With so many people suffering from chronic stress, anxiety, loneliness, grief, and depression, the cracks in an overburdened mental health system are showing. Over the next year, Americans’ lives will be affected by mental illness as they may never have been before. Lack of access to care, stigma surrounding mental illness, and a growing and persistent incidence of mental strain in both children and adults are among the challenges that need to be urgently addressed.

The good news is the pandemic has forced changes (can you say telehealth?) and some rethinking of our approach to mental health care. The widespread use of virtual meetings for medication management, treatment, and peer support, have worked well for many giving practitioners and patients more comfort with — and confidence in — home-based treatments which may grow permanent roots post-pandemic.

Yet widespread disparities still exist. The Centers for Disease Control and Prevention (CDC) has collected data reflecting how the pandemic disproportionately affects people of color and ethnic minority groups for myriad reasons, including systemic racism.[1]

Out of Reach: High Cost, Lack of Access and Other Barriers to Treatment

To put the issue in context, mental health costs were estimated to be $201 billion pre-pandemic and experts now predict mental and substance abuse disorders will surpass all physical diseases as the major cause of disability worldwide. [2]

Pre-pandemic, an estimated 26% of Americans suffer from a diagnosable mental health issue, according to the National Institute of Mental Health Disorders. There’s still no clear estimate of how much that number will rise post-pandemic, say experts.

Mental health does not discriminate — it’s a part of our lives regardless of race, ethnicity, age, gender, religion, sexual orientation, education, or income — but the pandemic exposed huge gaps in resources and care. “The pandemic has brought people’s life circumstances into stark contrast,” say experts at Johns Hopkins School of Medicine , adding that food insecurity, household crowding, and lack of childcare are having an outsized impact on mental health. Black and brown people — often frontline workers and caregivers for multiple generations — experienced a marked deterioration in their mental health.

In the US, there are many barriers to treatment. According to the National Alliance on Mental Illness (NAMI), more than 60% of people with symptoms of mental health problems don’t seek care due to stigma. Others say high cost and lack of access are factors and rely on crisis text lines, family, and sometimes prayers for support.

Substance use in teens has also become a growing national concern during the pandemic. Since the pandemic’s stay-at-home orders, national tracking has shown spikes in drug overdoses, according to a new report from ODMAP, a digital tool to track and analyze substance use trends.

Lack of certainty around whether schools will be using online or in-person models is contributing to this problem and becoming a huge issue. “The pandemic has caused traumatic stress for adults and children,” explains Jeremiah Aja, Assistant Director, and Counselor at Wellness Together, which trains teachers and empowers students by placing clinicians in schools. “There are very few things people can count on right now,” says Aja, who is currently preparing teachers via Blue Shield of California’s BlueSky initiative. “This uncertainty causes fear and fear puts people at high risk for mental health issues.”

Some positive news: an analysis conducted by the National Institutes of Justice revealed that brief alcohol interventions with adolescents improved outcomes for young adults by 4%. [3]

Finally, stigma continues to interfere with asking for help. The idea of mental illness as a weakness or liability is still very much ingrained in this country even though at least one-third of adults in the US deal with depression and anxiety.[4] That could be slowly starting to change.

Research showing that awareness of — and care for — the mental health of employees leads to greater productivity, and less absenteeism, are starting to resonate with business leaders, in part due to widespread stress and anxiety during the pandemic. At the workplace, too, it appears short, intense interventions can also help employees deal with stress.[4]

Work-Related Stress and the Impact on Vulnerable Groups

While headlines tend to focus on the economic impact of the crisis, the negative impact on well-being may be even higher. Living in quarantine — and the impact of work, or lack of it — are stressful for everyone but the most emotionally-distressed groups are women, young people, people with disabilities, and those with pre-school aged children.[5]

To make matters worse, some workplaces are conducting productivity monitoring of their employees working remotely. Employee monitoring measures include desktop surveillance showing browsing history, keystroke activity, and screenshots — much of which is legal (within limits) — and are likely contributing to even more stress and increased pressure.

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“Micro-monitoring” of work-from-home employees is the new micro-management. Over-supervising is less effective than most managers understand, for one reason—it compromises trust between employees and managers. “Virtual surveillance can’t replace the relationship building,” says Marlon Morgan, Founder, and Executive Director, Wellness Together. “Evaluating performance this way is only helpful to a point. Relationships are the glue that holds workplaces together.”

