Uncertainty and confusion have filled all of our lives during the last year.
The pandemic, which has claimed the lives of more than 500,000 people in the U.S. and nearly 2.5 million worldwide, has changed how we do everything.
With only around 5% of Americans fully vaccinated, masks and social distancing are still our primary weapons, and it is clear that the pandemic will continue to be with us for a while.
The link between public health crises and mental health has been known for decades, but the full impact that COVID-19 has had upon the U.S. is still unknown.
In early February, JAMA Psychiatry released a cross-sectional study of emergency department (ED) visits, comparing pre-pandemic mental health, overdoses and domestic violence cases with pandemic visits.
Researchers used the National Syndromic Surveillance Program, which collects information on over 70% of emergency departments nationwide to track mental health conditions, suicide attempts, overdoses, intimate partner violence and suspected child abuse.
The study looked at data from December 30, 2018, until October 10, 2020, and compared pre-pandemic admissions with pandemic admissions.
As expected, hospitals saw a significant decrease in ED visits during the pandemic, especially during the first three months.
Weeks 1-11 of 2020 saw an average of around 2.3 million visits a week, then a radical shift began in week 12 (March 15-21). Over the next 29 weeks, EDs saw visits drop to a mean of 1.7 million a week.
None of this is a surprise, since it is known that the general population clearly avoided clinics and hospitals out of fear of the virus.
It is noteworthy that the rate of ED total visits has declined compared to 2019, while the rate of mental health conditions, overdoses and possible domestic abuse visits remained stable.
For example, weeks 12-41 of 2020 saw around 40,200 mental health condition ED visits a week, while the same period in 2019 saw 40,400. Drug overdoses saw a similar trend, with around 15,000 visits in 2020 and 13,300 in 2019.
Cases of intimate partner violence were roughly the same in both years, while cases of suspected child abuse or neglect dropped about 200 cases to 1,040 a week in 2020.
Suicide attempts increased by 239 cases a week from 2019 to 2020, with a mean of 4,944 during this period in 2020.
At first glance, it might seem that the rates of ED visits are not as significant as was originally feared. However, the raw number of visits does not factor in the 25% decline in total ED visits during most of the pandemic.
Factoring in this decline, rather than seeing a decline in mental health conditions or domestic abuse reports, we are witnessing a significant uptick in these cases.
Granted, there is no clear evidence of how this increase is linked to the stress of the pandemic, the economy, political instability or even social distancing.
While the most dramatic increase in cases was from March to June, it is still unclear what the long-term mental health and social impacts will be in the coming year.
To add insult to injury, the last four months have seen a significant increase in ED and hospital admission rates.
This makes it difficult for our already strained health care system to focus on the special needs of people wrestling with depression, suicide, substance abuse, mental health challenges or domestic abuse.
In June, the Centers for Disease Control and Prevention reported that 40% of U.S. adults were struggling with mental health or substance abuse during the pandemic.
Since untreated depression and anxiety can compound over time, the longer the pandemic continues, the larger the problem will become.
Already existing mental health and substance abuse problems may become one of the most significant crises we face as the pandemic continues.
In support of both of the above studies, Kaiser Health News reported on February 10 that hospitals are seeing an increase in admissions related to alcohol abuse.
Admissions associated with alcohol-related liver diseases are up 30-50% nationwide. This parallels earlier studies that revealed that people were drinking 30% more during the early months of the pandemic.
This is a troubling pattern, since 5% of patients admitted with alcohol-related liver failure die in the hospital. In addition, patients with liver failure are three times more likely to die of COVID-19 than those without liver failure.
What needs to be done? And how can people of faith help?
First and foremost, we need to discuss the problem in a rational way.
There has been a tendency to ignore and avoid anything associated with mental illness. Our mutual silence has only fueled this epidemic.
A failure to address these issues and bring them to the forefront leaves individuals and families to fend for themselves.
Thus, we need to push for studies designed to give the public a better picture of this crisis and to insist that elected officials include support for mental health and substance abuse into any further COVID relief packages.
Second, we need to step up and reach out to those that are hurting.
Most experts who are willing to address this growing crisis acknowledge that it is either directly or indirectly related to the consequences of the pandemic because people have been cut off from many of their support systems.
I am not advocating that we ignore social distancing rules, but the faith community needs to find creative ways to reach out consistently to people who are facing substance abuse issues and mental health challenges.
Prior to the rise of professional psychiatry and other mental health professions, the faith community and clergy were the public’s primary support systems.
That is still in our DNA, and it is time that we work alongside these professionals by reaching out to patients and families as their struggles are exacerbated by the ongoing pandemic.