The masks are mostly off, group events have become almost normal, and many people believe — or at least hope — that the pandemic is waning. So it’s not surprising that Americans also want to move on from talking about Covid-19’s mental health impact. But walking away from the losses of the past two years will be harder than ditching our KN95s.
As part of the Covid States Project, since the beginning of the pandemic we and our colleagues at four U.S. universities have been surveying about 20,000 adults in all 50 states and the District of Columbia every six weeks about topics ranging from mask wearing and vaccines to politics and mental health. In our latest survey, published Wednesday, 4 in 10 respondents said they knew at least one person who had died of Covid-19; 1 in 7 said they’d lost a family member.
Americans continue to feel these losses — and all the other losses wrought by Covid-19 — acutely. Our survey also found that 27% of adults reported levels of depression that would typically trigger a referral for further evaluation. Young adults have been hit especially hard: Even now, half of the respondents between the ages of 18 and 24 described symptoms of depression.
The U.S. surgeon general issued a thoughtful advisory on the mental health crisis among children and adolescents. This topic made the front page of the New York Times, and rightly so. Yet neither of these addresses mental health among adults — even among the parents of these struggling young people. At one point in our data collection, parents with children at home had rates of depression 10% higher than non-parents. And while those numbers have improved, rates are still around 5% higher for parents.
The Centers for Disease Control and Prevention has also had little to say to the public about mental health as a component of the pandemic, beyond acknowledging that it contributes to people feeling stressed — despite levels of depression among adults being three to four times higher than they were in the before times.
When Americans do talk about mental health, we have an unfortunate habit of focusing on self-care as a solution to our problems. Just take care of yourself, the logic goes, and you’ll feel better. Do some deep breathing. Light a candle. And by all means, eat healthy food, exercise, and get plenty of sleep.
There’s nothing wrong with taking care of yourself. But self-care won’t work for everyone, or may not be enough, just like it might not be enough to cure a Covid-19 infection. Pretending otherwise makes it harder for people who might benefit from treatment to seek it. Depression then becomes a failure of self-care — If only I could exercise more! — rather than a mental health problem that may require professional help.
Not everyone who feels depressed needs treatment, or wants it. But in our haste to stop talking about the pandemic, we risk ignoring how many people are still hurting. In the U.S. Census Bureau’s Household Pulse data from early April, about one-quarter of people who reported anxiety or depression said they “needed counseling or therapy but did not get it” over the past four weeks. That’s 11.5% of the country’s adult population.
Talking about mental health — in adults as well as in in children — makes it easier for people to overcome their reluctance to seek care. Until we can talk about depression as comfortably as we do about high cholesterol and heart disease, we’ll have groups of people who suffer unnecessarily. The occasional brave athlete or physician going public notwithstanding, it’s hard to undo the resistance to treating mental health as part of overall health.
That disconnect between physical and mental health contributes to a massive access problem in the United States. Commercial insurance plans maintain ghost networks of mental health clinicians. Their websites list pages of providers who are ostensibly “in network,” but someone seeking help can spend days leaving voicemails before finding someone with an open appointment — months away. Schools and universities face similar challenges. Mental health services at educational facilities are consistently overwhelmed, leading to long wait times for any but the most serious cases. And the U.S. community mental health system remains chronically underfunded, a shadow of what John F. Kennedy spoke of 60 years ago.
Mental health parity laws are on the books, but have not been consistently enforced. While it’s not polite to say so, limiting access remains one way insurers seek to control their mental health costs. President Biden’s 2023 budget proposal includes funding, finally, to crack down on plans that fail to fund mental health care like other forms of health care, but this enforcement is likely to happen only if we resist the temptation to stop talking about mental health.
Telehealth can help bridge the gaps in access. Extending Medicare’s flexible policies for telehealth reimbursement during the pandemic was an important step, but if history is any guide, longstanding bureaucratic barriers will re-emerge as the public’s attention wanes. And, of course, telehealth is no panacea; the proliferation of online for-profit sites bears watching, both for its potential to transform the field of mental health, but also due to concerns about quality and safety.
On many mornings, psychiatric emergency rooms are filled beyond capacity, with some people waiting days for a hospital bed. The culprit here is not solely too few hospital beds — although more beds, particularly for children and adolescents, would certainly make things better. When someone can’t find a therapist, or can’t get an evaluation, the emergency room becomes the front door to care.
Covid-19 did not create these problems, but it is shining a bright light on the cracks that were already there. We need to keep talking about mental health, among adults as well as among children and adolescents, if we are to finally make things better, no matter how much we are tempted to just change the channel.
Roy Perlis is a psychiatrist, associate chief for research in the department of psychiatry at Massachusetts General Hospital, and professor of psychiatry at Harvard Medical School. Katherine Ognyanova is an associate professor of communication at Rutgers University’s School of Communication and Information.
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