Woman feels sad and desperate
While the rapid approval of two coronavirus vaccines raises optimism that the end of the pandemic may be in sight, experts warn that a parallel mental health crisis will be upon us in the years to come. Mental disorders and related drug problems can be just as deadly as the virus. A coalition of the country’s leading mental health organizations and professional associations says this often hidden epidemic deserves urgent and unified action.
“The mental health crisis that has developed along with the Covid pandemic is unprecedented,” the executives said in a joint statement. “The levies on an overwhelmed care system are broken and government leaders must strive to address mental health care as an integral aspect of their pandemic response.”
The coalition’s detailed policy proposals, compiled by leading organizations such as the American Psychiatric Association, the National Alliance on Mental Illness, and the Kennedy Forum, focus on the public sector. However, business executives will find that “A Unified Vision for Mental Health Transformation and Substance Use Care” is a useful lens in designing their health and wellness programs.
In addition, the group’s insistence on seeing mental health issues in a wider social context is a timely reminder that the pandemic and our national reckoning are very closely related to a myriad of social justice issues.
A “broken” mental health infrastructure
Although it is the coronavirus and the resulting economic slowdown that has brought many Americans to the breaking point, the group notes in a statement that the current mental health crisis has been underway for many years.
“For decades, the American health system was chronically underfunded and broken, leaving people with severe mental illnesses more likely to live on the streets, languish in jails, or die prematurely in poverty two decades instead of being treated compassionately. And all that was before Covid-19 arrived. “
The Kaiser Family Foundation also argues that the pandemic only exacerbated longstanding problems. Deaths from overdose have tripled in the past two decades. The suicide rate among teenagers has doubled in the last decade, and suicide is now the second leading cause of death among young people aged 12-17.
Although the burden of the pandemic on our mental health system seems increasingly recognized, the response from officials has not kept pace. For example, of the $ 2.5 trillion emergency relief approved in June, only $ 425 million (just over a hundredth of a percent) went to treating mental health and substance use. Meanwhile, overdose deaths have risen, although some clinics have been forced to close their doors due to lack of resources.
Early detection and prevention
Mental health problems often have deep roots. The Unified Vision report cites research showing that 50% of mental illnesses begin by age 14. Traumas or crises at a young age can have lasting consequences. The incidence of “childhood adverse experiences” (ACEs) was already alarming. Given the added burden of the pandemic and the fact that young people are excluded from the support systems provided by schools, these numbers are expected to go over the top.
Accordingly, the report emphasizes that all institutions providing services to children and adolescents should be “trauma-informed” – that is, staff should be trained to recognize and identify signs of trauma and be equipped to make referrals.
Keep an eye on justice
The report consistently identifies how mental health problems intersect with larger social justice issues. This is of particular concern in the emergency response to mental health crises and substance abuse. People in crisis need public health intervention, not a law enforcement response.
A recent report by the Brookings Institute also notes that insufficient funding for mental health services leads to police intervening in situations for which they are not appropriate. One study found that over 20% of civil servant deaths were due to mental health or substance abuse. According to the National Alliance on Mental Illness, people in a mental crisis are more likely to encounter the police than medical help.
Hence, mental health is closely related to other racial and economic justice issues that we are currently grappling with as a nation. The Kaiser Family Foundation also notes that the pandemic is disproportionately affecting women’s mental health. 57% of women say their mental health was negatively affected by the pandemic, compared with 44% of men. This is just a sign of a growing gender gap in mental health.
A holistic vision
Part of a holistic vision is to recognize all kinds of intersections of mental health with a range of economic, racial and gender issues. It also means examining how mental health and substance abuse in healthcare are sometimes marginalized.
Far too often, the Unified Vision report states that mental health and substance use care are “isolated” within health systems. Not only does siled care lead to substandard care, it also adds to the mental health stigma and discourages many from seeking help. The most effective way to counter this stigma is twofold. First, mental health and substance use screening should be integrated into all primary care services. Second, adequate care should be readily available within the primary care system.
Unfortunately, the coronavirus has exposed a broken health system that is piecemeal to respond to crises. We saw the exact opposite of a unified vision – in our response to the pandemic itself, to a range of related social and economic problems, and a parallel epidemic of mental health and substance abuse. The silver lining is that the pandemic has opened our eyes to the multifaceted real wellbeing. It really takes a village to ensure healthy and resilient communities. Hopefully in the future we can agree on a new vision of our collective health and wellbeing.