The U.S. was already on the brink of a mental health crisis before the COVID-19 pandemic. The associated stresses, which run the gamut from isolation and anxiety to unemployment and illness, are now threatening to create a mental health emergency among Americans.
In a commentary by Dr. Jeffrey A. Lieberman published by Medscape Psychiatry,1 several gains that have been made toward mental health outcomes are highlighted, such as scientific advancements in the understanding of mental illness, and positive changes in social attitudes toward those who are mentally ill. Such advances do little, however, to offset the sad state of mental health care in the U.S.
“The sobering reality is that high-quality mental health care is not available to most people,” Lieberman, a psychiatrist with Columbia University’s department of psychiatry, wrote. “This lack of strategy and access is especially concerning amid disasters such as COVID-19, which can cause considerable psychological trauma.”
Mental Health Care System Poised for Failure
With stay-at-home orders in place for more than 280 million Americans,2 and more than 3.2 million unemployment claims coming in during the week ending March 21, 2020, alone,3 the COVID-19 pandemic has upended Americans’ lives in an unprecedented way.
According to Lieberman, the mental health care system isn’t up for this monumental challenge, citing “systemic deficiencies of our country’s mental health policy and financing system.” He explained:4
“These engulf our individual efforts of the best departments and the most dedicated and talented clinicians among us. We lack the infrastructure, workforce, and capacity to deliver the evidence-based treatments that we have developed and proven and that should be widely available to patients. We simply don’t have the scope and scale of available services warranted by our country’s need for mental health care.”
Treating mental illness requires multiple modalities, targeting not only medical symptoms but also social skills, employment support, substance abuse treatment and residential care as necessary. Yet, no comprehensive center exists to offer mental health patients all of these services in one, coordinated location. “They simply don’t exist under one roof,” Lieberman wrote, adding:5
“In addition to limited access to care and deficient scope of services, there is the question of quality of care. It pains me to say that the quality of mental health care is highly variable and not what it should be. Mental health care lacks the consistency and standardization delivered in most other medical disciplines. Consequently, too many patients receive limited or substandard care.”
What does this mean for Americans struggling with existing mental illness or those developing new anxiety, depression and other psychological challenges? U.K.-based mental health charity SANE said in a statement on the COVID-19 pandemic that a mental health crisis was “inevitable.”6
Marjorie Wallace, SANE chief executive, stated that their telephone help line has been receiving increased calls from people suffering from depression anxiety, panic and obsessive compulsive disorder, “who are becoming acutely distressed.”7
80% of Mental Help Line Callers Talk About Suicide
Showing the magnitude of the problem, Wallace stated, “Already 80% of our callers talk about self-harm and suicide, and we fear that without being able to reach us or find other help they may be tipped over the edge.”8
Suicide rates rose across the U.S. from 1999 to 2016, making it the 10th leading cause of death. In 2016, nearly 45,000 Americans aged 10 and older committed suicide, and more than half of them did not have a diagnosed mental health condition.
“Relationship problems or loss, substance misuse; physical health problems; and job, money, legal or housing stress often contributed to risk for suicide,” the U.S. Centers for Disease Control and Prevention noted, but added, “Suicide is rarely caused by a single factor.”9
Suicide rates varied across the U.S., from a low of 6.9 per 100,000 residents per year in Washington to a high of 29.2 per year in Montana, and this was before the increased pressures brought on by COVID-19. According to the Suicide Prevention Lifeline:10
“Infectious disease outbreaks such as COVID-19, as well as other public health events, can cause emotional distress and anxiety. Feeling anxious, confused, overwhelmed or powerless is common during an infectious disease outbreak, especially in the face of a virus with which the general public may be unfamiliar. These feelings of distress and anxiety can occur even if you are not at high risk of getting sick.”
Unemployment, Job Insecurity Raises Suicide, Depression Risk
The U.S. is facing staggering levels of unemployment as a direct result of the COVID-19 pandemic. According to the U.S. Department of Labor, the week ending March 21, 2020, marked the highest level of seasonally adjusted initial unemployment claims in the history of the seasonally adjusted series,11 and the numbers are likely an underestimate of the true scope of job losses being felt across the U.S.12
Unemployment and financial insecurity are key factors in declining mental health, including suicide. “Unemployment directly affects individuals’ health and, unsurprisingly, studies have proposed an association between unemployment and suicide,” researchers wrote in The Lancet Psychiatry.13
The researchers conducted an observational study looking at the association between suicide and unemployment in 63 countries between 2000 and 2011, which notably included the 2008 global economic recession.
