In the Shadow of the COVID-19 Pandemic, A Looming Mental Health Crisis

As most Americans fixate on the surging COVID-19 cases and deaths, health care experts are growing weary of “an imminent mental health surge” in the United States. Over the past nine months, COVID-19 has affected Americans of all ages in every facet of daily life disrupting employment, education, religious practices, recreational activities and relationships. The staggering amount of death experienced in the nine months since the World Health Organization declared the virus a pandemic is devastating. In the United States, the number of deaths currently attributed to COVID-19 is nearly 4 times the deaths of Americans killed during the entirety of the Vietnam War which spanned two decades. This magnitude of death combined with an upheaval of normal grieving processes due to social distancing measures has significantly altered the ways in which individuals and families cope with grief, compounding their already disrupted daily lives. 

A recent study, conducted this year by scientists at the Journal of Affective Disorders, showed a global increase in the prevalence and severity of anxiety and depression and increases in post-traumatic stress disorder and substance abuse. Of central concern is the transformation of normal grief and distress into prolonged grief and major depressive order and symptoms of post-traumatic stress disorder. Indicators of prolonged grief disorder include at least six months of intense longing, preoccupation, or both with the deceased, emotional pain, loneliness, difficulty reengaging in life, avoidance, feeling life is meaningless, and increased suicide risk. These conditions, once established, could become chronic and may lead to substance use disorders. While prolonged grief affects approximately 10% of bereaved individuals, experts believe is an underestimate for grief related to deaths from COVID-19. Measurements estimate that each COVID-19 death leaves an estimated nine family members bereaved. This approximation projects over two million bereaved individuals at the current COVID-19 death count. Mental health experts warn this level of  bereavement, triggering new mental health disorders and intensifying existing mental health disorders, has the potential to overwhelm the American healthcare system beyond its capacity. 

America’s infrastructure for mental health and addiction services was fragmented, overburdened, and underfunded even before the COVID-19 crisis. An online survey of 880 organizations that provide behavioral-health services revealed that the pandemic has forced practices to reduce services, provide care to patients without sufficient protective equipment, lay off and furlough employees, and risk untimely closures. This reduction in services further burdens individuals with serious mental illness from receiving treatment and/or medication for their conditions, including those who are experiencing such symptoms for the first time. Alarmingly, mirroring COVID-19 itself, experts anticipate that a mental health surge will disproportionately affect Black and Hispanic individuals, older individuals, lower socio-economic groups of all races and ethnicities, and health care workers. 

Each day, as the United States continues to report record breaking COVID-19 cases, mental health care experts are certain the second wave of the COVID-19 pandemic is imminent. Experts suggest immediate emergent funding for mental health programs; widespread screening to identify those at the highest risk; availability of primary care clinicians and mental health professionals trained to treat those with prolonged grief, depression, traumatic stress, and substance abuse; and a diligent focus on families and communities to creatively restore the approaches by which they have managed tragedy and loss over generations. To further mitigate the threats of a mental health care disaster, states like Connecticut, are reaching out to the Centers for Disease Control and Prevention for grants to support expanded mental health resources after experiencing increases in both the use of the state’s suicide hotline and suicide rate amid the COVID-19 pandemic. 

Even as mental health care experts rush to mitigate the potential devastation of a second wave, it is clear that the havoc from COVID-19 will be felt for generations to come. The tremendous loss of life and the disruptions to all aspects of everyone’s lives reminds us of our fragility and how important it is and it will be to provide adequate mental health protections as an integral part of the healing process.