Even as the speedy approval of two coronavirus vaccines prompts optimism that the end of the pandemic may be in sight, experts warn that a parallel mental health crisis will be with us for years to come. Mental health disorders and related substance abuse issues can be just as deadly as the virus. A coalition of the nation's leading mental health advocacy organizations and professional associations says this often hidden epidemic deserves urgent and unified action.
"The mental health crisis that has evolved along with the Covid pandemic is unprecedented," the executives declared in a joint statement. "The levies have broken on an overwhelmed system of care and state leadership must move to address mental health care as an integral aspect of their pandemic response."
The coalition's detailed policy proposals put together by prominent organizations like the American Psychiatric Association, the National Alliance on Mental Illness, and The Kennedy Forum focuses on the public sector. But business leaders will find "A Unified Vision for Transforming Mental Health and Substance Use Care" a useful lens for shaping their health and wellness programs.
Moreover, the group's insistence on seeing mental health issues in a larger social context is a timely reminder that the pandemic and our national reckoning with a wide range of social justice issues are very much interconnected.
A "broken" mental health infrastructure
Although it is the coronavirus and the resulting economic slowdown that have pushed many Americans to the breaking point, the group points out in an op-ed that the current mental health crisis has been many years in the making.
"Over decades, America's mental health care system has been chronically underfunded and broken such that people with serious mental illness were more likely to be living on the streets, languishing in jails, or dying two decades prematurely in poverty rather than receiving compassionate treatment. And all that was before Covid-19 arrived."
The Kaiser Family Foundation also argues that the pandemic has only exacerbated long-standing issues. Deaths due to drug overdose tripled in the last two decades. Suicide rates among adolescents have doubled in the previous ten years, and suicide is now the second leading cause of death in young people aged 12 to 17.
Although there seems to be a growing recognition of the pandemic's strain on our mental health system, the response from public officials has not kept pace. Of the $2.5 trillion in emergency relief approved in June, for example, only $425 million (just over a hundredth of one percent) was designated for mental health and substance use treatment. Meanwhile, overdose deaths have been on the rise, even as some clinics have been forced to shut their doors due to lack of resources.
Early identification and prevention
Mental health issues often have deep roots. The "Unified Vision" report cites research showing that 50% of mental health illness begins by age 14. Trauma or crisis early in life can have lasting consequences. The incidence of "adverse childhood experiences" (or ACEs) was already at alarming levels. With the additional stresses of the pandemic, and with young people removed from the support systems provided by schools, those numbers can be expected to go through the roof.
Accordingly, the report stresses that all settings where children and youth receive services should be "trauma-informed"—that is, staff should be trained to screen for and identify signs of trauma and equipped to make the appropriate referrals.
An eye on equity
The report is consistent in identifying how mental health issues intersect with larger questions of social justice. This is a particular concern in the emergency response to crises involving mental health and substance abuse. People in crisis need a public health intervention, not a law enforcement response.
A recent report from the Brookings Institute also notes how inadequate funding of mental health services results in police intervening in situations they are not suited to handle. One study finds that over 20% of officer-involved deaths were related to mental health or substance abuse. According to the National Alliance on Mental Illness, people in a mental health crisis are more likely to encounter police than to get medical attention.
Thus, mental health is very much connected to other questions of racial and economic justice we are currently grappling with as a nation. The Kaiser Family Foundation also finds that the pandemic is disproportionately affecting women's mental health. 57% of women say their mental health has been negatively affected by the pandemic, compared to 44% of men. That is just one sign, they say, of a growing gender gap in mental health.
A holistic vision
Part of a holistic vision is acknowledging all of the ways mental health intersects with a range of economic, racial, and gender issues. It also means looking at how mental health and substance abuse are sometimes marginalized within the health care system.
Far too often, the "Unified Vision" report states, mental health and substance use care are "siloed" within health care delivery systems. Siloed care not only results in inferior care but contributes to the stigma around mental health and discourages many from seeking help. The most effective way to counter that stigma is two-fold. First, mental health and substance use screening should be integrated into all primary care services. Second, appropriate care should be readily available within the primary care system.
Unfortunately, the coronavirus has revealed a health care system that is fractured and responds to crises in a piecemeal fashion. We have seen the exact opposite of a unified vision—in our response to the pandemic itself, to a range of related social and economic issues and a parallel epidemic in mental health and substance abuse. The silver lining is that the pandemic has opened our eyes to how multifaceted real well-being is. It truly takes a village to ensure healthy and resilient communities. Going forward, we can hopefully unite around a new vision of our collective health and well-being.