Mental Health and the Post-COVID-19 World
We concur with these estimates; however, we also believe they miss the mark in one critical way. They fail to acknowledge that before COVID-19, our nation was in the midst of a massive mental health epidemic, characterized by millions of deaths of despair, and an 80-year high in our suicide rate.
More troubling than the possibility that we could see an epidemic go from bad to worse is the fact that our current mainstream approach to trauma, struggle, and suffering is not and has not been working for the vast majority of people the vast majority of the time. This approach, leveraging so-called “evidence-based treatments” and medication, not only fails to stem the tide, but makes little impact on those seeking treatment.
The former Director the National Institute of Mental Health, Thomas Insel, recently asked: “Are we somehow causing increased morbidity and mortality with our interventions?”.
Insel’s question goes to the heart of our biggest fear. Out of a wave of concern and compassion, we anticipate billions of dollars may be allocated to address this wave of despair and depression related to COVID-19. Logic suggests that the majority of these dollars will go to existing approaches – the very same approaches failing most people, and as Insel intimates, approaches that may actually be causing the problem in the first place!
We can and must do better. COVID-19 represents an inflection point; an opportunity to question who we are, what we are doing, and how we are doing it. We are seeing this as it relates to how we relate and connect with each other, how and where we work, and how we engage with and receive care from traditional healthcare providers (now over our phones or computers). The same must be true of our approach to mental health – or we risk seeing a mental health crisis spiral completely out of control.
A possible roadmap to success:
First, democratize delivery of mental health care. Dr. Vikram Patel says that, “Mental health is too important to be left to mental health professionals alone.” Patel isn’t saying that mental health professionals don’t have an important role to play; his experience shows that relying solely on such professionals is a losing strategy. There are an estimated 552,000 mental health professionals in the United States; it is believed that at least 44 million Americans struggle with their mental health. There is no feasible world where that number of people can care for that level of demand. One of the answers is to train up “laymen” to deliver basic and effective interventions. Patel’s work on the Empower effort at Harvard provides a great roadmap for how to meet the anticipated level of demand.
Second, focus more on training and less on treatment. When our Marine friends talk about getting mental health support they refer to it as “going to see the wizard to get cured.” The truth is that no one can heal you but yourself. We fundamentally believe that the reason why we tend to struggle poorly is because no one teaches us how to struggle well. A key component of any effective mental health strategy is to build capacity for the patient to handle future struggles; otherwise, you provide a short-term fix that doesn’t meaningfully impact their life.
Third, talk more about Posttraumatic Growth and less about pathology and diagnoses. The mental health world tends to see people as a set of symptoms in need of a cure. Given that most treatments offer about a 30 percent reduction in symptoms, clients tend to feel like their best option is to simply adjust to a “new normal” — a diminished existence filled with pain and suffering. We know that growth is not only possible in the aftermath of trauma, but the most common response. However, as Insel noted, when we tell people that their lives will be, at best, some fraction of what it used to be, we foreclose pathways to growth.
Now, more than ever, we have a collective responsibility to care for those struggling in the wake of COVID-19. As we consider how to best support them, it is incumbent upon all of us to ask the hard questions and see how we can make the most out of a tragic circumstance.
Ken Falke is the Founder and Chairman of the Boulder Crest Foundation, a Posttraumatic Growth-based nonprofit that serves combat veterans, first responders, and their families.
Josh Goldberg runs the Boulder Crest Institute for Posttraumatic Growth.