Mental Health During and After the COVID-19 Era

                                                          By Nathaniel Neptune and Elaine Nguyen

Mental health issues related to the COVID-19 pandemic are continuing to spread rapidly and invisibly, similar to the coronavirus. The necessary public health measures to encourage social distancing and reduce the spread of coronavirus have led to increased social isolation. Our isolation is also mixed with overexposure to the unrelenting media coverage of the pandemic. The combination of social isolation, information overload, and disruptions of daily life have caused increased feelings of anticipatory grief, worry, and anxiety around the nation.Further, the increased social deprivation, unemployment rates, and economic hardship caused by the pandemic are all linked with increases in suicide rates.

Public health crises typically expose and exacerbate weaknesses in the health system, and the COVID-19pandemic has done both for mental health support systems. Prior to the pandemic, Cigna’s survey of over 10,000 adults revealed 61% of Americans reported feelings of loneliness and 24% reported their mental health as fair or poor; both are increases from prior years. Additionally, over 10 million adults still report an unmet need for mental health care. Locally, survey data collected by the Partnership for a Healthy Durham revealed that 55% of Durham residents felt mental health should be a “top community priority,” and 1 in 4 Durham Public School children reported feelings of depression. The COVID-19 pandemic will increase the stress on our fragile mental health system while creating new challenges for a broader swath of Americans leading to a second-wave pandemic of mental health crises.

The decreased opportunities for social interaction will weaken people’s protective factors against psychosocial problems. Many will look to use alcohol, illicit drugs, or other maladaptive coping techniques to escape feeling out of control, lonely, or anxious about their health and economic livelihoods. School, work, and other outings often serve as a respite from stressful or abusive home situations. Since shelter-at-home orders have been issued, countries have reported up to a 50% increase in reports of domestic violence, and child welfare experts have expressed concerns of increased child abuse and neglect. Further, those in most need of help or with the fewest resources are suffering the most.The socio-economic needs of many adults have forced them to choose between paying bills or seeking support for their mental health needs. People without adequate internet access are unable to access virtual visits, and fewer people can pay for mental health services due to layoffs (see Boisvert, Durbha, and Nguyen reflection). Also, those belonging to racial, ethnic, gender, or sexual minority groups, who often face heightened barriers to care, continue to be more susceptible to poor mental health outcomes, discrimination, and a lack of access to services (see Durbha, Holtzman, and Matula reflection).

Our daily lives will not return to what we considered normal in the pre-COVID-19 era, but many opportunities exist to adequately address the mental health needs of the community.This point in time can be the moment of change for improved mental health services. Social distancing measures have forced clinicians and counselors to conduct virtual visits and they now have more tools available to reach patients virtually. Mental health experts should continue to capitalize on the surge in interest for telehealth and explore other avenues to conduct virtual visits, especially as a telehealth session does not have to be limited to a video conference. Other methods of communication, namely text messages, can also be used as another telehealth tool. Additionally, services such as the Crisis Text Line can provide anonymous mental health services to anyone with access to text messaging, at any time of the day. Other virtual counseling tools, including wellness applications, social media, and telephone groups, can help provide support for coping during this crisis.The lack of equity in the provision of mental health services, whether virtual or in-person, still must not be overlooked, as those who do not have access to the internet or other telecommunication services and devices will find these services inaccessible. The social drivers of health, mental well-being, and physical health are all intertwined and should be assessed and treated in tandem. Equity-based approaches are required to ensure mental health services are universally accessible regardless of race, income, language, age, physical ability, or technical knowledge.

Additional recommendations gathered from Durham residents during listening sessions held by the Partnership for a HealthyDurham prior to the pandemic can be implemented now. These include creating an anti-stigma mental health campaign to encourage people to discuss their mental health concerns and offering free mental health screenings for all school children. Local community workers can be a point of contact to initiate universal screening for our vulnerable populations whom food pantries and other support organizations are already in frequent contact with. Future work should focus on developing ways to monitor the mental health of communities and the impact of COVID-19, integrating behavioral health into primary care services, and addressing the social drivers of health in tandem with mental health services. North Carolina is in an advantageous position to lead the charge for change. We can address social risk factors for health by leveraging our current progress with initiatives such as the Health Opportunities Pilots to continue improving the overall healthcare of vulnerable populations.

The COVID-19 pandemic is a black swan event with profound mental health impacts on all of society. The detrimental effects of COVID-19 and social distancing on mental health will outlast the virus and continue to present challenges related to social distancing, adjusting to new norms, and coping with the trauma of enduring a pandemic. Now is the time for policymakers and healthcare organizations to focus our efforts equally on finding a cure or vaccine for COVID-19 and ensuring the mental health needs of all people are met.

If you or someone you know is in need of immediate help, please call 1-800-273-TALK (8255) any time to speak to someone and get support.

This reflection was authored by some of the 2019-2020 Duke University Margolis Scholars as part of a five-part series reflecting on the disparate impacts of the COVID-19 pandemic on the health of the Durham community. Each of the five reflection pieces centers around one of the five top health priorities in Durham, identified by the community in the 2017 Durham County Community Health Assessment. For more information, visit https://healthydurham.org/.