Image Credit: Photo by Taylor Knopf: https://www.northcarolinahealthnews.org/2020/05/08/managing-mental-health-during-covid-19/
By Hope Simas, JHBL Staff Member
Prior to the onset of the pandemic, the U.S. was already experiencing a high rate of adults affected by mental illness. Throughout this unprecedented time, fear and uncertainty are likely to amplify mental health issues. Further, epidemics induce a sense of general stress across people, which may lead to new mental health issues. An epidemic is an outbreak of disease that spreads quickly and affects people within a community or region, while a pandemic spreads over multiple countries or continents. As Covid-19 came in full swing in 2020, the government and state officials worked to put various mandates in place to stop the spread. However, these varying stay-at-home orders coupled with fear of the virus quickly heightened people’s emotions. As the pandemic continues on with no end in sight, the weight of isolation, job insecurity, personal economic sustainability, and the fear of exposure to Covid-19 will continue to take its toll on individual mental health.
A KFF Tracking Poll conducted in mid-July showed 53% of adults in the U.S. reported their mental health had been negatively impacted by the stress and worry induced by Covid-19. This is approximately a 21% increase from the 32% who reported in March 2020 after the first KFF poll.[1] Almost one in five U.S. adults reported having a mental illness in the past year, equating to roughly 47 million adults. In comparison, roughly 17 million adults reported having a major depressive episode between 2017 and 2018. Further, more than one in three adults in the U.S have reported symptoms of anxiety or depressive disorder during the pandemic. To compare, from January to June 2019, over one in ten adults reported symptoms of anxiety or depressive disorder. On top of that, a recent study showed that 13.3% of adults reported new or increased substance use to manage stress-induced by Covid-19.[2] Many adults have also reported specific negative impacts on their mental health, such as difficulty sleeping (36%) or eating (32%), increase in alcohol consumption or substance abuse (12%), and worsening chronic conditions (12%), due to stress of Covid-19.[3]
A broad body of research, including data on mental health prior to Covid-19, shows that social isolation and loneliness have a link to poor mental health.[4] Significantly higher rates of people who reported sheltering in place (47%) also reported negative health effects from worry or stress related to Covid-19, compared to people who were not sheltering in place (37%).[5] Isolation and loneliness during this time may present specific mental health risks for households with children and older adults. We know children are struggling with development while being in isolation, but they are also missing key interactions and moments of social learning with their classmates. Older adults, even where stay-at-home restrictions have been lifted, make the choice to shelter in place due to the fear of contracting Covid-19, leaving them further isolated and at a higher risk of loneliness. People who contract the disease, those at heightened risk, those living or receiving care in congregant settings, and people with preexisting conditions also have an increased risk for adverse psychosocial outcomes. Further, health care workers are also particularly vulnerable to emotional distress given their risk of exposure, concerns for loved ones, shortages of equipment, longer hours, and heavy emotional and ethical decisions. Finally, people with low incomes have been more likely to report major negative mental health impacts from stress over Covid-19. KFF’s poll conducted in July showed that 35% of people making less than $40,000 reported experiencing a major negative mental health impact, compared to 22% of those with income between $40,000 to $89,999 and 20% of those making $90,000 or more.
In April 2020, Colorado Governor Polis extended Colorado’s stay-at-home order and prohibited any and all gatherings.[6] Additionally, Massachusetts Governor Baker and Nevada Governor Sisolak also enacted stay-at-home orders and extended the closures of all non-essential businesses in April 2020.[7] On the other hand, Governor Ricketts of Nebraska still allowed gatherings of up to 10 people in April 2020 and stated that he did not believe a stay-at-home order was necessary.[8] Moving to the present, all four of these states have gone through numerous revisions of these guidelines, making them more and less strict as Covid-19 cases rise and fall. Colorado’s health department updated the state’s framework on February 6, 2021, to place restrictions by six different “levels” according to counties by the number of cases.[9] In the three mid-range levels of restrictions, gatherings are limited to no more than ten people with no more than two households present. Massachusetts most recently updated restrictions on February 8, 2021, limiting indoor gatherings to no more than ten people and outdoor gatherings to no more than 25, whether in a public or private space.[10] Similarly, Nevada modified current restrictions on February 15, 2021, mandating public gatherings cannot exceed 35% capacity or 100 people, whichever is smaller, and private gatherings cannot exceed more than ten people or twenty-five outside.[11] Finally, on January 30, 2021, Nebraska issued guidance that all gatherings at theatres, arenas, auctions, and similar establishments may increase to 100% capacity. Restaurants, bars, gyms, and other businesses alike may also begin to operate at 100% capacity. Further, people are no longer required to maintain a 6-foot distance.[12]
The heavy stay-at-home restrictions at the beginning of the pandemic clearly had an effect on people’s mental health. From March to July, the number of people reporting negative mental health impacts increased by 21%. This shows that remaining in isolation for extended periods of time coupled with the weight of the pandemic has a negative impact on mental health. With stay-at-home restrictions in place, no company but those in peoples’ own household, and all nonessential businesses closed, people quickly became scared, overwhelmed, anxious, and lonely. Unfortunately, as necessary as social restrictions are to our overall health and ability to recover from this pandemic, there are a slew of negative impacts as well. These restrictions have also caused children to miss ample amounts of social interaction. Even with stay-at-home orders now lifted, although recommended, there is still a high level of fear amongst people who have to go to work, school, the grocery store, etc., around contracting the virus and bringing it home to their loved ones. On the other hand, the state-imposed guidelines are important to ensure we will overcome the pandemic and ultimately keep one another safe.
