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The ominous consequences of COVID-19 for American mental health

Even in the best of times, mental health and illness tend to be minimized by U.S. health care. That problem is now magnified by an extended period of social isolation, economic disaster and fear. How can Americans cope with this building mental health crisis? Amna Nawaz talks to Dr. Joshua Gordon of the National Institute of Mental Health and former Rep. Patrick Kennedy of the Kennedy Forum.

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  • Judy Woodruff:

    In the best of times, mental health and illness often are underfunded and undertreated in the American health care system.

    Those concerns are especially magnified now, during this extended period of self-isolation, quarantines and shutdowns.

    Experts say a surge of need is building more widely and is only going to grow in the weeks and months to come.

    Amna Nawaz explores some of these issues and what people need to know.

  • Amna Nawaz:

    The layoffs, the financial pressure, the caregiving, they are all taking a toll on people across the country.

    Numbers are hard to come by, but a recent survey by the Kaiser Family Foundation found that 56 percent of people said worry or stress tied to these outbreaks have led to at least one negative effect on their well-being, including things like trouble sleeping, eating, and alcohol use.

    Let's turn now to two experts.

    Dr. Joshua Gordon is the director of the National Institute of Mental Health at NIH, and former Congressman Patrick Kennedy is the founder of the Kennedy Forum, which focuses on these issues. He's also a leader at the National Action Alliance for Suicide Prevention.

    Gentleman, welcome to you both, and thank you for being here.

    Patrick Kennedy, I want the start with you, because you have warned of what you call a coming epidemic of suicide and overdose stemming from this COVID-19 pandemic.

    What have you seen so far that leads you to that conclusion?

  • Patrick Kennedy:

    Well, first, we had an underlying epidemic to begin with, record levels of increase in suicide and overdose even before COVID-19 hit.

    And, as you just mentioned, COVID-19 is going to exacerbate exponentially the amount of suicide and overdose. You know that because the science from Dr. Gordon's research shows that, with unemployment and the dislocation that is caused through unemployment, we see suicide go up.

    And with this degree of unemployment, it only stands to reason that we're going to see enormous suicide rates. And so our job now is to make sure that what happened to COVID-19, where we knew it was coming, but we didn't really quite do what we needed to do to prepare for it, that that doesn't happen again with respect to the coming epidemic and tsunami of overdose and suicide.

  • Amna Nawaz:

    Dr. Gordon, talk to me a little bit about what you think we will be seeing.

    As Patrick Kennedy mentioned, millions of Americans pre-pandemic struggled with mental health and mental illness. You're talking about a time of increased anxiety and isolation. What do you think is ahead?

  • Joshua Gordon:

    Well, we can anticipate over the coming weeks and months that those of us who had preexisting mental illnesses may see exacerbations of their conditions, and those of us who have been in relatively good mental health may see the onset of new mental illnesses.

    And we have to prepare for that, and we also have to do what we can to prevent it.

  • Amna Nawaz:

    What about people who happen to be in support or seeking treatment for things like substance abuse or their mental illness? How does this time right now complicate those efforts?

  • Joshua Gordon:

    I would say it complicates it tremendously.

    We really need to figure out how best to be able to deliver mental health care under circumstances such as social distancing that we are currently engaged in.

    Fortunately, much of the mental health community has begun to make the shift from person-to-person visits to telehealth and digital health. But we need to do more than that. Not everyone can use these technologies. Not everyone has access to high-speed Internet or cell phones.

    So, we need to ensure that our community mental health centers and other health care providers are prepared with personal protective equipment and means of ensuring social distancing waiting rooms, et cetera, so that we can open up to everyone who needs help.

  • Amna Nawaz:

    Patrick Kennedy, I think it's fair to say our existing mental health infrastructure has long been under-resourced and underfunded, especially in rural areas, especially in communities of color.

    When you look at the responses you have seen so from the administration, from Congress, what has been done so far to bolster any of that?

