“Scientists are starting to see a global “surge” in depression. According to a December 2020 survey by the U.S. Census Bureau, 42% of people in the country reported symptoms of anxiety or depression that month. This was a huge increase from the 11% they recorded in 2019.”

Ana Sandiou, Mental health during the pandemic: 1 year on

The COVID-19 pandemic brought massive change to every industry. Healthcare rapidly shifted to embrace new methods of care like telehealth, while industries across the globe quickly pivoted to remote workforces. Now, as cases fall and vaccinations rise, we must look at how we’ve permanently changed due to the pandemic. One worry is the lasting emotional impact on a society that has survived global trauma. Reports say that mental illness is now universally on the rise. To combat it, we must ask how pervasive the issue is, what additional challenges need to be addressed, and what we can do.

Don’t Call it a Pandemic

Mental health is the next big healthcare hurdle we face as a nation. But Psychiatrist Dr. Ronald Pies warns that we shouldn’t call the latest trends a ‘Mental Health Pandemic’.

“…casual misuse of epidemiological terms has been commonly used in the popular press for years when referring to various “epidemics” of psychiatric illness in the United States—even though no credible evidence ever supported that bogus claim. And this is more than a semantic quibble. The use or misuse of language can have powerful effects on the public’s beliefs and perceptions…”

Ronald W. Pies, MD, Is the Country Experiencing a Mental Health Pandemic?

Dr. Pies is right. Words matter and we must be careful to use them correctly. To term a surge in mental health issues a “pandemic” both challenges the work to destigmatize mental illness and recalls the trauma of the last year. It also makes it harder for us to categorize what’s really happening.

While we may not see a sudden rise in in clinical depression diagnoses, we know that more people are dealing with feelings of grief, hopelessness, and a global level of trauma they’ve never experienced before.

“The mere fact that someone may not meet full DSM-5 criteria for a mental disorder does not mean that the person is unworthy of professional attention, or undeserving of insurance coverage for, say, telemedicine counseling.”

Ronald W. Pies, MD, Is the Country Experiencing a Mental Health Pandemic?

Those struggling need treatment, but can the system handle an uptick in need for mental health resources? Likely not. The system is already overburdened. That’s where telehealth can help. Virtual care allows for better distribution of resources and gives patients access to resources they otherwise didn’t have.

“We are incapable of serving this entire population,” Gold said. “We’ve never had a good system, and we’re going to have a system that’s only going to become more broken with this need.”

Andrew Joseph, As the Covid-19 crisis ebbs in the U.S., experts brace for some to experience psychological fallout

The Struggle Isn’t Over for the Healthcare System

External pressure on the healthcare system isn’t the only worry. Care providers themselves are not immune to mental illness. In fact, they are more susceptible to mental health impact by the pandemic, having dealt with both firsthand and vicarious trauma on the front lines. Care providers will become patients, and many will leave the field, further taxing the already overburdened and understaffed system.

“There’s also concern about the long-term impact on the mental health of health care workers and essential personnel, who have been stretched to the limit for months at a time and exposed to so much suffering, all while fearing for their own safety. Studies have shown that past crises have contributed to burnout, substance misuse, and PTSD among health care workers, some of whom left their jobs amid the emergency or months down the road.”

Andrew Joseph, As the Covid-19 crisis ebbs in the U.S., experts brace for some to experience psychological fallout

And, Minorities Are Once Again Disproportionately Affected

Just as with the pandemic itself, minorities are disproportionately impacted by the mental health repercussions that followed. They experience disproportionate levels of illness, death, and joblessness – all mental health stressors. And studies found that minorities started from a lower wellness baseline even before the pandemic.

“Throughout the pandemic, MNT have also reported on the unique mental health challenges faced by people of color, Indigenous communities, undocumented migrants, and many others whose baseline of what constitutes mental wellness was already lower than that of the general population.”

Ana Sandiou, Mental health during the pandemic: 1 year on

It doesn’t end there. Counter to what you’d expect, suicide rates often fall during war, hardships, and other times of crises. When you look at the overall numbers, suicide rates did in fact fall during the pandemic. But breaking down suicide rates by race tells a different story. One study showed that during the pandemic, suicide rates among white people went down by half. Among Black people they doubled.

