The crisis within a crisis: Panic and pandemic

The COVID-19 pandemic links the fates of individuals, communities and economies worldwide. But for those among us struggling with mental illness, their plight is particularly precarious. And just as the pandemic caught many hospitals and health systems unprepared, a crashing wave of suffering has entirely overwhelmed what meager systems are in place to deal with the mentally ill. If COVID-19 offers a wake-up call about our fragile human condition it is that the illness and suffering of one eventually touch us all, and that community health requires that we address the urgent needs of marginalized populations most in peril.

At any given time, people with mental illness are at greatest risk of homelessness, incarceration and a host of attendant physical health issues. It is estimated that nearly half of all those living on the streets of our great cities or on the margins of our rural communities suffer from some form of mental illness with a quarter of those classified as having a serious mental illness (SMI). In our jails and prisons, about 40 percent have been diagnosed with a mental illness and half of those with SMI. It is a cruel irony that the institutions most likely to house and treat the mentally ill in this country today are the Cook County Jail, the LA County Jail, and the Riker’s Island complex in New York City. 

It wasn’t always the case. Mental illness and its treatment have occupied the imaginations of social scientists and medical professionals for generations. The asylums that proliferated in the 19^th century were originally meant as a compassionate approach to care. Overcrowding, underfunding, and neglect as well as the emergence of pharmacological treatments led to mass deinstitutionalization in the 20th century. Neither approach achieved the success they promised and today we are left with a patchwork system of care that leaves far too many people to fend for themselves — typically in poverty, often on the streets and in conditions of contagion.

Enter COVID and this fragile system is in danger of collapse altogether. The thousands of small and community-based health clinics that serve the poorest patients face closure and cutbacks as resources are reallocated to fight the coronavirus pandemic. About 31 million Americans depend on safety-net health clinics for care, including mental health care, that is not available elsewhere because they lack insurance, or live in remote areas, or are homeless

The relief bills passed by Congress and signed by the president have provided about $2 billion for community health centers but health experts have said that’s less than half of what they need to handle both normal services plus coronavirus response through November. Scaling back services at community clinics now will have broad societal consequences long after the crisis is stemmed

Beyond the most vulnerable Americans, the COVID crisis is having a profound mental health impact. According to a survey released in early April by the Kaiser Family Foundation, 45 percent of adults (53 percent of women and 37 percent of men) say the pandemic has affected their emotional well-being, and 19 percent say it has had a “major impact.” 

The fact is, the United States was already in the midst of a mental health crisis before the COVID-19 pandemic. The rates of suicide and drug overdose have been on the rise over the past decade. More than a quarter of Americans live alone, and studies have linked loneliness to substance abuse and mood disorders. “Shelter-in-place” orders only exacerbate the anxiety and isolation that people cope with every day. The sudden change in everyday routines can lead to withdrawal for those with depression and relentless news alerts can trigger frantic thinking in those with anxiety. The constant reminders to wash hands meticulously can accelerate self-destructive behaviors for those with obsessive-compulsive disorders. 

The bottom line is that we are navigating this crisis together —and for some, it’s a health crisis augmenting an already profound crisis-in-living. If the pandemic offers a wake-up call of sorts, it crystallizes the deep social interconnectedness of all Americans —especially those at the margins. It begins with the recognition that community health measures must address the profound linkages between the conditions that spawn poverty, exacerbate serious mental illness and spread disease. And importantly, it reveals the urgent need for neuropsychiatric research that can produce the most effective treatments and make these therapies accessible to the most vulnerable among us.

The pandemic has shown that (like it or not) we are 327 million individuals whose fates are linked — even if our circumstances are not. If we are to battle our way out of this crisis, it will be together, and it will require new vision. We can expect that the lines between physical and mental health will continue to blur, as the nation seeks to recover from the emotional toll of the epidemic.

The COVID-19 crisis has exposed the profound interconnection of health and mental health vulnerabilities —especially for those on the margins. Will this de facto disruption of a failed system of mental health care serve as a wake-up call? Will our congressional leaders and public health authorities seek to devise a more holistic approach? Will we repeat the mistakes of the past, or double-down to expand effective mental health care intervention for all? How we respond to these challenges in the years ahead is ultimately a question for all of us.

Garen Staglin is co-founder and chairman of One Mind, a national mental health and brain research nonprofit. Former U.S. Rep. Patrick J. Kennedy (D-R.I.) is the founder of The Kennedy Forum and co-founder of One Mind.