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The pandemic could drive another national health crisis, GAO warns: Anxiety

From April 2020 to April 2021, there was a 29 percent increase in drug overdose deaths, according to the CDC’s National Center for Health Statistics. (Sarah L. Voisin/The Washington Post)
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As if more than 800,000 deaths and 50 million covid-19 cases in the United States are not bad enough, the virus appears to be spawning a different health calamity.

“The pandemic is potentially driving another national crisis related to its effects on behavioral health, with people experiencing new or exacerbated behavioral health symptoms or conditions.”

That’s the stark warning in the first paragraph of a letter to Congress in a new Government Accountability Office (GAO) report.

The expansive impact of the pandemic is demonstrated by this statistic: More than four out of 10 adults, 43 percent, told a Census Bureau pulse survey in November 2020 they suffered from anxiety or depression.

That survey did not include questions about substance abuse. Citing an August 2020 Centers for Disease Control and Prevention (CDC) study, the GAO said 13 percent of adults responding to a survey admitted “having started or increased substance use to cope with stress or emotions related to COVID-19.”

An ugly statistic not included in the covid-19 death data is the 29 percent increase in drug overdose deaths from April 2020 to April 2021, when more than 100,300 died, according to the CDC’s National Center for Health Statistics.

This data might not reflect the true extent of the problem. Therapists know “behavioral health problems are often under reported,” said Lynn Bufka, the American Psychological Association’s senior director of practice transformation and quality. Underreporting happens, she said, because of stigma, people accepting problems as simply “the way it is” or not connecting certain issues with behavioral health, such as linking sleep troubles with anxiety. It’s reasonable for people to assume, she added, “there is a 50-50 chance that the person they are with might be feeling stressed, anxious or depressed in response to the current situation.”

Mayor Bill de Blasio said on Dec. 19 that the city is seeing a “very substantial rise in the number of cases” from the variant. (Video: Reuters)

Government money is flowing to help those in need.

As of November, Washington has spent more than $8.5 billion in covid-19 relief for behavioral health, which includes mental health issues like anxiety and depression, in addition to substance abuse. Almost all of that was funneled through five programs of the Department of Health and Human Services Substance Abuse and Mental Health Services Administration. The rest went to the Federal Emergency Management Agency.

The GAO audits agency spending, but it has no verdict yet on how well Uncle Sam is spending those billions.

“I’m afraid it’s a bit too early to say,” Alyssa M. Hundrup, the GAO health care director, said by email. “Much of the money has just been recently awarded to grantees, such as in March or May of 2021, so we don’t yet have a clear picture of how (or to what extent) the money specifically has been used. We do believe … that it will be important to examine populations served by programs receiving COVID-19 relief funds to determine whether target populations were reached, and whether there were any gaps in intended populations served.”

The pandemic is hitting a mental health workforce that also is individually stressed and organizationally unable to fill the gaps in service.

“We're seeing a large increase in demand for anxiety and depression treatment” by mental health professionals who report long wait times for clients seeking care, Bufka said. “This was a challenge pre-pandemic … The workforce was stretched thin, wasn't in the places where always there was the greatest need. But now we're seeing even more of that, more demand.”

Echoing those issues, GAO said covid-19 was “expected to worsen” access to treatment. On the long-standing, insufficient availability of treatment in low-income areas, GAO added “the pandemic has exacerbated these concerns” because of behavioral health employee layoffs and “the loss of providers without the financial reserves to survive long-term.”

Senate Finance Committee Chairman Ron Wyden (D-Ore.) said in an email that the GAO report highlights the “urgent need to repair America’s mental health care system. That’s why the Finance Committee has launched a bipartisan effort to identify and address the many shortfalls facing Americans struggling with their mental health.”

GAO identified six broad populations that are at a higher risk of covid-19 related behavioral health issues:

— Native Americans who were hospitalized at a rate 3.5 times greater than that of White people; and African Americans and Latinos who were hospitalized 2.8 times more

— Health care workers who fear catching covid-19, worry about giving it to family members and suffer from exhaustion, burnout and the emotional toll of watching people die

— Children whose school closures produced stress and limited access to behavioral health screening, while keeping them at home with adults whose covid-19 experiences could lead to negative consequences in the home, such as substance abuse

— People with preexisting behavioral health issues whose conditions could worsen with isolation, unemployment and an inability to connect with treatment

— Young adults whose craving for socializing has been thwarted by the pandemic

— People in financial distress whose regular problems, including difficulty affording food, housing and transportation, are exacerbated by the fear of covid-19.

When I wrote about an earlier GAO report on covid and behavioral health, Wyden sounded a warning about the current report confirms: “Underlying the global pandemic is a five-alarm fire when it comes to the state of Americans’ mental health.”

But Bufka leaves us with a note of hope.

“We know people are resilient. People go through adversity and they get through it,” she said. “It is likely that a much smaller proportion of us will have longer term negative impacts as a result of all this.”

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