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COVID-19 and Ongoing Crisis in Mental Health
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COVID-19 spike virus floating around hands.

The COVID-19 pandemic has created historical challenges for communities around the world, both from a personal and public health perspective. As coronavirus-related deaths and economic collapses continue to occur, experts are warning of a severe repercussion of the pandemic; an emerging mental health crisis. According to a Kaiser Family Foundation poll, half of the Americans reported that COVID- 19 had detrimental effects on their mental health. This pandemic could lead to increased cases of depression, anxiety, substance abuse, post-traumatic stress disorder, and suicide.

The initial coronavirus outbreak caught hospitals and healthcare organizations off guard and highlighted their lack of preparedness for a pandemic of this magnitude. This lack of resources magnifies the mental health system’s traditional challenges of being underfunded, fragmented, and difficult to access. In our opinion, the current crisis has only intensified the old trends and examining the data could give us a better perspective.

Nearly 1 in 5 adults live with a mental illness, accounting for approximately 12% of the global burden of disease. While the economic weight for most diseases is made up of direct treatment costs, mental health issues cause an abundance of indirect costs such as decreased productivity, unemployment, social exclusion and marginalization. As a result, mental illness tops the list for most costly health conditions in the United States. Despite the prevalence and cost of these diseases, 60% of sufferers do not seek professional help.

How do health systems deliver mental health services to address these disorders? We think health systems have two main barriers in the delivery of mental health services: limited access and inefficient resource allocation. When determining who gets access to treatment, geographical determinism plays a significant role. In vast countries with a low population density such as Canada, the United States and Australia, providing consistent mental health coverage is not feasible. For comparison, in the US, two-thirds of the population lives in 3.5% of the land area. In rural areas, the population density is only 34 people per square mile, this number is 463 in developed European countries.

Mental illness tops the list for most costly health conditions in the United States. Despite the prevalence and cost of these diseases, 60% of sufferers do not seek professional help.

Examining the geographical access barrier would led us to the second barrier in delivering adequate mental health services: a lack of funding and poor distribution of treatments. Approximately 28% of countries do not have a budget dedicated to mental health services. Out of the countries that do, a large portion spends less than 1% of their health budget on mental health services. In Canada, mental illnesses comprise 26% of the economic burden of all disease but only 7% of healthcare expenditure.

Due to the lack of funding, there is a shortage of mental health workers. In the United States, there is only one psychiatrist available for every 2,320 patients. In 2018, 65% of non-metropolitan counties lacked a psychiatrist, whereas only 19% of metropolitan counties lacked one. Also, 80% of rural areas lacked a psychologist or psychiatric nurse practitioner versus 41% in urban communities. A result of these inefficiencies is long wait times for mental health treatments. In the US, the average wait time to see a psychiatrist in major cities is about one month. However, in countries that include mental health in public health budgets such as Canada and the UK, wait times could be as long as a year. The long wait times lead to no-shows and missed appointments, resulting in human resource waste.

While last month a federal emergency hotline for people experiencing emotional distress reported a 1000% increase in registration, out of the trillions of dollars dedicated to COVID-19 funding, only a small portion ($425 million out of $3 trillion, 0.015%) is allocated towards mental health.

These barriers are not the only factors restricting access to mental health treatment. Some other restrictions are deep-rooted into the structure of society, such as financial limitations and social stigmas. According to the US Substance Abuse and Mental Health Services Administration (SAMHSA), 50% of patients with mental health problems did not receive care due to financial difficulties, and 30% refrained from seeking help due to associated stigmas. Effective treatment for a mental illness often requires 12–15 sessions at a rate of $150–200 an hour. In many countries like Canada, these services are not entirely covered by the healthcare system. Subsequently, Canadians pay $950-million per year for private mental health services, often out of pocket. In the United States, the affordable care act (ACA) mandated the coverage of mental health treatment, and the percentage of patients who could not afford it decreased from 28.4% in 2012 to 16.7% in 2015. With the recent changes in ACA and the COVID-19 pandemic, likely, the number of patients who cannot afford mental health care will increase substantially. While last month a federal emergency hotline for people experiencing emotional distress reported a 1000% increase in registration, out of the trillions of dollars dedicated to COVID-19 funding, only a small portion ($425 million out of $3 trillion, 0.015%) is allocated towards mental health.

At this historical juncture, we have the opportunity to pause and think about our future. We can consider how our financial investments can gain better returns for society.

One approach that has shown promise for mental health treatment is telemedicine. The combination of digital therapeutics and modern communication networks can address many of our current inefficiencies in the delivery of mental health services. The digital revolution has yielded exponential growth for many industries. Now that several clinically validated digital solutions exist, by investing in and exploring digital therapeutics and telemedicine, we can use digital scaling and growth to leverage the resources for mental health services.

These numbers and ideas are adopted from a book by the OPTT founders. If you are interested in learning more, we recommend checking it out on our website.

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