Mental Health in the Era of COVID-19

Mental health care is a deeply personal issue for me. My experience in trying to help friends and family navigate the deeply flawed and broken U.S. health care system is a key part of what drives me to work on access and cost issues for patients, and reimbursement issues for providers.

Mental health conditions are much more common than we might think. According to the National Institute of Mental Health:

  • 1 in 25 people in the U.S. – about 11 million people – experience a serious mental illness that significantly limits a major life activity such as working or caring for family members;
  • 1 in 5 people – about 47 million people – experience a mental health condition, for example, ADHD, anxiety, bipolar disorder, or depression, at some point in their lifetime.

But we have not built a system that acknowledges, destigmatizes, or serves patients who experience mental health conditions.

Nearly 10 years ago, Támara Hill, a licensed therapist and certified trauma professional in private practice, wrote A Failed Mental Health System: The Top 5 Failures, which are:

“1) Poor access to financial support/high insurance costs

2) No direction after a psychiatric diagnosis

3) Feeling overlooked, alone, uncertain, and confused

4) Lack of knowledge about the mental health system in general

5) State laws and treatment policies that interfere with appropriate and timely treatment.”

Not much has changed, even with full implementation of the Affordable Care Act. Access to care, in particular, continues to be a problem. Before the coronavirus pandemic, even though most people with any mental illness under age 65 had some sort of health insurance, less than 10% had received any kind of inpatient treatment. For the 1 in 5 people experiencing a mental health condition (not considered a serious mental illness), less than 30% received outpatient mental health treatment, according to the Kaiser Family Foundation.

The Mental Health Consequences of COVID-19

The mental health consequences of COVID-19 are widespread and affect nearly everyone. Of course, they don’t affect everyone equally or in the same way. Further, we don’t really know the extent of what people are experiencing and what mental health care needs people will have in the future.

From a systems point of view, it seems obvious to say, but we need to make changes immediately to boost access to services and treatment, including destigmatizing the need for care, lowering costs and other barriers to patients, and improving reimbursement for all types of providers who can provide mental health care. Telehealth might be a great place to start!

Systemic changes also need to consider how communities can support mental health care, not just how large hospitals or integrated provider groups can provide medical treatments. Dr. Sandro Galea, Dean of the Boston University School of Public Health, made several suggestions recently in a co-authored piece focused on prevention and early intervention approaches to address mental health needs during and after the coronavirus pandemic, including offering stepped care, “training nontraditional groups to provide psychological first aid, and helping teach the lay public to check in with one another and provide support.”

Love, Care, and Concern

From a personal perspective, we might consider whether there is some action that can be taken immediately. Most of us are able, at least some of the time, to send a note, make a call, make a donation, or simply act compassionately toward another human in our path. Offering love, care, and concern will not fix all of the systemic problems of mental health care payment and delivery in the U.S. I am committed to continue working on these issues in my role as a policy advisor.

But in the meantime, I am also committed to continue to offer love, care and support to others. If you can, please join me.

Note: For useful information and resources related to Mental Health and COVID-19, please see:

Mental Health America

Mental Health Coalition