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Mental/Behavioral Health

COVID-19’s mental health impact: Converging crises mean it will persist beyond the pandemic

Tom Sullivan | December 8, 2021

In this series, Health Evolution is examining the year 2021 in health care through the lens of our eight imperatives. We will be examining the trends that were at the top of CEOs’ minds throughout the past year and what may come in 2022. This week: Mental and behavioral health. Previously: Health system resilience 

 
While it’s clear that COVID-19 has taken a toll on the mental health of Americans, the extent of that damage is not entirely understood. What has been realized, however, is the likelihood that COVID-19 will have a negative impact on the nation’s mental health long after the pandemic.  

Among the Eight Imperatives1 that Health Evolution identified for health care CEOs to focus time and resources on emerging post-COVID-19 is the need to confront the mental health crisis. Relative to the pandemic, that work begins with understanding the depth of COVID-19’s impact on mental health, considering the early promise and ongoing challenges that digital health apps and tools present and preparing for the coming wave of mental health issues and necessary care services.  

The depth of COVID-19’s impact on mental health 
From the one-in-five health care professionals leaving their jobs if not the profession during the pandemic2 to the ongoing overdose and death epidemic3 to parents of infected children and unpaid caregivers suffering from isolation 4 as 1 in 10 are experiencing suicidal ideation,5 COVID-19’s negative impact on the mental health of Americans has already proven to be deep and far-reaching. 


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“The COVID-19 crisis has also made it more difficult for mental health services to operate and this is concerning because those with underlying mental health difficulties may be particularly vulnerable,” according to an article in the Journal of Psychiatric Research.6 “Alongside the physical disease burden that COVID-19 has caused, the insecurity and isolation caused by the COVID-19 crisis and measures to mitigate the virus transmission may have substantial and long-lasting population mental health effects.” 

Basic access to mental health services within a reasonable timeframe, in fact, has become difficult enough that in October, California Governor Gavin Newsom signed a law requiring that mental health care wait times be reduced to no more than 10 business days.7 In so doing, California joined half-a-dozen other states pursuing legal means to shorten the time it takes patients to receive mental health care.8  

What’s more, with some 788,000 deaths and 49 million reported infections in the United States to date9 and increasing uncertainty as the new Omicron variant has begun circulating to multiple countries, the first months of 2022 ahead will inevitably be challenging.  

Digital health apps and tools: Early promise and ongoing challenges  
Much has been discussed relative to utilization spikes in telehealth early in the pandemic as well as the potential for digital front doors and other tools moving into the future.10 Currently, there are more than 10,000 mental health apps and digital tools available.11  

The mental health market has also seen some consolidation, notably when Headspace and Ginger merged to form Headspace Health with the stated goal of democratizing mental health.12 While that is perhaps the most high-profile deal, merger and acquisition activity in the behavioral health space, particular to clinical and digital capabilities, has increased and that new pace is predicted to continue.13 

Early evidence even suggests that digital tools have helped in the fight against COVID-19. One example: A study conducted by Penn Medicine found that among the 3,488 users of COVID Watch, three died. That’s compared to the 12 who passed among the 4,377 patients not using the automated texting program.14 Penn Medicine also determined that COVID Watch effectively addressed equity by reducing mortality rates within 60 days among White, Black and Hispanic subgroups.15   

Despite the promise of digital technologies to close COVID-19 related gaps in care, the tools also create new privacy and security concerns. Many offerings are unproven and lacking hard evidence, making it difficult for health care organizations to understand which work and which do not. Today’s regulatory environment has yet to keep pace with requirements necessary to protect sensitive consumer data16 as it is increasingly being shared with or without a given individual’s knowledge or understanding. These realities do not negate the potential but evidence and privacy and security implications must be taken into consideration.  

The coming mental health wave  
Prior to the Delta variant spiking and, more recently, Omicron sending researchers and government officials on their way to determine what to expect regarding how the new variant will impact the spread and severity of the pandemic, experts were predicting a coming wave of mental health crises driving the need for unprecedented levels of care. What’s more, social distancing measures as well as other issues such as employment loss that can increase isolation are likely to drive poor mental health outcomes as well.17  

“Even a small increase in the rates of people with new or worsening mental illness is going to be a problem,” Susan Borja, who serves as Chief of the Dimensional Traumatic Stress Research Program at the National Institute of Mental Health, told STAT. 18 

An increase in mental health needs has already been taking place. The Kaiser Family Foundation, in fact, found that 40 percent of adults have reported anxiety or depression symptoms, up from 10 percent before the pandemic.19 KFF also found that many adults are experiencing difficulty sleeping (36 percent) or eating (32 percent), increasing alcohol or substance abuse (12 percent) and worsening chronic conditions.20 

