2019 COVID-19 Pandemic Mental Health Crisis

In December 2019, the World Health Organization's "Country Office in the People’s Republic of China picked up a media statement by the Wuhan Municipal Health Commission from their website on cases of ‘viral pneumonia.'" The SARS-CoV-2 virus that caused the coronavirus disease 2019 (COVID-19) had spread from China to all corners of the globe rapidly, and on January 20, 2020 it was discovered that it had spread to the U.S. Throughout the pandemic's course in the United States, the Centers for Disease Control & Prevention (CDC) have confirmed 49,002,475 cases of COVID-19 and 785,655 deaths related to COVID-19 (as of Dec. 6, 2021). On a global scale, the World Health Organization (WHO) tracked 265,194,191 confirmed cases and 5,254,116 related deaths (as of Dec. 6, 2021). People's daily lives changed significantly when quarantine and stay-at-home orders were placed by local governments, and everyday routines and expectations were disrupted.

Research is ongoing to determine the exact impact of the pandemic on the state of the country's mental health, but researchers agree that rates of anxiety, depression, and substance abuse have increased year-over-year. One study found a three times increase in rates of depression when comparing 2020 to 2019. News headlines even picked up on a common theme with shared language: "The coronavirus pandemic is pushing America into a mental health crisis" - Washington Post; "Mental health professionals are in high demand as the pandemic enters a second year" - CNBC; "‘Nobody Has Openings’: Mental Health Providers Struggle to Meet Demand" - The New York Times.

**COVID-19 and Substance Use Disorders**

Since COVID-19 affected the world, it has created obstacles to receive care for substance use disorders. The pandemic forced not only businesses to shut down but also treatment facilities. Treatment facilities had to scramble to try and find a way to continue care through online platforms like Zoom. 43% of substance use treatment facilities had to reduce their number of patients. 10% of substance use treatment facilities had to close completely because of pandemic. Even though 43% of treatment facilities had to reduce their number of patients, they were still able to offer online treatment. Issues arose because many individuals did not have access to Wi-Fi, internet or a computer. If the clients had the appropriate resources they were able to receive treatment. Many individuals explained that the stress of COVID-19 has played a huge role in relapsing with their specific substance. Those individuals reported being riddled with fear, anxiety, isolation, and feelings of being disconnected. The pandemic has enhanced those negative feelings not only for people who have a substance use disorder but people around the world. This has increased an individuals' substance use, substance use disorder and the reoccurrence of a substance use . For example, in New Jersey a substance use disorder facility initially had twelve female residents living there for treatment. After COVID-19 swept through the United States, within six months 9 women left the program and eleven people relapsed. In the Global Drug Survey, 56% of the individuals reported that they have increased the number of days that they drink since COVID-19 started due to increase boredom, worry, depression, loneliness, and anxiety.

While the effects of COVID-19 have played a huge role in individuals seeking treatment, it has also heavily impacted the staff that work for these facilities. COVID-19 did not discriminate against people, all individuals were able to catch covid. When staff members got infected with covid, it took them away from helping treat individuals and it caused facilities to go into lockdown. Additionally, it would cause the staff members to be isolated themselves and overworked. This was creating burn-out very quickly among the staff. COVID-19 has produced staffing issues because the virus would spread quickly among people which resulted in being quarantined for at least 10 days. This has increase the staff's physical and emotional fatigue.

Additionally, other surveys have concluded that alcohol consumption has increase too 10-18% with adult, 6-8% with cannabis and 3% of other drugs. It was found that this is correlated with the anxiety or distress about COVID-19 and a way of coping with COVID-19. Research has indicated that there is COVID Stress Syndrome that increases substance use. There are five inter-correlated elements associated with this syndrome. It includes: "(a) fear of SARSCoV2 infection and fear of coming into contact with objects or surfaces contaminated with the coronavirus; (b) fear of socio-economic impacts of the pandemic; (c) fear of foreigners for fear that they are infected; (d) pandemic-related compulsive checking and reassurance-seeking; and (e) pandemic-related traumatic stress symptoms". In the beginning of the pandemic, no one knew what was going on. There were so many unknown answers and families did not know how to keep each other safe. This may have caused some people to become extremely anxious and nervous. If an individual presented with the above five elements and it caused significant distress and impaired functioning, then it would have become severe. Clinically speaking, it would have been called pandemic-related adjustment disorder.