The relative risk of suicide associated with unemployment was elevated by 20% to 30% during the study period. Further, 1 in 5 of an estimated 233,000 annual suicides that took place from 2000 to 2011 was linked to unemployment.14 The researchers stated:15
“Suicides associated with unemployment totaled a ninefold higher number of deaths than excess suicides attributed to the most recent economic crisis. Prevention strategies focused on the unemployed and on employment and its conditions are necessary not only in difficult times but also in times of stable economy.”
A 2014 Gallup Poll also found, “The longer that Americans are unemployed, the more likely they are to report signs of poor psychological well-being.”16 Further, the link between unemployment and depression is strong.
The poll found that about 1 in 5 Americans unemployed for a year or more either had or were being treated for depression, which is double the rate of those who were unemployed for five weeks or less. According to Gallup:17
“Gallup finds that unemployed Americans are more than twice as likely as those with full-time jobs to say they currently have or are being treated for depression — 12.4% vs. 5.6%, respectively. However, the depression rate among the long-term unemployed — which the Bureau of Labor Statistics defines as those who have been seeking work for 27 weeks or more — jumps to 18.0%.”
Also concerning, a notable decline in hope was found to occur the longer a person was unemployed. While about 7 in 10 Americans who were unemployed for five weeks or more believed they would find a job within the next four weeks, this fell to fewer than 3 in 10 among those out of work for a year or more.
Loneliness, Isolation Threatening Mental Health
Adding to the mental health stressors of unemployment and financial strain are loneliness and isolation — psychological detriments in their own right. One study found social isolation increases the likelihood of mortality by 29%, while loneliness increases it by 26%.18 Wallace from SANE noted that the experience of stay-at-home orders can vary widely:19
“For some people, particularly the elderly, the prospect of isolation can be daunting. For others four months at home may be seen as a change in lifestyle, but for those with no real home or who are living in a substandard flat staring at the four walls, as many patients are, isolation can loom like a living hell.”
Increasingly, research is showing that loneliness exacts a significant toll on your health, one that’s equivalent to smoking 15 cigarettes a day20 and is associated with increased risk of dementia.21 And while social distancing may be helping to “flatten the curve” of COVID-19, its effects on mental health are questionable.
A rapid review of the evidence, published in The Lancet in March 2020 looked into the psychological impact of quarantine, finding, not surprisingly, “Most reviewed studies reported negative psychological effects including post-traumatic stress symptoms, confusion, and anger.”22
Out of 2,760 quarantined people, 34% experienced high levels of psychological distress, which could include anxiety or depression.23 A number of stressors during quarantine were also noted, including:24
Longer quarantine duration | Infection fears |
Frustration | Boredom |
Inadequate supplies | Inadequate information |
Financial loss | Stigma |
Long-lasting psychological effects are possible, according to some researchers, and The Lancet study concluded, “In situations where quarantine is deemed necessary, officials should quarantine individuals for no longer than required, provide clear rationale for quarantine and information about protocols, and ensure sufficient supplies are provided.”
Protecting Your Mental Health During the COVID-19 Pandemic
In the video above, Julie Schiffman demonstrates how to use the Emotional Freedom Techniques (EFT) to relieve anxiety and other challenging emotions brought on by news and uncertainty about this pandemic and/or self-quarantining.
Another option is the Neuro-Emotional Technique’s First Aid Stress Tool, or NET FAST. Firstaidstresstool.com provides an excellent printable summary with visuals of the technique,25 which even a young child can do. Here is a summary of the FAST procedure:
- While thinking about an issue that is bothering you, place your right wrist, palm up, into your left hand. Place three fingers of your left hand onto the area of your right wrist where you can feel your pulse.
- Place your open right hand on your forehead. Gently breathe in and out several times while concentrating on feeling the issue that bothers you.
- Switch hands and repeat steps 1 and 2.
Exercise is also important, with many workouts available online that you can do at home, even during self-quarantine. Research published in The Lancet Psychiatry suggests that exercise three to five days a week for 45 minutes is the “sweet spot” that leads to the greatest mental health gains.26 Getting outdoors for a walk in nature is also mentally soothing and highly recommended during quarantine, as often as is feasible.
Remember, too, that even if you’re socially isolated at home, you can reach out to friends and loved ones via phone or online. Connecting with others, even virtually, can help you to feel less alone. It’s also a good idea to set a limit on watching the news or browsing social media, especially if it increases anxious feelings.27
If you live in the U.S. and are having thoughts of suicide, call the National Suicide Prevention Lifeline at 1-800-273-8255 or text 741-741 for the Crisis Text Line. If you are in danger of acting on suicidal thoughts, call 911 for immediate assistance.