Mental Health and American Healthcare’s Pre-Existing Conditions
Throughout the COVID-19 epidemic, there has been a heavy focus on social distancing, shuttering schools and stores as quickly as possible, the economic crisis, and frontline workers who battle a novel disease. This is rightly so. As of May 17th, more than four and a half million cases of COVID-19 have been confirmed and hundreds of thousands have died as a result. In this rush, however, the impact of the pandemic and the social distancing measures on mental health have become an afterthought.
Even before the pandemic started, loneliness was a major mental health issue. According to a 2019 report by Esteban Ortiz-Ospina, the amount of Americans living in single family households has doubled over the past sixty years. Another report by the Health Resources and Service Administration found that two in five Americans report that they sometimes or always feel their social relationships are not meaningful, and one in five say they feel lonely or socially isolated. This isolation can be life-threatening and can result in the development of depression, an increased risk of heart disease, or an increased risk of stroke. In 2018 Depression alone cost the United States economy $210 billion, half of which was shouldered by employers in the form of missed work and lost productivity. While laws exist that mandate the inclusion of mental-health related healthcare coverage, health insurance companies commonly deny those claims or provide limited coverage.
The United States’ healthcare system has caused inpatient and outpatient care in psychiatric hospitals to steadily decrease. This decrease came in the 1980s when the government began to reward states who had fewer patients in both inpatient and outpatient care. This movement, also known as “deinstitutionalization,” came after a rise in the popularity of psychiatric hospitals. Instead of going to one of those hospitals, those with untreated severe mental illnesses were funneled into prisons. The use of prisons as mental health facilities is inherently flawed, especially because prison guards are not equally as prepared as healthcare professionals to treat mental illnesses.
Many Americans also have little-to-no healthcare coverage. In 2018, more than 27.5 million Americans had no healthcare coverage, and this number has only continued to grow as the number of people who relied on their jobs for healthcare coverage lost those jobs. This number could increase as the Trump administration urges the supreme court to rule the Affordable Care Act, now repealed of its mandate that requires all Americans who do not buy health insurance to pay a penalty, unconstitutional. That pressure comes in spite of Attorney General Barr’s warning about possible ramifications of exerting that pressure. As a result of deinstitutionalization, lack of healthcare, and stigma, many people feel unable to get help for their mental illnesses. In fact, more than 80% of people reported not seeking help for mental health issues due to stigma. Stigma surrounding mental health has led to recent increases in depressive episodes and suicides.
In attempts to curve the intensity of the pandemic, countries have either placed lock-down or stay-at-home orders on their citizens. Those social distancing measures, a recession that threatens to further damage young workers still reeling from the 2008 economic crisis, and overall pandemic-related panic has led to an increase in demand for online therapy. TalkSpace, a text and video chat therapy provider, has seen a 65% increase in usage; Brightside, a company that provides anxious and depressed users with treatment and medication has seen a 50% rise in users. However, healthcare providers have only partly covered the costs of these services, and some providers have even completely balked.
All of these factors — an already unprepared healthcare system, an existing loneliness problem exacerbated by social distancing mandates, and lack of action from the nation’s biggest healthcare providers — have put some Americans in a dire position. While the CDC has resources on coping with the pandemic, it simply isn’t enough; the reality is that the United States’ healthcare system is extremely underprepared for the mental health issues that were either started as a result of the crisis or worsened by it. If the supreme court yields to Trump’s pressure and rules the ACA unconstitutional, more than 22 million people will lose coverage. In addition, the growing number of unemployed workers who relied on their jobs for healthcare will not be able to get healthcare under the ACA. This massive loss of coverage will come after a lackluster response from the president and his staff that includes the original dismissal of the crisis and refusal to use the medical supply stockpile, the inability to make testing free and accessible, and their fatal “open the country as soon as possible” stance. All of these missteps have already cost the country’s economy (the United States’ GDP fell 4.8 percent in the first quarter) and its citizens mental and economic health. While there would have inevitably been a decrease in economic growth and mental health during the pandemic, the Trump’s administration’s missteps have uniquely made the United States one of the worst countries in the world in terms of dealing with the virus. Scientists also fear that relaxing social distancing soon, a cause the administration has supported, could lead to a bigger wave of COVID-19 in the coming months. Therefore, a weak response to the pandemic now could spur a new wave of the virus that would potentially have stricter social distancing measures, thus prolonging and intensifying the loneliness epidemic and other pandemic-related stressors.
There are ways to fix this problem. The government could begin to subsidize inpatient care in psychiatric hospitals again, expand healthcare coverage, or even put pressure on America’s largest healthcare providers to cover the cost of online talk therapy — anything but the current indifferent, or even aggressive, stances on nationwide healthcare coverage. As it stands, the United States is at a precipice; if we choose to invest in mental health, then we could see a country with less loneliness, higher productivity, and overall better quality of life. However, if we choose to continue in the direction we are currently on, we stand to let mental health hurt the economy and worsen the lives of American citizens. The COVID-19 pandemic has forced this choice to be made now, and hopefully it is made wisely.