Job loss, of course, negatively impacts mental health and when people lose their job, they lose their healthcare benefits. That loss results in additional financial struggle for those who use expensive medication. Pricey prescription drugs are particularly problematic for people with chronic conditions like diabetes, depression, and attention-deficit hyperactivity disorder (ADHD).

In 2017, 1 in 20 people under age 65 spent more than $1,700 on prescription drugs per capita per year, according to research conducted by the Commonwealth Fund, a private foundation seeking to promote a high-performing health care system that achieves better access and quality for society’s most vulnerable populations. Rationing medication or skipping it altogether is a dangerously common way to save money.

Paving the Way to More Access and More Affordable Treatments

It’s clear that our healthcare system is broken and in the coming years, demand from a large aging population and a greater incidence of anxiety, stress, depression, and loneliness — in both children and adults — will continue. In response, entrepreneurs are scrambling to find solutions that are quicker, cheaper, and still highly effective.

Mental health start-up funding has reached new highs, according to What If Ventures, which tracks investments in the US. (In 2019, they estimate mental health startups raised $750mm across 105 deals.) Solutions being offered range from increasing awareness to less costly ways to access therapy through telehealth. “Our physical health is threatened by the Covid-19 but our mental health is under strain because of the uncertainty, isolation, stress, and anxiety,” says Michael Acton Smith, co-founder, and CEO of Calm, a mental health app. Mental health CEOs like Smith say traffic and engagement since the start of the pandemic continue to increase month over month.

[Click to Read: How to Make Online Therapy Work for You]

Companies are aware that childcare is preventing many employees from returning from work, so HR departments are seeking ways they can be more flexible and help reduce stress, according to a recent survey by Morning Consult for the Bipartisan Policy Center.[6]

The survey revealed that the barriers to work are greater in people of color: 55% of Hispanic and 44% of Black parents say returning to work will not be possible because of caregiving issues. The bipartisan group explored reasons for the dropout, noting that 52% of parents who quit did so due to childcare provider or school closures and 37% of caregivers who quit did so to care for a sick family member. This issue will be tougher to address but creating a more supportive culture at the workplace — one the provides greater flexibility to caregivers — is a step in the right direction. [6]

For people with substance use issues, those who are at risk of suicide, or who have a chronic mental health issue, group and peer support seems to be a viable, low-cost solution right now. Studies show peers offer a unique perspective and expertise gained through lived experience, complements the standard types of intervention.[7]

During the first months of stay-at-home orders, peer support became one of the best options for support. In fact, 750 peer support specialist certification programs had been completed in 24 states and four countries, says Karen Fortuna, PhD, Assistant Professor of Psychiatry at Dartmouth College in New Hampshire, who led the research on digital peer support. [7]

[To Learn More Read: What You Need to Know About Mental Health Support Groups]

The results were so impressive, peer support is now being deployed to help other at-risk populations like the elderly and people with disabilities that are more isolated because of the pandemic.

Telehealth is also playing a huge role in helping people who can’t or should not leave their homes for treatment. Much of the infrastructure for telehealth to succeed was in place before the pandemic, but strict privacy laws precluded many medical systems from practicing medicine via phone or video.

Those laws were relaxed during the pandemic, in an effort to help patients get care, explains Kimberly Noel, MD, MPH, Telehealth Director, and Deputy Chief Medical Information Officer at Stony Brook University Hospital in New York. Dr. Noel has been part of a multi-department team that used Microsoft Teams to create training for the hospital system’s large staff and community.

Telehealth is now better known in communities nationwide. At the start of the lockdown in March, close to half of 2,000 Americans who participated in a survey conducted by Sykes, a multinational outsourcing provider based in Tampa, Florida, said they unfamiliar with telemedicine. But within weeks, 60% (in the same survey) said they would consider using it.

This crisis has demanded that Americans and our government looks at new ways of treating mental health that is both affordable and easily accessible. Telehealth, peer support, and short-term behavioral intervention programs in corporate environments are all on the table and being welcomed as we enter a new era of community medicine.

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Last Updated: Aug 20, 2020