees.

"When you have so few providers available to see this many enrollees, patients start running into significant problems finding care," says Seife.

The findings are especially troubling given the level of need for mental health care in this population, she says.

"On Medicare, you have 1 in 4 Medicare enrollees who are living with a mental illness," she says. "Yet less than half of those people are receiving treatment."

Among people on Medicaid, 1 in 3 have a mental illness, and 1 in 5 have a substance use disorder. "So the need is tremendous."

The results are "scary" but "not very surprising," says Deborah Steinberg , senior health policy attorney at the nonprofit Legal Action Center. "We know that people in Medicare and Medicaid are often underserved populations, and this is especially true for mental health and substance use disorder care."

Among those individuals able to find and connect with a provider, many see their provider several times a year, according to the report. And many have to drive a long way for their appointments.

"We have roughly 1 in 4 patients that had to travel more than an hour to their appointments, and 1 in 10 had to travel more than an hour and a half each way," notes Seife. Some patients traveled two hours each way for mental health care, she says.

Mental illnesses and substance use disorders are chronic conditions that people need ongoing care for, says Steinberg. "And when they have to travel an hour, more than an hour, for an appointment throughout the year, that becomes unreasonable. It becomes untenable."

"We know that behavioral health workforce shortages are widespread," says Heather Saunders , a senior research manager on the Medicaid team at KFF, the health policy research organization. "This is across all payers, all populations, with about half of the U.S. population living in a workforce shortage."

But as the report found, that's not the whole story for Medicare and Medicaid. Only about a third of mental health care providers in the counties studied see Medicare and Medicaid patients. That means a majority of the workforce doesn't participate in these programs.

This has been well documented in Medicaid, notes Saunders. "Only a fraction" of providers in provider directories see Medicaid patients, she says. "And when they do see Medicaid patients, they often only see a few."

Lower reimbursement rates and a high administrative burden prevent more providers from participating in Medicaid and Medicare, the report notes.

"In the Medicare program, they set a physician fee rate," explains Steinberg. "Then for certain providers, which includes clinical social workers, mental health counselors and marriage and family therapists, they get reimbursed at 75% of that rate."

Medicaid reimbursements for psychiatric services are even lower when compared with Medicare , says Ellen Weber , senior vice president for health initiatives at the Legal Action Center.

"They're baking in those discriminatory standards when they are setting those rates," says Steinberg.

The new report recommends that the Centers for Medicare & Medicaid Services (CMS) take steps to increase payments to providers and lower administrative requirements. In a statement, CMS said it has responded to those recommendations within the report.

According to research by Saunders and her colleagues at KFF, many states have already started to take action on these fronts to improve participation in Medicaid.

Several have upped their payments to mental health providers. "But the scale of those increases ranged widely across states," says Saunders, "with some states limiting the increase to one provider type or one type of service, but other states having rate increases that were more across the board."

Some states have also tried to simplify and streamline paperwork, she adds. "Making it less complex, making it easier to understand," says Saunders.

But it's too soon to know whether those efforts have made a significant impact on improving access to providers.

CMS has also taken steps to address provider shortages, says Steinberg.

"CMS has tried to increase some of the reimbursement rates without actually fixing that structural problem," says Steinberg. "Trying to add a little bit here and there, but it's not enough, especially when they're only adding a percent to the total rate. It's a really small increase."

The agency has also started covering treatments and providers it didn't use to cover before.

"In 2020, Medicare started covering opioid treatment programs, which is where a lot of folks can go to get medications for their substance use disorder," says Steinberg.

And starting this year, Medicare also covers "mental health counselors, which includes addiction counselors, as well as marriage and family therapists," she adds.

While noteworthy and important, a lot more needs to be done, says Steinberg. "For example, in the substance use disorder space, a lot of addiction counselors do not have a master's degree. And that's one of their requirements to be a counselor in the Medicare program right now."

Removing those stringent requirements and adding other kinds of providers, like peer support specialists, is key to improving access. And the cost of not accessing care is high, she adds.

