As a senior member of the House Committee on Homeland Security and member of the House Budget Committee, I am writing to draw the attention of federal and state policy makers, health care professionals, first responders, the faith community, all enlightened Americans and impress upon them the urgent need to act in the face of one aspect of the collateral damage caused by COVID-19: the emerging mental health crisis.
Essential stay at home orders, which began in mid-March in the state of California, were quickly followed by much of the nation leaving tens of millions of Americans behind closed doors as the only means of stemming the spread of the deadly COVID-19 infection. This decision by state and local governments supported by public health officials has and continues to save tens of thousands, perhaps hundreds of thousands of lives. These steps were and continue to be necessary to flatten the curve of COVID-19 infections.
The reason stay-at-home orders became the primary tool for guarding against the spread of COVID-19 is linked to the lack of an aggressive national strategy to assure that each state and local government’s public health authority had sufficient tests to check for and monitor the progress of the disease. Much is being done to address COVID-19 testing deficiencies and much more needs to be done to overcome the late start on this critical aspect of public health mitigation and prevention.
It is time to address the resulting mental trauma that the constant threat in the form of COVID-19 has created; the sudden change in American life; the experience of those who contracted the virus who underwent the physical and mental anguish of recovery; those who lost a loved one whom they could not comfort in the last hours or could not attend a funeral service putting them to rest; and the uncertainty created by the long list of unknowns such as when will schools reopen, whether and when a vaccine will be found; when and how we will know who is and is not infected; and when will it be safe to move freely without face coverings or disinfection protocols.
Mental illness has long received too little attention from policy makers and public health advocates who too often reflect upon and stress the importance of physical health insurance with little note of the importance of mental health coverage. COVID-19 should be the catalyst for the nation that spurs the adoption of universal public health policies that accept the necessity of dollar for dollar mental health coverage. Today, we are seeing an unprecedented number of people exhibiting mental health challenges for the first time in their lives, whether in the form of stress and anxiety, panic attacks, or sleep disorders which are robbing them of behaviors that support independent daily living.
The severity and pervasiveness of this hidden health crisis is evident in the increasing suicide rates, domestic violence calls, withdrawals from routine communications, changes in the manner of communicating, or changes in behavior that may be revealed in mood swings that are not associated with the personality of the person known by family, friends or colleagues.
According to Mental Health America, family and friends and co-workers may observe the following behaviors from a person with mental illness: confused thinking; prolonged depression (sadness or irritability); feelings of extreme highs and lows; excessive fears, worries, and anxieties; social withdrawal; dramatic changes in eating or sleeping habits; strong feelings of anger; strange thoughts (delusions); seeing or hearing things that are not there (hallucinations); suicidal thoughts; reporting unexplained physical ailments; alcohol or substance abuse, or the growing inability to cope with daily problems and activities.
In the United States the number of people seeking help is far outpacing the ability of the 100,000 licensed mental health professionals, of which only 4 percent are African American, to respond. Just as COVID-19 had economic ramifications, so will the consequences of undiagnosed and untreated mental and emotional health conditions. Most of these conditions can be addressed through self-care once they are identified by the person experiencing them, while many others will need professional mental health intervention and may also need medication to bring symptoms under control so they can focus on doing what is needed to improve their condition.
In 2019, prior to the arrival of COVID-19, the National Alliance on Mental Illness reported that one-in-four people have a mental health issue. Mental Health America states that 56 percent of people seeking mental health care have limited access due to restricted health insurance coverage, clinician shortages, uneven levels of care and stigma.
Mental illness has an economic cost, which exceeds the cost of providing care and extends to costs associated with loss of productivity due to mental illness. Contributing to the cost of mental health is the stigma imposed by society through interpersonal, societal, and organization engagement. The cost of society’s unwillingness to appreciate the seriousness of mental illness contributes to the plight of the mentally ill’s efforts to avoid getting help during the early stages of mental illness when the ability to arrest the effects of mental illness is most promising.
For example, PTSD could be one of the least costly mental health conditions, but often is one of the costliest due to confusion on the part of the sufferer that they are ill and the lack of acceptance by routine support mechanisms in the form of family and co-workers that someone they know is in trouble. PTSD, which effects those who have served our nation in times of war but can also affect people who survive a traumatic event like an accident, criminal assault, or a drastic change in life routines—like the sudden arrival of a deadly pandemic.
The physical and emotional wellbeing of Americans is linked to fear of COVID-19. We must be able to not only assure people that it is safe to go to restaurants, movie theaters, sporting events, barber shops, beauty shops and nail salons, we must demonstrate that we have the disease under control. This can only be done with effective testing, contact tracing and social distance programs that work.
There is a role for faith, family, friends, and co-workers in helping people retain, regain, and maintain good mental health during these difficult times. Faith, family, friends and co-workers can aid in improving mental and emotional health and can support selfcare efforts during difficult times, and in appropriate circumstances can help those in need when other sources of assistance may be limited. Faith is not be a substitute for care but an important component of the care provided.
In addition, insufficient levels of mental health care will not end until mental health care has parity with medical health care in the United States. Access to mental health care continuously has taken a back seat to medical health care. Mental health care must be recognized as the equal of medical health care to make enough progress for overall health. Congress must take the lead in moving toward this goal.
To address America’s immediate need for access to mental health care, the following steps need be taken:
- Primary Care physicians should be encouraged to use mental health prescreening tools for depression and anxiety assessments to determine if a patient needs prompt care and to prescribe mild medications for anxiety, depression, or other mental health issues;
- Congress through Medicare, Medicaid and CHIPS and state insurance boards, which set the requirements for health insurance sold in the states, should require that insurance companies make dollar for dollar parity for mental and physical health;
- The capacity of in-patient beds dedicated for mental health treatment should be increased by 100 percent;
- Social workers should be embedded to work with police and emergency responders to provide consultation so that responders engaging with persons impacted by mental illness can be treated appropriately.
My thanks to Dr. Sybil McPherson Curry for sharing her expertise and insights into the state of mental health in the United States. Dr. Curry is a licensed clinical social worker and psychologist at the New View Behavioral Health Services-PLLC., in Fayetteville, N.C.
Congresswoman Jackson Lee is a Democrat from Texas’s 18th Congressional District. She is a senior member of the House Committees on Judiciary and Homeland Security and is the Founder and Co-Chair of the Congressional Coronavirus Task Force.