Fighting Two Pandemics: COVID-19 and the Mental Health Crisis

Vinay Nagaraj
Vinay Nagaraj
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It has now been exactly one year since the first case of COVID-19 was identified. Many would have found it exceptionally difficult to imagine back then that a raging pandemic would bring the world to its knees, marking 2020 as a time filled with uncertainty, isolation, and despair.

In response to the unprecedented circumstances, (some) communities have shown tremendous collective resilience in the form of social distancing & mask-wearing, while our frontline workers have put us all on their shoulders to keep society functioning and whole. Even with the fury of another COVID wave upon us this winter, testing has become more widespread, healthcare providers have stocked up adequately with PPE, and caregivers are using proven therapies much more effectively to treat coronavirus cases. Lastly, the imminent availability of a viable vaccine has offered a glimmer of hope that positive change will arrive soon.

However, as much as attention has been fixated on COVID, it is imperative that we don’t forget the behavioral health and addiction crisis across the country has sharply intensified. As reported by USA Today, suspected overdoses increased by as much as 42% this May. An opioid-related death occurs every 11 minutes.

Why have we not been able to develop a consistent public health response to address behavioral health the same way we have had to reckon with COVID? To really unpack these questions, the term “behavioral health” needs to first be understood. According to the American Public Health Association, behavioral health is a state of mental/emotional well-being along with choices or actions that affect overall wellness. The state of our individual behavioral health reflects the extent to which our own thoughts, emotions, and actions allow us to fully partake in and enjoy the functional roles we play in daily life. As such, behavioral health actually expands on mental health to include substance use, behaviors, habits and any other external factors that may impact our well-being.

With this understanding, we see why a lack of recognition for and neglect of behavioral health has led to a widespread epidemic of opioid addiction, psychological distress, suicide, and a host of other mental and substance-related disorders. Mainstream medicine has historically viewed the body as somehow independent and separate from the mind, where we know and have seen in reality that both are strongly interlinked; only when body and mind nurtured together are we truly healthy and happy.  Additionally, mental health and substance use also have an unfair associated stigma by which public perception often confuses these disorders with moral weakness and/or poor judgment. This large misunderstanding leads to discrimination against those with behavioral health disorders. Furthermore, it has downstream effects on how the system at large provides treatment to these populations in underfunded, fragmented environments, and often falsely attributing the responsibility to social welfare instead.

As a result, these are the staggering numbers we see today:

  • Behavioral health disorders account for nearly ⅓ of the overall disease burden in the US, more than any other single health condition
  • The lifetime prevalence of any behavioral health disorder in the United States is ~50%, which is nearly twice that of any other developed country
  • The World Mental Health Survey of 17 nations determined that the US ranks first in prevalence of mental illnesses and second in substance use disorders
  • The Institute of Medicine (IOM) estimated that mental, emotional, and behavioral health disorders among children and young adults resulted in $247 billion in quantifiable costs
  • Minority groups by race & ethnicity along with LGBTQ populations disproportionately bear a high disability burden from mental and substance use disorders

It is no surprise that the magnitude of this behavioral health crisis is a key driver of other chronic physical illnesses, such as asthma, cardiac disease and even higher risks for developing type 2 diabetes.

As the numbers and troubling trends show, the impacts of behavioral health on physical health, societal well-being and overall public health outcomes are undeniable. The silver lining is that as behavioral health struggles to enter mainstream public consciousness, the answers in academic literature on how to holistically address behavioral health are all but hidden in plain sight.

It turns out that behavioral health is no different than any disease or health condition in the sense that social factors are the major influence. We need to focus on the social determinants of behavioral health. Factors such as social support, food insecurity, unsafe environments, access to transportation, and poverty are all key behavioral health risk factors, with exposure to violence, social isolation, and discrimination as sources of immense toxic mental stress that not only create but also exacerbate behavioral health disorders.

So what is our responsibility moving forward? Our perspectives must change from viewing patients in a silo within a care setting to a broader understanding of their lived reality in which social stressors need to be removed, and access to proper behavioral health care needs to be ensured. Additionally, local, state, and federal governments need to develop policies and funding mechanisms to address these systemic barriers in coordination with providers, community health organizations, and accountable care organizations.

I am proud to be working with an organization like Roundtrip that aims to alleviate at least one of these prevalent social barriers in transportation. We have seen that the lack of transportation has disproportionately affected those with behavioral health conditions, with no-show rates as high as 50% for behavioral health appointments and mental health patients particularly displaying an alarming eightfold increase in mortality rates when appointments are missed. On the other hand, when transportation is not a bottleneck to access care and a patient is able to complete their prescribed treatment plan for addiction or mental health disorders, the vast majority of findings actually point to the fact that the chances for recovery are generally high.

In light of this, Roundtrip is currently working with the University of Pennsylvania, Lyft, and Brightview on an NIH-funded study to show that providing a ride along with sufficient individual engagement allows patients with opioid use disorder to successfully make it to their treatments, pick up their medication, and attend individual and group counseling sessions, all of which are essential components of addiction recovery. We are excited for the potential and impact that can be proven through this initiative, and we are committed to serving several behavioral health providers and organizations across the country to ensure that transportation is one less worry for their patients.

With these small steps like this in the right direction across many communities, organizations, and governmental bodies, we can start to reverse the behavioral health trends just as we have shown we are capable of doing with COVID.