Earlier this year, experts warned of a rise in suicides, overdose deaths, and mental health problems resulting from COVID-19 and its economic and social stressors. In this update, we look at how views have evolved with a vaccine now on the horizon. If nine family members are left behind to grieve each of the nation's 320,000+ COVID-19 deaths, nearly 3 million Americans are grappling with loss on an unprecedented scale of mass bereavement. But unlike past disasters in which communities could come together to heal, this one has kept them six feet apart. "If you think of that bereavement as grief, that's not necessarily mental illness ... that's just pain, emotional pain, that needs to be validated and normalized and expressed out loud," said Jessica Gold, MD, of Washington University in St. Louis. "Until we really do that, I think we're kind of stalled in healing." Now that COVID-19 vaccine distribution is underway, clinicians are zeroing in on the toll the pandemic has taken on the nation's collective mental health. With more than 10 million individuals unemployed and 11.7% of Americans estimated to be living in poverty, people are not just grieving death, but the loss of work, school, and life as they knew it pre-pandemic, Gold said. If there are not resources dedicated toward prevention now, the mental health fallout of COVID-19 could become the "fourth wave" of the pandemic, said Luana Marques, PhD, the director of community psychiatry at PRIDE. "We have had 9 months of chronic stress, where your body is on some level of fight or flight," Marques told MedPage Today. "Often what you see clinically is that when that stressor goes away, people ... have the capacity to understand how much this has affected them." Before the pandemic, 15-19% of adults had anxiety or depression symptoms. By June, that number had jumped to 31%, and nearly 11% reported seriously considering suicide, according to CDC survey data. For healthcare workers who experienced high rates of burnout and mental health distress pre-pandemic, the amount of loss they have witnessed working on the front lines is especially taking an emotional toll, said Anish Agarwal, MD, MPH, of the University of Pennsylvania Perelman School of Medicine. "In March, there were pots and pans banging at 7 p.m. across the country," Agarwal told MedPage Today. "That phase has ended and now there is a lot of exhaustion and frustration, and it's important we all realize this is what's happening and we invest in ways to support each other in and outside the hospital." The vast majority of psychiatrists have transitioned to telehealth services during the pandemic following loosened federal guidelines that allowed virtual services to be reimbursed and controlled substances to be prescribed online. However, preliminary data suggest that wasn't enough to ward off the pandemic's mental health repercussions. Nearly all states have anecdotally reported increased overdose deaths, and coroners and medical examiners are reporting a spike in suicides. In Maryland, one analysis found that suicides among Black Americans had doubled over the time of the pandemic. Certain populations disproportionately shoulder the burden of COVID-19 deaths and bereavement. Black and Latinx individuals, along with Native Americans, have been disproportionately killed by COVID-19. Yet many patients of color don't have access to providers who look like them, said Ayana Jordan, MD, PhD, of the Yale University School of Medicine. Black, Latinx, and Native American psychiatrists comprise roughly 10% of the psychiatric workforce compared with 33% of the U.S. population. "Folks who are from racial and ethnic minority backgrounds are doubly -- or sometimes triply -- hit because we are also dealing with the trauma of vicariously witnessing racism through the height of very publicized police brutality," Jordan told MedPage Today. "All of these things together are hitting folks from marginalized backgrounds." The mental health system was strained pre-pandemic overall. In one 2017 report from the National Council for Behavioral Health, the demand for mental health services was projected to outstrip the system by 6,090 to 15,600 psychiatrists by 2025. "[Therapists] are taking extra hours, trying to find time to add them into the schedule," Gold said. "That was already happening, and then you add in what will be the eventual end of the pandemic's acute bleed." In the CDC survey, 13% reported using substances to cope with the pandemic's stressors. Alcohol consumption, specifically, increased by 14% in 2020 compared with the year prior in a RAND survey. To increase access for substance use disorder, the Substance Abuse and Mental Health Services Administration also loosened regulations on prescribing medication-assisted treatment to include telemedicine providers. Although that prevented the disruption of treatment for many, a recent analysis of Medicare Advantage and commercially insured patients published in JAMA found that fewer patients with opioid use disorder initiated treatment during the pandemic and fewer overall patients received urine tests, which are critical in preventing many patients from relapsing. Yet there has been an increase in the number of new mental health conditions and substance use disorder diagnoses during the pandemic, said Nora Volkow, MD, director of the National Institute on Drug Abuse of the NIH. In December, the CDC issued an advisory for medical professionals to watch for drug overdoses, which have soared to the highest number ever recorded in a 12-month period. For patients in remission, the social isolation, economic insecurity, and anxiety of acquiring COVID-19 have all contributed to an increased risk for relapse as well, Volkow said. Plus, patients with mental illness and substance use are at an increased risk of COVID-19 infection, adding to this population's vulnerability, she added. "We've also seen some of the support systems there to help them along are no longer present, which again puts them at much higher risk if they do get infected, and that could explain why we are also seeing much worse outcomes," Volkow told MedPage Today. "COVID has affected them from two directions." Volkow recommended dedicating resources to public health campaigns and increasing reimbursements for psychiatric services to handle the coming surge of mental health needs. In addition to the resources needed for vaccine distribution, "we also need the resources to provide mental health support," Volkow said. "Without it, once the COVID-19 pandemic is put into control, we will be in serious trouble." Jordan stressed the importance of deploying community-based mental health services to hard-hit areas and providing free subscriptions to online talk therapy services to prevent suicide and overdose rates from continuing to rise. She also urged increased federal support for programs that linked healthcare professionals, in particular, to mental health services. "Any administration would be naive to not have a plan for physicians during this time," Jordan said. "We are living through the pandemic of our century, we need help, and there has to be a concerted effort to proactively help the healers." Source