People had to isolate themselves from others and stay six feet away if they did see someone. It was found that during self-isolation, people who had high levels of stress and scored high on the COVID Stress scales were more likely to engage in self-defeating forms of emotion-focused coping. This consisted of over-eating, drug and alcohol abuse, and excessive online shopping. Additionally, if an individual with the COVID Stress Syndrome was severe they had the tendency to abuse drugs and alcohol. Isolation has caused a great deal of stress within individuals. Some of these include running low on prescription medications, fights or arguments with the person/people you live with, difficulty taking care of your family and pets, financial problems and lack of personal space. Stress comes in all forms but when it collided with the pandemic it caused people to partake in maladaptive coping behaviors, such as drinking.

**Pre-existing Mental Health Disorders and COVID-19**

COVID-19 has affected many people but research has indicated that those with a pre-existing mental health disorder may have a higher risk of contracting COVID-19 rather than those without a mental health disorder. There are specific risk factors that an individual can have that can increase the likelihood of becoming infected with COVID and have a severe case of COVID. Those risk factors include mental health illness, alcohol or drug misuse, and homelessness. Physically speaking, a person who has a mental health disorder has an increased risk of getting an infection in general. Since this is the case, an individual with a mental health disorder is more likely to develop a severe organ dysfunction and possibly die in the ICU when they have covid than people who do not have a mental health disorder. Additionally, COVID can cause a dysregulation of an individuals stress system. This can cause in an individual's psychiatric disorder to develop or be exacerbated.

Individuals who had a pre-existing anxiety disorder displayed higher levels of self-isolation than those who did not have a pre-existing anxiety disorder. Research has also indicated that these individuals had higher fears regarding danger and contamination, socioeconomic consequences, xenophobia, and traumatic stress symptoms than individuals who did not have a pre-existing mental health disorder . Additionally, individuals with a pre-existing mood disorder had an increase on traumatic stress symptoms and socioeconomic consequences that those who did not have a mental health disorder. COVID-19 has placed many individuals in thee hospital for care. Individuals with thought or internalizing disorders (post-traumatic stress disorder, depression, panic disorder, and generalized anxiety disorder) were 2.34 times more likely to be hospitalized with COVID compared to people who did not have a pre-existing mental health disorder. The data that is provided shows the impact of how a pre-existing mental health disorder not only increased with COVID but also increased the likelihood of being infected with COVID and hospitalized.

**COVID-19 and Mental Health Access**

As soon as the world shut down, many resources had to stop providing treatment. Treatment providers did not know how to continue care for their patients while doing things remotely. Between March and August 2020 it was reported that there was 28% less outpatient appointments for mental health. In total, 471,448 individuals lost the ability to continue their mental health treatment. 68% of group therapy sessions decreased and psychiatric hospitalizations decreased 33%. With these stark numbers, people were receiving less care during this time. Mental health professions quickly had to find a way to continue the care for their clients. New online platforms came about, in which most people use telehealth communications via Zoom. Zoom is a platform in which you set up a HIPPA compliant video chat with patients. Providers were able to send out zoom links and continue to see their patients when they were home. This changed the dynamic for mental health services.

In early December 2020, telehealth was being used 56% of the time for all mental health services. While many individuals benefited from this, there were still some individuals who were without care. It was found that individuals who lived in rural communities often were not offered telehealth services for mental health due to the lack of providers in that area. Telehealth was found to be 25% lower in rural areas rather than in urban areas. This may be due to the lack of providers but also because the lack of technology available to others. In order to do telehealth services and individual needs to have access to wifi or a smart phone in order to have a video chat feature. It was found that only 69.3& of individuals who lived in rural areas had access to high-speed internet and 71% of these individuals reported owning a smartphone. In order for a provider to give treatment via telehealth you must follow the state requirements for licensing and credentials. Usually, the providers must be in the state where they are licensed and only give treatment to those in that specific state. It may be hard to find a provider in your area due to lack of providers and availability.

