By Brian Skinner, Esq.
As the COVID-19 pandemic drags on and the economy continues to suffer, policymakers must be prepared address an increased need for both a public health response and policies to increase intervention and prevention efforts associated with the mental health of the state's population.
Recent studies are highlighting the impact the COVID-19 pandemic and the resulting economic recession are having on the mental health of our citizens and the new barriers for those already suffering from mental illness and substance use disorders.
According to a new US Centers for Disease Control and Prevention (CDC) report on surveys of US adults in late June, more than 40% are experiencing elevated adverse mental health conditions associated with the COVID-19 pandemic. Among the surveyed population, those who were disproportionally affected were younger adults, racial/ethnic minorities, essential workers and adult caregivers. They reported worse health outcomes, increased substance use, and elevated suicide risk.
In a Kaiser Family Foundation (KKF) Tracking Poll conducted in mid-July, 53% of adults in the US reported that their mental health has been negatively impacted due to worry and stress over the coronavirus. This is significantly higher than the 32% reported in March, the first time this question was included in KFF polling. Many adults are also reporting specific negative impacts on their mental health and wellbeing, such as difficulty sleeping (36%) or eating (32%), increases in alcohol consumption or substance use (12%), and worsening chronic conditions (12%), due to worry and stress over the coronavirus. As the pandemic wears on, ongoing and necessary public health measures expose many people to experiencing situations linked to poor mental health outcomes, such as isolation and job loss.
Research has linked social isolation and loneliness to poor mental health, and data from late March shows that significantly higher shares of people who were sheltering in place (47%) reported negative mental health effects resulting from worry or stress related to coronavirus than among those not sheltering-in-place (37%). In particular, isolation and loneliness during the pandemic may present specific mental health risks for households with adolescents and for older adults. The share of older adults (ages 65 and up) reporting negative mental health impacts has increased since March. Polling data shows that women with children under the age of 18 are more likely to report major negative mental health impacts than their male counterparts.
Additionally, research shows that job loss is associated with increased depression, anxiety, distress, and low self-esteem and may lead to higher rates of substance use disorder and suicide. Recent polling data shows that more than half of the people who lost income or employment reported negative mental health impacts from worry or stress over coronavirus; and lower income people report higher rates of major negative mental health impacts compared to higher income people.
These findings were echoed in a recent survey study published in JAMA Network Open indicating the prevalence of depression symptoms in the US is more than 3-fold higher during COVID-19 compared with before the COVID-19 pandemic. Individuals with lower social resources, lower economic resources, and greater exposure to stressors (eg, job loss) reported a greater burden of depression symptoms. Post–COVID-19 plans should account for the probable increase in mental illness to come, particularly among at-risk populations.
The study looked at the burden of depression symptoms among US adults during the coronavirus disease 2019 (COVID-19) pandemic compared with before COVID-19, and the risk factors associated with depression symptoms. It included 1441 respondents from during the COVID-19 pandemic and 5065 respondents from before the pandemic. The results showed prevalence of depression symptoms was more than 3-fold higher during the COVID-19 pandemic than before. Lower income, having less than $5000 in savings, and having exposure to more stressors were associated with greater risk of depression symptoms during COVID-19.
This suggests that there is a high burden of depression symptoms in the US associated with the COVID-19 pandemic and that this burden falls disproportionately on individuals who are already at increased risk.
All of this emphasizes the need for mental health care and substance abuse as the state recovers from the effects of the pandemic. It also spotlights both existing and new barriers to accessing mental health and substance use disorder services not only in West Virginia, but nationwide. The lack of mental health professionals is particularly acute in West Virginia which ranks 48th in the nation in the number of psychiatrists, psychologists, licensed clinical social workers, counselors, marriage and family therapists, providers that treat alcohol and other drug abuse as well as advanced practice nurses specializing in mental health care per 100,000 population according to America’s Health Rankings®. The limited access to mental health care and substance use treatment that already exists will only be exacerbated by the COVID-19 pandemic.
There has been some help at the federal level to provide mental health and substance use disorder treatment services. The Coronavirus Aid, Relief, and Economic Security Act (CARES Act) includes $425 million for use by SAMHSA, in addition to several provisions aimed at expanding coverage for, and availability of, telehealth and other remote care for those covered by Medicare, private insurance, and other federally-funded programs. It also allows for the Secretary of the Department of Veterans Affairs to arrange expansion of mental health services to isolated veterans via telehealth or other remote care services. These provisions may alleviate some of the acute need for remote mental health and substance use services. In addition, the CARES Act extends the duration of, and expands, Medicaid Community Mental Health demonstrations, which are currently underway as part of efforts to increase care access and quality at community behavioral health clinics.
There is ample evidence that poor mental health due to burnout among front-line workers and increased anxiety or mental illness among those with poor physical health and the economically disadvantaged are serious concerns for the state as it continues to combat the virus. As the state looks for ways to alleviate the burdens of the COVID-19 pandemic, it must be prepared for the increased need for mental health and substance use services even as new cases and deaths related to the COVID-19 pandemic decrease. It is imperative that state policymakers address mental health disparities and be prepared to support systems to mitigate mental health consequences of the pandemic and its aftermath.
Brian is the former counsel to the West Virginia House of Delegates Judiciary Committee and counsel to the West Virginia Senate Minority Caucus. He was also general counsel to the West Virginia State Health Officer and Commissioner for the Bureau for Public Health. He has almost two-decades of experience as a strategic advisor and chief legal counsel to both executive and legislative branch public officials.