Four immediate priorities to flatten the mental distress curve

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The men­tal health cri­sis trig­gered by COVID-19 is esca­lat­ing rapid­ly. One exam­ple: When com­pared to a 2018 sur­vey, U.S. adults are now eight times more like­ly to meet the cri­te­ria for seri­ous men­tal dis­tress. One-third of Amer­i­cans report clin­i­cal­ly sig­nif­i­cant symp­toms of anx­i­ety or clin­i­cal depres­sion, accord­ing to a late May 2020 release of Cen­sus Bureau data.

While all pop­u­la­tion groups are affect­ed, this cri­sis is espe­cial­ly dif­fi­cult for stu­dents, par­tic­u­lar­ly those pushed off col­lege cam­pus­es and now fac­ing eco­nom­ic uncer­tain­ty; adults with chil­dren at home, strug­gling to jug­gle work and home-school­ing; and front-line health care work­ers, risk­ing their lives to save others.

We know the virus has a dead­ly impact on the human body. But its impact on our men­tal health may be dead­ly too. Some recent pro­jec­tions sug­gest that deaths stem­ming from men­tal health issues could rival deaths direct­ly due to the virus itself. The lat­est study from the Well Being Trust, a non­prof­it foun­da­tion, esti­mates that COVID-19 may lead to any­where from 27,644 to 154,037 addi­tion­al U.S. deaths of despair, as mass unem­ploy­ment, social iso­la­tion, depres­sion and anx­i­ety dri­ve increas­es in sui­cides and drug overdoses.

But there are ways to help flat­ten the ris­ing men­tal health curve. Our expe­ri­ence as psy­chol­o­gists inves­ti­gat­ing the depres­sion epi­dem­ic and the nature of pos­i­tive emo­tions tells us we can. With a con­cert­ed effort, clin­i­cal psy­chol­o­gy can meet this challenge.

Reimagining mental health care

Our field has accu­mu­lat­ed long lists of evi­dence-based approach­es to treat and pre­vent anx­i­ety, depres­sion and sui­cide. But these exist­ing tools are inad­e­quate for the task at hand. Our shin­ing exam­ples of suc­cess­ful in-per­son psy­chother­a­pies – such as cog­ni­tive behav­ioral ther­a­py for depres­sion, or dialec­ti­cal behav­ioral ther­a­py for sui­ci­dal patients – were already under­serv­ing the pop­u­la­tion before the pandemic.

Now, these ther­a­pies are large­ly not avail­able to patients in per­son, due to phys­i­cal dis­tanc­ing man­dates and con­tin­u­ing anx­i­eties about virus expo­sure in pub­lic places. A fur­ther com­pli­ca­tion: Phys­i­cal dis­tanc­ing inter­feres with sup­port net­works of friends and fam­i­ly. These net­works ordi­nar­i­ly allow peo­ple to cope with major shocks. Now they are, if not com­plete­ly sev­ered, sure­ly diminished.

What will help patients now? Clin­i­cal sci­en­tists and men­tal health prac­ti­tion­ers must reimag­ine our care. This includes action on four inter­con­nect­ed fronts.

First, the tra­di­tion­al mod­el of how and where a per­son receives men­tal health care must change. Clin­i­cians and pol­i­cy­mak­ers must deliv­er evi­dence-based care that clients can access remote­ly. Tra­di­tion­al “in-per­son” approach­es – like indi­vid­ual or group face-to-face ses­sions with a men­tal health pro­fes­sion­al – will nev­er be able to meet the cur­rent need.

Tele­health ther­a­py ses­sions can fill a small part of the remain­ing gap. Forms of non­tra­di­tion­al men­tal health care deliv­ery must fill the rest. These alter­na­tives do not require rein­ven­tion of the wheel; in fact, these resources are already read­i­ly acces­si­ble. Among avail­able options: web-based cours­es on the sci­ence of hap­pi­ness, open-source web-based tools and pod­casts. There are also self-paced, web-based inter­ven­tions – mind­ful­ness-based cog­ni­tive ther­a­py is one – which are acces­si­ble for free or at reduced rates.

Democratizing mental health

Sec­ond, men­tal health care must be democ­ra­tized. That means aban­don­ing the notion that the only path to treat­ment is through a ther­a­pist or psy­chi­a­trist who dis­pens­es wis­dom or med­ica­tions. Instead, we need oth­er kinds of col­lab­o­ra­tive and com­mu­ni­ty-based partnerships.

For exam­ple, giv­en the known ben­e­fits of social sup­port as a buffer against men­tal dis­tress, we should enhance peer-deliv­ered or peer-sup­port­ed inter­ven­tions – like peer-led men­tal health sup­port groups, where infor­ma­tion is com­mu­ni­cat­ed between peo­ple of sim­i­lar social sta­tus or with com­mon men­tal health prob­lems. Peer pro­grams have great flex­i­bil­i­ty; after ori­en­ta­tion and train­ing, peer lead­ers are capa­ble of help­ing indi­vid­ual clients or groups, in per­son, online or via the phone. Ini­tial data shows these approach­es can suc­cess­ful­ly treat severe men­tal ill­ness and depres­sion. But they are not yet wide­ly used.

Taking a proactive approach

Third, clin­i­cal sci­en­tists must pro­mote men­tal health at the pop­u­la­tion lev­el, with ini­tia­tives that try to ben­e­fit every­one rather than focus­ing exclu­sive­ly on those who seek treat­ment. Some of these pro­mo­tion strate­gies already have clear-cut sci­en­tif­ic sup­port. In fact, the best-sup­port­ed pop­u­la­tion inter­ven­tions, such as exer­cise, sleep hygiene and spend­ing time out­doors, lend them­selves per­fect­ly to the needs of the moment: stress-reliev­ing, men­tal ill­ness-block­ing and cost-free.

Final­ly, we must track men­tal health on the pop­u­la­tion lev­el, just as intense­ly as COVID-19 is tracked and mod­eled. We must col­lect much more men­tal health out­come data than we do now. This data should include eval­u­a­tions from men­tal health pro­fes­sion­als as well as reports from every­day cit­i­zens who share their dai­ly expe­ri­ences in real time via remote-based sur­vey platforms.

Mon­i­tor­ing pop­u­la­tion-lev­el men­tal health requires a team effort. Data must be col­lect­ed, then ana­lyzed; find­ings must be shared across dis­ci­plines – psy­chi­a­try, psy­chol­o­gy, epi­demi­ol­o­gy, soci­ol­o­gy and pub­lic health, to name a few. Sus­tained fund­ing from key insti­tu­tions, like the NIH, are essen­tial. To those who say this is too tall an order, we ask, “What’s the alter­na­tive?” Before flat­ten­ing the men­tal health curve, the curve must be visible.

COVID-19 has revealed the inad­e­qua­cies of the old men­tal health order. A vac­cine will not solve these prob­lems. Changes to men­tal health par­a­digms are need­ed now. In fact, the rev­o­lu­tion is overdue.

– Dr. June Gru­ber is an Assis­tant Pro­fes­sor of Psy­chol­o­gy and Neu­ro­science at Uni­ver­si­ty of Col­orado Boul­der, and Dr. Jonathan Rot­ten­berg is a Pro­fes­sor of Psy­chol­o­gy at Uni­ver­si­ty of South Flori­da. This arti­cle was orig­i­nal­ly pub­lished on The Con­ver­sa­tion.

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