There is also the question of whether these stay-at-home orders are constitutional. It is important to note that the government’s ability to impose these restrictions are different for state and local governments than for the federal government. Further, even in our current situation, the governments’ powers are limited. The constitutionality of a law may be challenged either “on its face” or “as applied.” A challenge “on its face,” means striking the law down in its entirety, while “as applied,” means to a particular person. For example, someone with a medical condition may challenge a restriction, “as applied,” that prevents them from going outside for necessary exercise. In determining what restrictions cross the line, courts will most likely apply the “strict scrutiny” test. This requires that a law be “narrowly tailored to further a compelling government interest.” Even basic rights such as freedom of speech, assembly, and travel may be restricted by the government if it meets the demands of strict scrutiny.[13] In this situation, preventing the spread of a pandemic is a compelling government interest. Any challenges to the State’s restrictions will, in turn, examine whether they are narrowly tailored to preventing the spread of Covid-19. For example, one reason they may not be narrowly tailored is if they are or become egregiously excessive. State’s restrictions likely would cross the line, for example, if it were racially discriminatory or over-restricting access to food, medicine, medical treatment, etc. Further, restrictions with political favoritism may fail the strict scrutiny test, as well. Fortunately, we did not reach the point of excessive restrictions and are gradually seeing them begin to loosen up.
It is important to recognize ways in which the pandemic may be affecting you. It may also be helpful to recognize that not all strong emotions are a sign of clinical diagnosis. Strong emotions are a normal reaction to stress resulting from a major external event, such as a pandemic. This amount of stress leads to the production of stress hormones leading to distress in the body and the mind including: increased heart rate, changes in respiration, muscle tension, irritability, disruption in sleep, appetite and concentration, and repetitive thoughts involving danger and helplessness.[14] Some strategies recommended by Yale Medicine psychiatrists include: control your exposure to the news; incorporate three to five-minute meditations each morning; physical exercise; daily journaling; and get adequate sleep.
If you or someone you know is in need of immediate help, the CDC recommends the following helplines:
- Substance Abuse and Mental Health Services Administration (SAMHSA) Disaster Distress Hotline, 800-985-5990
- National Domestic Violence Hotline, 1-800-700-7233
- National Suicide Prevention Lifeline, 1-800-273-8255, or call 911.
Hope Simas is a second-year law student at Suffolk University Law School and a staff member of the Journal of Health and Biomedical Law. Her legal interests include public interest and family law. Ms. Simas graduated from the University of Rhode Island in 2019 with a Bachelor of Arts in both Philosophy and Gender & Women’s Studies.
Disclaimer: The views expressed in this blog are the views of the author alone and do not represent the views of JHBL or Suffolk University Law School.
[1] The Implications of COVID-19 for Mental Health and Substance Use, (August 21, 2020), https://www.kff.org/coronavirus-covid-19/issue-brief/the-implications-of-covid-19-for-mental-health-and-substance-use/
[2] Id.
[3] Id.
[4] Id.
[5] Id.
[6] https://covid19.colorado.gov/public-health-executive-orders
[7] See https://www.mass.gov/lists/press-releases-related-to-covid-19#april-2020- (April 2020); See also https://en.wikipedia.org/wiki/COVID-19_pandemic_in_Nevada#April_2020 (April 2020).
[8] See Governor Ricketts: Stay-at-home order not necessary for Nebraska (April 2020) https://www.1011now.com/content/news/Governor-Ricketts-Stay-at-home-order-not-necessary-for-Nebraska-569424601.html.
[9] Dena Bunis and Jenny Rough, List of Coronavirus Restrictions in Every State, (February 17, 2021), https://www.aarp.org/politics-society/government-elections/info-2020/coronavirus-state-restrictions.html.
[10] Id.
[11] Id.
[12] Id.
[13] Evan Gerstmann, Are ‘Stay At Home’ Orders Constitutional? (March 25, 2020), https://www.forbes.com/sites/evangerstmann/2020/03/25/are-stay-at-home-orders-constitutional/?sh=1f2c5203104e
[14] Kathy Katella, Taking your ‘Mental Health’ Temperature During COVID-19, (August 5, 2020) https://www.yalemedicine.org/news/mental-health-covid-19.
Sources:
- https://www.yalemedicine.org/news/mental-health-covid-19
- https://www.nejm.org/doi/full/10.1056/NEJMp2008017
- https://www.nature.com/articles/d41586-021-00175-z
- https://abc7chicago.com/black-mental-health-matters-covid-racism-and-19/10318356/
- https://globalnews.ca/news/7617298/alberta-doctor-depression-suicide-covid-19/
- https://www.who.int/news/item/05-10-2020-covid-19-disrupting-mental-health-services-in-most-countries-who-survey
- https://www.kff.org/coronavirus-covid-19/issue-brief/the-implications-of-covid-19-for-mental-health-and-substance-use/
- https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/managing-stress-anxiety.html
- https://www.bbc.com/news/technology-55826238
- https://www.healio.com/news/psychiatry/20201107/covid19-pandemic-has-caused-dramatic-changes-in-approach-to-mental-health-care
- https://www.mass.gov/lists/press-releases-related-to-covid-19#april-2020-
- https://en.wikipedia.org/wiki/COVID-19_pandemic_in_Nevada#April_2020
- https://www.1011now.com/content/news/Governor-Ricketts-Stay-at-home-order-not-necessary-for-Nebraska-569424601.html
- https://www.aarp.org/politics-society/government-elections/info-2020/coronavirus-state-restrictions.html
- https://covid19.colorado.gov/public-health-executive-orders
- https://www.forbes.com/sites/evangerstmann/2020/03/25/are-stay-at-home-orders-constitutional/?sh=1f2c5203104e