"Over the past two decades, [in] the older adult population, the number of overdose deaths has increased fourfold — quadrupled," says Steinberg. "So this is affecting people. It is causing deaths. It is causing people to go to the hospital. It increases [health care] costs."

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Guest Essay

A.I.-Generated Garbage Is Polluting Our Culture

By Erik Hoel

Mr. Hoel is a neuroscientist and novelist and the author of The Intrinsic Perspective newsletter.

Increasingly, mounds of synthetic A.I.-generated outputs drift across our feeds and our searches. The stakes go far beyond what’s on our screens. The entire culture is becoming affected by A.I.’s runoff, an insidious creep into our most important institutions.

Consider science. Right after the blockbuster release of GPT-4, the latest artificial intelligence model from OpenAI and one of the most advanced in existence, the language of scientific research began to mutate. Especially within the field of A.I. itself.

Adjectives associated with A.I.-generated text have increased in peer reviews of scientific papers about A.I.

Frequency of adjectives per one million words

Commendable

A study published this month examined scientists’ peer reviews — researchers’ official pronouncements on others’ work that form the bedrock of scientific progress — across a number of high-profile and prestigious scientific conferences studying A.I. At one such conference, those peer reviews used the word “meticulous” more than 34 times as often as reviews did the previous year. Use of “commendable” was around 10 times as frequent, and “intricate,” 11 times. Other major conferences showed similar patterns.

Such phrasings are, of course, some of the favorite buzzwords of modern large language models like ChatGPT. In other words, significant numbers of researchers at A.I. conferences were caught handing their peer review of others’ work over to A.I. — or, at minimum, writing them with lots of A.I. assistance. And the closer to the deadline the submitted reviews were received, the more A.I. usage was found in them.

If this makes you uncomfortable — especially given A.I.’s current unreliability — or if you think that maybe it shouldn’t be A.I.s reviewing science but the scientists themselves, those feelings highlight the paradox at the core of this technology: It’s unclear what the ethical line is between scam and regular usage. Some A.I.-generated scams are easy to identify, like the medical journal paper featuring a cartoon rat sporting enormous genitalia. Many others are more insidious, like the mislabeled and hallucinated regulatory pathway described in that same paper — a paper that was peer reviewed as well (perhaps, one might speculate, by another A.I.?).

What about when A.I. is used in one of its intended ways — to assist with writing? Recently, there was an uproar when it became obvious that simple searches of scientific databases returned phrases like “As an A.I. language model” in places where authors relying on A.I. had forgotten to cover their tracks. If the same authors had simply deleted those accidental watermarks, would their use of A.I. to write their papers have been fine?

What’s going on in science is a microcosm of a much bigger problem. Post on social media? Any viral post on X now almost certainly includes A.I.-generated replies, from summaries of the original post to reactions written in ChatGPT’s bland Wikipedia-voice, all to farm for follows. Instagram is filling up with A.I.-generated models, Spotify with A.I.-generated songs. Publish a book? Soon after, on Amazon there will often appear A.I.-generated “workbooks” for sale that supposedly accompany your book (which are incorrect in their content; I know because this happened to me). Top Google search results are now often A.I.-generated images or articles. Major media outlets like Sports Illustrated have been creating A.I.-generated articles attributed to equally fake author profiles. Marketers who sell search engine optimization methods openly brag about using A.I. to create thousands of spammed articles to steal traffic from competitors.

Then there is the growing use of generative A.I. to scale the creation of cheap synthetic videos for children on YouTube. Some example outputs are Lovecraftian horrors, like music videos about parrots in which the birds have eyes within eyes, beaks within beaks, morphing unfathomably while singing in an artificial voice, “The parrot in the tree says hello, hello!” The narratives make no sense, characters appear and disappear randomly, and basic facts like the names of shapes are wrong. After I identified a number of such suspicious channels on my newsletter, The Intrinsic Perspective, Wired found evidence of generative A.I. use in the production pipelines of some accounts with hundreds of thousands or even millions of subscribers.

