Science

Expanding Mental Health Care Is a Medical Necessity


It is a classic refrain in psychological research: people are more resilient than they realize. The acute upheaval of the early pandemic era led to a spike in depression and anxiety. A year or so later those numbers appeared, in many studies, to return to prepandemic levels, reflecting the science that says most of us tend to bounce back from traumatic events. But the longer-term disruptions, losses and volatile shifts from hope to fear to languishing are harder to parse. COVID has already killed or disabled millions, deepened economic insecurity and racial inequality, and forced radical adaptations to daily life; its serious effects on mental health and well-being very likely will continue and in ways still unknown.

In 2020 the U.S. Congress responded to the mental health crisis by providing temporary funding for services and forcing the expansion of insurance coverage. These emergency measures must be permanently extended to meet emerging needs—and expanded to tackle long-standing and systemic inadequacies in care. In September the American Psychological Association called on Congress to do just that, along with mandating increases in the number of mental health providers. The Lancet COVID-19 Commission Task Force on Mental Health, meanwhile, wrote that the pandemic “offers a critical opportunity to invest in and strengthen mental health care systems to achieve a ‘parity of esteem,’ meaning that someone who is mentally ill should have equal access to evidence-based treatment as someone who is physically ill.”

The idea that mental health is less legitimate than physical health has led to paltry insurance coverage, a scarcity of counseling professionals, and regulatory hurdles that make finding care especially difficult in rural and other underserved locations. Yet research has continued to reveal that the separation between mind and body is a false one: chronic emotional distress can significantly increase the chances of developing serious physical disease.

Talk therapy is especially well-suited to telemedicine, which has grown rapidly as an emergency measure and can be adopted as a true alternative to clinical settings. Video-based sessions work as well as, if not better than, in-person sessions, perhaps because it is easier for people to show up consistently. Insurance companies must continue to cover virtual appointments. Equally important are systemic policy changes to bolster socioeconomic support: it is harder to cope with emotional distress when also worrying about financial security.

Young people, in particular, have been hurt by pandemic disruptions. Many are struggling to see a hopeful future for themselves—a key to resilience. Researchers agree that preempting behavioral problems and mental illness makes more sense than beginning treatment after a crisis. One way to proactively reach more young people is to teach cognitive-behavioral therapy and mindfulness in schools. Using standard textbooks and trainings, students could learn to self-soothe, regulate emotions and form healthy coping mechanisms for stress. Such institutional programs would be especially helpful for the more than two million children worldwide who have lost a caregiver to COVID.

Two other groups of people need dedicated focus: those who were infected with COVID and those who treat them. In a recent global review, more than half of people who tested positive report symptoms of so-called long COVID, including brain fog, lethargy and depression. Approximately one in three survivors has been diagnosed with a generalized anxiety disorder and one in eight with post-traumatic stress disorder. Clinicians must prepare for a surge of patients who need psychiatric treatment. Nurses, doctors and other health-care workers, too, need more institutional support; many still avoid speaking up about psychological distress, fearing (often rightly) that it could jeopardize their jobs. Ending the stigma of seeking care would help acknowledge the traumas of COVID, as well as the burnout that was already endemic in the profession.

The “end” of the pandemic must not signal a return to the status quo, if only because it is not the only global force threatening emotional resilience. Severe wildfire seasons, rapidly intensifying hurricanes and deluges of rain—all consequences of climate change—mean that more and more people are experiencing terrifying disasters and loss. Such upheavals will keep overlapping rather than dissipating. It is long past time to prioritize mental health as essential to overall health. Fostering resilience in a world of accelerating uncertainty depends on it.


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