The Global Mental Health Crisis

We are currently entering the second year of the COVID-19 pandemic and there are hopes that it will begin to recede, and we will begin to return to “normal”.  Many have practiced social-distancing, and mask wearing to minimize their risks as well as to attempt to benefit the greater good.  These efforts, along with vaccines being rolled out and other individuals contracting the virus naturally are meaning that many are seeing the potential for normalcy on the horizon.  However, there is a side effect to the pandemic that is being mentioned but not nearly as widely publicly discussed as the coronavirus and its impact on the world.  There is associated fallout related to the pandemic and the changes in our day-to-ay existence that we are encountering specifically related to mental health.  For those who have struggled with their mental health, they are seeing their symptoms exacerbated by the change to life and their routines.  The move to lockdowns has taken away their routine and often some of the coping skills that have kept them from being in a crisis.  Change is not something we humans excel at, we often fear it and fight it because of the “what if” factor.  “What if this is worse than it was?” or “what if this hurts?” are often some of the leading questions we face.  However, the changes to the world at large has also impacted those who previously did not struggle with their mental health.  The changes they have been facing in their routines and their worry over contracting or spreading this, and the deviation from their normal daily routines has caused many people to seek out treatment who have never been engaged in the mental healthcare world before.  As we have gained a better understanding of COVID-19 we have been able to slowly open things back up to varying degrees that offer some additional supports to those who have been dealing with their mental health issues and need that additional level of support.  However, for some it is not sufficient, and the current conditions of the mental healthcare system are not meeting their needs because of the restrictions necessary to combat the virus.  Beyond that, the systems had gaps to begin with because of lack of funding, lack of training, and the ongoing stigmatization of mental health problems. For those who have a newfound struggle with their mental health there is not a very good roadmap about what to do or where to turn.  Because of the aforementioned stigma surrounding mental health, people turn to sources that lack the training or capacity to help them or fall into the web of internet research trying to decipher what can help them. 

To fall back on the serenity prayer that many know from twelve step meetings, I am only going to focus on the things that CAN be controlled, so looking at the systems in place in a “normal” year.  The first issue that must be addressed is accessibility.  For starters, people seek to access mental health treatment (therapy or psychiatry typically speaking) through the medical professional they know best.  That means individuals are going to their primary care physician (PCP) and talking to them about their mental health struggles.  Inherently, there is nothing wrong with that.  However, a PCP does not have the same depth of training around mental health that a psychiatrist does, and a PCP does not know therapy.  They may have their own experiences with both and obviously have some training around psychiatry, but that is not their specialty.  Because they care and have compassion they will do their best to help someone who comes to them struggling.  That may mean prescribing a medication, listening, talking, maybe even suggesting therapy.  Because the systems in place do not necessarily communicate efficiently, that may mean that the individual has to take a referral to “therapy” and consult with their insurance to find a therapist.  Perhaps even worse, therapy may not be a covered or even available benefit (depending on where they live).  Many areas lack the infrastructure to support the demand for mental health treatment, both psychiatry and therapy.  Technology can help some with that by providing telehealth services, but there are many clinicians who are wary of utilizing technology to provide their services, and for a segment of the population, specifically the more acute, telehealth may not be a viable option.  As a therapist, there are certain clients I would not be at all comfortable with working in a remote setting but would be at ease working with in an in-person modality.  Strengthening our system of care, on a global basis is a step we must address to alleviate some of the strain we currently face.  Educating doctors and nurses about what is available and developing a better, more open and effective line of communication across the healthcare system may open doors for these individuals in need as well as reduce the failing safety net system of utilizing hospital emergency departments (ED) and police departments from serving as the frontline in mental health crisis treatment.

To expand on the last point, hospital ED’s and the local police are often the first contact someone has when they reach a mental health crisis.  These are not the place nor the people who should be that first line of contact when someone is in crisis.  While there are trainings those who serve in both places often go through to help them better handle someone experiencing a mental health crisis, that is not their specialty and they should truly be serving as the last line of defense.  Some locales are addressing their system of care more effectively and prioritizing mental health crisis work better than others, but this is a global issue.  When someone is in crisis they either go directly to an ED or they call the emergency number to have help come to them because that is all they know to do.  To combat this, we have to implement better communication with the public to let them know what is available to them where they live.  Maybe that is a mobile crisis team who comes to their home, maybe that is a case manager who ensures they are getting connected to the right treatments and checks in with them on an ongoing basis.  Often, those in crisis may be able to be diverted from contact with the police or an ED, lessening the taxing of the system but also avoiding the stigma that comes from engaging either of those while in crisis.  A trained professional who is available to respond to crisis situations can often deescalate the crisis and avoid engaging the safety net aspect of the system, but again, many locales also lack these resources.  This leads to individuals who are in crisis being put in the back of a police car, despite committing no crime.  This leads to individuals being placed in a spartan room in the ED and having their symptoms exacerbated by the hustle and bustle the ED has as well as potentially being viewed as an obstacle because the person in crisis will sit in the ED for many, many hours waiting for a resolution rather than being triaged and moved along as a normal ED patient would be. 

Addressing mental health needs should not be a lower line-item agenda for the world, but instead should be prioritized as urgently as a new virus or disease that is impacting thousands or millions of individuals.  We have to publicize the need for this, talk about it openly, and ensure that we create a safe and understanding space for those in need.  For those who struggled prior to the pandemic, they need more and better resources, ones that are available to them consistently and reliably.  They need places free from judgement that approach them with respect and civility, using their preferred pronouns and understanding them as a person and not a diagnosis.  For those who have recently begun struggling with their mental health and are seeking help for the first time, we need to make it less intimidating to enter treatment.  Many of the first-time clients seeking therapy I have encountered over the last year have been nervous and on edge about participating in therapy.  Educating the global population that therapy is a good and productive thing and helping everyone understand what it looks like can help alleviate some of those fears.  But ultimately, we have to talk about this stuff as a society.  We have to be open, transparent, and start having a discussion in order for things to improve.