Oct 28, 2020

The Second Wave – A Mental Health Crisis

By: Eric Meier, CEO of Owl Insights

The impact caused by the first wave of Covid-19 in the U.S. has caused many to worry about the effects of the increase in cases around the country as we head into winter. However, many experts report that there is also danger in a different type of “second wave” – declining mental health. Data suggests that this healthcare issue must be confronted immediately, as access to professional support will be a crucial fortification in the fight for the nation’s physical and mental health recovery. The numbers show that the mental health epidemic resulting from Covid-19 is likely to be experienced by all Americans.

Mental Health Impact on Caregivers

Through a national analysis of caregivers conducted by Blue Cross Blue Shield (BCBS), entitled “The Impact of Caregiving on Mental and Physical Health,” BCBS leverages insurance data to identify major healthcare trends. Some key findings include that there are at least 6.7 million BCBS members acting as caregivers for their family members, and these caregivers are seeing a 26% greater impact on health conditions that could lower their overall health (as measured by the BCBS Health Index). These health conditions are not merely physical — according to this report, the demand for such intense caregiving has increased “self-reported stress, isolation and loneliness among caregivers.” The recent National Pulse Survey conducted by the Blue Cross Blue Shield Association (BCBSA) found that “1 in 4 unpaid caregivers are feeling more stress trying to balance work and family due to Covid-19.”

Mental health concerns for those acting as caregivers are reportedly more severe for millennials than Gen X or Baby Boomers according to BCBS. The report states, “adjustment disorder and hypertension are 82% more prevalent among millennials who are caregivers.” Adjustment disorders, according to the Mayo Clinic, develop from major life changes that cause stress, resulting in ongoing “emotional or behavioral reactions that can contribute to feeling anxious or depressed” — often resulting in suicidal thoughts or behavior.

Rise of Loss Related to Mental Health Issues

In an October 2020 article published by JAMA, mental health disorders related to the overwhelming losses during this pandemic are on the rise, and the effect of the tragedies is likely to continue its surge. While the number of Covid-19 related deaths reached 225,000 between February and August of 2020, the second wave of mental health repercussions is still building. According to Dr. Simon, this “imminent mental health surge will bring further challenges for individuals, families, and communities including increased deaths from suicide and drug overdoses.” The concern is not whether this second wave is on its way, but rather how our already broken mental healthcare system will meet the demand — specifically the imminent problem of access to care for the most vulnerable community members. The first wave of Covid-19 saw a disproportionate effect on Black and Hispanic individuals, older adults, lower socioeconomic groups of all races and ethnicities, and health care workers. These vulnerable people are also at high risk from the mental health impact and must be able to access effective mental health care.

Rising Emotional Distress

Researchers at a multinational level are also warning that adults in the U.S. are more likely to experience severe mental health effects as a result of the pandemic. The Commonwealth Fund joined with the security research firm SSRS and their investigation revealed that the negative impact of this pandemic on mental health was nearly instantaneous, and given the nature of mental health, this may have “long-term effects in every country it has touched.” The survey found that in the US since the beginning of the pandemic, over 30% of adults experienced either stress, anxiety, or heavy sadness that they felt they were unable to cope with in isolation.

According to this research, even before the Covid-19 pandemic, Americans were already experiencing higher levels of “emotional distress”, now worsening in the face of ongoing uncertainty. Out of this significant portion of adults in the US experiencing mental health issues, only one in three have reported being able to access support from a professional (as compared to “approximately half of Australians and Canadians”).5

Impact on Marginalized Communities

In June of 2020, the House Energy and Commerce Subcommittee on Health held a virtual hearing on the coronavirus pandemic’s impact on mental health. In attendance was the CEO of the American Psychological Association (APA), Dr. Arthur Evans. Dr. Evans spoke to the systemic nature of the destruction produced by an under prioritized mental health system, which is “having a disproportionate impact on marginalized communities.” Dr. Evans described the causes and effects of this nationwide emergency: “… we have multiple crises happening simultaneously. We have a pandemic that is creating a number of psychological challenges for individuals. We have on top of that an economic crisis that is always contributing to the psychological distress of Americans, and then on top of that […] we have been dealing with systemic racism and the impact that that has on many of our fellow Americans.” He stated that all of this results in data showing “increases in anxiety, depression, post-traumatic stress disorder, and eating disorders.”

Other government representatives have spoken out on this issue as well. Former U.S. Rep. Patrick J. Kennedy wrote in an article for The Kennedy Forum (an organization he founded in 2013 to pursue mental health equity in the U.S.) that the Covid-19 pandemic has put the nation in a dangerous position regarding mental health. He warns that Covid-19 has unleashed “a new wave of mental health and substance use disorders in the U.S.” Further, Kennedy expresses concern regarding access to care. He states, “[w]e have a serious shortage of mental health and addiction treatment providers across the country, and […] we are operating under shortsighted policies that actually hinder access to care.”

In light of this, it is clear that the ongoing Covid-19 pandemic will have significant mental health repercussions. This devastation will likely appear in the form of worsening anxiety, depression, eating disorders, suicidal thoughts, and other reactions to emotional trauma.

Change is Needed to Combat the Second Wave

In summary, the consequences of the Covid-19 pandemic have had a severe impact on the mental health of U.S. adults, and the unfortunate truth is that our system is not prepared to address the challenge. Robust changes are needed to enhance access to mental health treatment, possibly through collaborative care models, in order to get ahead of this impending second wave of mental health distress.

In order to prepare for this next wave, healthcare systems and community mental health organizations must find ways to scale resources to efficiently screen patients for behavioral health conditions, match them with the right resources, and then monitor their progress over time. Technology creates the opportunity to provide more efficient and effective care – enhancing treatment and potentially access to care – while improving quality. Telehealth has broken through as a significant opportunity for behavioral health to expand access, but without the ability to screen, triage, and accurately diagnose and treat mental health issues – this second wave may be more devastating than the virus itself.  

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