In the World Health Organization’s latest Mental Health Atlas, WHO found “a disappointing picture of worldwide failure to provide people with the mental health services they need.” Specifically, WHO’s Atlas highlights a lack of effective leadership because only half of its members indicated their mental health plans and policies are in line with international measures. Also, only half meet targets for promoting mental health and prevention programs.21 

Yet, promoting mental health care options and prevention are more critical than ever. On a global basis, central nervous system, respiratory system and cardiovascular system organs emerged as the most impacted by the virus thus far22 and among central nervous system conditions, the top three are anxiety, fatigue and depression.23   

“It is extremely concerning that, despite the evident and increasing need for mental health services, which has become even more acute during the COVID-19 pandemic, good intentions are not being met with investment,” Tedros Adhanom Ghebreyesus, MD, Director-General, WHO, said in a statement accompanying the Atlas. “We must heed and act on this wake-up call and dramatically accelerate the scale-up of investment in mental health, because there is no health without mental health.” 

Looking ahead: Emerging post-pandemic   
With the pandemic still ongoing, the breadth and depth of COVID’s impact on mental health and the new degrees of isolation and uncertainty many people have faced have yet to be well understood. Research prior to the pandemic, however, determined that conditions as seemingly simple when compared to COVID-19 as workplace uncertainty can corelate to negative psychological impacts tied to conditions such as elevated blood pressure.24  

“It is likely that the mental health fallout from the pandemic will continue to grow. The exacerbation of social determinants of health will last for years (and likely decades), which will have long-term implications for mental health,” according to the Commonwealth Fund.25 “The 1918 flu pandemic led to reduced educational attainment, higher rates of physical disability, and lower income for individuals, suggesting there may even be intergenerational effects.” 

The crisis is not over. The pandemic itself, shortages of mental health care providers and the projected surge in the need for those very professionals are all contributing factors to what will likely become negative and longstanding impacts COVID-19 has on the nation’s mental health.  

Sources & Citations  
1. The year(s) ahead: Eight imperatives emerging post-pandemic, Health Evolution  
2. Nearly 1 in 5 health care workers have quit their job during the pandemicMorning Consult   
3. Issue brief: Nation’s drug-related and death epidemic continues to worsen, American Medical Association  
4. Why COVID-19’s toll on unpaid caregivers’ mental health is ‘terrible and heartening’, Health Evolution  
5. Mental health among parents of children < 18 years and unpaid caregivers of adults during the COVID-19 pandemic — United States December 2020 and February March 2021Centers for Disease Control and Prevention  
6. Psychological distress and adaptation to the COVID-19 crisis in the United States, Journal of Psychiatric Research 
7. California joins other states in limiting wait time for mental health issues, NPR 
8. California joins other states in limiting wait time for mental health issues, NPR 
9. Coronavirus pandemic (COVID-19) — the data, Our World in Data via New York Times 
10. Why next-gen digital front doors require ‘breaking the incumbent attitude’, Health Evolution 
11. Protecting users of digital mental health care, World Economic Forum 
12. Headspace, Ginger merge to form Headspace Health: An interview with CEO Russell Glass, Health Evolution 
13. A defining moment for digital behavioral health: Four market trends, Rock Health 
14. Comparative effectiveness of an automate test messaging service for monitoring COVID-19 at home, Annals of Internal Medicine  
15. Comparative effectiveness of an automate test messaging service for monitoring COVID-19 at home, Annals of Internal Medicine  
16. Protecting users of digital mental health care, World Economic Forum  
17. KFF health tracking poll – July 2020, Kaiser Family Foundation 
18. As the COVID-19 crisis ebbs in the U.S., experts brace for some to experience psychological fallout, STAT 
19. The implications of COVID-19 for mental health and substance use, Kaiser Family Foundation 
20. KFF health tracking poll – July 2020, Kaiser Family Foundation  
21. WHO report highlights global shortfall in investment in mental health, World Health Organization 
22. Assessing the global burden of post-COVID-19 conditions, IQVIA Institute for Human Data Science 
23. Assessing the global burden of post-COVID-19 conditions, IQVIA Institute for Human Data Science 
24. Changes in mental well-being, blood pressure and total cholesterol level during workplace reorganization: The impact of uncertainty, Work & Stress, a Journal of Work, Health & Organizations 
25. The long-term impacts of COVID-19 on mental health, The Commonwealth Fund

About the Author

Tom Sullivan, EVP & Editor-in-Chief of Digital Content

Tom Sullivan brings more than two decades in editing and journalism experience to Health Evolution. Sullivan most recently served as Editor-in-Chief at HIMSS, leading Healthcare IT News, Health Finance, MobiHealthNews. Prior to HIMSS Media, Sullivan was News Editor of IDG’s InfoWorld, directing a dozen reporters’ coverage for the weekly print publication and daily website. Contact: toms@healthevolution.com or @SullyHIT on Twitter.