COVID-19 and Mental Health: A Message That Needs to Be Heard

A s of March 13, the Centers for Disease Control and Prevention (CDC) reported 1,629 cases of COVID-19 in the United States, with confirmed cases in 46 states and the District of Columbia, and 41 deaths. The World Health Organization, which tallies international cases, reports 153, 517 cases worldwide and 5,735 deaths, as of March 15. The virus has affected nearly every country in the world. By the time you are reading this, these figures may have multiplied exponentially.

The speed with which the virus has spread is perhaps the most frightening aspect: Information from the World Health Organization on March 15 stated that 10, 982 cases had been reported in the previous 24 hours.

We have entered an extraordinarily challenging period. Despite some exceptional public health agencies like the CDC, leadership was slow to recognize the seriousness of the outbreak earlier, failing to provide clear, consistent and reliable information (to the extent it was available) and preparing a broad-based public health response (especially regarding the availability of tests for the virus). It’s a difficult line to walk between encouraging protective behaviors and causing excessive anxiety or panic. The lack of preparation for a pandemic by federal, state, and local agencies is regrettable.

The passage of the bipartisan $8 billion coronavirus relief package (including a relaxation of restrictions on telemedicine, which APA had called for) is an important step in the right direction—hopefully, one that will remain after the passing of the epidemic. Physicians at the state and local levels are working to combat and contain the epidemic, as have many other entities, including professional societies like APA. Amid all the noise, we are learning about protective steps we can take, and APA has posted useful information on its website at psychiatry.org/coronavirus.

Using basic, common-sense hygienic practices recommended by the CDC, will help prevent the spread of infection. Among them: Wash your hands often with soap and water for at least 20 seconds; avoid close contact with people who are sick; avoid touching your eyes, nose, and mouth; stay home when you are sick; and use a tissue to cover a cough or sneeze and then throw it in the trash. Our CEO and medical director, Saul Levin, M.D., M.P.A., is a former health director and recommends these precautions as well: Do not make physical contact, including shaking hands; use disinfectant wipes and antibacterial hand gel; do not share pens or food plates; and avoid directly touching elevator buttons, ticket kiosk buttons in public garages, etc.

As psychiatrists we are especially aware of the mental health repercussions of the pandemic and the associated fear and panic. It is important that we help our patients, colleagues, friends, family, and ourselves maintain some perspective on the risks of infection. For many, their fears and anxiety will need to be addressed with supportive and cognitive interventions, and we can reassure them by citing similar past experiences through which we persevered, including the SARS, MERS, and swine flu outbreaks and the Y2K computer blackout scare.

We must do our best to minimize the burden of this contagion on the elderly and most vulnerable of our patients. The now urgent response to COVID-19 unfortunately contrasts with the failure of our mental health system.

There has been no comprehensive approach to the epidemic of suicide, providing resources and access to mental health care for people with serious mental illness many of whom are left to languish on city streets or in jails and prisons. Only recently has the epidemic of opiate use and overdose deaths attracted federal funding. Research dollars to find new treatments and understand the underlying neurobiology of psychiatric disorders is wholly insufficient.

Even people with health insurance face barriers to getting mental health care. Despite the promise of mental health parity laws, enforcement has been slow, and beneficiaries still encounter a multitude of problems, such as care denials and “phantom” provider networks.

There is no question that we are in a period of great turmoil. The pandemic is liable to get worse before it gets better, and it will likely take longer to dissipate than any of us wish.

But the truth is that this is going to pass. What won’t pass, and will likely be made worse by the pandemic, is our broken mental health system where deaths from suicide, overdoses, and the associated higher mortality and morbidity of mental illness disability will remain. While we are rightly concerned about the safety of our family, friends, and communities, let us also use this extraordinary crisis to commit ourselves ever more earnestly to the task of building a system of care of which we can be proud, rather than ashamed.

Be well, and stay safe. ■