America can’t wait: It’s time for a Marshall Plan for mental health

The COVID-19 pandemic has engulfed this country in a crisis that stands to transform every aspect of our lives for years to come. Economists have raised alarms about a devastating, drawn-out recession because of this unprecedented public health emergency. Depression, anxiety, and PTSD, though, will be the invisible handicap. Our country was already experiencing rising rates of suicide and substance misuse and our recovery will be further disadvantaged by an inequitable and inadequate health infrastructure that provides scant resources for mental health.

As a mental health advocate in New York City, the national epicenter of this pandemic, I know that we must brace ourselves for its severe, long-term impact. We are only in phase one in dealing with the tsunami of loss after the pandemic subsides. 

Imagine the families devastated by multiple deaths, the displaced gig economy workers, the small-business-people starting over. Our frontline health care workers and first responders — much like our returning war veterans — will need wide scale treatment for PTSD. The National Alliance on Mental Illness estimates that untreated mental illness currently costs the country up to $300 billion annually due to losses in productivity, an amount we can ill afford in the post-pandemic landscape.

Americans are coming together these days, but the pandemic’s toll on our well-being can be gleaned in media reports of an uptick in calls to crisis lines, like those for domestic violence and suicide. A recent survey by Fluent of over 1.85 million American adults 18 and over revealed a 70 percent spike in overall nervousness in recent weeks. A Kaiser Family Foundation poll found that 19 percent of adults say the pandemic has had a “major impact” on their mental health.

Now is the time for the federal government to put forth a kind of American Marshall Plan for mental health to meet our individual and collective needs after the pandemic.

Named after the plan to boost the U.S. economy by aiding our Western Europe allies after WWII, this plan would be more than a crisis response — it would be a blueprint for a mental health infrastructure with a broader, more flexible mental health workforce, new technology, and massive funding investments to deliver integrated, community-based services. It would support best practices, on the state and local level, while providing direct funding to localities that are often left underfunded.

For an entire generation, the federal government has been largely absent in meeting our needs for a mental health infrastructure, beginning with lack of funding for community mental health services proposed by President Kennedy in the 1960s until today, when big city jails have become key providers of psychiatric care. The reforms of the Affordable Care Act and the 21^st Century Cures Act represented progress, but they have not been adequately enforced or funded. The recent Stimulus Bill provided some support for mental health initiatives, but it is a one-time response and not nearly enough, given the urgency and need.

A Marshall Plan, though, could devise ways to expand and fund networks of local clinics. Those clinics should be as common as urgent healthcare, treating both mental health and substance use disorders in locations people already go for primary care and social services. It is essential to increase access to tele-mental health services.

We must also rethink our workforce and add capacity. We could, for example, expand the role of psychiatric nurses, create a new category of community health workers and train peers to perform effective interventions and provide support to families. We should also encourage more young people to go into the field of mental health care by providing scholarships in exchange for practicing in high need areas.

For now, cities, state and localities have had to find innovative solutions.

Here in New York City, for instance, we created ThriveNYC. Thrive’s partnerships with city agencies have created services that include prevention and education across the continuum, from serious mental illness to other levels of suffering and trauma. Programs include a 24/7 helpline where people can talk, text or chat with counselors in over 200 languages.  Mobile treatment teams provide treatment in the field to people who have otherwise been hard to serve. New York City also offers supportive housing, which is in urgent need of federal support.

Our federal government must take the lead again if we want to remain the country that always put forth bold solutions to big problems, as we did in creating the War on Poverty in the sixties or the Works Progress Administration (WPA) during the Great Depression.

To manage the post COVID-19 recovery, Americans must demand that our government treat our minds and our hearts as well as our bodies. Because there is no health without mental health.

Chirlane McCray is First Lady of New York City; her husband is Mayor Bill deBlasio. McCray created ThriveNYC. She also spearheads the Cities Thrive Coalition, with more than 200 mayors, county officials and thought leaders from all 50 states. She was named to TIME Magazine’s 50 Most Influential People in Health Care for 2018. Follow her on Twitter @NYCFirstLady