April 17, 2020

Weekly line: Covid-19 may be creating a mental health crisis

Daily Briefing

    The physical effects of the new coronavirus epidemic are clearly evident. Each day, we see America's case and death counts tick upward. We hear stories from frontline providers warning of the toll Covid-19, the disease caused by the virus, can take on our bodies. We wear masks in public and wash our hands frequently. The smell of disinfectants has become a staple in the air.

    Starter list: How you can support frontline staff during the Covid-19 crisis

    But lingering in the background is another health crisis threatening Americans that tends to go unnoticed—or, at least, commonly undiscussed: the growing number of people who are struggling with their mental health in the face of the country's Covid-19 epidemic.

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    As US Covid-19 epidemic worsens, so does Americans' mental health

    Data show that Americans increasingly are experiencing heightened feelings of anxiety, depression, and suicidal thoughts amid the coronavirus epidemic. For example, 45% of respondents to a Kaiser Family Foundation (KFF) Health Tracking Poll conducted at the end of March said worry and stress regarding the new coronavirus has affected their mental health—up from 32% in a poll KFF conducted just two weeks earlier.

    The Disaster Distress Hotline, a crisis hotline run by the Substance Abuse and Mental Health Services Administration, saw a 338% increase in call volume between March and February, and an 891% increase when compared with March 2019.

    While the data's alarming, experts say it's not all that surprising given the widespread health and economic hardships facing the country: the unemployment rate is the highest since the Great Depression; grocery stores are still being cleared out of household essentials; and parents are being asked to take on their children's schooling and keep their children entertained without going into shared public spaces like parks and jungle gyms.

    In addition, many Americans have been physically separated from their typical support systems, which can cause people to feel socially isolated and lonely. This can be particularly problematic for vulnerable populations, such as the elderly and those with existing mental health conditions.

    Krystal Lewis, a clinical psychologist at the National Institute of Mental Health, told The Hill's Anagha Srikanth, "For those who may already struggle with feelings of isolation due to depression, anxiety, or other mental health conditions, social distancing could increase those feelings of loneliness and isolation."

    The growing mental health crisis is spiking demand for mental and behavioral health services across the country, and that demand raises another red flag: The U.S. mental health system was strained even before the Covid-19 epidemic, meaning it is "ill-prepared" to serve the increasing demand now, the Wall Street Journal's Stephanie Armour writes. She notes that Merrit Hawkins, a physician consulting firm, has estimated that about half of the United States doesn't have the mental health practitioners necessary to meet patients' needs.

    Could telehealth be the answer?

    To address the problem, many experts are calling for public health officials to increase efforts focused on preventing mental health conditions and increasing access to treatment, in hopes of stemming an even more severe mental health and substance misuse crisis in the country—and telehealth is emerging as a viable path forward.

    States and payers have taken measures amid the new coronavirus epidemic to increase access to telehealth services, such as treatment for opioid use disorder. At the federal level, CMS in March expanded telehealth benefits for Medicare beneficiaries enabling them to receive mental health counseling and other services remotely. The $2 trillion stimulus package enacted late last month, meanwhile, included $425 million to support mental health and substance use disorder services.

    And some providers are rising to meet increased virtual demand. For example, in New York—which is the epicenter of the United States' Covid-19 epidemic—more than 8,000 mental health professionals have volunteered to provide online mental health services at no cost to patients.

    But some experts note that telehealth may not be a cure-all for the growing mental health crisis, as many patients and providers, particularly those in rural areas, lack the technology to conduct virtual visits.

    Politico's Mohana Ravindranath also notes that few behavioral and mental health providers have embraced telemedicine in part because of federal and state regulatory barriers. And because telehealth hasn't yet been widely adopted for mental health and substance use disorders services, there are questions and concerns about whether the care will be effective.

    Some research suggests telemental health care and telehealth for substance use disorders can be just as effective—and perhaps more adaptable and far-reaching—than traditional in-person services, but the services' limited uptake thus far provides only limited insight.

    Advisory Board's John League notes that, as telehealth services for mental health and substance use disorders expand, researchers and providers will be able to have a better understanding of when the services work—and when they don't.

    And there's one important population that's largely been missing from the remote mental health services conversation to date: health care providers on the frontlines of the Covid-19 epidemic. A study published last month in JAMA found that, among a group of 1,257 health care workers in China who treated Covid-19 patients, 50.4% reported symptoms of depression, 44.6% reported symptoms of anxiety, and 34% reported symptoms of insomnia.

    "This is definitely something we as an industry need to be promoting," League said. "Frontline staff are under tremendous pressure and they shouldn't have to be 'heroes' all the time."

    Other suggestions for helping people cope

    While the health care industry works to scale telemental health services, experts are recommending other actions Americans can take to try reducing anxiety:

    • Limiting media consumption. Lewis, of the National Institute of Mental Health Mass, told Srikanth, "Mass media coverage of a topic can have long standing and far-reaching effects. It is common for children and adults with health anxiety and generalized anxiety to be triggered by world events and news."

    • Maintain a routine and stay active: Without the ability to go to work or bring kids to school, many Americans have lost their sense of routine. Experts say it's important to stay active while you're social distancing, such as by taking a walk. Forming new daily routines can also be helpful, such as taking time each day to journal your feelings.

    • Stay connected to your feelings via friends: Experts say talking through your anxieties and fears with a loved one or health care professional on the phone or through video can help you navigate your emotions.

    If you're struggling with your mental health or experiencing suicidal thoughts, there are people at the U.S. National Suicide Prevention Lifeline at all times who want to help. You can reach them by calling 800-273-TALK (8255), or you can contact the nonprofit Crisis Text Line by texting BRAVE to 741741. Please, reach out.

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