As more than 100,000 people have died of Covid-19 in the United States, and 40 million will have lost their jobs, there is another looming crisis that may eclipse these losses: a national mental health trauma.
The necessity for implementing social distancing, in large part because of the failure to test, trace, and isolate contacts properly in the early stages, a pandemic that has gotten out of hand is not just causing an economic recession but a “social recession.” We hear of domestic violence and problems of depression and anxiety every day, while isolation and sheltering in place become risk factors for substance abuse, suicide, and even homicide.
More than half of Americans report the coronavirus crisis is harming their mental health. Among frontline health care workers and their families, 64% reported worsened mental health, as did 65% of those who had lost income. A federal emergency hotline for people in emotional distress registered an increase of more than 1,000 percent compared to last year. Another recent report by the Well Being Trust said the pandemic could lead to 75,000 additional “deaths of despair” from drug and alcohol misuse and suicide due to unemployment, social isolation, and fears about the virus.
The pandemic could lead to 75,000 additional “deaths of despair” from drug and alcohol misuse and suicide due to unemployment, social isolation, and fears about the virus.
Still, there are concerns about the mental health system’s ability to absorb or to reach most people in need. While the initial outbreak of the novel coronavirus caught hospitals unprepared, the United States’ mental health system—vastly underfunded, undervalued, and difficult to access before the pandemic—is even less prepared. Yet there are no White House briefings about it, and no word of a plan. Congress’ trillions of dollars in emergency coronavirus funding allocated only a tiny portion for mental health, which may not even make up for the recent healthcare cuts and insurance blockage by the Trump administration.
We know that surges of suicides, overdose deaths, and other forms of suffering often follow natural disasters, terrorist attacks, wars, and economic downturns. An existential crisis occurs with a changed sense of safety and security, an altered view of the world, and, when the disaster is human-caused or human-exacerbated, a serious loss of faith in humanity. Collective helplessness about the situation, as the politicization of the pandemic pits us against one another instead of bringing solidarity, intensifies trauma and grief. We are rapidly heading toward a form of national post-traumatic stress disorder (PTSD), which may last many years.
The good news is that we can do something about it. Amid tragedy, there is an opportunity to recognize and to correct our course—and using our experience of suffering to bring about change is precisely how PTSD is healed. We can prevent, share, and repair.
A great deal of prevention is done through education. In my 15 years of clinical teaching at Yale Law School, I trained students to consider self-care an “integral part of professional responsibility.” It is not selfishness or weakness but an important aspect of building and protecting one’s overall health. I have instructed to: (a) put aside time for self-care, just like exercise (an hour a day, an afternoon week, etc.); (b) devote it to pure enjoyment (which during quarantine may include virtual communication to stay in touch with friends and family, or, for those in close quarters, asking for personal time and space); and (c) not be afraid to consult when necessary. Awareness of one’s own needs and the importance of mental hygiene itself serves as a huge step in prevention.
A great deal is mitigated through sharing. A National Academies of Sciences report on the health consequences of social isolation and loneliness in older adults showed that social isolation is associated with significantly increased premature mortality not just from mental but from physical causes. It found an increase of risk by 59 percent for functional decline, 50 percent for dementia, 32 percent for stroke, 29 percent for incident coronary heart disease, and 25 percent for cancer mortality. Older adults may be the most vulnerable, but we are all affected. Breaking through the social isolation and stigma to find ways of sharing is thus critical. As many as one in five American adults suffer from mental illness, and speaking openly offers significant relief.
Even though one in five adults have a diagnosable mental illness, less than half receive treatment, according to federal statistics. The United States trails behind the rest of the world in mental health awareness and prevention. This is seen in how suicide rates have fallen around the world, while rates in the United States have climbed every year since 1999, increasing 33 percent in the past two decades. Large, systemic changes are necessary to meet this scale. Parity and access problems need to addressed immediately. Mental health should no longer to be marginalized but treated the same as physical health, as all scientific evidence and the seriousness of the issue require.
Finally, we can no longer ignore the elephant in the nation’s room. We receive a recurring question from the public: “I am in a state of constant anxiety because of Trump’s refusal to deal with the pandemic in a scientific manner: he’s making it worse by both his actions and inaction. How do I cope with this anxiety?”
Over Memorial Day weekend, we approached the mark of 100,000 casualties, not by an external enemy but by bioterrorism of our own government. We have a president who went golfing after stating: “I don’t take any responsibility at all.”
Leaving people helpless, unable to discuss the overarching problem in properly rigorous terms, let alone respond to or prevent it before the devastation happened, worsens the trauma. How this “cultural trend” came about is an important story that has been reported on elsewhere.
Just as 250 years of scientific enlightenment vanished in an instant to descend us into a medieval-level plague when a president did not wish to apply knowledge, 25 years of mental health awareness went up in smoke to descend on us a dark age of ignorance and stigma when a psychiatric establishment wished to withhold knowledge from the public.
It does not have to be this way. The people have a right to expertise, or access to the best available knowledge, alongside the free press, or access to facts, which are the foundation of democracy. They are the empowerment of people against oppression and autocracy and, in this case, also the best medicine.