It’s Not a Very Pretty Picture
Consider these basic statistics: 28% of Americans reported worsening mental health and 34% report worsening emotional well-being at the end of April, according to the Axios-Ipsos Coronavirus Index.
The Crisis Text Line (which is a free 24/7 support for those in crisis who can text 741741 from anywhere in the US to connect with a trained Crisis Counselor) has seen a 78% increase in texts relating to domestic violence, a 44% increase in texting about sexual abuse, and the largest group of texters are now in the 18-to-35 age range, who are being disrupted by quarantines and the effects of the economy.
It isn’t only that people are isolated from care, but from each other — their family and friends. In the United States, more than a quarter of the population lives alone, and studies have consistently shown correlations between loneliness and substance abuse/mood disorders. And there are others who are stuck inside with abusive partners or trying to survive already strained relationships.
Other groups are at risk as well. Such as those managing addiction, who could have a heightened risk of relapse without in-person meetings or access to rehab. While some will bounce back after normalcy returns, for others, unmanaged stresses put them in jeopardy of having bigger problems down the line.
The COVID pandemic is swiftly fomenting another crisis in our country — a mental health crisis that will carry with it impacts that will likely be felt for years to come. The primary causes of these deleterious mental health effects are a combination of media coverage, the economy, and quarantines instituted around the country.
COVID-19 hasn’t just disrupted how our lives work, it has disrupted how our minds work. “We’re constantly drawing on past experiences to make predictions about the future,” says Mimi Winsberg, a psychiatrist and co-founder of Brightside, a mental health telemedicine service.
“That feature of our brains is working in overdrive if you will because many of the things that we have learned to expect are suddenly different. We’re trying to adjust to a new set of rules, a new set of circumstances.”
“Much like how we don’t know how many asymptomatic coronavirus carriers are going to manifest into needing care, we’re seeing the same thing in mental health,” Winsberg says. “All of us that are struggling with the adjustments to new circumstances; some percentage will actually manifest into clinical anxiety or depression.”
Crises Take a Heavy Toll on Mental Health
What History has to Teach Us
According to Joshua Gordon, director of the National Institute of Mental Health, “After [Hurricane] Katrina, up to 50% of the people who lived in affected counties had a diagnosable mental illness, most of them post-traumatic stress disorder.”
There weren’t any studies about how the flu pandemic of 1918 impacted mental health, but one of the researchers who studied that period found evidence that many survivors of the flu at the time experienced sleeplessness, depression, and other unpleasant disruptions to conducting their daily lives.
Essential Workers, Including Health-Care Personnel
One of the populations who may not be receiving enough attention is essential workers, including health-care personnel. The latest round of survey data shows the impact that COVID is having on their mental health. Two-thirds of those surveyed who live in a home with a health-care worker reported that the worry or stress from the virus had caused them to experience at least one adverse effect on their mental health or well-being sometime over the past two months.
Recent suicides and increased calls to crisis lines dedicated to health professionals and other essential workers highlight the severity of the unaddressed problem. The mental health challenge is daunting—and not only for those already saddled with mental-health and substance-abuse issues or those at risk because of the changes in their life caused by the pandemic. The people crucial to fighting the COVID are vulnerable as well.
Demand for Remote Therapy Continues to Rise
Client demand for Talkspace, the text and video chat therapy service endorsed by gold-medal Olympian Michael Phelps, has increased 65% since mid-February. According to Neil Leibowitz, Talkspace’s chief medical officer, the company has also been bombarded with inquiries from employers who are interested in setting up the service for their workers, many of whom are juggling parenting duties with their jobs.
Winsberg’s Brightside, an app offering treatment and medication for depression and anxiety, has witnessed a 50% rise in new users in recent months. Big Health, a digital therapeutics company, has recently released free programming that combines cognitive and behavioral techniques to mitigate anxiety and poor sleep.
And the corporate world is quickly jumping on the bandwagon. Already 50 large companies such as Nike, Target, and supermarket chain HEB have initiated or expanded their use of online mental health programming tools. (The American Psychiatric Association finds video-based sessions “equivalent” to in-person care for diagnosis, treatment, quality, and patient satisfaction.)
But Congress Has Yet to Do Its Share
Thus far, lawmakers haven’t provided explicit financial support for mental health and addiction clinicians to provide meaningful, timely, and convenient care. Nor have they included within enhanced funding to Medicaid programs and hospitals explicit instruction for allocation to mental-health resources, including prioritization for programs that integrate mental-health resources in emergency rooms and other hospital wards.
