As the pandemic paralyzes the healthcare system, the impact of social isolation,

economic turn-down and exacerbating pre-existing barriers to access care will continue
to devastate the people’s mental well-being unless we take immediate action. 

Introduction 
 
Since the emergence of the COVID-19 virus, the increasing rate of mental illnesses and
the rise of a global economic crisis has branded the pandemic as the worst health crisis
in a generation. Is this the beginning of a mental health epidemic? Though it shares
similar characteristics to a mass traumatic event, the unique case of the COVID-19
outbreak exhibits an invisible and omnipresent nature that belays the severity of the
disease. Not only is it unevenly distributed across populations, but the profound mental
health implications of the pandemic shared worldwide directly contribute to the
preexisting social inequality within our society. As the U.S enters its ninth month of the
global pandemic, the efficacy of the current mitigation measures for the public's well-
being is called into question. Despite a spike in demand for mental health treatment, a
World Health Organization survey reported a disruption in the acquisition of mental
healthcare services in more than 93% of countries. As the pandemic paralyzes the
healthcare system, the impact of social isolation, economic turn-down and exacerbating
pre-existing barriers to access care will continue to devastate the people’s mental well-
being unless we take immediate action. 

The Mental Health Impact Of Social Isolation  

Although nationwide measures have mitigated the spread of the COVID-19 virus
to some extent, the psychological impact of social isolation measures has increased the
levels of psychological and substance use disorders among the general population.
According to Brookes et al. (2020) 's rapid review on the psychological effects of
Quarantine, being in Quarantine, or self-isolation is a risk factor severely impacting
mental health to the extent that they can be diagnosed as post-traumatic stress disorder
(PTSD). Since the beginning of the pandemic, the physical toll has been broadcasted
worldwide. However, the mental health decline from societal disruption and economic
devastation of the viral outbreak did not surface until the implementation of lockdown
measures. Many studies have been done during other disease outbreaks to understand
quarantines' psychological impact better. By examining mental health problems relative
to 13 pandemic-specific stressors, the researchers of a population survey found that the
more reported stressors, the more likely those people were to report anxiety and
depression symptoms. These studies indicate the severity of compulsory confinement, a
derivative of the virus's invisible threatening nature. Along with the continuing physical
cases overburdening an already overworked healthcare system, healthcare providers
must also be prepared for a tsunami of psychological ailments that could drown the
mental healthcare system. Is this an adaptive response to the pandemic's stress or the
beginnings of a mental health epidemic? 
During this unprecedented time of global lockdown measures, the existing mental
illnesses among at-risk groups may be exacerbated by the pandemic. The closure of
schools and businesses prevents them from receiving the same access to mental health
services. As a result of a disruption within the healthcare system, adolescents are
increasingly engaging in substance abuse. Not only are they at high-risk for suicidal
ideation, but research conducted by the CDC states that substance abuse disorder is
prevalent among adolescents and, therefore, a particular concern for mental healthcare
services. Further research also reveals that this abuse usually goes hand in hand with
other risky behaviors, potentially leading to mental health problems in adulthood.
Former U.S. Surgeon General Vivek Murthy highlighted suicidal ideation's association
with reduced lifespan and greater risk of physical and mental illnesses. Along with the
possibility of worsening preexisting mental health conditions among those who already
have a mental illness, the normalcy of a 24-hour society and economy brought to a halt
begs the question of whether forcing people into long-term self isolation has the efficacy
to prevent a potential mental health epidemic. The healthcare system must be able to
meet the increased demand by incorporating treatment to cater to those facing mental
health challenges. Nevertheless, these quarantine measures restricting nationwide
travel and changes in the foundation of healthcare services could disrupt access to and
provision of psychiatric care while simultaneously worsening the public's mental well-
being. 

