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Ideas


THE COMING MENTAL-HEALTH CRISIS

Congress must rethink the American approach to mental-health care during the
pandemic.

By Norm Ornstein, Benjamin F. Miller, and Kavita Patel

Shutterstock / The Atlantic
May 14, 2020
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About the authors: Norm Ornstein is a contributing writer for The Atlantic, a
contributing editor and columnist for National Journal, and a resident scholar
at the American Enterprise Institute for Public Policy Research. Benjamin F.
Miller is a psychologist and the chief strategy officer of Well Being Trust, a
national mental-health foundation. Kavita Patel is a physician and a nonresident
fellow at the Brookings Institution.

Even before the COVID-19 crisis, America’s infrastructure for mental-health and
addiction services was fragmented, overburdened, and underfunded. The
coronavirus has put far more stress on that broken system. So far, Congress has
failed to shore it up. That oversight will prove harmful to patients and their
families and costly to insurers and taxpayers. Mental-health disorders were
already at the top of the list of the most costly conditions in American health
care even before COVID-19.

The organizations that provide behavioral-health services face their greatest
economic challenge in memory. As an online survey of 880 such organizations
recently found, the pandemic is forcing practices to reduce services, provide
care to patients without sufficient protective equipment, lay off and furlough
employees, and risk closure within months. For people with serious mental
illness who are trying to get treatment or access their medications, the doors
of many community mental-health centers are closed. For those with both mental
illness and COVID-19, including a large number who are homeless, no care is
available, and they are at risk of exposing others.

Congress must do much more to help mental-health providers adapt.

Read: I was depressed before all of this. Now what?

First, lawmakers should provide explicit financial support for mental-health and
addiction clinicians to provide meaningful, timely, and convenient care. Any
enhanced funding to Medicaid programs or hospitals should explicitly include an
allocation for mental-health resources, including prioritization for programs
that integrate mental-health resources in emergency rooms and other hospital
wards.

Second, the pandemic is a prime opportunity to rethink the American approach to
mental-health care in its entirety—to adopt a new vision and create an
integrated system of services that reaches into settings as varied as primary
care, our schools, our prisons, our workplaces, and our homes. Such a system
will require substantial investment.

Yet better mental-health services have not been a priority during the current
pandemic. The CARES Act, the $2 trillion relief bill that flew through Congress,
included a paltry $425 million for the Substance Abuse and Mental Health
Services Administration. That investment is welcome, but it also underscores the
dearth of official interest in this vital area. For reference, $425 million is
less than 1 percent of the total amount invested in the airline industry and an
even smaller fraction of the $185 billion dedicated to health-care providers as
a whole. Crises offer policy makers a chance to take a fresh look at the
nation’s problems. But Congress is failing to capitalize on the mental-health
crisis in any meaningful way.

George Packer: We are living in a failed state

Recent data from the Kaiser Family Foundation illustrate the need for both a
short- and long-term strategy for better mental- and behavioral-health care.

When asked if worry or stress related to the coronavirus had hurt their mental
health, four in 10 in the Kaiser survey reported that worry or stress had led to
sleep problems. Others reported that the coronavirus had caused them to
experience a variety of health-related ills, such as frequent headaches or
stomachaches and increased alcohol or drug use. If these problems are not
addressed now, they may fester and worsen in the future.

The challenge is daunting—and not just for those who already face mental-health
and substance-abuse issues and those at risk because of the changes in their
life caused by the pandemic. The people crucial to fighting the coronavirus are
vulnerable as well. Most telling in this latest round of survey data is the
impact that COVID-19 is having on essential workers, including health-care
personnel. Two-thirds of those surveyed who live in a home with a health-care
worker reported that the worry or stress from the virus had caused them to
experience at least one adverse effect on their mental health or well-being
sometime over the past two months. Recent suicides and increased calls to crisis
lines dedicated to health professionals and other essential workers underscore
the size of the unaddressed problem.

That problem will not solve itself. And the longer the crisis continues, the
greater the danger to Americans’ emotional well-being. “After infections begin
ebbing, a secondary pandemic of mental-health problems will follow,” The
Atlantic’s Ed Yong recently wrote. “At a moment of profound dread and
uncertainty, people are being cut off from soothing human contact.”

Read: The pandemic could change how Americans view government

The coronavirus has laid bare the failings of American health care and public
health. Without immediate action, it will do the same to America’s fragile
mental-health system. Investment in that system will pay off, not just in terms
of lives saved and bettered, but in monetary savings as well. The demands for
money to ease economic, medical, and social problems will accelerate when the
coronavirus pandemic ebbs. The United States cannot allow the needs of mental
health to be pushed aside by other priorities. If that happens, the price we
will pay as a society will be fearsome.





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