Prioritizing mental health care and access after the pandemic

All over the world, mental health has been severely affected by the COVID-19 pandemic, and although many areas of life seem to have returned to normal, people continue to look for ways to improve their mental health.

With more young adults telling about his condition mental healthand many are looking care providersTufts Now reached out to clinician Paul Summergrad, chief psychiatrist at Tufts Medical Center, and Dr. Frances S. Arkin, chair of psychiatry and professor of psychiatry at Tufts University School of Medicine, to learn about the state of mental health in America, especially for young adults as they continue to navigate the new world. .

“A mental health topic that includes use of psychoactive substances and its complications have increased dramatically over the last three or four years,” Summergrad said. “Certainly the COVID-19 pandemic has had a major impact on that, just because that’s the nature of pandemics — they’re very devastating.”

Tufts Now: How has the pandemic affected mental health in particular?

Paul Sommergrad: When a world-changing event like a pandemic happens, it creates uncertainty.

It threatens people’s lives, changes the way we live, and disproportionately affects a wide variety of groups. There is a huge unacknowledged and unrepentant death toll at the societal level. We lost over a million people in the United States. If you look at excess mortality, it’s much higher, but we don’t have a public way to mourn.

Twenty-one years after the horrific events of September 11, 2001, I remember it like it was yesterday. That is very clear in my mind. We mourn this day. We do not have a national monument of mourning for COVID-19. We did not come together to throw off the partisan jerseys, if you will.

Then you think about the impact on the children who were unable to go to school. We haven’t had enough research into why children’s mental health has suffered so much. ​​​​​​While this may seem self-evident, there are still many questions that need to be answered, such as if children cannot go to school, why does this affect them? Is it because they can’t play? What else is going on? Is it because they watch their parents worry? Or watch your grandparents get sick or die from this virus? I think all of these things have had a really big impact on mental health.

Do you think people have become more open about their mental health?

I think the conversation about mental health has come a long way in the last decade, people are more comfortable talking about it. But it doesn’t always lend itself well to public discourse because it tends to become politicized.

What I mean by that is that it becomes a topic of conversation when we consider what to do with things like guns. There are people who believe that we shouldn’t be doing something about guns, we should be doing something about mental health. Similarly, there are people who don’t think we should have restrictions on COVID-19 because it can have a negative impact on mental health. It’s great that people are concerned about mental health, but it’s worrying when they seem to be caught up in a certain political point of view.

For one thing, there’s more openness to talking about mental health than ever. There was also a greater understanding that we had a very serious access crisis.

Can you elaborate on this access crisis specifically in Massachusetts?

As of September 12, nearly 700 people in Massachusetts had long waits in psychiatric emergency rooms: including 488 adults and 87 pediatric patients and over 100 geriatric patients. And the numbers will increase again, partly because summer is over. Interestingly, historically, child psychiatric appointments during the summer, when children are not in school, are very close to zero. Another reason to understand why the pandemic experience was so different.

That’s what’s happening in the Commonwealth, but it’s also happening across the country, and we have a lot of beds compared to other places in the United States. This remains a very serious problem.

How common are mental disorders today?

Mental disorders remain very common. Whether they are as common as our diagnostic nomenclature suggests is another question. But probably it should not be surprising that they are common.

What is unusual about them is that they tend to be disorders of young people. A lot mental disorders begins in childhood or adolescence and may include:

• autism spectrum disorders (ASD)
• attention deficit/hyperactivity disorder (ADHD)
• learning difficulties
• anxiety disorders, especially social anxiety disorder
• obsessive states
• mood disorders
• bipolar disorder

Schizophrenia also has a peak onset in the late teens to early 20s.

These are disorders that tend to be detected early and are the dominant disorders in terms of disability among young adults in the United States. What’s most likely to make you sick, disabled, or disabled in the United States when you’re 25 isn’t cardiovascular disease, it’s most likely a mental disorder, including substance use disorders. Death by suicide is one of the most common forms of mortality in the same age group and certainly results in the loss of decades of life.

Have any significant scientific breakthroughs been made to improve mental health?

We have treatments for many diseases that work better than what we had 30 or 40 years ago, but whether they are good enough is another story. Perhaps they are not focused enough. They probably have too many side effects. We have too little data on how long treatment is needed for which conditions and when it is safe to stop. We need more research on both psychotherapeutic and psychopharmacological treatments.

What is clear is that our treatments are not perfect. Of course, not everything that is emotional, existential, or human suffering is a mental disorder, even if it causes pain. Not everything that causes suffering, even if it is prolonged, is a “mental disorder.” Even if someone has what we call a “mental disorder,” it does not mean that their inner being is disordered. Mental disorders and mental experiences are partly related to the most intimate things in our lives. It is a truly privileged and personal experience.

Some of what goes on in our minds is visible outwardly through behavior, but much of what you feel is known only to you. It is not known to other people in the same way, even if there are signs, symptoms or signals. All of this makes psychiatry a very unique field of practice that should be approached with great respect for patients and with humility and circumspection for practitioners.

When we last spoke to you in 2014, the general consensus was that approximately 25% of people had some form of mental disorder. Is that number relevant today?

I’m not sure I fully trust any of those numbers, but whether it’s 20% or 25%, it’s a significant number. And the years of life lost due to or related to disability can be very significant.

If you have an illness that starts at age 90 and you live to age 93, you have three years to live with disability. But the number of years of exposure is not enormous. If you take your own life at 23 because of a mental disorder, and the average life expectancy is 75 or 80, that’s a lot of years of life lost.

Has telehealth helped create greater access for young people with mental health problems?

For patients, yes. I think it allowed care to continue during the pandemic. It is not a panacea in the sense that it does not create more clinicians or time with them. We have rules governing the practice of medicine and other treatment disciplines that require providers to treat patients only in the states in which they are licensed, even in telemedicine appointments.

Fortunately, during the pandemic, emergency rules went into effect that allowed students who returned home to continue receiving care where they went to school. This allowed them to work with their doctors or therapists out of state. Now those rules are starting to get back to normal, which is a shame because it’s getting harder for people to continue service out of state. But I really think it’s allowed for changes that we wouldn’t have seen before.

For example, Medicare has said it will continue to pay for telepsychiatry, and MassHealth (Medicaid in Massachusetts) has made the same commitment. The use of telemedicine platforms has also become more standardized, even with interstate licensing issues. But the demand for mental health services is so high that it’s been very difficult to attract people, and telehealth doesn’t automatically give you space and access to care simply because it’s a different medium than sitting in an office.

What can be done to improve access to health care and reduce the stigma attached to mental health care?

Much of this depends on how the teaching positions are funded and how those positions are funded by Medicare or health systems. Also, if the clinicians are reimbursed insurance companies at a lower rate than they could earn on their own, or if people find it difficult to use their insurance because of the amount of paperwork or the intrusion and micromanagement by outside entities is extremely high, then doctors will not take insurance. And there’s such a demand that providers will see people privately, which means patients won’t be able to use their insurance, creating barriers for many patients, especially those who don’t have the means to pay for treatment out of pocket.

Funding and financial solutions for mental health care is one area that needs significant improvement.

In terms of stigma, the most powerful antidote to stigma is openness. The more people can talk openly and honestly about their experiences of mental health and mental illness, the more it becomes something that doesn’t happen to some ‘others’ who may be stereotyped or marginalised. It becomes something that your neighbor, your friend, your colleague or your family member is trying to figure out – which of course it always has been.