Mental Health In A Time Of Economic Uncertainty 

As the pandemic continues to devastate the world with an unprecedented economic

crisis, the United States must psychologically prepare to enter a potentially extensive
and deep recession. Though public health officials and economists are concerned with
many Americans facing continued job uncertainty and stress during this time of crisis,
they are more concerned with the efficacy of psychological interventions for helping
people cope. "Work provides us time structure, it provides us identity, it provides us
purpose, and it also provides us social interactions with others," said Connie Wanberg,
an industrial and organizational psychologist at the University of Minnesota.
Additionally, a meta-analysis led by Frances McKee-Ryan (Journal of Applied
Psychology, Vol. 90, No. 1, 2005) found that those with fewer financial resources and
those who perceive more financial strain from unemployment are less satisfied with their
lives. Likewise, those who perceive unemployment as an immediate threat to survival
are at most risk for mental health challenges after a job loss. Given a large body of
research revealing that unemployment is linked to anxiety, depression, and loss of life
satisfaction, the mental health impacts of today's job losses are likely to be significant.
For instance, the University of Bristol epidemiologist David Gunnel emphasized that "the
rise in the number of suicides is only a small part of the emotional distress" (The British
Medical Journal, Vol. 347, 2013). While this may be true, many fail to consider that this
downturn is disproportionately burdening people with disabilities, communities of color,
those with marginalized gender identities, and those at the intersection of these
identities, while also exposing them to trauma, stress, and uncertainty. While symptoms
of distress will abate for many once the crisis is under control, others may develop
trauma-related psychiatric disabilities requiring long-term support. 
With this in mind, psychologists must be prepared to confront this economic
upheaval with a mental-health-informed approach that minimizes potential long-term
mental health implications, while also addressing the need for long-term investment in
mental health services for populations experiencing higher rates of trauma exposure. As
socioeconomic status is a significant social determinant of mental health, the COVID-19
induced recession, as well as a combination of economic uncertainty and job loss at all
income levels, is likely to exacerbate or trigger new incidences of psychiatric disability. 

Mental Health Care: Barriers To Mental Health Care Access

COVID-19 has exposed the U.S. mental health system's disparities, leaving many
without accessible and affordable care as policymakers fail to address the crisis
adequately. According to the American Psychological Association, 11.8 million
Americans in 2016 had an urgency for mental health services that went unmet. Of
these, nearly 38% could not afford the high cost of treatment. The viral pandemic
consequently spotlights existing and new barriers to accessing mental health and
substance use disorder services. Due to a national shortage of providers, the high cost
of care, and a lack of insurance coverage for services, many Americans with existing
mental health disabilities have struggled to access mental health care long before the
pandemic. This preexisting barrier of limited access to affordable quality services has
been further diminished due to COVID-19, as the pandemic has disrupted health
services worldwide. In fact, a UN policy release emphasizes that 'decades of neglect
and underinvestment in addressing people's mental health needs have been exposed
by the COVID-19 pandemic,' in a call for commitments from countries in their approach
towards mental healthcare treatment amid a potential global spike in suicides and drug
abuse. 
Similarly, systematic racism has adversely fueled the pandemic’s many disparities. To
be specific, the ethnic and racial disparities within access to mental health care raise
many social justice concerns about distributing resources and underlying social drivers
of inequality. Racial groups use mental health services at a substantially lower rate than
white Americans as they have historically been discriminated against. To illustrate,
recent data following the release of the video footage of George Floyd's murder enacted
by Minneapolis police officers exhibit the shared suffering of Black people from
psychological distress symptoms associated with depression and anxiety, jump from
36% to 41%. The sudden emergence of the Black Lives Matter movement's second
wave brought attention to the impact of systematic racism and discrimination on
domains central to recovery from the pandemic. As these communities endure the
heaviest mental health burdens and face the critical barriers to accessing equitable
mental health treatment and support, this percentage increase may have grave
implications. Finally, those without insurance coverage face another barrier to mental
health care access because out-of-pocket costs to mental health coverage are far from
affordable. More than half of U.S. counties have no practicing psychiatrists, 37% of
counties have no psychologists, and two-thirds of counties have no psychiatric nurse
practitioners. Due to the scale of the problem, the disruption of services has caused the
vast majority of mental health needs to remain unaddressed. Thus, as COVID-19
continues to devastate people belonging to a minority or racial group at rates that far
outpace white people, equitable access to mental health support will increasingly
become imperative. 
Mental Health Care: Disruption Of Services

