“Deteriorating mental health,” Can Pac Swire

“Water running along a pavement will readily seep into every crack; so, too, did the unchecked coronavirus seep into every fault line in the modern world.” So wrote Ed Yong in his August 4, 2020, Atlantic article on “How the Pandemic Defeated America.” At that time, the US was nearing 150,000 lives lost due to COVID-19. Now, five months later, the US death toll has nearly tripled, with over 420,000 lives lost to date.

Yet the nation’s health challenges extend beyond lives lost. Mental health is also a growing challenge—a pandemic within the pandemic, if you will. A recent survey of 3,334 physicians from 24 countries by Sermo, a medical social media platform, found 86 percent of doctors who responded believe that mental health and depression will be the biggest non-COVID-19 public health issue after the pandemic. Increased violence, spousal and child abuse, suicide, and increased opioid abuse are other major areas of apprehension.

Substance use and mental health are deeply interconnected—and these intersect with matters of economic, racial, health, and criminal justice. A Kaiser Family Foundation poll during mid-July found 53 percent of adults in the US reported negative mental health effects connected to the coronavirus. These effects took many forms, such as difficulty sleeping, increased alcohol and substance use, and eating disorders, as well as a worsening of prior chronic conditions.

An alarming recent report from the Centers for Disease Control and Prevention (CDC)  found 81,230 people died of drug overdoses between May 2019 and May 2020, a record loss for a single year. Prior to COVID-19 overdoses related to substances such as fentanyl were on the rise, yet the pandemic increased the risk of overdose by affecting systems of service for those being treated for addiction and access to healthcare and support systems. Increased isolation, heightened anxiety and depression, and socioeconomic and emotional hardship are further risk factors.

The global concerns reflected in the Sermo findings are even more concerning when we take into account a September 2020 report from the nonprofit Well Being Trust (WBT). The WBT report projected various scenarios of recovery, which affect “deaths of despair,” defined as drug and alcohol use and suicide. By investigating trends of unemployment, isolation, and the state of supportive services across the US during COVID-19, the report estimated a range of deaths of despair from 27,644—if there is quick comprehensive action taken—to 154,037 additional lives lost if the recovery efforts or slow and poorly rolled out.

These fault lines cannot be remedied overnight. Yet, a new foundation of recovery, service, and care might be modeled on those nations that aim to uphold “the right to health” as defined in the 1966 United Nations treaty, The International Covenant on Economic, Social and Cultural Rights (ICESR). The United States signed ICESR in 1977, yet it has not ratified the treaty, which defines a broad array of equity issues like the right to housing, healthcare, education, labor, and many more as basic human rights. Unlike the US, in Canada healthcare is seen as a basic human right.

The Canadian health system traces its origins to the election of a social democratic government in the rural province of Saskatchewan in 1944. In 1947, public hospital insurance was introduced; in 1962, this was expanded to doctors’ visits after a strike by provincial doctors failed to prevent implementation. This expanded across the country in the decade that followed. A 1984 law, the Canada Health Act, served to consolidate the current system. Territories and provinces health systems need to meet five criteria to receive federal dollars: public administration, comprehensiveness, universality, portability, and accessibility. All Canadians are covered.

“To Canadians, the notion that access to healthcare should be based on need, not ability to pay, is a defining national value. This value survives despite a shared border with the USA, which has the most expensive and inequitable healthcare system in the developed world,” Dr. Danielle Martin, the chief medical officer at the Women’s College Hospital and professor at the University of Toronto wrote in a 2018 Lancet article, along with other Canadian health care professionals.

Yet, the Canadian healthcare system is not without its own compromises. The system covers medically necessary care and essential services, but fails to cover dental, mental health, long-term care, vision, or ambulance billing, which requires many Canadians to rely on supplemental insurance plans, sometimes through employers, like in the US. Amid COVID-19, the lack of coverage for mental health has deepened health problems stemming from social isolation.

In response, some provincial governments have moved to increase mental health funding. At the federal level, Prime Minister Justin Trudeau has committed his government to investing over $240.5 million towards virtual services and Health Minister Patty Hajdu announcing $10 million to support research on COVID-19’s effects on mental health and substance use. Margaret Eaton, CEO of the Canadian Mental Health Association (CMHA) and an advocate for universal mental health coverage, hopes public awareness will put pressure onto policymakers to include mental health coverage fully within the Canada Health Act framework:

My wishful thinking is, maybe the fact that 40 percent of Canadians now have been impacted and understand what it’s like to experience anxiety means there’s more willingness for the public to actually push politicians to have that long term built-in support, not just for the pandemic, but after.

Even without universal mental health coverage, CMHA provides unique free mental health resources on their platform that are regularly updated, as well as the BounceBack program. The free program links people dealing with mental health issues to resources and personnel, as well as assists individuals who are on the queue for services, which may decrease wait times for individuals in significant need.

Meanwhile, in the US, policymakers, including Biden, have resisted calls for Medicare for All, to say nothing of universal mental health coverage. One obstacle has been misinformation regarding the actual performance of universal health care, which is the norm in not just Canada but every other comparably wealthy country in the world. Former corporate communication Cigna head Wendell Potter took to Twitter to highlight his past involvement in misinformation:

Amid America’s COVID-19 disaster, I must come clean about a lie I spread as a health insurance exec. We spent big money to push the idea that Canada’s single-payer system was awful and the US system much better. It was a lie, and the nation’s COVID responses prove it. I’ll regret slandering Canada’s system for the rest of my life.

Potter left his position in 2008 and has since dedicated his work to promote universal health coverage.

In both the US and Canada, COVID-19 has revealed structural weaknesses. As always, hoping for policymakers to “do the right thing” is not a strategy. In the US, provisions of the Affordable Care Act that mandate mental health coverage in insurance plans help, of course, but fall far short of the need. Advocacy by social movements to provide full mental health coverage is required in both Canada and the US to address the evident cracks in healthcare systems laid bare by COVID-19.—Chris Cannito