May 14, 2020 - Science

The coming coronavirus mental health crisis

Miriam Kramer, author of Space

Illustration: Sarah Grillo/Axios

The coronavirus pandemic is bringing another crisis to the U.S. — mental health impacts that will likely be felt for years to come.

Why it matters: Experts are concerned the U.S. health care system isn't prepared for the potential mental health crisis on the heels of the pandemic.

Driving the news: 28% of Americans report worsening mental health and 34% report worsening emotional well-being at the end of April, according to the Axios-Ipsos Coronavirus Index.

  • These mental health effects are likely caused by a combination of media coverage, the economy and quarantines in place around the country.
  • Experts say this doesn't mean stay-at-home orders and social distancing shouldn't occur, but that the health system needs to be prepared for the mental health effects caused by these life-saving policies.

What's happening: Experts are now seeing waves of mental health effects from the pandemic being felt across the country.

  • "In wave one we saw massive anxiety, and the anxiety has echoed the locations where COVID is showing up most," Nancy Lublin, CEO of Crisis Text Line, said during a webcast.
  • That anxiety took the form of people worrying about their loved ones and themselves, expressing concern about whether they might have it.

The second wave of effects from the pandemic is now breaking, according to Lublin, and she expects it to last longer than the first.

  • This wave is marked by effects from stay-at-home orders, including domestic violence, sexual abuse and economic hardship.
  • The Crisis Text Line has seen a 78% increase in texts relating to domestic violence, a 44% increase in text about sexual abuse, and the largest group of texters are now in the 18-to-35 age range, who are being disrupted by quarantines and the effects of the economy.

What's next: Experts don't expect the number of people who need mental health support will necessarily go down once stay-at-home orders are lifted and people start venturing out again.

  • Instead, they say the types of issues people are dealing with will shift into chronic problems like depression and PTSD.
"I think it's going to be a long journey that will not be linear, and I think that the scar of the mental health repercussions is going to burn for years," Lublin said.

Between the lines: The mental health infrastructure of the U.S. may not be up to the task of serving all of the people that need help in the wake of the pandemic.

  • "We really have a very broken — and I would say disjointed behavioral health system — even on the best of days," Stuart Archer, the CEO of Oceans Healthcare, told Axios.
  • The behavioral health system, according to Archer, is underfunded and has been largely left behind by government aid made available to offset the economic effects of the crisis.
  • Many mental health facilities are already facing collapse due to the financial situation brought on by the virus, forcing organizations, including the American Psychiatric Association among others, to ask the Trump administration to help support struggling facilities during this time.

Yes, but: Providers are moving toward telehealth as people are staying at home, increasing access to mental health services for many.

  • However, it still may not be enough for at-risk groups like kids, healthcare workers, students and people who have previously diagnosed mental health conditions who need services immediately.

The big picture: These waves of need around mental health are in line with past disasters, which could help experts lay out a roadmap for how to deal with the fallout from the virus.

  • "After [Hurricane] Katrina, up to 50% of the people who lived in affected counties had a diagnosable mental illness, most of them post-traumatic stress disorder," Joshua Gordon, director of the National Institute of Mental Health, said during the webcast.
  • Studies about mental health were lacking after the flu pandemic of 1918, but one of the researchers who did look into it found that many survivors of the flu at the time experienced depression, sleeplessness and other disruptions to their daily lives.

The bottom line: Extreme measures were taken to try to stave off the physical health effects of the coronavirus pandemic. Experts warn that hospitals and providers need to similarly prepare for the mental health effects expected as the crisis continues — and for years to come.

Go deeper

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Data: The Center for Systems Science and Engineering at Johns Hopkins; Map: Andrew Witherspoon/Axios. This graphic includes "probable deaths" that New York City began reporting on April 14.

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