Inaccessibility of Mental Health Care During COVID-19

With the rise of COVID-19, the American healthcare system faced a massive crisis. The country mobilized to provide enough personal protective equipment for healthcare workers and the general public, bed space for COVID patients, and more recently vaccinations. During this public health mobilization, one serious impact of the pandemic has been overlooked: mental health. Despite increased prevalence of mental health disorders in Americans during the COVID-19 pandemic, especially young adults, the availability of mental health services has not increased substantially, creating a less obvious but immensely harmful healthcare crisis. Due to the stress and uncertainty of COVID, the prevalence of mental health disorders has increased in Americans, hitting certain groups such as young adults harder than others and leading to an increased need for mental health resources and treatment. Before the pandemic, an estimated 10% of the American public suffered from a mental health disorder (Panchal). By June 2020, this value jumped to 41%, increasing the need for mental health services (McCluskey). While all age groups and demographics reported increased adverse mental health effects, the pandemic hit young adults particularly hard. 56% of young adults during the COVID-19 pandemic reported symptoms of anxiety or depression. Even before the pandemic, young adults were at higher risk for anxiety and depression and less likely to receive treatment (Panchal). Only obesity had higher rates of hospitalization for young adults than mental health disorders. With the stress of COVID-19 this risk has increased even more. The pandemic caused job loss and insecurity and sent schools online, causing immense stress for this age group. Young adults in the job force are less likely to have significant savings, making job loss particularly stressful. For those in high school or college, the transition to online learning took away not only social and academic opportunities but also access to resources, healthcare, housing, food for some students. Although the need for mental health services increased during COVID-19, hospitals failed to increase their resources, leading to a severe shortage in mental health treatment. Like the prevalence of mental health disorders, this is an existing problem that was exacerbated by the pandemic. According to the United Nations, even before COVID, there were “decades of neglect and underinvestment in addressing people’s mental health needs” (“UN Leads Call”). Mental healthcare was under supported and inaccessible before, and now with an increased patient load the problem has only gotten worse. In person, the lack of space for mental health patients has caused a rise in boarding. Boarding is when people who need mental health treatment are stuck in emergency departments and medical units. These areas are not equipped to deal with the unique challenges of mental health disorders. They focus on preventing the patient from hurting themselves and others rather than treatment (McCluskey). This practice increases the burden on medical services already weighed down by COVID-19 patients and their normal caseloads. It also prevents patients from receiving the care they need and increases the time and cost of treatment.

Mental health care has attempted to transition to a virtual platform to provide care without filling up hospitals or clinics. However, the transition to telehealth leaves under-resourced patients behind and fails to treat all mental health conditions. While there is growing evidence that telehealth is effective for many mental disorders, there are limited numbers of clinicians who are properly trained in telehealth. It’s also inaccessible, as a patient's access to telehealth depends on their ability to access a computer, the adequacy of their internet connection, and whether they have a quiet and private space where they can talk to a therapist. There are also jurisdictional issues and inferiority of care for some conditions. The jurisdictional issues are particularly present for young adults. Laws prohibiting virtual mental health care from crossing state lines makes it harder for out-of-state college students to have consistent access to care (“Covid-19 and the Need for Action on Mental Health”). While it’s a more accessible option for some patients, telehealth fails to make up for the lack of in person mental healthcare resources. Colleges and universities, such as UCLA, provide a useful case study for examining the inaccessibility of mental health care during COVID-19. Young adults, who make up the majority of the study body at universities, are in critical need of mental health care. At UCLA, students can get mental health care through UCLA Counseling and Psychological Services (CAPS). CAPS provides free, short term services such as psychiatric evaluation and treatment, crisis consultation, and workshops (“About Us”). While this program provides quality care to students, it fails to meet the demand, especially during COVID. Students have a limit on the number of appointments they can make and wait times can be extremely long. Within UCSHIP, the university’s health insurance, students have a maximum of six appointments. Without, the maximum is only three (“Eligibility and Fees”). While it’s a step in the right direction that these appointments are free, these maximums fail students in need. Those who can not afford UCSHIP are left behind, and even those who can do not get enough appointments to treat their conditions. According to the American Psychological Association, it takes on average 15-20 sessions for 50% of patients to recover. Many patients also choose to continue treatment for up to 30 sessions to completely solve their symptoms and feel more confident in their new management skills (“How Long Will It Take for Treatment to Work?”). For students to get all of the help they need, they must be referred off campus, which takes extra time and money for transportation. While outside treatment is often covered by insurance, there are hidden barriers. For students with busy schedules, it can be hard to find the time to go off campus to appointments. UCLA also has limited parking, forcing most students, who do not have cars, to either pay for expensive car share services or take extra time for public transportation. This forces many students to pick telehealth, which poses its own accessibility and effectiveness concerns. A more comprehensive service on campus would provide more options for all students and ensure that their treatment is minimally disruptive to college life. College mental health services, such as CAPS at UCLA, provide much needed and important care for students in need. However, lack of funding and providers, especially at a large university such as UCLA, prevents these systems from providing for all students. While students can get much needed advice and referrals from CAPS, college students need more support during the pandemic. Increasing funding and the number of employees at CAPS could help turn the program into an extremely valuable resource for all students, not just those with access to resources such as UCSHIP. Even beyond colleges, healthcare facilities need to take a closer look at how to address the growing need for mental health care and the inequities in access to help.

References: 1. “About Us.” UCLA Counseling and Psychological Center, https://counseling.ucla.edu/about-us. 2. “Covid-19 and the Need for Action on Mental Health.” Columbia University Department of Psychiatry, 9 Oct. 2020, https://www.columbiapsychiatry.org/news/covid-19-and-need-action-mental-health. 3. “Eligibility and Fees.” UCLA Counseling and Psychological Center, https://counseling.ucla.edu/about-us/eligibility-and-fees. 4. “How Long Will It Take for Treatment to Work?” American Psychological Association, American Psychological Association, https://www.apa.org/ptsd-guideline/patients-and-families/length-treatment#:~:text=Recet%20research%20indicates%20that%20on,by%20self%2Dreported%20symptom%20me sures. 5. McCluskey, Priyanka Dayal. “'This Is a Crisis on Top of a Crisis': Patients with Mental Illness Are Waiting for Overwhelmed Hospitals to Treat Them.” BostonGlobe, The Boston Globe, 8 Aug. 2021, https://www.bostonglobe.com/2021/08/07/metro/other-covid-crisis-patients-with-mental- llness-are-waiting-overwhelmed-hospitals-treat-them/. 6. Nirmita Panchal, Rabah Kamal, and Feb 2021. “The Implications of COVID-19 for Mental Health and Substance Use.” KFF, Kaiser Family Foundation, 20 July 2021, https://www.kff.org/coronavirus-covid-19/issue-brief/the-implications-of-covid-19-for- ental-health-and-substance-use/. 7. “UN Leads Call to Protect Most Vulnerable from Mental Health Crisis during and after Covid-19 | | UN News.” United Nations, United Nations, https://news.un.org/en/story/2020/05/1063882#:~:text=Decades%20of%20neglect%2 0ad%20underinvestment,in%20suicides%20and%20drug%20abuse.