There is a research model going around that suggests as many as 150,000 additional people could die from mental health-related outcomes of COVID-19. I could argue the merits of the mathematical model as many of my colleagues have. I could also make the case that discussing the depths of despair and predicting increasing suicide rates over and over could, in fact, lead to copycat suicides. But what if I took an alternative stance, and told you that—though absolutely no one would wish a pandemic on anyone— this is actually what mental health needed to stop being stigmatized and start being valued?
I’m not naïve. As a psychiatrist, I understand the realities of the mental health stressors that exist from this global pandemic and the potential for an increase in psychological care needs now and in the aftermath. However, it’s possible that we emerge from this with innumerable positive mental-health outcomes.
Over the past decade or so, the public perception of mental illness has changed. More and more people are openly speaking about their experiences with care; celebrities are disclosing their diagnoses not just when they have “been outed” by the press but to raise awareness; and television shows now often include characters who have mental health disorders that add to their story (like Randall in This is Us and Devi in Never Have I Ever) and are not used simply to portray them as different or violent. Nevertheless, mental health is still viewed negatively in our culture. I have had patients’ parents throw away their medication when they found it and tell them not to take it. I have also had patients who delayed coming in until they were really sick because they thought “I would just get over it” or “I am just a girl and girls are emotional.”
The stigma can also directly impact people’s job opportunities and livelihoods. In many states in the U.S., state licensing applications to practice medicine ask physicians to disclose if they have ever had a mental illness in their lives, right next to questions of if they have committed any serious crimes. This not only equates mental illness treatment to felonies, it makes physicians, who have some of the highest rates of suicide of any profession, fear seeking treatment because of what it might mean to their license and any other possible repercussions at work. These are the messages we send about mental health—that disorders are somehow a weakness or even your fault, that having one makes you different or not as capable at your job, and that you should be able to get better without treatment.
Mental health is often considered categorically unequal to physical health. This is perhaps best evidenced by the fact that the fight to create parity between the way insurance covers mental-health/substance-use disorders and other medical conditions is ongoing.
In my practice, I often have to get prior authorization for coverage of the first line or generic medications (or hospital stays) I believe would best help my mental-health patients. In many cases, “physical” problems are treated very differently by insurance companies. For example, if a patient has shortness of breath, it is unlikely they would need prior authorization to get a CT scan to rule out that they have a pulmonary embolism or blood clot. However, if I suspected that anxiety or panic were the underlying cause of the shortness of breath, I would likely have to get on the phone with their insurance company, trying to convince the provider to cover counseling and mental health medications. As a result, mental health patients often are limited in terms of which care providers they can see, and even when they do find someone, they often have to pay higher costs because they are denied services not considered “medically necessary.”
The COVID-19 pandemic is a sort of equalizer. Nearly everyone is self-isolated at home, trying to work while managing a household, and dealing with uncertainty and grief. To some degree, everyone is experiencing what life with anxiety is like. This includes those in management, who are dealing not only with their employees’ stress but also their own. Though depression is already the number one cause of disability worldwide, this is the first time many employers and managers are thinking and openly talking about mental health in the workplace.
This change is now visible on social media. Typically, social media can cause depression in young adults due to what those in the field sometimes refer to as “social comparison.” In my patients, this manifests as feeling like no one else is stressed or sad or struggling in college because they look happy and appear to be having a lot of fun on social media; by comparison, my sad and stressed patient feels like “something must be wrong with me.” Some students maintain a “finsta” (a “fake-Instagram” account) they share with a select group who have “earned” seeing their true selves. However, during COVID-19, nearly all people—from influencers to celebrities to students—are finally being vulnerable about their lived experiences and emotions. They are removing the perfectly curated images, in part, because they have to, without makeup or stylists or even access to haircuts and shopping. But the trend may also be due to fact that this moment calls for people to just be more real. Perhaps this will lead to more social connection, or even a decrease in depression and loneliness. Hopefully, this vulnerability stays long after the pandemic ends.
The coronavirus crisis has made clear just how inextricable mental health is from physical health. You cannot talk about a lack of personal protective equipment (PPE) without talking about the mental health repercussions, and you cannot talk about patients who are dying of COVID-19 without talking about grief. You also cannot talk about unemployment or social isolation without talking about anxiety and depression.
In the U.S., almost half of all adults will experience mental illness during their lifetime. These are rates similar to people who suffer from heart disease. Imagine saying to someone with heart disease that they are weak for having it, or that they cannot get care because their care is less important or valued. That is what we have always done with mental illness, and hopefully, because of this pandemic, it will finally stop.
Instead of looking at the post-COVID-19 mental health future through a lens of inevitable doom, we can, and should, use this moment as the impetus for the changes that mental health care has always pushed for. Let’s invest in expanding access to affordable mental health care coverage in our communities, companies, hospitals, and through the use of tele-health platforms. Let’s finally enforce parity and make mental health care coverage and reimbursement equal to physical health care. And, let’s say once and for all that having a mental illness is a disease that requires treatment, just like any other illness.