SERIES: COVID-19’s Long-Term Policy Implications - Responding to a National Mental Health Crisis
The COVID-19 pandemic has rightly become the sole focus of the public health policy world, but it is also having far reaching effects into policy landscapes way beyond healthcare. This blog post is the seventh in a series that will explore how COVID-19 is changing American life, and as a result, impacting various policy areas. This series will explore changing American attitudes, examine new policy ideas, and project on legislative and regulatory activity we may see as a result of the virus in the months ahead.
It is impossible to deny that the physical effects of COVID-19 on both individuals and our country at large are staggering. Policymakers are beginning to understand that COVID-19 has also taken a significant toll on our nation’s mental health, and a legislative response is warranted.
According to The Crisis Text Line, 34 percent of Americans reported a worsening of emotional well-being at the end of April, and the trend is worsening as the pandemic continues to impact our society. Every day the cumulative effect of the daily doses of sickness, death, isolation, and fear are generating a widespread psychological trauma. Those with and without existing mental health conditions may find themselves struggling during this pandemic, especially those who have lost loved ones, employment, or health insurance.
Public health experts caution that this issue does not imply that stay-at-home orders and social distancing rules should be lifted, but rather that our healthcare system needs to be prepared for what may come. Unfortunately our mental health care system, which is vastly underfunded, fragmented, and difficult to access before the pandemic, is currently struggling to keep up with the swell. As the pandemic unfolds, some lawmakers increasingly believe there is a need for a more robust response and help may be on the way.
Vulnerable Populations
So many Americans are vulnerable to experiencing mental health issues during this time. Those with a history of substance abuse, depression, anxiety, PTSD, suicidal ideation, and self-harm are more likely to experience relapses or a worsening of symptoms during this pandemic. A few additional groups of vulnerable populations are highlighted below.
Our nation’s frontline workers are especially vulnerable. An overwhelming number of patients along with short supplies of personal protective equipment (PPE), are causing nurses and doctors to experience severe symptoms of burn out, depression, anxiety, insomnia, and distress. Many hospitals have bolstered their employee wellness programs in response to the crisis, and The Crisis Text Line has set up a specific frontlines counseling line for these workers.
As has been widely reported, nursing homes are at the center of many coronavirus outbreaks across the country. Residents are not able to visit with family members, and while necessary in mitigating the spread of COVID-19, such distance can not only be emotionally painful for nursing home residents and their families, but it causes actual distress and a worsening of behavioral health. Nursing homes are balancing this need for increased emotional support for residents against the case fatality rate of 20 percent. Some nursing homes are taking progressive steps by making sure that all their behavioral health partners and providers understand that the need for their services is still essential. Others have acquired large numbers of iPads and provided them for behavioral health telemedicine, as well as for residents to video chat with their family members.
Individuals experiencing domestic abuse may currently be facing a worst case scenario – finding themselves trapped in the home with a violent perpetrator during a time of severely limited contact with the outside world. The Crisis Text Line has seen a 78 percent increase in texts relating to domestic violence, and a 44 percent increase in texts reporting sexual abuse. Experts caution that the issue could be even worse than is realized given that domestic violence rates are notoriously difficult to track using police data, and that many victims may find themselves in situations with an abuser who can now make it virtually impossible to call for help.
State Responses
New York State is taking proactive measures to address increased mental health support services during the pandemic. On March 21, Governor Andrew Cuomo (D) announced the creation of a statewide hotline to provide free mental health services to individuals sheltering at home who may be experiencing stress and anxiety as a result of COVID-19. The governor called on mental-health professionals to volunteer their time and provide telephone and/or video counseling. Four days later, more than 6,000 mental health workers volunteered their services, making New York the first state to address the mental health consequences of the pandemic in this way.
Recognizing that mental health issues like addiction and substance abuse, anxiety, and depression can be triggered by a lack of opportunity, Massachusetts is tackling this issue by prioritizing the rebuilding of their social safety net. Bills currently in the state legislature would provide cash assistance to immigrants and families in deep poverty, and enact paid sick time for those not protected by federal legislation.