  • Patrick Kennedy:

    Well, as they take the tally of the dollars that are flowing from Washington today to help shore up our health care system and our economy, we're talking trillions of dollars.

    And it's a real sign of the continued persistence of stigma against mental illness and addiction that a small, small, infinitesimal fraction of those dollars have gone to mental health and addiction.

    And I think the big change, the paradigm shift we're going to have with COVID-19 is that, since everybody is going to be affected by some kind of mental health system, as Dr. Gordon said, I think that now mental health won't be something of us vs. them, oh, they're the ones that need mental health. I think, after COVID-19, it's going to be all of us.

  • Amna Nawaz:

    Just to follow up on that, what would it take, how much money, what kind of effort? And do you think we have the resources to do that?

  • Patrick Kennedy:

    Well, I believe that we could easily put some dollar numbers to changing the whole system of health care, such that we have achieved the vision of President Kennedy, when we combined the Community Mental Health Act.

    Sure, we need new beds, more beds in psychiatric hospitals, but what we really need to do is get a much better prevention strategy. That should be our mental health policy of the future. And I think that that's affordable, when you look at the cost of us not doing that.

  • Amna Nawaz:

    I wanted to ask you as well, Dr. Gordon, about what's being done right now, what is being seen and endured by the front-line workers.

    What's the mental health burden there? And what's the effect and the ripple effects of that down the line?

  • Joshua Gordon:

    I think the mental health burden on our first responders, on our health care workers and, indeed, on our grocery workers and our delivery personnel is tremendous.

    First, many of them are too busy right now to seek the help and to maintain their mental well-being. A lot of hospitals and health care organizations are reaching out to their workers and offering them discussion groups and support, et cetera, but they just don't have the time to take advantage of them.

    The second thing we need to think about is those who are also hit, but don't have those resources, again, the warehouse workers, the grocery chains, the delivery people.

    These are folks who are out there every day facing the COVID pandemic, not from the perspective of trying to help people, you know, deal with the medical consequences, but trying to help people live their lives.

    And they're taking risks every day.

  • Amna Nawaz:

    You know, Patrick Kennedy, I should ask.

    You have been very open talking about your and your family's own struggles with substance abuse and with mental illness. You sought help.

    I would like you now, if you don't mind, to speak to the millions of Americans who might be similarly struggling out there. What is it you can say to them right now?

  • Patrick Kennedy:

    Well, that we need each other and that we're important to our family and our friends, and that, when it doesn't seem that way, often because of our disease, our disease is one that pushes people away and makes them angry with us and upset with us.

    Our disease, you know, jeopardizes our jobs and our relationships with the people we love. It's a terrible disease. The symptoms are awful. And those symptoms create anger and shame towards people who have these illnesses.

    And Dr. Gordon can tell you, these are physical symptoms of the neurobiology of depression, anxiety, of alcoholism and addiction. When you present with these symptoms, you are not someone that anyone wants to help.

    It's kind of counterintuitive that when — people who need the help the most are the ones that people least want to help, because the symptoms are so awful in terms of interpersonal connection.

    So, all I would say to people is, there's great help in peer support. There's also great help in the medical system. And there needs to be a spiritual component, which I think is just really a love and connection, and wherever you can find that connection. And that's just so important to have, and especially in turbulent times like we're living in.

  • Amna Nawaz:

    Dr. Gordon, I have to ask you.

    We want to give people someplace they can turn if they do need help. What are a couple of the resources you can recommend that people can turn to right now, if needed?

  • Joshua Gordon:

    So, there are two national hot lines that people should be aware of.

    The Substance Abuse and Mental Health Services Administration has a disaster distress line. And the Suicide Prevention Organization has a national hot line. Please use those resources. They're available.

  • Amna Nawaz:

    I can't thank you enough to both of you.

    Dr. Joshua Gordon of the National Institute of Mental Health, and Patrick Kennedy of the Kennedy Forum, thanks for being here.

  • Patrick Kennedy:

    Thank you.

  • Joshua Gordon:

    Thank you for having us.

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