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By Rohit Sinha, JHBL Staff Member
The Coronavirus pandemic shook the United States to its core and is exposing so many flaws in America’s health care system and political institutions. However, aside from the nearly half-million deaths nationwide, record high unemployment, and drastic life adjustments, Americans are starting to feel the psychological toll the pandemic is placing on them. In January 2020, before the first reported COVID-19 case in the United States, one in ten adults reported symptoms of anxiety or depressive disorder. That number quickly increased to four in ten once the pandemic forced the United States to essentially shut down and caused a massive economic recession.
So why have the consequences of the pandemic prompted 4 in 10 Americans to feel anxious or depressed? The data is reading as “pick your poison” by highlighting numerous factors, including the shut-down of schools, transitioning to remote work, the loss of income or employment, and stress in relationships. A study conducted by The Lancet shows that 18% of individuals who received a COVID-19 diagnosis, whether they had a past psychiatric diagnosis or not, were subsequently diagnosed with a mental health disorder. Even as the COVID-19 pandemic continues into a second year, different populations are not only suffering mentally from the repercussions of the pandemic, but will also continue to face challenges in accessing the proper treatments they need and deserve.
Several years of data collection from more than 600,000 individuals across the U.S. shows one clear and undisputed fact: young people, specifically those in their early 20s, are reported to be more depressed than any other age group. Declines in sleep duration and the rise in social media are two of the biggest factors, but academics and self-image perceptions also play a substantial part. Insert a once in a lifetime pandemic. Suddenly, young people are experiencing the abrupt shut-down of their universities and college lifestyle and the transition to remote learning and employment. Fifty-two% of young adults are deciding to wait out the pandemic by living with their parents. In this climate, it comes as no surprise that one in four Americans between the ages of 18 and 24 reported considering suicide because of the pandemic and its lingering consequences.
In April 2020, the U.S. unemployment rate surged to 14.8% – a figure not seen since the Great Depression. Given the pandemic’s shut-down in the travel and hospitality industries, workers were laid off and saw their salaries completely diminish or turn into part-time minimum wage positions. A Pew Research Center study showed that 70% of those who are unemployed say that being out of a job has left them more stressed out.[1] In that same pool, over half of the polled individuals said they were dealing with mental health challenges and 81% said they’d felt adrift, fought more with loved ones, or experienced emotional issues since losing their jobs.
The COVID-19 pandemic has also exposed a large number of marriages and relationships as toxic and unhealthy. One in ten married or partnered individuals in the U.S. say that they are very likely to separate from their spouses due to issues stemming from the pandemic. Additionally, one in five married or partnered people were fighting more with their significant other during the pandemic, and 30% of partnered or married individuals said they had been more annoyed with their spouse than usual. Experts credit the new troubles in relationships to the uncertainty that the pandemic has caused and the new practical challenges presented. Couples may want to navigate the pandemic in different ways or they may disagree over the distribution of parental labor. As a result, relationships and marriages are much more susceptible to some type of strain or tension.
The groups mentioned above are a small part of the American people who are struggling emotionally during the pandemic. However, Congress has acted accordingly by passing legislation that would assist those experiencing mental health struggles during the pandemic. A bill combining the 2021 fiscal year federal budget and COVID-relief provisions allocated $4.25 billion for the Substance Abuse & Mental Health Services Administration (SAMHSA). Additionally, the March 2020 CARES Act, passed in March 2020, ensures that $250 million would be granted to Certified Community Behavioral Health Clinics and $50 million for suicide prevention – however, this legislation ends in March 2021.
While the legislation passed last year was a good start to address the increased mental health issues in light of the COVID-19 pandemic, simply allocating money to relevant institutions will not rid the rising mental health crisis among the American people. There needs to be systemic changes in U.S. institutions to ensure that the taboo around mental health is smashed and every American will not face any institutional barriers to seek mental health treatments. First and foremost, the annual funding for peer support and community-based services needs to continue. Secondly, the pandemic and its effects on mental health illustrate the urgent need for expanded access to health care coverage, potentially in the form of universal health care. While the unemployment rate has somewhat recovered, there are still several employees and industries that will continue to suffer as the nation recovers. For example, under America’s current health care framework, a hotel service professional who was furloughed indefinitely and now suffers from anxiety and depression about his future will have to either seek mental health treatment by paying out of pocket to enroll in an Affordable Care Act Marketplace plan or essentially do nothing to resolve problems stemming from their mental health.