Further Readings

1. https://www.tandfonline.com/doi/full/10.1080/08897077.2020.1784363
2. https://www.nature.com/articles/s41380-020-00880-7.
3. https://www.frontiersin.org/articles/10.3389/fpsyt.2021.653674/full
4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7368103/

1. ↑ https://www.who.int/emergencies/diseases/novel-coronavirus-2019/interactive-timeline#event-0
2. ↑ https://www.cdc.gov/museum/timeline/covid19.html
3. ↑ https://www.cdc.gov/coronavirus/2019-ncov/index.html
4. ↑ https://covid19.who.int/
5. ↑ https://www.cdc.gov/mmwr/volumes/70/wr/mm7013e2.htm
6. ↑ https://www.cdc.gov/nchs/data/nhis/mental-health-monthly-508.pdf
7. ↑ https://www.cdc.gov/mmwr/volumes/69/wr/mm6932a1.htm
8. ↑ https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2770146
9. ↑ 9.0 9.1 9.2 9.3 9.4 https://www.nytimes.com/2021/01/04/nyregion/addiction-treatment-coronavirus-new-york-new-jersey.html
10. ↑ 10.0 10.1 Schmidt, R. A., Genois, R., Jin, J., Vigo, D., Rehm, J., & Rush, B. (2021). The early impact of covid-19 on the incidence, prevalence, and severity of alcohol use and other drugs: A systematic review. *Drug and Alcohol Dependence*, *228*, 109065. https://doi.org/10.1016/j.drugalcdep.2021.109065
11. ↑ Pagano, A., Hosakote, S., Kapiteni, K., Straus, E. R., Wong, J., & Guydish, J. R. (2021). Impacts of covid-19 on residential treatment programs for substance use disorder. *Journal of     Substance Abuse Treatment*, *123*, 108255. https://doi.org/10.1016/j.jsat.2020.108255
12. ↑ 12.0 12.1 12.2 https://www.sciencedirect.com/science/article/pii/S0306460320308832?casa\_token=HKpCRrBFUrQAAAAA:M\_rvogJhv8h8lVvBt8eJ2TTphGbyGpY8W62wBK5Dn65HJ704ucto\_lw1OmWWakQXjwMJCl3arrw
13. ↑ 13.0 13.1 13.2 13.3 https://link.springer.com/article/10.1007/s11920-021-01226-y
14. ↑ https://onlinelibrary.wiley.com/doi/full/10.1002/da.23071
15. ↑ 15.0 15.1 15.2 15.3 https://www.sciencedirect.com/science/article/pii/S2215036620303072
16. ↑ https://www.frontiersin.org/articles/10.3389/fpubh.2021.684112/full
17. ↑ 17.0 17.1 17.2 https://www.sciencedirect.com/science/article/pii/S0887618520300852?casa\_token=-4GOUXnlucwAAAAA:dk8icSZiL9zBsQifP82BTKpvUJIgemYFX8\_Q4cPV09PqGKnHm1-sdjUtK4oCVVyIFeXS7bExw24
18. ↑ https://www.news-medical.net/news/20211027/Do-pre-existing-mental-disorders-and-their-co-occurrence-affect-COVID-19-clinical-outcomes.aspx
19. ↑ 19.0 19.1 19.2 https://www.thelancet.com/journals/lanam/article/PIIS2667-193X(21)00057-0/fulltext
20. ↑ https://dispatch.m.io/eric-yuan-zoom/
21. ↑ 21.0 21.1 21.2 https://www.healthaffairs.org/do/10.1377/forefront.20211004.155145/
22. ↑ https://www.ruralhealthinfo.org/toolkits/telehealth/1/barriers