Addressing the Challenge of Increasing Mental Health Concerns Following the Global COVID-19 Pandemic

After a disruptive year navigating the global COVID-19 pandemic, we are beginning to see a sense of normalcy return. However, one topic that will remain at the forefront of healthcare is the recognition and value of mental health.

According to the CDC and National Center for Health Statistics, approximately 16 million Americans are impacted by depression yearly. Additionally, 11.2% of adults report regularly feeling worried, nervous or anxious. In the summer of 2020, the CDC released a study showing 40% of U.S. adults had struggled with mental or behavioral health issues at some point from June 2019 to June 2020. Moreover, the National Institute of Health found anxiety disorder diagnoses had increased from 8% of Americans in July 2019 to 36% of Americans just one year later. According to Mental Health America, over the past year, 19% of U.S. adults are actively experiencing an uncontrolled mental illness, with 5% of those being classified as severe. Finally, as reported by Becker’s Hospital Review, the CEO of Children’s Hospital – Colorado declared a state of emergency in pediatric mental health on May 25^th after they observed a significant increase in pediatric suicide. The article went on to say that the hospital has seen a 90% increase in demand for behavioral health treatment.

Recently, Avtex released the Omnichannel Healthcare Experience Report, which returned similar findings described by the CDC and NIH. In the past 18 months, 26% of Gen Z participants, 21% of Millennials, 15% of Gen X, and 6% of Baby Boomers have admittedly received care for mental health concerns. It can be assumed these numbers would be higher in each group for total mental health concerns after including respondents who did not seek formal care.

Mental Health is Multi-Faceted

Since the beginning of the pandemic, we have seen numerous reasons for an increase in mental health concerns.

• The COVID-19 virus ushered in isolation on every level. Families were separated, students lost vital social connections, nursing homes were placed in lockdown protocol, and physical touch was infrequent, and in some cases, even impossible. People around the world were questioning their individual purposes.
• Rising rates of layoffs and furloughs placed increased strain on people’s ability to pay bills, mortgages, and rent. Small and large business succumbed to complete collapse, altering decades of work, dedication, and service to their respective communities.
• In transitioning to working from home, parents not only had to manage their own occupational duties, but became moderators for their child’s virtual learning, while also managing fluctuations in daycare protocols.
• Severe illness and death associated with COVID-19 forced families to be absent during some of the most vulnerable points in their loved ones lives and have not allowed families to grieve appropriately, both in a physical and emotional sense.

Outlining a Response for Providers and Payers

As increasing amounts of patients experience and navigate mental health concerns, both providers and payers have a responsibility to their clients to respond with efficiency and compassion. Here are a few factors to consider when developing your response:

• Recognize the growing numbers of patients suffering from numerous mental health diagnoses, varying in severity, not only clinically, but socially as well.
• Address the shortage of mental health professionals across the country. We need to continue to promote legislature, student loan repayment options, rural employment, and advanced mental health training to help repair this shortage.
• Promote the convenience of virtual care. This allows patients, in many scenarios, to experience easier access to their providers, without having to rely on a means to transport themselves to a physical location.
• Continue to increase access for patients to communicate with their providers and payers.
• Promote omnichannel communication methods through voice, SMS, in-person interaction, email, paper mail, etc.
• Recognize that inappropriately treated mental health issues can lead to worsening physical conditions, ultimately increasing the number of healthcare dollars spent. This further crowds emergency departments and hospital wings, lengthens wait lists and heightens barriers to care for the entire population.

Outlining a Response for Employers

As noted above, business both large and small, were affected by the global COVID-19 pandemic. This might have meant a transition from in-person work to remote work, closure of departments or entire operations, workforce reduction, or even increased demand for work and high turnover due to imbalance between supply and demand. Regardless of the situation, businesses were forced to make foundational changes, catalyzed by the pandemic. Following loosened guidelines with increasing vaccination numbers, employees will be expecting responses from their employers regarding mental health employment retention. Here are some factors to consider in your response strategy:

• Recognize and embrace mental health in the workplace. Ensure that every employee knows their mental health is valued and is directly correlated to the workmanship and success of the business.
• Consider employment of a mental health professional for employees. Whether it be a full-time staffed position or a consulting position that can be utilized as needed, access to mental health care in the workplace could alleviate frustration and wait times if an employee were to seek care in a different setting.
• Consider including mental health days as a component of a benefits package that would function in conjunction with paid time off and sick leave. Associating days off for mental health issues with “paid time off” or “sick time” further promotes a negative connotation with self-care and devalues mental health from an employee perspective.

Clinical Perspective – The Story of Mary and John

As a practicing internal medicine clinician, I have been discussing COVID-19 and mental health issues day after day. I wanted to highlight an encounter from December 2020 that may provide a personal association with the information outlined above.

I had been caring for John and his wife, Mary, for the past four years. At 83 and 84 years old, they were inseparable and each other’s best friend. In December, John appeared on my schedule with a chief complaint of “personal.” As I walked into the room, I could tell something was off. He had bags under his eyes. His previous proper attire was dressed down to an old t-shirt and loose-fitting pair of sweatpants. He spoke quieter and slower. I started by asking where Mary was, and he broke down.

On a Wednesday night in October, Mary began to experience a cough and mild shortness of breath. The couple acted quickly, contacting our triage center to review her symptoms. Drive-up COVID testing was closed for the night. She was advised to monitor symptoms and set up a COVID test the following morning.

As the evening progressed, Mary’s breathing worsened. A home O2 monitor read 91%. EMS was called to the home and she was transported to the local hospital. John was told he could not ride with her but could meet them at the hospital. Upon arrival, John was told he could not see his wife in the ER. She was transferred to the ICU on Thursday morning. She was placed on a ventilator Friday afternoon after being diagnosed with acute respiratory failure and sepsis secondary to COVID-19 pneumonia.

Mary passed away the following Tuesday. John was able to say his goodbyes through the screen of an iPad early Tuesday morning, but had not spoken to or been with his wife since her symptoms started. A marriage that had lasted almost 70 years, was suddenly over, without so much as a warning or kiss goodbye.

John and I spoke for almost an hour, discussing his life with Mary and the weight he would now have to carry alone. We talked about medications, therapy, counseling, and how this could affect his congestive heart failure and obesity.

John’s story is his own, but it is also one of many that both patients and healthcare providers have had to navigate throughout this pandemic. Millions of people across our country and world have experienced isolation, anxiety, depression, grief, anger, worry, fear, and hopelessness. The recognition and response to the growing mental health crisis is upon us. How providers, payers, and employers act will have lasting impacts on numerous components of healthcare in 2021 and beyond.

Be well and take care.