Along with the preexisting barriers to mental health care access, the disruption of
services due to physical-distancing policies have also created a new barrier to access
in-person psychiatric and peer support services. Peer support is defined by the
provision of guidance, care, and nonclinical support services from people that have
experienced a psychological disability, disorder, or trauma. These services represent a
model of care by offering a wide range of programs that promote an affirming and
equitable model of health to equalize the inherent power imbalance in traditional clinical
relationships. Although some peer support services have transitioned online to ensure
the continuity of care, physical-distancing policies and other pandemic-related
movement restrictions have disrupted most in-person mental health outreach in
communities tormented by high rates of violence, displacement, economic
disinvestment, ecological destruction, and other forms of oppression. A recent survey of
880 community behavioral health care organizations found that 61% have discontinued
at least one program, and nearly all of those organizations surveyed have reduced their
operations due to the pandemic. These underserved communities have a significant
need for these services, which are typically performed by peer workers, community
health workers, violence disruptors, and others to expand service utilization. As a result
of the cessation of such-in person outreach, it is likely to cause adverse mental health
outcomes. 
As the ongoing viral pandemic continues to enforce pandemic-related closures and
distancing policies for the public's physical well-being, many have resorted to telehealth
platforms as an alternative. Though this may be the best option for those unable to
access in-person services, policymakers must consider privacy concerns and dissimilar
access to broadband while also adapting to the increased utilization of virtual options
through adequate telehealth services regulation.

SOLUTIONS: 

In a viral pandemic, responses to trauma are typically delayed due to its manifestation,
and psychiatric symptoms may likely produce long-term mental health implications. By
carrying out all funding and reforms set in place in the wake of the crisis, it ensures their
continuity even after the pandemic expires. 
Amid unbridled job loss, risk of infection, and increased demand for mental healthcare
services, universal health coverage has never been more critical. However, the Trump
administrations’ commitment to undermining health insurance coverage through
repeated attacks on Medicaid and the ACA has forced federal and state governments to
adopt an intermediate approach that provides affordable coverage to the uninsured
within the existing ACA and Medicaid foundation. Under the ACA, the COVID-Specific
special enrollment period (SEP), in particular, is an essential provision of individual
market coverage for those uninsured. Not only would this alleviate pandemic-related
financial concerns and distress of COVID-19, but the more people enrolled in coverage,
the more people will be allowed to access healthcare services. In addition to the ACA,
millions of low-income Americans will lose the ability to access COVID-19 testing and
treatment or mental health services without the Medicaid program. Henceforth, to
further support millions of unemployed folks, States should offer Medicaid expansion
and obtain 100% federal funding through the financial matching assistance percentage.
If some States refuse Medicaid expansion, the federal government should offer a
Medicaid option that best resembles the state-based option to establish Medicaid
enrollment for the unemployed. 
Given the psychological challenges of the pandemic faced by frontline healthcare
workers, essential workers, survivors of COVID-19, and communities disproportionately
affected by the virus, increased access to affordable mental health services must go
hand in hand with targeted funding for peer-to-peer support. Though many peer-led
support groups and services have quickly shifted to an online format to maintain
continuity of care, the allocated funds of $200 million from the CARES Act is shared
amongst telehealth and peer support services. This allocation is woefully insufficient to
meet the increased demand and support the training costs to provide tailored and
culturally affirming resources to those acutely in need. For instance, the 30 million
sufferers of eating disorders within the U.S. face new pandemic-related stressors due to
elevated concerns about food scarcity, coupled with a surge in media content focused
on food and weight. Solutions such as online meal support groups can connect
underserved populations with those who have a shared understanding of the unique
challenges this pandemic poses. By adequately funding such services through
operational grants that extend beyond the pandemic is crucial to ensuring continuity of
care thus;, increased federal funding for peer support training is essential to facilitating
outreach efforts that target the most affected populations during and after the pandemic.
Until the government adequately contains the coronavirus and provides economic and
social support to those affected, Americans will continue to face increasing distress and
trauma.

ports of domestic violence have tripled in China and risen by 30 percent in France and
by 40 to 50 percent in Brazil, indicating broader global patterns of rising rates of
domestic violence during the pandemic.44 While data on domestic violence in the
United States are limited,45 several agencies have reported increased rates of physical
and emotional abuse during the pandemic and new forms of pandemic-related
manipulation.46 As such, it is essential to provide ongoing tailored support for survivors
of intimate partner violence and child abuse both during and following this crisis.