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    In the midst of national outrage over racial inequity, a global pandemic, and an international economic meltdown, another silent crisis is looming: breakdowns in mental health.  Experts warn that the US should brace for significant increases in depression, anxiety, substance abuse, post-traumatic stress disorder and suicide.  Just as the coronavirus flooded US hospitals and exposed the government’s lack of preparedness for such widespread devastation, the United States’ mental health system is ill-equipped to prepare for and handle this pending crisis.

    The Kaiser Family Foundation conducted a poll on how the coronavirus crisis is harming the mental health of Americans in late March, 2020 and found that 45 percent of adults admit that the pandemic has been a “major impact.”  These rates were higher in women, black and Hispanic adults.[i]

    Census Bureau data shows that a third of Americans are already showing signs of clinical depression or anxiety[ii].  The National Center for Health Statistics (NCHS) partnered with the Census Bureau to conduct a “Household Pulse Survey.”  The 20-minute on-line survey seeks to elicit relevant information about the impact of the coronavirus pandemic in the US.  The survey began in late April, 2020 and will continue through late July, 2020.  Respondents were given a modified version of the two-item Patient Health Questionnaire (PHQ-2) and the two-item Generalized Anxiety Disorder (GAD-2) scale, collecting information on symptoms respondents experienced in the past 7 to 14 days.  Survey results thus far reveal 24% of participants reported clinically significant symptoms consistent with the diagnosis of major depressive disorder, and 30% reported symptoms consistent with a diagnosis of generalized anxiety disorder.  By comparison, the National Health Interview Survey (NHIS) conducted by the NCHS in 2019 found that only 8.2% of adults had symptoms of anxiety disorder, only 6.6% had symptoms of depressive disorder, and 11.0% had symptoms of anxiety disorder or depressive disorder.

    The Substance Abuse and Mental Health Services Administration, which runs an emergency hotline for people experiencing emotional distress, reported a more than 1000 % increase in April 2020, compared to distress calls in April, 2019[iii].  In May 2020, approximately 20,000 people texted the hotline to report levels of distress, an eight-fold increase from February 2020.

    Talkspace, an online mental health therapy provider, reported a 65% increase in clients since the pandemic broke out in this country, with coronavirus-related anxiety being the dominant patient concern[iv].

    Not surprisingly, the mental health toll from the pandemic has hit the poor much harder, per data from the Census Bureau.  60% of individuals earning $150,000 or more per year said they did not struggle with “uncontrollable worry” over the pandemic.  Conversely, nearly 70% of individuals earning less than $25,000 per year experienced uncontrollable worry nearly every day over the pandemic[/vc_column_text][/vc_column][/vc_row][vc_row][vc_column][vc_column_text][v][/vc_column_text][/vc_column][/vc_row][vc_row][vc_column][vc_column_text].  This is particularly alarming, as access to mental health is already a challenge to many Americans.  Federal statistics show that, while 1 in 5 adults experience mental illness each year, only half receive treatment[vi].  For disadvantaged Americans experiencing poverty, access to mental health is even more challenging.

    Another particularly vulnerable group are health-care workers on the front lines who are responding to the pandemic.  A March 2020 study of 1,257 doctors and nurses in China during the coronavirus peak found that 50% of health care workers reported depression, 45% reported anxiety and 34% reported insomnia.[vii]

    Despite the glaring evidence that a mental health crisis is looming, and the trillions of dollars approved by Congress in emergency coronavirus medical response funding, only a tiny fraction has been allocated for mental health.  Therapists are scrambling to open “virtual” practices with video or telehealth conferencing, which is challenging and restricted due to licensing and reimbursement limitations[viii].  Much-needed behavioral health centers which tend to treat vulnerable populations at risk are struggling to stay afloat.

    During this time of uncertainty and devastating loss, there is room for hope, creativity and innovation.  The opportunity for access to virtual mental health services is open, and the time is now for telehealth and video health conferencing to thrive.  Lives depend upon it.

    If someone you know is experiencing a mental health crisis, encourage them to call the National Suicide Prevention Lifeline at 800-273-TALK (8255).  The Crisis Text Line also provides free 24/7 confidential text mental health support, text 741741.

    [i] https://www.kff.org/coronavirus-covid-19/issue-brief/the-implications-of-covid-19-for-mental-health-and-substance-use/

    [ii] https://www.cdc.gov/nchs/covid19/pulse/mental-health.html; https://www.census.gov/householdpulsedataexternal icon

    [iii] https://publicintegrity.org/health/coronavirus-and-inequality/coronavirus-calls-texts-mental-health-hotlines-are-surging/

    [iv] https://abcnews.go.com/US/wireStory/virus-drives-demand-talkspaces-online-therapy-70603681

    [v] https://www.cdc.gov/nchs/covid19/pulse/mental-health.html;

    [vi] https://www.nami.org/mhstats

    [vii]  Facts Associated with Mental Health Outcomes Among Health Care Workers Exposed to Coronavirus Disease 2019,  JAMA Netw Open. 2020;3(3):e203976. doi:10.1001/jamanetworkopen.2020.3976

    [viii] https://www.milliman.com/en/insight/addiction-and-mental-health-vs-physical-health-widening-disparities-in-network-use-and-p


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