September 8, 2020; Spokesman-Review
During the fall and winter months, millions in the US cyclically suffer debilitating mental health conditions caused by seasonal affective disorder (SAD), which typically affects five percent of US adults. But as the days begin to shorten and darken, we enter the back half of the year amid a pandemic that has killed over 190,000 Americans, an economic recession with millions out of work, a housing crisis, and heightened political turmoil and civil unrest.
Since March, rates of depression, anxiety, suicidal ideation, and domestic abuse have been rising all across the country. The increased number of those already suffering mental health challenges, coupled with the psychological symptoms of SAD beginning this fall, will put severe strain on already overburdened state and local mental health providers.
The behavioral and mental health response triggered by COVID-19 is different than other disaster events. According to Dr. Kira Mauseth, the co-leader of the behavioral health strike team at the Washington State Department of Health, “The responses people are having are [marked] by the sense of isolation and uncertainty, so that’s not PTSD—it’s depression.”
The Centers for Disease Control (CDC) released a report in mid-August saying 40 percent of US adults reported struggling with mental health and substance abuse due to the pandemic. The CDC found “symptoms of anxiety disorder and depressive disorder increased considerably in the United States during April–June of 2020, compared with the same period in 2019,” which are translating into higher rates of suicidal thoughts.
The survey shows that these rates are higher for adults between the ages of 18 and 24, essential workers, unpaid caregivers, and people of color, who all reported experiencing “disproportionately worse mental health outcomes, increased substance use, and elevated suicidal ideation.” One study predicts we could see as many as 75,000 more suicides because of the pandemic. Another study published in QJM: An International Study of Medicine claims the “mental health consequences of the COVID-19 crisis including suicidal behavior are likely to be present for a long time and peak later than the actual pandemic.”
The increase in substance abuse documented by the CDC corresponds to findings put out by the market research firm Nielsen, which reported that “US sales of alcoholic beverages rose 55 percent in the week ending 21 March 2020 compared with the same period last year. Online alcohol sales jumped 243 percent.”
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The heightened distress, anxiety, fear, depression and substance abuse is also manifest in rising domestic abuse cases. A major Massachusetts hospital reported a “significant year-over-year jump in intimate partner violence cases among patients—nearly all women—who sought emergency care during the COVID-19 pandemic’s first few weeks.” In May, the United Nations predicted a 20 percent rise in domestic abuse cases across the globe.
Julie Hall, the director of admissions at the Washington state psychiatric hospital Inland Northwest Behavioral Health (INBH), commented they are seeing “an exacerbation in symptoms and more acuity” among their patients. INBH’s numbers are staggering: “A 365 percent increase in patients with schizophrenia; a 140 percent increase in patients with major depressive orders with psychotic features; and a 198 percent increase in patients with schizophrenic depressive-type disorders, all compared to client diagnoses pre-COVID.”
Many behavioral health hospitals in the Washington state region are already at or close to capacity. Their Department of Health states expects that will worsen in the fall, with “October and November mark[ing] the lowest points in mental health and behavioral health responses” and predicting the “highest risk of suicide most likely to occur between October and December 2020.”
But despite the significant rising numbers in mental health conditions and a mental health system currently stretched thin, the Guardian reports “the economic fallout from COVID has left states facing a cumulative budget shortfall of $555 billion by 2022, according to the Center on Budget and Policy Priorities. And some cities and states have proposed axing mental health services in order to help balance the books despite the looming wave of despair.” In New Jersey, for example, the governor’s latest budget proposal cuts a decades-old mental health and counseling program for youth that currently operates in a hundred New Jersey public schools. Thousands are petitioning to save the School-Based Youth Services Program and help raise the needed $11 million to keep it in place.
As Dr. Mauseth puts it, “A new spike in COVID-19 infections in the fall could also trigger a ‘disaster cascade’ pattern, which could restart the current pandemic disaster response curve that we are all living through.” If the US is truly looking at a mental health crisis peaking in the months to come and persisting for years to come, now is not the time to cut mental health services due to state and local budget deficits. Instead, as the CDC recommends, we should increase “intervention and prevention efforts to address associated mental health conditions. Community-level efforts, including health communication strategies, should prioritize young adults, racial/ethnic minorities, essential workers, and unpaid adult caregivers.”—Beth Couch
Yesterday was World Suicide Prevention Day. The US National Suicide Prevention Lifeline is 1-800-273-8255.