The data in the August report were stark.
U.S. adults reported considerably elevated harmful mental health conditions associated with COVID-19, according to a study published in the Centers for Disease Control and Prevention’s (CDC) Morbidity and Mortality Weekly Report (MMWR). COVID-19 hit younger adults, racial/ethnic minorities, essential workers, and unpaid adult caregivers particularly hard, with disproportionately worse mental health outcomes and increases in substance use and suicidal thoughts.
Indeed, COVID-19 makes World Mental Health Day on October 10 more important than ever. It’s a day to highlight what legislators, public health officials, mental health experts, and frontline workers need to keep in mind as they face increased needs among these populations.
Those needs translate into both a current and long-term increased demand. The Substance Abuse and Mental Health Administration’s crisis hotline, for example, registered a 1,000 percent increase in April 2020 over April 2019. By September, depression symptoms had roughly tripled from pre-pandemic levels. In addition to the current spike in demand, research shows that behavioral health issues such as Post-Traumatic Stress Disorder (PTSD) have long-term effects. An Abt longitudinal study of Vietnam veterans found that 11 percent of combat veterans still dealt with intrusive PTSD-induced nightmares, memories, and anxiety 25 years after the initial study in the 1980s, and about a third suffered from major depression. Vietnam veterans with PTSD had a higher risk for chronic health problems, and Black and Hispanic Vietnam vets were two to three times more likely than white vets to develop PTSD.
The study in the CDC MMWR argued that community-level interventions need to target the hardest hit groups. Here are four community-level activities key stakeholders should consider.
1. Increase Access to Quality Health Services
Increasing capacity is critical given the large unmet need even before the pandemic. In 2016, for example, 11.8 million American adults believed that they had a need for mental health services during the past year that went unmet, according to the American Psychological Association. Cost and lack of knowledge about where to get services were major factors in not getting treatment. A comprehensive approach to expanding capacity would include community behavioral health centers, integration of behavioral health into primary care, telehealth, and crisis lines.
2. Foster a Health Care Workforce Able to Address Current and Emerging Needs
Increasing access requires more qualified staff who can provide behavioral health care or refer people to providers who can. A 2016 report from the Health Resources and Services Administration found shortages in 2013 for the nine most common behavioral health practitioners, from psychiatrists to mental health and substance misuse social workers. Most specialties were projected to have shortages exceeding 10,000 each by 2025.
Addressing current, emerging, and long-term needs requires the ability to provide and evaluate training, data-informed analysis, and modeling to determine healthcare worker distribution and track workforce trends. Abt has considerable experience in designing and evaluating behavioral health training and expand the workforce. We worked with Medscape Education on a course to enable primary care providers to detect and help patients with PTSD. And our evaluation of the NYC Mental Health First Aid, a public education program, showed that it prepares individuals without clinical training to recognize signs of mental health and substance use concerns and to respond empathically and effectively.
3. Use Data to Support Responsive Behavioral Health Care Systems
Collecting data to understand the impacts of COVID-19 on vulnerable households is critical to effective responses. In collaboration with the Saul Zaentz Early Education Initiative, Abt’s robust data collection platform supported an important survey of early child care providers and parents on the effects of COVID-19. The survey effort was designed and conducted to describe the impacts of the pandemic on children, families, and Department of Early Education and Care providers in Massachusetts, which experienced one of the earliest and most widespread outbreaks of COVID-19 in the United States. Results showed that lower-income families had high levels of job loss, but also high levels of teacher and school outreach as well as technology supports for continued remote education.
Abt’s COVID-19 Assessment & Tracking Tool (or CATT) is a web-based assessment tool that helps agencies and organizations collect essential data such as behavioral health services available during and after the COVID-19 pandemic. The tool can help quickly analyze this information on a daily basis and facilitate fast action to address problems and plan for future needs. CATT is built on a combination of three simple, scalable concepts: a customizable landing page, a set of 25-30 questions based on an organization’s interests, and a dynamic dashboard for daily reporting.
4. Develop a Communications Strategy
Improving population health for all requires a variety of approaches: coordination of health services, community-based partnerships, payment reform, communications strategies, and development of adaptable, outcome-focused, and sustainable programs. The communications strategy will help educate stakeholders, empower those affected, and lay the foundation for the other elements of the effort.
Abt created and implemented such a strategy as Zika was spreading rapidly. Our team of health communicators, graphic designers, and public health professionals worked with the CDC to create in just two months a crisis communications campaign composed of nearly 370 creative pieces. We used digital and social media, including animated banner ads, Facebook and Instagram ads, and Google AdWords to target specific audiences. Additional media channels provided broader audience reach, including in-flight magazines, newspapers and radio ads, and billboards. We reached more than 37 million people on the U.S. mainland and in Puerto Rico and won a MarCom Platinum Award in the category of traditional and social media for quality, creativity, and resourcefulness.
Confronting the mental health pandemic will require a village to adopt multiple, long-term strategies that cross numerous areas of interest, from health, criminal justice, and social equity to education, workforce development, and housing. Fortunately, the mental health community’s long experience with traumas, from hurricanes to terrorist attacks to wars, provides us with tools and best practices to deal with those affected. Unfortunately, COVID-19’s geographic scale, ruinous financial destruction, and widespread risk of death dwarf any previous traumas. But if we develop sound, data-informed, and integrated strategies--and put our minds and money behind them--we can address the behavioral-health fallout from the COVID-19 pandemic.