Experts are warning that the United States is ill prepared for a coming mental health crisis caused by the coronavirus pandemic, which has killed more than 100,000 people in the nation and caused millions to lose their jobs.
Barriers to mental health care existed before the pandemic, but those challenges are being exacerbated now as millions report feelings of stress, depression and isolation.
The problem is expected to get worse in the coming months as people begin to reckon with the emotional impacts of the pandemic, and experts say there may not be enough resources to help them.
“The mental health aspect of this will come later and it won’t be as visible. You’re not going to be on a ventilator in a mental health center,” said Chuck Ingoglia, president and CEO of the National Council for Behavioral Health, which represents more than 3,300 mental health and addiction treatment providers.
“We still underinvest in mental health, and these crises have just exacerbated that disparity,” he said.
Four in 10 adults said in a recent Kaiser Family Foundation (KFF) poll that worry and stress related to the coronavirus has had a negative impact on their mental health.
Loneliness and isolation is a risk factor for poor mental and physical health, and calls to crisis help lines have skyrocketed as Americans practice social distancing to slow the spread of the coronavirus.
The Well Being Trust released an estimate earlier this month that the COVID-19 pandemic could cause 75,000 “deaths of despair” from drug and alcohol use and suicide if the U.S. does not improve access to mental health and substance use disorder treatment.
The United States already faced a mental health crisis before the pandemic hit, partly due to limited access to health care, an underfunded system and the stigma people still face when asking for help.
“Pre-Covid, the mental health and behavioral health substance abuse system were in crisis,” said Laurel Stein, chair of the Mental Health Liaison Group, a coalition of national organizations including the American Psychological Association and Mental Health America.
“Congress was working to and had to responded to the opioid epidemic, but a lot more needed to be done. All of these things have been exacerbated by the pandemic and the public health emergency,” Stein added.
Suicide rates in the U.S. increased 33 percent from 1999 through 2017 and is now the 10th leading cause of death overall. Men face the highest risk, particularly those who are LGBT, American Indian, Alaska Native or white.
One in five U.S. adults experience mental illness, with anxiety and depression being the most common disorders. Yet less than half of those experiencing mental illness received treatment in 2018. More than 20 million people had a substance use disorder in 2018, and about half also had a mental health disorder.
“Mental health and substance use treatment has always been at the periphery of health care,” Ingoglia said. “Going back for years, the responsibility of paying for this treatment always has been a little different than how we handle the rest of health care.”
Insurers weren’t required to cover mental health care and substance use treatment at the same levels of physical illnesses until 2008.
But getting treatment can be difficult even for people who do have insurance. Mental health professionals are commonly not in network with insurance plans, forcing patients to pay out of pocket for services, which is unfeasible for low-income patients who are more likely to go without care.
The expansion of telehealth during the pandemic has been a bright spot in mental health treatment; providers have said anecdotally the number of missed appointments have decreased. But there is still a long-standing shortage of mental health providers, especially psychiatrists.
“Provider participation and provider availability has been a longstanding issue in mental health care. There just aren’t enough providers in many areas to treat everyone, even if everyone participated in all insurance plans, it wouldn’t be enough to treat everyone,” said Rachel Garfield, co-director for the Kaiser Family Foundation’s Program on Medicaid and the Uninsured.
Telehealth isn’t covered by all insurance plans, though a bipartisan bill sponsored by Reps. Kim Schrier (D-Wash.) and Phil Roe (R-Tenn.) would make it a requirement.
The need for help is expected to be exacerbated by the pandemic, yet mental health providers are already strained by demand.
Providers have faced unexpected costs in transitioning from in-person visits to telehealth; losses in revenue have led to layoffs and reduced services and hours.
One-third of the providers represented by the National Council for Behavioral Health said in April they have had to cancel, reschedule or turn away patients; 92 percent said they reduced operations and 62 percent believe they can only survive financially for three months under current conditions.
The council is asking Congress for $38.5 billion for its members, to avert the “collapse” of the country’s mental health system.
Still, the money appropriated by Congress hasn’t met the moment, said Ingoglia, who noted that of the $2.2 trillion appropriated in the CARES Act, only $425 million was dedicated specifically to mental health and substance abuse treatment.
The bill passed by the House earlier this month that Senate Majority Leader Mitch McConnell (R-Ky.) has described as dead on arrival includes $3 billion for programs at the Substance Abuse and Mental Health Services Administration (SAMHSA.)
Another concern for experts is the millions of Americans who lost job-based insurance coverage as the result of coronavirus-fueled layoffs.
While federal law allows laid off workers to keep their employer-sponsored health plan for up to 18 months, employers typically don’t continue paying the premiums.
The coronavirus bill that mostly recently passed the House would cover subsidies for individuals who lose their job-based coverage.
For the ranks of the uninsured, which totaled 27.5 million people before the pandemic, mental health care can be expensive and waitlists for free or low-cost services can be lengthy. Some community health centers that offer mental health services have had to close or reduce services due to the pandemic.
Democrats and advocates are pushing the Trump administration to reopen the Affordable Care Act exchanges for the uninsured, but it has so far resisted those efforts, meaning only people who have lost job-based coverage qualify for a special enrollment period.
“If there isn’t federal action to open up enrollment in the marketplace, and there isn’t federal action to subsidize COBRA, we’re just going to see more and more people lose coverage and not have an opportunity for getting in the coming months,” said Cheryl Fisch-Parcham, director of access initiative at Families USA, a national nonpartisan consumer health care advocacy organization.
If you are having thoughts of suicide, call the National Suicide Prevention Lifeline at 1-800-273-8255 (TALK). More resources are available at SpeakingOfSuicide.com/resources.