In Maryland, state officials report that calls to the state’s mental health and substance abuse crisis hotline were up 45 percent from February to March. In response, the Maryland Department of Health has launched initiatives like a new interactive telebehavioral health map to help individuals find mental health professionals. They are also partnering with other state agencies to bolster its mental health services for frontline and essential workers. According to the state, Maryland has also rolled out a series of webinars tailored to health care providers and crafted a burgeoning program to offer mental health care services to nursing home staff.
The CARES Act
The president signed the CARES Act into law on March 27. This bill included provisions aimed at alleviating some of the acute need for remote mental health and substance abuse services. CARES included a $425 million appropriation for use by the Substance Abuse and Mental Health Services Administration (SAMHSA). The law also included:
Provisions aimed at expanding coverage for, and availability of, telehealth and other remote care for those covered by Medicare, private insurance, and other federally-funded programs;
Language expanding the ability for the Secretary of the Department of Veterans Affairs to arrange mental health services to isolated veterans via telehealth or other remote care services; and
Language extending the duration of Medicaid Community Mental Health demonstrations, which are already underway as part of efforts to increase care access and quality at community behavioral health clinics.
The Administration’s Response
The Centers for Medicare & Medicaid Services (CMS) has taken several steps to expand access to mental health services across the country. CMS is temporarily allowing Community Mental Health Centers to offer partial hospitalization and other mental health services to clients in the safety of their homes. Previously, clients were required to travel to a clinic to receive these intensive services. Now, Community Mental Health Centers can furnish certain therapy and counseling services in a client’s home. Additionally, CMS has announced Medicare will pay for broader coverage of behavioral health and patient education conducted by telehealth.
SAMHSA has begun to implement the CARES Act. Recognizing the serious concerns for domestic violence victims that are posed by mass stay-at-home and quarantine orders, they are requiring that a minimum 25 percent of direct services funding requests for their National Suicide Prevention Grant be used to support this population. Under normal circumstances, domestic violence can lead to situations of increased stress, anxiety, depression and trauma. These are all contributing factors to risk for suicide if unaddressed.
The Heroes Act
On May 6, Speaker Nancy Pelosi (D-CA) unveiled House Democrat’s $3 trillion stimulus proposal—The Heroes Act. This bill includes the most robust response to the mental health crisis to date, with $3 billion going to increased mental health support and substance abuse treatment, and to offer increased outreach. It includes:
$1.5 billion for the Substance Abuse Prevention and Treatment Block Grant;
$1 billion for the Community Mental Health Services Block Grant;
$100 million for services to homeless individuals;
$100 million for Project AWARE to identify students and connect them with mental health services;
$10 million for the National Child Traumatic Stress Network;
$265 million for emergency response grants to address immediate behavioral health needs as a result of COVID-19;
$25 million for the Suicide Lifeline and Disaster Distress Helpline; and
Not less $150 million for tribes, tribal organizations, urban Indian health organizations, or health service providers to tribes across a variety of programs.
Republican leadership has called the HEROES Act a Democratic wish list that is dead on arrival in the Senate, but the language outlined serves as a marker for Democratic priorities on mental health legislation.
As policymakers continue to discuss further actions to alleviate the burdens of the COVID-19 pandemic, more data will be required to measure its growing effect on mental health. The increased need for mental health services will likely become a long-term issue, even as new cases and deaths due to the pandemic subside.
Response from the Campaign Trail
While neither the Trump nor Biden campaigns have released formal policies on addressing the mental health aspect of this pandemic, the Biden campaign has highlighted the issue on several occasions. Dr. Jill Biden has expressed the need for a robust recovery plan that includes additional funding for mental health services, particularly for school aged children. Additionally, the Biden campaign has called for more funding for domestic violence shelters and other direct service providers to meet the increased demand for assistance to victims of domestic violence.