The intensified mental health crisis during the pandemic has given the federal government an incentive to transition to a single-payer healthcare system that offers universal coverage. The U.S.’s current multi-payer system is proving to be difficult when it comes to providing sufficient mental health treatment for those who seek it. As mentioned above, a furloughed employee who wants to seek mental health care will have to resort to paying out-of pocket or do nothing. However, those who have not lost their jobs will also have to overcome a significant hurdle when seeking mental health treatments. A 2019 report from a Milliman publication found that a behavioral health office visit is over five times more likely to be out-of-network than a primary care appointment.[2] Another report conducted by NAMI shows that individuals had more difficulties finding in-network providers for mental health care compared to general or specialty medical care.[3] As a result, these inadequate provider networks for mental health treatment have forced individuals to wait long periods of time before getting treatment, travel longer distances to see an in-network provider, or see a professional outside of their network and face higher out-of-pocket costs.
The United States is the only advanced country with a health care infrastructure that is centered around profits than maximum coverage. First and foremost, a single-payer healthcare system such as Medicare for All, which gained tremendous support during the 2020 Presidential election, would guarantee universal coverage for those who desire any mental health treatments. Individuals will no longer have to worry about whether their treatment is in-network or paying out-of-pocket costs because they were furloughed. Secondly, it will ensure that America’s health care framework is actually driven by health care and not profits. Insurance and pharmaceutical companies have funded campaigns in an attempt to discredit different methods of therapy and mental health treatments in an attempt to label mental health problems as “biological imbalances” to ultimately profit from drug sales. This practice in general is wrong, but during a pandemic, when stress and anxiety are at much higher levels, it’s even more reprehensible. Adopting a single-payer healthcare system would be a major first step in addressing the increasing mental health crisis.
Outside of a universal overhaul of national healthcare practices, there are several immediate steps that Congress can take to mitigate the increasing distress and trauma Americans are facing. First and foremost, the U.S. government must invest in the social determinants of mental health. This country has historically used numerous systemic structures of oppression that automatically put those with less means at a higher risk of poor health and premature death. The stress and anxiety of living at this status has only been accelerated by the pandemic and its subsequent consequences. As such, Congress must step in and fully invest in permanent housing solutions and expanded food assistance programs while eliminating unnecessary barriers to government assistance. Investments in these social determinants of mental health and giving serious considerations to fundamentally changing the U.S. health care system would go a long way in actually prioritizing mental health issues and treatments rather than the government simply writing a check with no regard for systemic inequities.
Rohit Sinha is a second-year law student at Suffolk University Law School with an interest in criminal prosecution and civil rights law. Rohit currently interns at the Suffolk County District Attorney’s Office. He holds a bachelor’s degree from the University of Connecticut.
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.
Sources:
[1] Kim Parker et al., Unemployed Americans are feeling the emotional strain of job loss; most have considered changing occupations, Pew Research Center (Feb. 10, 2021), https://www.pewresearch.org/fact-tank/2021/02/10/unemployed-americans-are-feeling-the-emotional-strain-of-job-loss-most-have-considered-changing-occupations/?utm_source=AdaptiveMailer&utm_medium=email&utm_campaign=21-2-10%20Media%20Advisory%20-%20Unemployment%20and%20COVID%20recession%20FT&org=982&lvl=100&ite=7945&lea=1731213&ctr=0&par=1&trk=
[2] Steve Melek et al., Addiction and mental health v. physical health: Widening disparaties in network use and provider reimbursement 6 (2019).
[3] National Alliance on Mental Illness, Out-of-Network, Out-of-Pocket, Out-of-Options 2 (2016).
https://www.jdsupra.com/legalnews/cares-act-includes-behavioral-health-67531/
https://www.bls.gov/opub/mlr/2020/article/employment-recovery.htm