Flattening The Mental Health Curve
This is an excerpt from an article titled “Flattening The Mental Health Curve” originally published by Garen Staglin for Forbes.com on 3/30/2020. See the full story here.
In the last two weeks, the COVID-19 situation has become perhaps the single most disruptive event in recent history, impacting personal and professional lives around the globe. Beyond the apparent and immediate rise of stress and anxiety that accompanies drastic changes in work and life routines, cancelled plans, closed businesses and constant uncertainty, the pandemic will have hidden and long-term mental health consequences for individuals and the mental healthcare system more broadly. Below are several observations pointing to the challenges and opportunities in flattening” the mental health curve in the midst and wake of the COVID-19 outbreak.
Acute increase in demand for support
Reports indicate that nearly 3 million people lost their jobs last week, and nearly every state has shut down its public schools. With so many people home from work and school, issues like domestic and child abuse and financial stress are exponentially exacerbated, leading to a surge in demand for hotlines such as the Crisis Text Line. The organization has stated that total volume of messages increased 116% between March 16th and March 20th, with the coronavirus mentioned in 15% of all conversations, and nearly 40% of conversations having to do with anxiety. Similarly, news from this week show that volume of calls for National Suicide Hotlines have gone up 300% in recent weeks. Fortunately, a number of efforts are already underway to collect resources and quickly find innovative ways to care for those with the most acute mental health needs, including healthcare workers.
The psychological impact of quarantine
On March 14, The Lancet published a ‘rapid review’ of evidence of the psychological impact of quarantine – both mandatory and voluntary. Everyone is currently experiencing some level of quarantine and therefore some degree of psychological impact. While short-term consequences like anxiety, insomnia, and acute stress are almost obvious, the review, which was based on analysis of data from the SARS and Ebola outbreaks, pointed to other longer-term psychological consequences that can persist beyond the quarantine period. For instance:
Alcohol and other substance abuse disorders may develop
Individuals may continue demonstrating avoidance behavior such as social isolation, avoiding public gatherings and crowds
Not reporting to work (especially among healthcare workers, many of which experience symptoms of PTS)
In the eventual aftermath of the COVID-19 crisis, it will be crucial to ensure that individuals that were on the frontlines at hospitals or lived in one of the virus epicenters have access to the mental health support they need.
The complexities of reliance on telehealth
While psychologists are deemed essential and can keep doors open even in a “lockdown” state, many support groups have been forced to temporarily cease or go virtual as a result of the COVID-19 outbreak. Telehealth has many virtues; however, for certain populations and conditions, it is not always the best form of treatment. For example, addicts could experience higher rates of relapse being forced to stay home and away from in-person meetings, while adding virtual distance between a care provider and someone at-risk for suicide is well understood, even in normal times, to cause treatment challenges. Additionally, finding privacy can be a concern for some patients shuttered indeterminately in their homes with other family members or roommates.
Still, the ability to turn to virtual therapy is an enormous comfort for many. The sudden increase in demand for telehealth services has challenged the system to adapt. Last week, the Trump administration announced that more telehealth services, including mental health counselling, will be covered under Medicare. A few days later, the Drug Enforcement Administration temporarily lifted the requirement of an in-person exam prior to psychiatric prescription. And on March 25, New York Governor Andrew Cuomo announced the launch of free online mental health services provided by psychologists, psychiatrists and clinical workers in the state – the most tangible, proactive move taken by a state government so far to address the mental health consequences of the pandemic.
Increased utilization of mindfulness apps
On an encouraging note, and perhaps as an indication of the future potential of integrated health, “mindfulness” has been a key term in many headlines having to do with COVID-19. Mayo Clinic is one of many healthcare institutions advising individuals to take intentional care of their emotional wellbeing through meditation, mindfulness or yoga. In that vein, the popularity of mindfulness apps has surged. Headspace has observed customers completing 13 times as many calming meditations than in typical months and is offering free services and guides for people to manage anxiety, with specific advise and services for those in the healthcare and education sectors.
Everyone will experience some degree of mental health fallout as a result of the COVID-19 pandemic. As we all adapt to an abrupt new reality and unprecedented challenges on a personal, professional and global scale, everyone – including governments, insurers, employers, and healthcare providers – will undoubtedly emerge from this health crisis with a fresh perspective on the importance of high-quality, accessible mental health support.