In past blogs, I have shared studies from China about mental health needs in lockdown. In the USA, many of us are in week six of shelter in place, I live in California and know other States started that process a little later. The news is full of discussions on peaks and curves, but many are preparing for the second wave of COVID-19. Life won’t be the same until we have a vaccine, and increasingly the impact of pandemic on mental health is also featuring in national discussions.
In the current issue of JAMA Internal Medicine, Sandro Galea and colleagues from the Boston University of Public Health frame opportunities to be proactive in addressing prevention and early intervention for mental health in the next wave of COVID-19.
The authors point to three distinct areas of focus for comprehensive planning. Firstly, current data points to the increases in anxiety, depression, and substance use. Social distancing or physical distancing, as it is also called, may lead to an epidemic of loneliness. As humans, we are social creatures, so having additional restrictions on our movement has been challenging many; children not seeing grandparents and adult children speaking with parents through windows in now a regular occurrence. The social ties that bind us need to be woven into the new fabric, so we stay connected and safe. Having outreach programs to text and video chat will be necessary, especially for marginalized and isolated groups like undocumented immigrants, those who are homeless and the elderly will need additional supports.
Secondly, children are also vulnerable, especially those who relied on schools for their breakfast and lunch and who may live in high-risk environments where child abuse is prevalent. How will we know who is at risk? What plans do we have in place to ensure those children have safe, nurturing environments? We know domestic violence and child abuse co-occur, so families who already had this as part of their daily lives and now at increased risk.
Thirdly, mental health systems, which were already seeing an increase in demand for services, will continue to experience increased needs as we enter new phases of COVID-19. The authors suggest an acceleration of stepped care models to include screening and appropriate referral that can occur in a comprehensive manner to triage care and meet needs. Broader partnerships between health systems and community organizations will emerge to meet these needs.
Many health systems have already made the pivot to telemedicine across their care footprint- this is no different for mental health. Medicare has expanded coverage to allow people to access care in these new ways. How can we advance population management systems to ensure what we build to meet the moment can live beyond our current understanding? How can we continue to learn from rapid deployments and make subsequent deployments better and more effective?
While there may be differences of opinion on how severe this pandemic is, politics aside, tremendous collaboration is happening across the USA and globally. Keeping people safe and healthy in the coming months will be as crucial as addressing the economic fallout from this pandemic. Science can guide us to what our sustainable future looks like.
Thanks for reading – Trina
(Opinions are my own)
Galea S, Merchant RM, Lurie N. The Mental Health Consequences of COVID-19 and Physical Distancing: The Need for Prevention and Early Intervention. JAMA Intern Med. Published online April 10, 2020. doi:10.1001/jamainternmed.2020.1562