As a neuroscientist, this worries me. Isn’t it possible that human culture contains within it cognitive micronutrients — things like cohesive sentences, narrations and character continuity — that developing brains need? Einstein supposedly said : “If you want your children to be intelligent, read them fairy tales. If you want them to be very intelligent, read them more fairy tales.” But what happens when a toddler is consuming mostly A.I.-generated dream-slop? We find ourselves in the midst of a vast developmental experiment.

There’s so much synthetic garbage on the internet now that A.I. companies and researchers are themselves worried, not about the health of the culture, but about what’s going to happen with their models. As A.I. capabilities ramped up in 2022, I wrote on the risk of culture’s becoming so inundated with A.I. creations that when future A.I.s are trained, the previous A.I. output will leak into the training set, leading to a future of copies of copies of copies, as content became ever more stereotyped and predictable. In 2023 researchers introduced a technical term for how this risk affected A.I. training: model collapse . In a way, we and these companies are in the same boat, paddling through the same sludge streaming into our cultural ocean.

With that unpleasant analogy in mind, it’s worth looking to what is arguably the clearest historical analogy for our current situation: the environmental movement and climate change. For just as companies and individuals were driven to pollute by the inexorable economics of it, so, too, is A.I.’s cultural pollution driven by a rational decision to fill the internet’s voracious appetite for content as cheaply as possible. While environmental problems are nowhere near solved, there has been undeniable progress that has kept our cities mostly free of smog and our lakes mostly free of sewage. How?

Before any specific policy solution was the acknowledgment that environmental pollution was a problem in need of outside legislation. Influential to this view was a perspective developed in 1968 by Garrett Hardin, a biologist and ecologist. Dr. Hardin emphasized that the problem of pollution was driven by people acting in their own interest, and that therefore “we are locked into a system of ‘fouling our own nest,’ so long as we behave only as independent, rational, free-enterprisers.” He summed up the problem as a “tragedy of the commons.” This framing was instrumental for the environmental movement, which would come to rely on government regulation to do what companies alone could or would not.

Once again we find ourselves enacting a tragedy of the commons: short-term economic self-interest encourages using cheap A.I. content to maximize clicks and views, which in turn pollutes our culture and even weakens our grasp on reality. And so far, major A.I. companies are refusing to pursue advanced ways to identify A.I.’s handiwork — which they could do by adding subtle statistical patterns hidden in word use or in the pixels of images.

A common justification for inaction is that human editors can always fiddle around with whatever patterns are used if they know enough. Yet many of the issues we’re experiencing are not caused by motivated and technically skilled malicious actors; they’re caused mostly by regular users’ not adhering to a line of ethical use so fine as to be nigh nonexistent. Most would be uninterested in advanced countermeasures to statistical patterns enforced into outputs that should, ideally, mark them as A.I.-generated.

That’s why the independent researchers were able to detect A.I. outputs in the peer review system with surprisingly high accuracy: They actually tried. Similarly, right now teachers across the nation have created home-brewed output-side detection methods , like adding hidden requests for patterns of word use to essay prompts that appear only when copied and pasted.

In particular, A.I. companies appear opposed to any patterns baked into their output that can improve A.I.-detection efforts to reasonable levels, perhaps because they fear that enforcing such patterns might interfere with the model’s performance by constraining its outputs too much — although there is no current evidence this is a risk. Despite public pledges to develop more advanced watermarking, it’s increasingly clear that the companies are dragging their feet because it goes against the A.I. industry’s bottom line to have detectable products.

To deal with this corporate refusal to act we need the equivalent of a Clean Air Act: a Clean Internet Act. Perhaps the simplest solution would be to legislatively force advanced watermarking intrinsic to generated outputs, like patterns not easily removable. Just as the 20th century required extensive interventions to protect the shared environment, the 21st century is going to require extensive interventions to protect a different, but equally critical, common resource, one we haven’t noticed up until now since it was never under threat: our shared human culture.

Erik Hoel is a neuroscientist, a novelist and the author of The Intrinsic Perspective newsletter.

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