Six months after the novel coronavirus disease 2019 (COVID-19) was first diagnosed, it is worth looking at the impact of early intervention and prevention efforts on community-wide anxiety, depression, substance use and other mental health conditions.
There is no precedence for how to prepare mentally and emotionally for a global health pandemic. Previous large-scale disasters – from the World Trade Center to mass shootings to deadly hurricanes – have seen significant increases in mental and behavioral health issues such as depression, post-traumatic stress and substance use disorders. These spikes occurred immediately following the event and persisted for long periods.
COVID-19, however, has created an ongoing, unfamiliar era in which every citizen has been forced to make sacrifices. The shelter-in-place requirement has left many older adults isolated and vulnerable to loneliness and depression. Quarantines, coupled with closed schools, have created a very real concern for substantial increases in domestic violence and child abuse. The religious pray at home. For the newly unemployed, a sagging, uncertain economy gives little reassurance that their bills will get paid. Health care workers, above all, have been at the forefront of the pandemic, with death a daily reality and the lack of a cure a daily frustration.
While social distancing, face masks and hand-washing hold the promise of a new normal as states begin to reopen, these efforts don’t mitigate the short-and long-term consequences to our collective mental and emotional well-being. Instead, an April 2020 article in JAMA, authored by Sandro Galea, MD, proposed that three steps “can help us proactively prepare for the inevitable increase in mental health conditions and associated sequelae that are the consequences of this pandemic.”
First, Galea recommended intervening with populations that may have been physically and socially isolated prior to COVID-19, including older adults, marginalized individuals, undocumented immigrants, the homeless and those with mental illness. Many online activities have been hosted by religious organizations, gyms/workout studios and community centers that maintained a schedule similar to their “live” schedules. It is important to continue staying engaged with these populations, and to direct them to mental health resources such as support groups and hotlines. Employers will want to maintain regular check-ins with staff working remotely, with phone and video calls preferable to email and text messaging for maximum engagement.
For children who have been out of school, and now face the summer months with the possibility that camps will be cancelled or parents will be unable to afford vacation and other activities, there is a need for “structure…and socialization to mitigate the effect of short- and long-term sheltering in place.” Parents may want to join forces and create a schedule of activities, taking turns being in charge for the day. Many libraries, state parks and community centers offer free programs for children of all ages. While social distancing will affect how programs are run, the development and implementation of routines and structure can help create certainty and reduce anxiety in children and youth.
The second step, said Galea, is to have mechanisms in place to identify and intervene in cases of domestic violence and child abuse. While individuals at risk for abuse may have had fewer opportunities to seek help during the stay-at-home order, there will continue to be ongoing cautions to prevent the spread of COVID by remaining at home when possible. Social services and child protection agencies will need to find creative ways to maintain social distancing yet also engage at-risk individuals and assist them with safe ways to seek help and safe places to stay.
Finally, our mental health system needs to prepare for the treatment demands that are yet to come, Galea asserted. One recommendation is “stepped care, the practice of delivering the most effective, least resource-heavy treatment to patients in need, and then stepping up to more resource-heavy treatment based on patients’ needs.” This approach requires effective screening practices, creative treatment models and a well-prepared force of mental health professionals. Telemedicine is already being embraced by patients and providers around the world, and payers have expanded coverage to include virtual mental health services. Online support groups can make a difference to someone who is feeling isolated. Providing care in the midst of a crisis – even virtual care – is offering a connection that can combat despair.
Population-level, preventive care is an evolving model in the field of mental health. Never in human history has a pandemic such as COVID-19 both isolated and united the world. Finding ways to respond to the unique challenges it presents must be achieved swiftly and with a goal of uplifting spirits around the globe.