But perhaps more importantly, Congress seems to be missing the opportunity to rethink the American approach to mental health care in general, to craft a new vision. This vision would create an integrated system that serves settings as varied as primary care, our schools, our prisons, our workplaces, and our homes. Such a system will require a substantial allocation of resources.
The sad reality is that improving mental health services has not been a priority during the current pandemic. The CARES Act, the $2 trillion relief bill that flew through Congress, included a measly $425 million for the Substance Abuse and Mental Health Services Administration. While this investment is welcome, at the same time it also underscores a general lack of official interest in this crucial area.
To better understand these numbers, one needs to realize that $425 million is less than 1 percent of the total amount invested in the airline industry and an even smaller fraction of the 5 billion dedicated to health-care providers as a whole. Crises provide policymakers the opportunity to take a new look at the nation’s problems. But thus far, Congress has failed to capitalize on the mental-health crisis in any meaningful way.
Congress’s failure to seriously engage the problem will invariably prove harmful to patients and their families, and in the long run will be costly to insurers and taxpayers as well. Mental-health disorders were already at the top of the list of the most costly conditions in American health care even before COVID-19.
Add in a Vulnerable Healthcare System
The Situation Before COVID
Even prior to the COVID-19 crisis, America’s mental-health infrastructure for addiction and substance abuse services was fragmented, overburdened, and underfunded. The pandemic has placed further stress on that broken system.
Rates of drug overdoses and suicides have been climbing over the past few years. In 2017, 17.3 million adults in the U.S. had at least one major depressive episode. Despite a law that requires insurers to cover mental health care, it is reported that many insurance companies routinely deny claims or limit coverage.
In some states, patients are 10 times more likely to pay for expensive out-of-network visits for mental health than for primary care. Aside from the problem of cost, many people don’t seek treatment at all. One report found that stigma and shame keep 80% of people out of treatment. COVID has the potential to make these problems even worse.
An Uncomfortable Exposure
Experts are worried that the U.S. healthcare system may not be up to the task of serving all of the people who need help in the wake of the pandemic.
Many mental health facilities are already facing collapse due to the financial fallout from COVID, forcing organizations, including the American Psychiatric Association, to request that the Trump administration extend support to those struggling facilities during this time.
Organizations that provide behavioral-health services are facing their greatest financial challenge anyone can remember. As an online survey of 880 such organizations recently found that the pandemic is forcing practices to reduce services, provide care to patients without sufficient protective equipment, lay off and furlough employees, and risk closure within months.
For many people plagued with serious mental illness who are seeking treatment or access to their medications, the doors of many community mental-health centers are closed with no immediate plans to reopen. For those who are suffering from both mental illness and COVID, including many who are homeless, no care is available for them at all, and they risk exposing others to the virus.
Mirroring the U.S. health-care system, the sudden and growing need for mental health care is leaving providers overwhelmed. One of the reasons for this overwhelm is that there aren’t enough therapists to go around. “Demand has increased substantially for American mental health, and our supply hasn’t changed in a meaningful way,” says Ken Duckworth, Chief Medical Officer for the National Alliance on Mental Illness.
“It’s not really a system,” he says of the U.S. mental health infrastructure. “It’s a patchwork quilt of individuals and well-meaning policy people trying to provide large numbers of services to large numbers of people in a payment structure that is varied and complex. It’s quite a challenge.”
And the longer the crisis drags on, the more potent the danger to Americans’ emotional well-being. “After infections begin ebbing, a secondary pandemic of mental-health problems will follow,” The Atlantic’s Ed Yong wrote. “At a moment of profound dread and uncertainty, people are being cut off from soothing human contact.”
What to Expect Going Forward
Experts don’t expect the numbers of those requiring mental health support will decrease once the quarantines are lifted and people start venturing out again. Instead, they say the types of issues people currently are dealing with will transition into chronic problems — like depression and PTSD.
When the pandemic ebbs, the demands for money to ease economic, medical, and social problems will accelerate. When that happens, we cannot allow the needs of mental health to be pushed aside by other priorities. If that occurs, the price that our entire society will pay will be difficult to gauge. But one thing is certain — it will be fearsome!
“I think it’s going to be a long journey that will not be linear, and I think that the scar of the mental health repercussions is going to burn for years,” Nancy Lublin, CEO of Crisis Text Line said.
The bottom line is that extreme measures were taken to try to stave off the physical health effects of the coronavirus pandemic. Experts warn that hospitals and providers, and indeed the United States Government, need to similarly prepare for the mental health effects expected as the crisis continues — and for years to come. We can’t afford any other option.