A public–private partnership, led by mental health advocate Patrick Kennedy and the head of the National Institute of Mental Health (NIMH) Joshua Gordon, MD, PhD, want urgent action to address the wave of mental illness and suicide caused by to COVID-19.
“Our country is in serious denial about the full impact of mental health in this country and certainly as part of this pandemic,” said former congressman Kennedy, co-chair of the Action Alliance’s Mental Health & Suicide Prevention National Response to COVID-19, at a briefing unveiling the group’s new six-priority Action Plan.
“That’s reinforced when all we hear from is Dr Fauci,” and only about the physical effects of the disease, said Kennedy, the founder of the Kennedy Forum, a nonprofit dedicated to changing the health system’s approach to mental health and substance use disorders.
“We’re seeing suffering on a whole new, unprecedented scale,” he said. Kennedy noted the huge effort to speed therapeutics and vaccines to the American public. “We need to bring that same sense of urgency to these deaths of despair hiding in plain sight.”
Gordon, NIMH’s director and a co-chair of the National Response group, was also at the briefing.
“We know many people report experiencing symptoms of distress, including anxiety, sleep problems, depression, substance use, and suicidal thoughts at rates two to three times higher than we might expect in times before the pandemic.
“Just as the country has come together to mitigate the physical impacts of pandemic, we also have to identify how to mitigate the mental health impacts,” said Gordon.
Plan of Action
Kennedy emphasized that it is crucial that federal lawmakers and regulators find a way to increase parity between mental and physical health.
Paramount in that effort would be ensuring stronger enforcement of the Mental Health Parity and Addiction Equity Act, he said.
That 1996 law requires health plans to ensure that benefits for physical and mental health were equivalent, but it has frequently been ignored. In 2019, a US federal court found that one of the nation’s largest behavioral health insurers, United Behavioral Health, had been violating the law. Kennedy said he expects this decision to continue to have a positive impact on achieving parity.
In November, United was ordered by a federal judge to reprocess 67,000 claims that it illegally denied.
The Alliance’s Action Plan has six priorities:
Change the national conversation about mental health and suicide
Increase access to evidence-based treatments for substance use and mental health disorders in specialty and primary care, and include better reimbursement for services and make permanent reimbursement for telehealth services
Increase the use of nonpunitive and supportive crisis intervention services, including keeping people out of the criminal justice system
Establish near real-time data collection systems to promptly identify changes in rates of suicide, overdose, and other key events, and of clusters or spikes
Ensure the equitable delivery of comprehensive and effective suicide prevention and mental health services for Black Americans; Latinx Americans; American Indian/Alaskan Natives (AI/AN); lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQ) individuals; and others disproportionately impacted by the pandemic
Invest in prevention and early intervention approaches that treat the root causes of suicide and mental health problems
Uptick in Distress
Gordon noted that recent data indicate that although emergency room visits for children are still down in 2020 compared to previous years, mental health emergency room visits are back to pre-pandemic levels.
A September survey showed an increase in suicidal thoughts and attempts, anxiety, and depression pandemic in youth because of the pandemic. Almost one quarter of those surveyed said they knew a peer who developed suicidal thoughts since the start of the pandemic and 5% reported making a suicide attempt themselves.
In early December, research reported in JAMA Psychiatry showed the overall rate of overdose-related cardiac arrests in 2020 was about 50% higher than trends in 2018 and 2019, and that all overdose-related incidents were about 17% above baseline in 2020.
COVID-19 also appears to be striking individuals who are living in behavioral health facilities, and some of those facilities are reducing inpatient care and other programs because they don’t have enough personal protective equipment, testing supplies, or staff to cope with the disease.
The facilities are not required to report infections to the federal government. Senator Elizabeth Warren (D-MA) and Reps. Carolyn Maloney (D-NY) and Katie Porter (D-CA) issued a issued a report based on their own offices’ survey of 10 large behavioral health program operators.
Eight of those operators — covering 376 facilities and more than 100,000 patients in 40 states and Puerto Rico — provided substantive responses.
More than half had at least one COVID case and 14% had large outbreaks of 10 or more cases. The infection rate for patients was in line with that of the general public.