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Any COVID-19 Response Must Include Mental Health Care

As the COVID-19 crisis continues, most people are focused on its impact on the economy, or worried about an older relative falling ill. But there is another public health crisis looming over all of us -- one that will slowly ripple outward, but then hit us like a tsunami if we don't prepare now, and it will come in the form of a mental health crisis.

Stress, anxiety, and trauma -- the "big three" of mental health issues. We've seen stress humorously commented on in our social media news feeds. We make light-hearted jokes about anxiety, then forget about it. Why? Because to acknowledge that they truly exists is to give them a credibility that offends the sensibilities of most people. Those of us who have served in the military, especially since the turn of the century, know about "post-traumatic stress disorder", or PTSD. Post-traumatic stress is a real condition, and it doesn't require being in combat to develop it; almost any traumatic situation can be a contributor. And if you believe that you are immune to its effects, you are only fooling yourself. "It cannot happen to me" was a phrase that I used to tell myself a lot until it came up to me, bit me on the butt and said, "I'm here, Marine, so you'd better get with the effing program."

I read a story some years ago about an Army Sergeant Major who went to weekly sessions with the base psychologist. During these sessions, they would simply talk about general things -- small talk about nothing specific, and nothing on the part of the Sergeant Major that would warrant a visit to a psychologist. After a few of these weekly sessions, the psychologist asked the Sergeant Major why he continued to schedule and attend these sessions if there was not an issue that he wished to discuss. "Quite simply," said the Sergeant Major, "I want my soldiers to see me doing it. They don't need to know why I do it, but if they see me, at my age and rank, coming in regularly to talk with a psychologist, then maybe some of them who actually do have issues will not feel so stigmatized, and will feel like they can get the help that they need to get through their own issues."

In the era of COVID-19, we hear about how we need to "flatten the curve" and find ways to slow the spread of the virus, but no one seems to be considering the tremendous amount of stress and anxiety that is being inflicted on all of us as a result of the handling (or mishandling, as the case may be) of this crisis. Millions of people are losing their jobs, and those that still have jobs that require being physically present are enduring increasing levels of anxiety, stress, and trauma as they try to navigate potentially contaminated spaces, and deal with people who may not be taking precautions to protect themselves or others. Additionally, there is the trauma that the livelihoods of small-business owners, some of whom may have been in business for decades, are being destroyed virtually overnight, as well as that of workers whose jobs rely on human interaction, many of which cannot be transitioned online.

And it's not just about job loss. A recent article out of the New York Times talked about COVID-19 survivors being ostracized AFTER their recovery by friends and neighbors, and even family members. Some even reported feeling survivor's guilt. While we are ALL  vulnerable to the impacts of the pandemic on our individual mental health, certain groups are particularly at risk including mental health workers, adolescents, and those over the age of 65. Health care workers and first responders are already at a greater risk for mental health conditions as data from before the pandemic shows that both physicians and nurses have a higher rate of depression, burnout, and suicide when compared to the general public.

The hidden undertow to the current COVID-19 crisis, the hidden impacts of social isolation (not "social distancing"), fear, uncertainty, and even loss often remain silent, but are just as impactful -- and deadly -- as the virus itself. A recent poll conducted by CVS Health and Morning Consult found that two-thirds of adults reported more stress now as compared with this time last year, and nearly one quarter of those also indicated that they do not feel confident in locating resources to address their mental health concerns.

We are already reeling with the aftermath of having our health care system and disease prevention programs undermined. Political de-prioritization of these services has already led to an inability to proactively contain COVID-19, which in turn has led to reactive responses that are often too little, too late. And yet that same over-politicized and reactive system is even worse for the various mental health programs that, over the years, have had to deal with deep cuts in already scarce services. It seems like mental health issues only surface as an important topic after events like school shootings or shootings at large social events, but they soon fade into the background after the partisan bickering starts, and big-money entities start pulling their collective marionette strings.

Mental health services are critical to staving off a disaster of monumental proportions, and mental health treatment must be included in any response to the COVID--19 pandemic crisis. The United States cannot afford to continue making mental health a reactionary crisis response or a political musical-chair issue, especially during this pandemic. As a candidate, and as someone who personally benefits from the occasional visit to such a professional, I think that mental health care should be made a priority, and here are a few ideas that can be easily implemented to make that happen.

First, prioritize telemedicine. Make it low-cost and available to all people living in the United States regardless of income, age, or citizenship status. This can be achieved through smartphone apps and smart technology, and training for mental health professionals on how best to use this technology. Also, transition group meetings (like substance abuse meetings) to online forums which can continue to help those people who are working hard to stay clean. These programs can also be continued once social distancing restrictions have been lifted.

Second, develop community and neighborhood-level emotional support systems, then train a new group of local providers who can focus their time and efforts on enhancing social cohesion and empathetic listening. Many faith-based groups and institutions can serve as a model for this, and can also help to facilitate its activities. Most mental health professionals will agree that people need community during times of crisis, so developing these neighborhood-level support systems can help many who might be suffering.

And third, be prepared to offer a wide range of necessary mental health resources and support structures. Many people in these communities may not have the luxury of being able to work from home, and so may face increasing anxiety related to increased risk of virus exposure, or fears about losing their jobs. For those that have the ability to shelter in place, depression may be the biggest factor due to physical isolation or loss of income. Additionally, people may face prejudice based on how the virus has already been labeled by governmental agents, leading to horrific, targeted attacks.

Many of our political and government leaders operate merely in reactionary mode, the idea being "deal with it when it arrives, but not before". For instance, the World Health Organization plan to deal with COVID-19 does not have any strategies for mental health, and while Congress has authorized hundreds of millions of dollars for behavioral health efforts -- including suicide prevention programs -- as a result of COVID-19, there was a massive need for such services even before this crisis as tremendous changes already impact our daily lives. Politicians and government workers have the ability to get these policies changed and enacted, to get financial resources allocated and structures in place to support mental health workers now, before the wave of need washes over all of us.

Committee to Elect Darren Hamilton
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