“One study in Maryland found the suicide rate doubled among Black people during the early months of the pandemic, while it was halved for white people. Researchers in Connecticut reported that while the suicide rate dropped 13% during the stay-at-home period, “a significantly higher proportion of suicide decedents were from racial minority groups.””

Andrew Joseph, As the Covid-19 crisis ebbs in the U.S., experts brace for some to experience psychological fallout

With systemic inequalities, we can never discount how race and socioeconomic status play a part in health and wellness. As we seek to repair the mental well-being of our nation, we must also examine what caused us to suffer in the first place. We didn’t all start in the same place, and we certainly won’t all end in the same place. We need programs that do more than recognize inequities in care: we need programs that overcome healthcare disparities.

Can Telehealth Help?

The pandemic brought rapid change to the healthcare industry, in some surprisingly positive ways. The swift adoption of telehealth changed care delivery, connecting providers and patients across the barriers of time, distance, and language. Before the pandemic, mental health appointments had a high rate of cancellation and no-shows. With the implementation of teletherapy, those numbers dropped significantly. It‘s simply easier for patients to keep appointments that accommodate their needs.

“Some outpatient programs previously had no-show rates as high as 60%, according to several studies. Only 9% of psychiatrists reported that all patients kept their appointments before the pandemic, according to an American Psychiatric Association report. Once providers switched to telepsychiatry, that number increased to 32%.”

Eric Berger, No-Cancel Culture: How Telehealth Is Making It Easier to Keep That Therapy Session

Telehealth could be the key to addressing mental illness. While in-person appointments can be more effective, digitally-delivered therapy serves as a valuable complement. Successfully delivering care to the patient is always the most optimal form of care. With decreased cancellation rates, an expansion of available services, and the easy integration of language services into virtual platforms, telehealth may succeed where the traditional industry has stumbled.

“And telepsychiatry performs as well as, if not better than, face-to-face delivery of mental health services, according to a World Journal of Psychiatry review of 452 studies. Virtual visits can also save patients money, because they might not need to travel, take time off work or pay for child care, said Dr. Jay Shore, chairperson of the American Psychiatric Association’s telepsychiatry committee and a psychiatrist at the University of Colorado medical school.”

Eric Berger, No-Cancel Culture: How Telehealth Is Making It Easier to Keep That Therapy Session

That said, digital access itself is a privilege. While those who have access to reliable internet and devices can more easily get help, many cannot – particularly the lower socioeconomic groups most grievously impacted by the pandemic.

What telehealth can do – in fact, its greatest strength – is to make care providers available when and where they otherwise might not be. Next, community centers and clinics can broaden their scope to include mental health professionals beyond their geographical region. Government-run health and human services can then leverage those assets to reach patients where they are. In this way, disadvantaged communities can access care previously beyond their reach.Telehealth is not a technology that replaces us, but one that brings us together – provided we overcome the obstacles along the way

The catch? This kind of change needs support – financially. Agencies need to purchase devices and technology, train staff, and build community awareness. We need comprehensive programming to bring telehealth to the people that most need it. Additionally, as we transition to a post-pandemic world, insurers will dictate what services patients can access and afford, as they deem how to commoditize virtual care going forward. Decision-makers will be forced to tackle payment parity in the reshaping of healthcare.

For now, we know that the pandemic is far from over. Its effects will have a lasting impact on our health and wellness. We must be prepared to provide relief for many years to come by meeting patients where they are, with equitable care and resources.

References

Berger, E. (2021, May 24). No-Cancel Culture: How Telehealth Is Making It Easier to Keep That Therapy Session. Kaiser Health News. https://khn.org/news/article/no-cancel-culture-how-telehealth-is-making-it-easier-to-keep-that-therapy-session/.

May, A. J. (2021, May 6). Experts brace for a long-term impact on mental health after the pandemic. STAT. https://www.statnews.com/2021/05/07/as-the-covid-19-crisis-ebbs-in-the-u-s-experts-brace-for-a-long-term-impact-on-mental-health/.

Pies, R. W. (2020, October 13). Is the Country Experiencing a Mental Health Pandemic? Psychiatric Times. https://www.psychiatrictimes.com/view/are-we-really-witnessing-mental-health-pandemic.

Sandiou, A. (2021, March 11). The mental health effects of the pandemic, 1 year on. Medical News Today. https://www.medicalnewstoday.com/articles/mental-health-during-the-pandemic-1-year-on.