In October, the CDC updated its list of medical conditions that contribute to worse outcomes with Covid-19 infection. It’s an essential list, used for prioritizing testing, treatment, and vaccination. For the first time it includes “certain mental health conditions.”
Specifically, according to the CDC, “having mood disorders, including depression, and schizophrenia spectrum disorders can make you more likely to get severely ill from Covid-19.”
It’s good to see the CDC updating its list, which for the last several months has included asthma, hypertension, liver disease, and substance use disorder among others — all conditions with lower risk profiles for adverse Covid outcomes than serious mental illness. These are mental disorders that seriously impair function, such as schizophrenia, bipolar disorder, and depression. Scientific reports from around the world have demonstrated higher rates of hospitalization and death from Covid-19 in people with serious mental illness for nearly a year. Why has it taken the CDC so long to recognize the science?
When it comes to mental illness, the CDC has been mostly missing in action, not only during the Covid-19 pandemic but for years before it. To know what the CDC prioritizes, just look at the Morbidity and Mortality Weekly Report (MMWR), its open-source publication loaded with information about death and disability from a range of causes. Yet a search of “schizophrenia” over the past five years reveals a conspicuous absence of reports beyond noting an association with marijuana and how it is distinct from ADHD. There is an abundance of information on autism, anxiety, and mild depression, but serious mental illness, which affects 14.2 million Americans, is oddly missing from the MMWR.
There is a pattern here. While the CDC reports on infectious disease deaths across the country weekly, suicide death statistics have, until recently, lagged by two years. What we know about the prevalence of serious mental illness and how many people are seeking treatment for it come largely from reports of the Substance Abuse and Mental Health Services Administration (SAMHSA), a service agency that lacks the epidemiological firepower of the CDC and has failed to include institutionalized and homeless people in its population-based studies of the prevalence of serious mental illness.
Deaths of despair — deaths from suicide, overdose, and alcohol-related disease — likely surpassed 175,000 in 2020, more than deaths from any infectious disease (except Covid-19) and any form of cancer (except lung cancer). But this number is a rough estimate because there is no rigorous, real-time surveillance system for tracking deaths of despair. The truism from business — you can only manage what you measure — is equally relevant for public health.
To its credit, the CDC has implemented the Household Pulse Survey to track anxiety and depression during the pandemic. This is a great example of responding quickly to an urgent need, and it demonstrates how the agency can track behavioral health symptoms relevant to the pandemic. The problem is that it continues to neglect the most severe behavioral health problems. No one is tracking people with serious mental illness.
The Covid-19 pandemic has revealed the importance of a public health infrastructure for preparedness and surveillance. The CDC’s mission is clear. “As the nation’s health protection agency, CDC saves lives and protects people from health threats.” To accomplish that, the CDC “conducts critical science and provides health information that protects our nation against expensive and dangerous health threats and responds when these arise.”
There can be little doubt that mental illness is an expensive and dangerous health threat. Individuals and families struggling with serious mental illness need the CDC to respond to it.
Thomas Insel is a psychiatrist and neuroscientist, co-founder of MindSite News, a former director of the National Institute of Mental Health, and author of “Healing: Our Path from Mental Illness to Mental Health” (Penguin Press, February 2022). Andy Keller is the president and CEO of the Texas-based Meadows Mental Health Policy Institute.
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