Much has been written about the stress on communities wrought by COVID-19. From everyday social isolation to postponing weddings and graduations to conducting virtual Passover Seders, Easter Egg hunts, and even funerals.
In contrast, we have heard little from or about the communities of individuals with serious mental illness during this COVID-19 crisis. These communities are made up of individuals that live on the margins, even in the best of times. So how are they faring in the throes of this pandemic?
1. Who are we talking about and who serves this community? Individuals with serious mental illness include those with severe depression or bipolar disorder, schizophrenia and other psychotic disorders. We estimate that about one in twenty-five adults – or 4% of the general population – has serious mental illness. In the New York metropolitan area alone, that would be more than 800,000 people – probably an underestimate. Community mental health and social service agencies provide the so-called safety net: counseling, psychotherapy, primary care, medication, housing, coaching, and everyday living supports to the most vulnerable individuals in this community. Every day it’s noble work. Today, it’s nothing short of heroic work. This are our mental health frontline workforce.
2. COVID-19 is stressful for everyone. What makes individuals with serious mental illness more vulnerable?Individuals with serious mental illness who are being served by community mental health and social service agencies are also likely to have other health conditions that make them more vulnerable to COVID-19. Individuals with serious mental illness have high rates of smoking, obesity, and diabetes. These co-morbid health conditions confer a worse prognosis if someone does contract COVID-19. Individuals with serious mental illness are also likely to face challenges with housing and employment that increase risk of exposure to COVID-19. For those who depend on housing supports, they often live in close quarters with shared public spaces and limited privacy. For people who are homeless, the challenges are multiplied – both in terms of exposure and in terms of identification and treatment. Consider the photo above. It is a makeshift shelter with social distancing lines demarcated in a parking lot in Las Vegas that was set up after a nearby homeless shelter was closed because someone tested positive for COVID-19. Putting it all together, Emory University physician, Dr. Benjamin Druss, warns that individuals with serious mental illness may be among those hardest hit by COVID-19.
3. Are we seeing a worsening of symptoms for individuals with serious mental illness as a result of the pandemic?In New York, a team leader from one of the community programs of The Jewish Board reports that they are seeing a range of responses. Many individuals are coping and managing the stress of COVID-19 in similar ways to the general population, including leaning on support networks now more than ever. However, for individuals with serious mental illness, support networks can be thin, causing individuals to experience spikes in anxiety and other symptoms. This can take the form of a client whose obsessive compulsive disorder dramatically worsens with non-stop hand washing or a client who suffers from serious depression losing hope and feeling suicidal. Much has been written about the pandemic of distress, anxiety and fear in the general population, and data from other disasters would predict a rise in mental disorders. However, we have a paucity of data on the impact of disaster, including the current pandemic, on the course of serious mental illness.
4. What about substance use disorders? Similar to individuals with other mental health conditions, COVID-19 puts those with substance use problems at increased risk as well. Substance use disorders are linked to an increased susceptibility of infectious disease, in general. This may be in part due to a higher propensity for risk taking behavior and in part due to cellular effects of substance use that compromises the immune system. COVID-19 attacks the lungs, so tobacco, marijuana, opioid and methamphetamine use disorders may make people more vulnerable because of these drugs’ effects on respiratory and pulmonary health. The practice of self-quarantine and other public health measures also run the risk of significantly disrupting access to treatments for individuals in recovery. Yes, technology is facilitating creative adaptations for the delivery of care, but many individuals with serious mental illness and substance use disorders have limited access to the most modern technologies. And some things, like clean syringes and medications, cannot be delivered over Zoom.
5. What is happening to psychiatric beds in the hospitals? As is always the case, community mental health and social service agencies are working diligently to provide all necessary services to those in need in the community. However, if inpatient care is needed for clients, some people have concerns about whether beds will be available. In some places, psychiatric beds are being repurposed for COVID-19 patients. If beds are available, there are concerns about provision of care. In most places, designated COVID-19 floors at state psychiatric hospitals or dedicated areas for COVID-19 patients on psychiatric floors do not exist. Given the generally open layout of psychiatric inpatient floors, the risk of the virus spreading rapidly is quite high. In fact, community health workers described several instances in which their clients refused, or have been resistant, to go to the hospital because they are afraid of contamination or because they are afraid they won’t make it out alive.
We have seen time and again, and around the world, disasters disproportionately impact those who are most vulnerable. COVID-19 is no exception. We are all looking for ways to help in the context of this pandemic. I urge everyone to think about one thing you can do to support those with serious mental illness in your community. For the New Yorkers among us, please take a few minutes to learn more about The Jewish Board, S:US, Fountain House and CSPNJ. These organizations are all about people in our community: those living with serious mental illness and those serving individuals with serious mental illness. Everyday heroes. Even more so in the midst of COVID-19.