A Mental Health Pandemic: The Second Wave of COVID-19

Call for a National Strategy

The COVID-19 pandemic is causing suffering on a magnitude that is unprecedented in living memory. Millions have lost their livelihoods and are struggling financially. Tens of thousands have lost loved ones, and hundreds of thousands who have been infected with the virus face the very real prospect of serious illness or death. The health and financial costs of COVID-19 have resulted in widespread feelings of helplessness and overwhelming anxiety and despair in response to circumstances over which we have little or no control. Chronic exposure to severe stress in the absence of control among countless millions constitutes a perfect storm, with severe mental health consequences on a global scale, including increased rates of depressed mood, suicide, and posttraumatic stress disorder.

Individuals who were already struggling with mental illness before COVID-19 are now facing even greater challenges. After effective antivirals and vaccines have been developed and we have begun to contain the pandemic, the US and many other countries will be faced with a mental health pandemic that will probably continue for years to come. Historically, increases in rates of severe mental illnesses have often followed in the aftermath of national crises. For example, during the decade of the Great Depression from 1929 to 1939, the suicide rate rose from 13.9 to 17.4 per 100,000. Traumatic memories of surviving years of hardship during the Great Depression resulted in high rates of anxiety and depressed mood for generations. Although economic downturns disproportionately affected the health and well-being of the lower income segment of the population, all socioeconomic groups are negatively impacted.

A second wave of the pandemic will be driven by intense feelings of anxiety and despair in a world that is no longer predictable and safe due to high rates of unemployment and homelessness coupled with traumatic memories of surviving one’s own brush with COVID-19 or the death of a partner, parent, or loved one. The personal, social, and economic burden of human suffering, treatment costs, disability compensation, and productivity losses related to mental health problems in normal times have been major public health issues in the US and worldwide. This pandemic has served to amplify the personal, social, and economic costs of mental illness to a magnitude that is unprecedented. It is likely that the mental health consequences of COVID-19 will become the most urgent public health challenge worldwide for decades to come, impacting the well-being and productivity of billions. If left untreated, the psychiatric sequelae associated with the pandemic will have serious long-term social and financial consequences for all areas of human life, including personal relationships, family dynamics, academic performance, and work productivity.

The need for a comprehensive strategy

Developing and implementing programs aimed at enhancing resilience and treating individuals struggling with the mental health consequences of COVID-19 deserves the same urgent priority that is now being assigned to the development and testing of vaccines and antivirals. Large scale proactive measures are a key part of successfully preparing millions of people as they resume their day-to-day lives and livelihoods and is an essential step in re-starting stalled economies on a global scale. In the absence of such proactive measures, COVID-19’s long-term global impact on mental health could easily be as devastating and costly as the financial impact of the virus.

Rethinking the usual model of care

Such large-scale programs must be realistic from a cost perspective. Implementing resources that are both adequate and affordablecalls for a review of limitations of the existing model of mental health care. In the current model of care (so-called usual care), individuals with medical problems are triaged and treated by family physicians while individuals with mental health complaints are seen in a different outpatient setting by psychiatrists and psychologists. The result is that individuals who have both medical and mental health problems typically receive care at different times, in different clinical settings, and from different clinicians who often do not have pertinent information about pre-existing health problems and treatment history. In outpatient medical clinics, the priority on efficient triage of medical problems may cause delays in the diagnosis and treatment of serious psychiatric disorders, including major depressive disorder and PTSD, due to the limited time spent screening patients for mental health problems.¹

Although usual care segregates medical care and mental health services, depressed mood, anxiety, and other common mental health problems are frequently comorbid with medical problems such as cardiovascular disease, lung disorders, chronic pain, and diabetes. In addition, usual care is associated with disparities in the delivery of mental health services to different socioeconomic classes.

In response to the limitations of usual care, innovative collaborative care models are being developed and implemented in outpatient clinic settings. In collaborative care, a team of family physicians (or other primary care providers) and behavioral health clinicians work together using systematic and cost-effective approaches aimed at providing patient-centered care that addresses both medical and mental health problems. Studies show that collaborative care models are more effective than usual care for treatment of mental health problems while simultaneously reducing health care disparities. Collaborative care has also been shown to be more effective for managing patients with chronic mental health problems who have comorbid medical disorders, and is more cost-effective than usual care.

Rethinking mainstream mental health approaches

In addition to improving the existing model of care, we need to rethink current mainstream approaches in mental health care in order to adequately address the mental health impacts of the pandemic. Although psychotropic medications are often effective treatments of depression, anxiety, and PTSD, such conventional treatments have limited effectiveness and safety problems, and they are unaffordable to large numbers of individuals who would otherwise benefit from them. Initiatives aimed at enhancing psychological resilience and treating mental health problems resulting from the pandemic should include non-medication (ie, complementary and alternative medicine [CAM]) interventions supported by research evidence. Examples include a regular mindfulness practice for anxiety, exercise for depression, and select natural supplements known to be safe and efficacious adjunctive treatments of specific mental health problems.

A call to urgent action

It is time for the Department of Health and Human Services, the National Institutes of Mental Health, the American Psychiatric Association, the American Psychological Association, and experts in complementary and alternative medicine to join forces and propose a national strategy for developing and implementing large-scale programs and resources needed to adequately address the growing COVID-19 mental health pandemic. Clinical resources should ideally be implemented following a collaborative care model placing equal emphasis on enhancing psychological resilience in healthy individuals and treating serious mental health problems. In order to be most effective and cost-effective, a COVID-19 mental health initiative should incorporate evidence-based conventional and alternative treatments, and should be made available at little or no cost to the millions of Americans who have lost their jobs and their health insurance.

Dr Lake is a Psychiatrist in private practice in California. His most recent book is An Integrative Paradigm for Mental Health Care: Ideas and Methods Shaping the Future.

Reference

1. Lake J, Mason T. Urgent need for improved mental health care and a more collaborative model of care, special report. Perm J. 2017;21:17-24.