The world has come to a standstill and the consequences are far-reaching. The impact of the Coronavirus on the economy, healthcare system, and families is unprecedented. Social distancing, along with the many stresses of this time has led to a notable increase in mental health concerns. With more and more people experiencing mental health challenges and a significant cut to resources, we are headed for a new phase of this crisis. The impacts of this pandemic will be felt for years to come and the emotional trauma will contribute to an already overloaded mental healthcare system.
Prior to the Coronavirus, it was estimated that 1 in 5 American adults experience mental illness and that rate was already trending upward. This statistic also does not include those who are struggling with their mental health but are not classified as having a mental illness. Those without diagnosed mental illnesses are the group that will experience the most growth during, after this pandemic. Yet, despite these distressing numbers, roughly 60% of those living with mental illness do not receive mental healthcare in the United States. The rates among those in the African American, Hispanic, and Asian American communities are even more staggering. This is mirrored by the disproportional impact the Coronavirus has had on these communities. According to the most recent statistics, “COVID-19 mortality rate for Black Americans is 2.4 times as high as the rate for Whites and 2.2 times as high as the rate for Asians and Latinos”. This prevalent issue has far-reaching consequences including a significant impact on the economy. Depression is currently the leading cause of disability worldwide. In the United States alone, serious mental illness causes a loss of earnings amounting to $193.2 billion dollars annually. With businesses struggling to stay alive during this pandemic, this loss of earnings is unmanageable. There is an evident need for more resources that are accessible to all who are struggling with mental illness and those who are seeking to improve their mental wellbeing. Despite this clear need, the current economic and social climate means that even more of those who require support will not be able to access crucial care.
According to the WHO, in regions most impacted by the Coronavirus, such as Lombardy in Italy, there has already been a notable issue regarding service access and ongoing care for people with pre-existing mental health conditions. The development of new mental health issues, especially for frontline workers, and the impact they will have on the existing system is a major concern. While there is limited existing research on the impacts of social distancing on mental health, there are close comparisons to draw from. Large scale disasters, whether natural or otherwise are almost always accompanied by notable increases in mental health conditions and substance abuse. For past traumatic events such as Hurricane Katrina and the 9/11 attacks, the impact on mental health occurred in the immediate aftermath and persisted over long time periods. For example, 1 out of 10 adults in New York City showed signs of major depressive disorder in the month following the 9/11 attacks. The SARS epidemic also significantly impacted the mental health of both patients and clinicians. The evidence all points to one conclusion, we must be prepared for a wave of new mental health concerns. We need to implement systems now that will be able to manage the influx in 2020 and for years to come.
Improving access to mental health support long term is a multifaceted issue that requires participation by several key players. Input and investment from governments, insurance companies, educational institutions, and other organizations is required if this global issue is to be conquered. Mental illness was already one of the greatest global health crises of this generation and following this pandemic it will be an even more pressing issue. It is clear that mental healthcare must become more accessible, less stigmatized, and more personalized. In 2012 the World Health Organization published “Mental Health Action Plan 2013–2020” and set forth 4 major objectives:
More effective leadership and governance for mental health
The provision of comprehensive, integrated mental health and social care services in community-based settings
Implementation of strategies for promotion and prevention
Strengthened information systems, evidence, and research.
In 2020, however, there is still a significant one disparity between the services needed and those available.
Slowly, governments have begun to take action to curb this crisis. In 2020 the government of Ontario rolled out a long-awaited free, online mental health platform. This BounceBack plan is a structured program to guide users through the principles of Cognitive Behavioural Therapy. Specifically targeted toward the most common mental health issues, anxiety, and depression, this program aims to provide support to the vast numbers of people unable to afford traditional care. The implementation of a program like BounceBack signals a shift in how mental health issues are perceived. When governments take action, it emphasizes the importance of mental healthcare. These initiatives can impact how other key stakeholders, like insurance companies, view the crisis. In addition to the BounceBack program, the government of Ontario has shared a collection of mental health resources that are accessible during the COVID-19 crisis. These resources include specific services for vulnerable populations such as Indigenous women.
MindBeacon is a great resource for people living in Ontario. They are offering government-funded digital therapy to support Ontarians through COVID-19. They provide CBT therapy to aid those struggling with anxiety, depression, panic disorder, and several other mental health conditions.
Insurance companies’ role is crucial as the financial burden of receiving care is significant. The National Comorbidity Study showed that “47 percent of respondents with a mood, anxiety, or substance use disorder who said they thought they needed mental healthcare cited cost or not having health insurance as a reason they did not receive that care”. There is also evidence that this statistic is increasing over time. While several laws have been put in place in the United States in order to require insurance companies to treat mental illness and physical illness equally, Insurance companies use various methods to circumvent the laws. One such strategy involves imposing rigorous guidelines for determining the necessity of services. These can include the most stringent thresholds for formal diagnoses. For example, a patient with a severe eating disorder was told “that unless she weighed 10 pounds less — which would have put her at 5-foot-7 and 90 pounds — or was admitted to a psychiatric unit, she wasn’t eligible for coverage”. In addition to creating strict guidelines of who is ‘sick enough’ to warrant coverage, insurance companies are limiting the length of the coverage. In many cases, the companies only cover enough treatment to stabilize a patient but not enough to result in real improvement. For each new law put in place, insurance companies have developed new workarounds to ensure they do not pay for the expensive, but necessary, treatment.
Insurance companies are vital in not only lessening the financial burden of care but also the other accessibility issues. Several factors impact the accessibility of care including, geographical proximity, scheduling feasibility, and stigma. The availability of a wide range of options for care is crucial in ensuring all patients receive the appropriate support. Patients require a toolbox of options. These possibilities include, but are not limited to, online video therapy, chat-based counseling, in-person sessions, and in-patient treatment. While the latter two are not currently possible, the former two are very doable while social distancing measures are in place. By providing this mix of options, insurance companies will enable patients to self-select or be practitioner guided into the right choice for their needs. The current pandemic highlights the need for this toolbox. If online therapies were more widely available, the system would be better able to manage the large influx of new cases. These forms of care would also ensure those with pre-existing mental health conditions would be able to access lifesaving ongoing care. It is difficult to retroactively implement these alternative therapy options and therefore many who are in desperate need of care cannot access it. Insurance companies, now more than ever, have an important role in making these alternatives affordable. The economic impact of Coronavirus means that more and more people cannot afford the necessary psychological care. Without coverage, patients are left to their own devices during one of the most stressful times in recent memory.
This pandemic has served to highlight the structural deficiencies of the existing mental healthcare system. If stakeholders do not step up now to tackle this crisis, the system will breakdown entirely. It is more important now to make alternative therapies accessible and affordable. Now is the time for governments and insurance companies to become leaders and take significant steps forward. Now, it is not the time for gradual change.