In the midst of the coronavirus pandemic, we are also on the brink of a mental health pandemic that our current system is not equipped to handle.
A recent poll by the Kaiser Family Foundation found that 45% of U.S. adults said the pandemic has affected their mental health, with 19% saying it has had a “major impact”. A majority of Americans (57%) also said they were worried they could be exposed to COVID-19 since they couldn’t afford to miss work and therefore couldn’t stay home.
Even before the coronavirus outbreak, roughly 1 in 5 Americans experienced a mental illness within a given year, with some 10 million adults having serious thoughts of suicide. Now, these issues are poised to grow worse: In my psychiatry practice, some of my college-aged patients who were previously able to manage their depression and anxiety are crippled in paralyzing fear of going outside, or depressed about the loss of their year and uncertain of their future. My health care worker patients can’t sleep, spending most waking hours consumed by the vicarious trauma of managing the pandemic. My older patients have voiced thoughts of suicide, as they do not want to be a burden on family or the health system should they test positive for COVID-19.
Like physical health, mental health waxes and wanes, underscoring the need for a system that addresses all stages of mental health throughout the lifespan, and for one that is able to meet the emerging effects of this pandemic among health care workers, older adults, those with suicidal thoughts, children out of school and the general population.
And yet many Americans struggle to pay for mental health, with almost half (42%) viewing cost or poor insurance coverage as the main barrier for Americans overall to accessing care. Despite federal laws that require mental health and medical services to be comparable, mental health care continues to lack the same reimbursements as care for physical health. For example, one insurance company has covered only what was considered a crisis, but not needed treatment before or after the crisis resolves. This is the pandemic equivalent of only covering COVID-19 patients while they are on ventilators, but not the medical care before or after they are in acute respiratory failure.
We need solutions that will provide lower-cost mental health care. A staged approach to mental health problems that emphasizes prevention and recovery maintenance can be cost-effective and build on family and community resources. Training people in resiliency skills should be the norm in clinical practice and the community, to help people as they navigate key points in their lives such as leaving school, becoming a parent, losing a job, retiring from the labor force or even living through a pandemic.
Technology can help with social interaction, anxiety, depression and substance abuse, and can passively track mental health symptoms, but may not be enough. Prior to the pandemic, telehealth was not always covered by insurance; restrictions have temporarily been lifted for many, but need to continue post-pandemic. Meanwhile, the number of psychiatrists accepting insurance is low due to poor reimbursement rates, but will increase with mental health parity.
As we move forward, we also must continue to combat the social and personal stigma against seeking mental health care. A cross-disciplinary collaboration involving business, technology, entertainment and medicine can help do so through public education and social awareness. People trained in basic first aid should also be trained in Mental Health First Aid. Employers can innovate and change workforce policies to highlight the importance of mental health, showing that mental health problems are as common and critical as medical problems. This could enhance not only well-being, but also productivity.
For too long, the stigma of mental health problems has influenced both policy and practice in America, leading to unnecessary and unfair suffering. While our battle against the novel coronavirus requires all our collective will, we must not forget that our society also requires adequate mental health care to survive and thrive, both now and after we emerge from the coronavirus’ shadow.
Suzan Song, M.D.
Copyright 2020 U.S. News & World Report