Before Covid-19 arrived in the U.S., the country was in the midst of a mental illness crisis. Suicide rates in the United States rose 33% between 1999 and 2017. In 2018, 1.7 million people had an opioid use disorder. Now a deadly virus and the resulting isolation and economic hardship threaten to exacerbate the crisis.
As suicide, opioid use disorder, and other mental health issues were playing out, the country’s capacity to help wasn’t up to the task. When people became ill enough to need hospitalization, there was only one psychiatric bed for every 3,000 Americans. That’s one-tenth of what we had in the 1950s. For people with severe mental illness, it was hard to find inpatient treatment and, for those who did, they were often forced into shorter stays than necessary for quality treatment.
Then came Covid-19. In early polling by my organization, the American Psychiatric Association, one-third of Americans said the coronavirus was having a serious effect on their mental health. Subsequent polls from other organizations have shown increases in that number. Crisis hotlines have reported an extraordinary rise in calls, which are the canary in the coal mine for the devastation this pandemic is having on Americans’ mental well-being.
We know why. Frontline physicians, nurses, and other health care workers are looking death in the face every day. Shift workers in economically treacherous situations are forced to risk their health for a paycheck. Millions of Americans have lost their jobs. Still more are separated from the people they love, their daily routines have been disrupted, and they are making anxious choices every day that affect their physical and mental health.
All of this is happening within the current broken health care system, highlighted by the long-standing health care inequities that reverberate in Covid-19 casualties. We are seeing highly disproportionate impacts on Black people, Latinos, Native Americans, the elderly, individuals with developmental disabilities, residents of rural communities, and people living in poverty.
We can and must act now to diminish the fallout of mental illness from this grim situation, which could be as devastating as the destruction wrought by the direct effects of Covid-19.
The American Psychiatric Association has outlined a number of steps Congress should take right away:
- Provide health care workers with sufficient and appropriate personal protective equipment and mental health support
- Expand telepsychiatry and require insurers to pay clinicians for providing it just like any other medical service.
- Treat patients’ behavioral health needs the same as their physical health needs, and release emergency funding to ensure that community mental health centers, crisis centers, and essential local clinicians can meet the growing need for mental health care.
That will get us over the initial shock. But for Americans to thrive in the long-term, Congress must make a sizable investment in our existing mental health infrastructure, and there are three proven, necessary elements.
First, many Americans with mental illness get care for it, or access to it, through their primary care physicians. They do not have direct access to psychiatrists, which creates a barrier to getting specialized treatment for often complex mental health conditions.
The American Psychiatric Association backs what’s called the collaborative care model, in which a primary care physician works with a psychiatrist and a behavioral health care manager to optimize treatment for patients with mental illness in the primary care setting. This team-oriented approach to treatment for mental disorders means patients get the highest-quality care in a way that maximizes the use of limited resources.
Second, Covid-19 has laid bare the severe doctor shortage across the United States, and that shortage includes psychiatrists. While every kind of mental health professional is necessary and indeed critical to responding to the crisis, psychiatrists bring unique expertise in serving some of the most severely compromised patients in psychiatric units and hospitals, long-term care facilities, homeless shelters, and jails and prisons. Forgiving some of the debt that students amass during medical school would incentivize more individuals to serve in these capacities, as would lifting caps on federal funding for new residency slots.
Third, we needed more psychiatric beds in hospitals before Covid-19, and need even more now as physical distancing continues — yet some hospitals have decreased the number of psychiatric beds by converting them to beds for individuals with Covid-19. Patients in psychiatric units who contract Covid-19 need to be separated from other patients. We currently do not have enough beds to treat everyone for the length of time they need. Without federal funding for psychiatric beds, we will have an increase in deaths from the mental health sequelae of Covid-19.
Just as the majority of Americans have dramatically changed their ways of life to combat Covid-19 infection, the federal government needs to dramatically change how it deals with mental illness. Without such action, Americans are ripe for a pandemic of depression and despair.
Jeffrey Geller is a psychiatrist, professor of psychiatry at the University of Massachusetts Medical School, and president of the American Psychiatric Association.