Opinion | Healthcare

The Biden coronavirus task force has a mental health problem

The views expressed by contributors are their own and not the view of The Hill

Recent headlines about coronavirus are anything but uplifting. Numbers are surging in most states and hospitals are becoming more strapped for resources. A glimmer of hope to many public health and medical professionals was the naming of President-elect Biden's COVID-19 task force, and the promise of centering science and testing come January. 

As delighted as we were to see the steps being taken to start combatting the pandemic more effectively, as psychiatrists we couldn't help but notice one glaring expertise missing from the conversation: mental health. 

We understand that it can feel like we are all simply arguing that each of us needs to be in the room because it is what we trained in and we believe our specialty to be an important area of concern. It can look like we are selfishly arguing for our own interests to be prioritized over others. But, believe us when we say, this is far from about a specialty war or who deserves to be in the conversations. This is about need and the data back us up. This is about foreseeing the future and knowing that even if we stop the bleed of mass casualty from the pandemic, if we do not think about the eventual mental health aftermath, we will be dealing with it in our already broken system ineffectively for years to come.

The data make the case themselves. Patients with psychiatric illness have a 60 percent greater risk of contracting the virus, and a substantial proportion of people develop new psychiatric conditions after infection. In fact, the mental health of nearly every demographic has been hit by the pandemic, from pregnant women to frontline workers to children. The Centers for Disease Control and Prevention (CDC) just released data on mental health emergency department visits for children. It showed that though visits were down during lockdown, from April to October they increased 24 percent in kids aged 5 to 11 and 31 percent in kids 12 to 17. The mental health needs of children are increasing, and parents are turning to the emergency room as they have for years, due to the shortage of pediatric mental health providers. We are also seeing more young people with the mental health sequelae of being sexually exploited online, as online abuse surges during the pandemic. 

During a pandemic with rising cases, it seems emergency department beds could be better used for coronavirus patients, and mental health could be better treated with resource investment elsewhere. Even before the pandemic, one in eight emergency room beds were occupied by patients with mental health emergencies. This can be prevented through initiatives that increase access to mental health care outside the emergency room. The federal government could further adjust telehealth restrictions to increase access to care, as just one example. However, investment and prioritization of mental health in coronavirus task force meetings would need to occur for things like this to happen, and someone would need to be arguing for it and to know the data.

There are serious warning signs that we are on the brink of a mental health crisis that warrants substantial intervention. However, it is not listed as one of the four crises that the Biden administration plans to tackle - the economy, racial injustice, climate change and the pandemic. If you viewed the world like we do, you would know that each of these crises has a mental health component that needs to be addressed in parallel. You might also know that CDC data show suicidal thoughts in the past 30 days nearly doubled and were substantially higher in groups like unpaid caregivers, Black and Hispanic populations, and 18 to 24 year olds. You would know that opioid overdoses have increased. You would know that mental health is deserving of its own interventions. This is particularly true as suicide rates in this country have been increasing over the past two decades, and our system still allows many to go without access to affordable and sustained mental health care. We have the ability to prevent deaths from occurring, and we know we have treatment and expertise that can do so. Not to mention the mental health sequelae of potential pharmacologic interventions and the intricacies of some of the psychiatric medications that have been proposed to treat the disease. 

Finally, every single person impacted by coronavirus and this pandemic is experiencing trauma, and this country would be well served to take a trauma-informed approach to messaging and understanding. This, again, is a specialty and not something any person can do simply because they went to medical school. Grief, loss, racial injustice and what health care and frontline workers are experiencing day after day at work, all of this is trauma will take a substantial toll. Starting from the standpoint of viewing the conversation through this lens, would serve our country well. Not to mention, mental health professionals are highly trained in listening and communicating, and that ability has been sorely missing at the governmental level for years. The government has failed to understand the psychology of people who don't socially distance or wear masks, issuing ineffective messaging that resulted in behavior among Americans that increased the spread of the virus.   

Ultimately, this pandemic has affected all of us in innumerable ways, but at the core of many of them is our emotional and mental health. It is doing us a disservice to neglect that crisis, to put it off for the future, or to assume that someone without real expertise in it can argue for it or understand it as well as someone who does. Please do not wait to help the mental health of this country and invest in real improvement and change. This is one of the rare bipartisan topics. Ninety-one percent of registered voters said they want elected officials to focus more on mental health. We should listen to them.

Jack Turban MD is a fellow in child and adolescent psychiatry at Stanford University School of Medicine. His writing has appeared in The Hill, The Washington Post, The New York Times, and The Los Angeles Times, among others. Follow him on Twitter @jack_turban.

Jessica Gold MD MS is an assistant professor of psychiatry at Washington University in St. Louis. Her writing has appeared in The Washington Post, The New York Times, and The Atlantic, among others. Follow her on Twitter @drjessigold.

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