Ashwin Vasan M.D., Ph.D. – Fountain House, Columbia University
Benjamin F. Miller, PsyD - Well Being Trust, Stanford School of Medicine
The winning slogan for our current presidential election could well be “it’s mental health, stupid.” Why? Because the mental health impacts of COVID-19 are likely to outlast the virus itself and to be a defining theme of the next four years and more.
Our mental health and well-being is shaped by social and economic systems from housing, education, jobs and infrastructure, all the way through to loneliness and opportunities for social connection. The same societal structures and inequities that are threatened by the virus. For too long, though, mental illness has been viewed as a solely personal issue to be tackled by the individual privately, without a systems approach.
A recent survey by the CDC found that 40% of U.S. adults reported struggling with mental health or substance use in the last month. More than 30% of adults experienced symptoms of anxiety or depression and 11% of adults seriously considered suicide. Further research conducted by JAMA found that depression rates have more than tripled since the pandemic’s inception. This latest data confirmed what we’ve long feared: we are now experiencing a profound mental health crisis that if left unchecked, will break our chances of collective recovery from this pandemic.
As COVID-19 struck the United States, we learned that while the virus did not discriminate, we as people, do, and thus its greatest impact was felt by communities of color and already vulnerable and marginalized populations. Coupled with what we already know regarding COVID-related job loss, this new study makes this impact painfully clear and it is deepening racial and social inequities that were already embedded before the pandemic.
In an election season in which candidates must hold themselves accountable to both pandemic recovery and structural racism, a winning strategy for political leaders against this one-two punch is to prioritize mental health.
The mental health crisis exacerbated by COVID-19 is not going anywhere, and without mitigation, research shows that the associated trauma can be passed down through generations. We need to take the gravity of the CDC’s data to heart by lifting up mental health as an election issue. We need to demand that our political leaders step up with a far-reaching, intersectional mental health plan to address this silent crisis.
As Republicans and Democrats gather this month to preview their vision for the country moving forward, access to affordable mental health care and strengthening the social and community building blocks for good mental and physical health, must be a part of our response to COVID-19. In fact, over two thirds of American voters are demanding it. Here are some concrete steps that must be part of any domestic policy platform:
1. Improve mental health screening. Research following the Ebola pandemic showed that patients suffered persistent trauma, leading to long-term psychological distress. Additional investment in screening and treating mental health and addiction must be done using front-line clinicians like primary care, breaking down existing barriers to mental health care in a system that often fails to link the most obvious of connections – the mind and body - primary and mental health care.
2. Use telemedicine. Prior to COVID-19, mental health care in the U.S. was difficult to access, with an estimated 111 million people living in a Mental Health Professional Shortage Area. The use of telemedicine for mental health makes mental health care more accessible and its use must persist long-term. Making these temporary changes permanent would go a long way in helping increase access to countless.
3. Achieve universal health coverage. The U.S. remains one of few countries in the industrialized world where health insurance is tied to employment. More than 30 million people have lost their jobs in the pandemic, which will mean millions have already lost insurance or struggle to pay for it, likely adding to the rolls of 28 million Americans who were uninsured prior to COVID-19.
4. Increase paraprofessional mental health care. Paraprofessionals provide an important component of mental health care, including hotlines and recovery and support groups. Recent reports indicate that, while crisis call and text lines have skyrocketed in volume, thousands of support groups that prevent crises have been forced to either close their doors or scramble to provide care and fellowship via technology. These resources are key to supporting good mental health, and effective programs must be funded at higher levels.
5. Create programs to support vulnerable populations, first-responders, and essential workers. COVID-related school closures have already adversely impacted millions of children who rely on schools for structure, socialization, and fundamental services like daily meals and primary health care. Social distancing will also exacerbate the existing health risks loneliness and isolation pose to socially vulnerable populations like those with serious mental illness, the chronically homeless, refugees, and the incarcerated and formerly incarcerated, and older adults. Additionally, Front-line healthcare workers are braving conditions that are traumatizing, leading to burnout and, tragically, even suicide. This latest CDC study highlights that almost 31 percent of unpaid caregivers and 22 percent of essential workers had also contemplated suicide within the previous 30 days. We must provide these groups with universally covered mental health supports, including those focused on post-traumatic stress disorder (PTSD).
6. Create a financial safety net. Previous studies demonstrate a strong association between economic downturn and a rise in mental and behavioral health diseases, especially for young people. The Federal government must provide a robust financial safety net for the people most impacted financially by the crisis, including social services, employment opportunities, and income support.
7. Invest upstream in communities. Addressing the mental health toll of COVID will not be possible by focusing on mental health care alone. We must also redirect resources into building healthier communities. This means that stimulus or investments into affordable housing, education, transportation, safety, environmental protection, must not only be seen as goods in and of themselves, but also as upstream preventive measures for future health and mental health crises, that will cost us in human and economic terms going forward, if not addressed.
8. Include mental health experts in task forces. Other countries found that without a mental health lead involved in planning, resources are wasted, and the efficacy of mental health responses is reduced. Mental health experts must be at the policy table to sufficiently incorporate solutions for acute and long-term needs into our epidemic and recovery response.
The next stage of this public health crisis is at our doorstep and how we respond will reflect who we are as a civil society for decades to come. This is not about one individual but all of us. How we address mental health may be the very thing that could make or break our collective recovery.