America's mental health Covid-19 recovery needs to start now
Opinion by John R. Kasich and Dr. Henry Harbin - April 13, 2020
John R. Kasich is the former governor of Ohio, serving from 2011 to 2019. A Republican, he was previously a member of the House of Representatives. Henry Harbin is a psychiatrist and past CEO and chairman of Magellan Health Services.
Throughout our history, America's greatest challenges have summoned our greatest strengths, and this battle to defeat the coronavirus pandemic will prove no different. But, as we've also seen in history, those on the frontlines of a crisis inevitably face great danger, physically and mentally alike. Sadly, this campaign is already seeing casualties.
Across the nation in our hospitals, nursing homes, and other institutions sheltering our most vulnerable, we are seeing a great strain showing on our doctors, nurses, social workers, and emergency medical workers as they valiantly care for a growing population sick and too often dying from Covid-19. Also under the pressure are those unsung everyday heroes providing us with the things we need to live and stay safe, from food and household goods to law enforcement and medicine, we all depend on the essential ones who cannot stay home to protect themselves and their loved ones from the pandemic.
As in our previous wars, these frontline troops bear the brunt of the burden, and we need to be prepared for the toll it is taking -- and will take -- on their mental health and their lives.
But what may be most unique about this crisis is how much damage it's inflicting and will continue to inflict on people behind the front lines: those who are quarantining and social distancing to try to flatten the curve with the coronavirus outbreak. Beyond the fear of getting sick, many are facing extreme economic stress, job uncertainty, worries about children and elderly parents, and other family pressures including, for too many, an increased risk of domestic violence and abuse.
A Rapid Review published last week in the medical journal The Lancet outlined the potential psychological effects of quarantine, and painted a desperate picture of what we have to face in the months and years to come. Similar to what we saw after other mass traumas, such as 9/11 and hurricanes like Katrina and Harvey, not only are the effects expected to be significant, they continue to manifest over the years. The Lancet warned of rates of post-traumatic stress among quarantined children more than four times higher than baseline, and rates of depression among quarantined hospital staff many times higher than their peers, even years later.
And even after the virus is brought under control, this pandemic has already wreaked an unprecedented economic disruption that has swamped businesses of all sizes and looks to dramatically increase unemployment for an undetermined time to come. We're seeing it. Millions of American workers have filed for jobless benefits in the last weeks amid the crisis, and job losses are coming at a worrisome fast pace.
The Meadows Mental Health Policy Institute analyzed past economic recessions to put together initial estimates of the effects that a "Covid recession" might have on "diseases of despair," including deaths from suicide and addiction. The data suggests that, for every 1% increase in the unemployment rate, over a year we could lose 775 more Americans to suicide and 1,100 to overdose, as well as 10,000 more suffering addiction more broadly. Based on those estimates, a 5% increase in unemployment could lead to nearly 10,000 more deaths and a 23% increase -- on par with the Great Depression -- could lead to over 43,000 more lives lost.
As former governor of Ohio, a state that fought extensively -- and effectively -- against an opioid abuse epidemic during a period of relative prosperity, it is jarring to imagine the impact of these losses on generations of Americans.
But there are steps we can take now to mitigate the consequences and save precious lives.
According to The Lancet report, we, as a nation, can minimize stress on people in quarantine by communicating the essential facts of the situation effectively and steadily, keeping supplies moving, and emphasizing the good that people are doing by making this sacrifice. Good crisis management is itself good mental health care.
As individuals, we need to practice self-care: avoid fixating on the news; be mindful with your time by prioritizing things that matter to you; stick to a routine that is as close to "normal" as you can manage; get some fresh air in a manner consistent with social distancing; and stay connected by checking in with close friends and family via Zoom, FaceTime, calls, text messages or other social media platforms.
Experts say another proven technique is to focus on what we are grateful for, and those things are in no short supply: healthy friends and family, grocery store clerks and delivery people, health care workers, mental health and addiction counselors, first responders, and so many more.
These people and their families are the backbone of our nation, and their hard work and the hope they inspire among us all will be the key to getting back on our feet once this outbreak is controlled. And what is more, how quickly and how fully we recover depends more than ever on how each of us takes care of ourselves, and each other, in the weeks and months to come.