The Mental Health Crisis is Spreading Faster Than Our Infrastructure Can Support

As the COVID-19 pandemic takes a global toll on physical health, it is simultaneously feeding a related mental health epidemic. In the United States, a second emerging crisis—brought on by the virus itself, coupled with the pandemic’s impacts on the economy and disruption of daily life—is exposing gaps in health care infrastructure that can no longer go ignored. 

Since March, ICF has been regularly tracking Americans’ attitudes and behaviors around COVID-19, including mental health symptoms and substance use. At the end of March, 70% of Americans had experienced some symptoms of depression or anxiety in the prior two weeks. This remained consistent in June (69%). 

For many, those feelings stemmed from the physical health effects of the virus: being diagnosed or having a household member diagnosed with COVID-19; concern for family members; and increasing worry about the likelihood of getting sick. 

Economic concerns played a role as well. At the end of March, the loss of a job or reduction in work hours were linked to poorer mental health, as was the expected inability to pay future bills. Since then, COVID-19 and its economic impacts have taken an even greater toll on many Americans. 

The health and financial strains caused by COVID-19 led more Americans to report poorer mental health, which in turn was associated with increases in smoking and alcohol consumption. Those behaviors increased among Americans with symptoms of depression and anxiety whose job statuses had been impacted. We saw these trends continue through June. 

The mental health impacts of COVID-19 are being exacerbated by the fact that mental health issues carry a greater stigma compared to physical health issues, which for many creates a barrier to seeking treatment. This is especially true now, as Americans are quarantining with roommates or family members and may not feel comfortable engaging in virtual therapy sessions without the privacy of a provider’s office. 

All of these things are risk factors for suicide, and mental health experts are starting to warn of the potential for an increase in suicide rates as a direct result of the pandemic. A new analysis from The Well Being Trust and The Robert Graham Center for Policy Studies in Family Medicine and Primary Care projects that the pandemic could lead to 75,000 additional deaths from alcohol and drug misuse and suicide. Additionally, it is well documented that suicide rates increase during economic downturns like the one we are currently experiencing. For instance, a study of the Great Recession found a strong association between unemployment rates and total suicide rates over time. 

Policy Implications

Shortcomings in the health care system are longstanding and the pandemic has only compounded them, further limiting access to care. More than 40 million Americans are without a job, in many cases without insurance, rendering many unable to afford treatment. At the same time, another key access point to mental health care that has been compromised is the school system, where many children rely on behavioral support and interventions. 

As public health officials respond to the COVID-19 crisis and its aftermath, it is paramount that they understand and address the short- and long-term mental health and substance use needs of citizens. While physical health and safety is an immediate priority, officials must also assess and strengthen current health care infrastructure—including the workforce, resources, points of entry and technology—in order to address Americans’ psychological needs. 

That starts with data. Policy makers must ask core questions about whether our behavioral health support and capacity meets the magnitude of current needs. Such questions should include: 

• Is the mental health and substance abuse workforce available and prepared to respond? 
• Are crisis support services mobilized and ready across the country? 
• Has the rapid pace of tele-medicine deployment during this period of social distancing been as easy to adopt and deploy in the behavioral health fields (i.e. making virtual therapy accessible to those who need it)?

Data-informed policies must expand, modify, or redirect behavioral health support and service infrastructure in our country. Mental health should be an equal concern alongside physical health, as opposed to the back seat it’s often taken in the past. 

Public health officials must ensure that the same basic infrastructure and the same modern intervention processes that are used in physical health care make their way to mental health care. They should look for opportunities to deploy care to individuals in new ways, including through telemedicine and remote visits. Remote treatment and intervention infrastructure exists in the mental health space, but it must be expanded so that it is widely available for patients.

Treatment alone, however, is not enough. We also need stronger prevention infrastructure. That requires creating the policies and programs to prevent things like substance abuse and suicide. Bolstering prevention offerings, coupled with more treatment options, will allow the United States to address both current and future issues. 

It is critical that COVID-19 relief funding be directed to mental health and substance use problems in addition to the needs of those on the front lines of infectious disease response. Public health officials at all levels of government need more resources, not simply a reallocation of existing resources.  

Initial Progress

The pandemic’s exposure of long-standing challenges in our mental health care system is already beginning to inspire policy and industry solutions. Emergency response funds are being directed to state and local jurisdictions to support the increased demand for mental health and substance use resources. The Substance Abuse and Mental Health Services Administration is making the applications shorter and easier to navigate, pushing the dollars out quickly, requiring that organizations applying for grants have the infrastructure to perform the work right away, requiring telemedicine, and focusing on evidence-based practices for suicide prevention funding. 

This will have a positive impact if the government receives applications and mobilizes funding quickly. However, more action is needed. Other essential efforts include: 

1. Enhancing screening efforts for early detection
2. Focusing on therapeutic and medication continuity
3. Mitigating barriers to access—financial and physical
4. Combating the stigma associated with seeking help 

By using data to understand the impacts of COVID-19, public health officials can develop new support, service and prevention structures for citizens. Government officials have an opportunity to fortify the country’s mental health infrastructure and improve it. It’s vital that they do so. 

Christine Walrath, Ph.D., is a Senior Vice President of Public Health at ICF.