Erin N. Marcus is a professor of clinical medicine at the University of Miami and a Public Voices fellow.
My observations are consistent with those of national surveys, which have found significant increases in depression and anxiety during the pandemic. In one large nationwide survey, U.S. adults were more than three times more likely to screen positive for anxiety and depressive disorders, compared with one year earlier. Another survey found a significant increase in alcohol use.
Those surveys were conducted in April through June, before the spread of the coronavirus escalated to encompass the entire nation. Today, it’s likely that the psychological toll is much worse. Every person who dies of covid-19 leaves behind, on average, nine close family members — a grandchild, son, daughter, brother, sister, spouse, mother or father. The grief experienced by those surviving family members and friends is a normal reaction to loss. But some psychologists fear that the circumstances of covid-19 — in which people might die unexpectedly or alone, and without the normal rituals of community remembrance such as a memorial service — may increase the likelihood of prolonged grief disorder, a disabling condition that can last years and raise the risk of suicide or alcohol and drug abuse.
More than 1 in 10 adult American workers are employed in the health-care sector, and many of them have witnessed events that leave them vulnerable to post-traumatic stress disorder and other psychological consequences. Other Americans have lost their jobs, which itself can cause anxiety and depression.
Mental illnesses increase a person’s likelihood of developing other health problems, such as heart disease. They also significantly affect productivity, costing employers billions annually. To get our country on track toward some sort of normalcy, President-elect Joe Biden’s pandemic advisory board will need to address our nation’s psychological recovery.
Even before the pandemic, a shortage of mental health professionals — and a lack of adequate insurance coverage — made it difficult if not impossible for many people to get timely and appropriate care. Psychiatric and psychological services are often put in a separate silo by insurance companies, making it tough for primary care physicians and nurses to refer patients. People often don’t want to go to a mental health professional, both because of a perceived stigma and because it’s so difficult to jump through the bureaucratic hoops to get this care.
But there are affordable ways to begin to tackle these problems. Given that primary care physicians and nurses are likely to see anxious and depressed people, it makes sense for us to be trained to routinely screen everyone and provide some initial counseling — with adequate backup when we need to refer patients. Low-cost community mental health clinics, which have long been inundated with patients, need to be expanded so that they can accommodate more people, and need to be paid adequately for telephone counseling. Telehealth support groups, led by trained mental health professionals, have been helpful for front-line health workers during the pandemic. Perhaps this strategy could be expanded to help the general public as well.
Peer support programs — in which people who themselves have experienced anxiety and depression are trained to help others — may be a way of reaching more people. Peer support has been endorsed by the Substance Abuse and Mental Health Services Administration, which is issuing 16-month emergency grants to states to provide assistance for mental health and substance abuse disorders during covid-19; that effort may need to be continued. Public advertising campaigns — perhaps in conjunction with the National Ad Council’s efforts to promote vaccine acceptance — could help de-stigmatize mental illness, help people realize they may be experiencing symptoms, and provide information about where to go for treatment. Social workers and other trained counselors need to be placed in schools, in workplaces and in community centers to make it easier for everyone to get help.
These actions would help address the psychological needs created by the pandemic — and might in the longer term begin to improve a rickety system that has failed to reach so many for far too long.
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