While we watch America’s COVID-19’s daily case numbers and death tolls rise, a shadow pandemic is hiding in plain sight, eroding our mental health and making access to mental health care even worse than it already was. Without immediate and sustained financial resources, mental health challenges from the coronavirus pandemic will spiral into a widespread and long-lasting crisis of mental illness, substance abuse, and suicide.

There is hope, but to address the drivers of the growing mental health crisis, we must first understand them. Although they operate in discrete waves, the three drivers of the COVID-related mental health crisis are dynamic, interrelated, and coalesce to create an omnipresent environment of uncertainty and confusion that exacerbates our collective emotional strain.

First, there is the COVID-19 disease itself, which has created widespread fear and anxiety as people experience psychological trauma from the illness, grief from deaths of loved ones, or worry about themselves or their loved ones getting sick. Older adults, individuals experiencing homelessness, people of color, immigrants, LGBTQ+ individuals, and frontline health care workers are bearing a disproportionate burden of disease. In turn, they are overwhelmingly reporting symptoms of depression, anxiety, insomnia, and burnout.

The second driver is the mitigation effort intended to keep communities safe. While physical distancing and closures are necessary to slow the spread of the disease, these measures continue to be major factors driving population-wide loneliness, fear, anxiety, and depression. Social isolation is the most acute mental health challenge for people who live alone, older adults, and children. In addition, with schools, daycare centers, and summer camps closed, caregivers of children or older family members are at risk for burnout and chronic mental health challenges. Even as lockdown measures are eased, new stressors emerge as these caregivers have to decide for themselves and their families what risks are worth taking. The fact that their decisions may be at odds with the directions from leaders or the social behavior of their communities adds to the anxiety.

Lastly, there is the economic fallout. The coronavirus pandemic has wrought swift, severe economic damage, disproportionately borne by Americans who already struggled with economic insecurity. Economic hardship caused by the pandemic contributes to increased anxiety and exacerbates existing problems for individuals trying to access care. Because so many Americans receive health coverage as an employee benefit, job loss will cause more families to fall into insurance “coverage gaps.” Previous recessions reveal a direct relationship between economic well-being and increased rates of deaths from drugs, alcohol, and suicide, a phenomenon known as “deaths of despair.” We are already seeing evidence of an uptick—the first four months of the pandemic saw a surge in drug overdose deaths.

Impacts on the Mental Health System

Before the pandemic began, national statistics showed that 1 in 5 adults in the US experienced serious mental illness each year, with fewer than half (43%) receiving treatment.

Today, more than 1 in 3 Americans report signs of clinical anxiety and depression at a time when mental health treatment has become more difficult to access. The use of telemedicine has surged now that the U.S. government relaxed rules to increase healthcare access, but these changes are temporary, and telemedicine is less than ideal for those seeking help for drug addiction or suicide ideation.

Opportunities for philanthropists to address impacts of the COVID-19 pandemic on mental health are multi-faceted and interconnected. As such, solutions must be catalyzed by public and private support.

The Center for Strategic Philanthropy (CSP) has identified mechanisms through which philanthropy can support mental well-being immediately and over the longer term.

  1. Immediate Crisis Response: Intervene with vulnerable populations to support their mental health. Philanthropic actions are needed to support acute interventions that meet the needs of vulnerable communities such as deployment of crisis counselors in hard-hit geographic regions.
  2. Support the development of and expand access to tools to screen, prevent, and treat mental health conditions. Digital health tools, such as telehealth technologies, crisis text lines, and online educational resources, can be deployed immediately to expand access to mental health services. Philanthropists can also provide financial relief to existing mental health treatment infrastructure, such as community urgent care and crisis facilities that have suffered COVID-induced economic damage.
  3. Advocate for social and policy solutions to reduce stigma and improve the mental health ecosystem. The COVID-19 pandemic provides opportunities to normalize emotional well-being needs, reduce stigma surrounding mental health, and ultimately build a better mental health system. Philanthropists can engage in long-term efforts for expanded mental health care access, improved and continued use of telehealth technologies, and further research to understand the social constructs that drive mental health challenges and inform evidence-based policy solutions.
  4. Invest in research for improved understanding of brain health, treatments, and cures for mental health conditions. Many people who seek help ultimately find that treatment for mental health conditions is not as effective as they hoped. Persistent lack of understanding about how therapeutics act in the brain, and incomplete knowledge of fundamental mechanisms that underlie mental health disorders hold back meaningful progress. Philanthropic investments are needed to support researchers devoted to understanding the causes of mental health and substance use disorders, and to develop new methods to treat, diagnose, and prevent mental illnesses.

Persistent stresses on Americans’ mental health, and the mental health system as a whole, have been highlighted throughout the duration of the pandemic. Without immediate and sustained attention, the pressures on Americans, and on the system that seeks to help them, will worsen. While the challenges on the system predated COVID-19, a philanthropically-led, multifaceted systems-approach that targets specific mental health initiatives during this time can lay the foundation for a strong system that is set up to meet America’s mental health needs now and in the future.

To download CSP's report, Philanthropic Action for America's Mental Health System, click here.

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By Sylvie Raver, PhD, Associate Director, Milken Institute Center for Strategic Philanthropy.