A Second Wave: The Unseen Pandemic Facing America Now

States and communities across the country are beginning to reopen after stay-at-home orders move into “orange” and “yellow” phases, causing many to fear the onset of a “second wave” of COVID-19 diagnoses.

What many fail to realize, however, is that the second wave has already hit—but it wasn’t a second wave of coronavirus. The COVID-19 pandemic has caused a tidal wave of behavioral health problems for many of our most vulnerable patient populations that is continuing to grow even as pandemic peaks are starting to wane.

 

The Impact of the Pandemic on Behavioral Health

A poll published by the Kaiser Family Foundation shows that 45 percent of U.S. adults have had their mental health negatively impacted by the COVID-19 pandemic. And 75 percent of Americans fear that the worst is still yet to come.

When it comes to the affect a pandemic has on the population, behavioral health problems are not limited to those already struggling with diagnoses, those in large cities or those with social determinants of health. Even ever-feuding political parties agree when it comes to the pandemic’s impact on mental health. And the impact is being felt across individuals young and old.

Forecasting a Behavioral Health Storm

While social distancing measures help hide behavioral health concerns behind closed doors, examining the current conditions of our country suggest that behavioral health concerns are more prevalent than we can now see.

This month, unemployment claims hit 36 million—rivaling those seen during the Great Depression. In one-fifth of US states, more than 25 percent of the workforce is unemployed. Unemployment and job instability strongly impact mental health, with one classic textbook study from John Hopkins University suggesting that for every 1 percent increase in national unemployment, the suicide rates increase by 4.1 percent.

Other conditions have also contributed to the rise in behavioral health conditions, including extended social distancing measures and increased threat to patients with chronic care conditions—who are often more susceptible to comorbid behavioral conditions. Furthermore, studies showing significant upticks in domestic violence—as much as 30 percent in some countries—as more children and adults are quarantined in abusive situations will also contribute to conditions such as PTSD, anxiety and depression.

While rates of depression, loneliness and PTSD may be difficult to measure right now, as shelter-in-place orders relax, we will begin to see the toll that isolation has taken on the collective mental health of our country.

The Role of Communities in Supporting Behavioral Health Patients

As care teams and communities, we can work together to help support our behavioral health patients by letting go of the stigma that surrounds mental and behavioral health.

In Massachusetts, our Behavioral Health Community Partners program works to help patients move past existing stigmas and get connected to the care they need—especially for those most-vulnerable individuals who may also be struggling with substance use disorder or be facing social determinants of health.

While the pandemic has necessitated a shift in operations from in-person visits to telemedicine, ensuring that each patient remains connected to key care team members has been crucial in mitigating the impact of the pandemic on individual mental health. Regular phone or video check ins help our case managers understand who needs help and identify problems early-on.

Better supporting these patients with behavioral health needs has not only helped the patient but contributed to better workflows for neighboring hospitals fighting the pandemic.

The Healthcare Cost and Utilization Project (HCUP) suggests that 1 in every 8 emergency department visits are for mental or behavioral health conditions that could have been resolved with access to the appropriate behavioral health support. During a pandemic, when beds, PPE and staff are all limited, doing our part as a community to address behavioral health needs outside the ED can preserve limited resources for addressing the virus at hand.

Carving out the time and financial resources in our communities to properly care for our patients with behavioral health needs improves patient care, prevents unnecessary ED utilization and saves in long-term care costs across the board.

Rainbows After Rain: Flecks of Hope for the New Normal

Individuals with behavioral health conditions can be amongst the nation’s most vulnerable. Many have had negative experiences with the system and may be slow to trust.

But with the pandemic, we’ve seen outpouring of care collaboration between care teams and the impact that has on rebuilding patient trust to better improve outcomes. More and more, I see case managers, therapists, ED doctors and community partners realizing that we’re all in this together—and that everyone plays a role in making sure these patients get the care they need.

Moving forward, as we work to secure both the financial and manpower resources needed to support ongoing collaboration, we will strengthen our ability to support these individuals throughout the pandemic and afterward—rebuilding communities and hearts as part of the “new normal.”

Related Reading: Improving Transitions of Care While Reducing Administrative Burden

Dr. Parsons is an experienced professional in the fields of children’s mental health, social services, and healthcare in Massachusetts—working for over 25 years in program design, operation, and management and serving as a consultant for the Association for Behavioral Healthcare and adjunct faculty at Quincy College, Lasell College, and the University of Massachusetts at Boston. She currently leads two Community Partner programs in a Massachusetts Medicaid incentive program, providing high quality care coordination for adults who have complex physical, behavioral health, and social needs and integrating primary care, behavioral health services, and social resources to achieve healthier outcomes and community stability. Dr. Parsons is sharing her insights through a partnership with Collective Medical.

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