A mental health crisis: the other cost of the pandemic 5:22
(CNN) -
Michael Siracusa was struggling.
He thought changing his prescription for antidepressants would help.
But getting an appointment was difficult.
"When I started looking for a psychiatrist on my own, I had very little luck," said Siracusa, who lives in Whitefish, Montana.
While her therapist, a non-prescribing provider, gave her a referral, there were no appointments available for six to eight weeks.
For a person battling mental health in the midst of a pandemic, that seemed a long way off.
"If I'm honest, it wasn't very good," he said.
"I felt that no matter what I was doing, I couldn't get the help I was looking for or that it was out of reach."
At a time when the ongoing pandemic is affecting mental health, many people are not receiving care at all.
Experts say the pandemic is exacerbating a shortage of mental health care providers that goes beyond the current crisis.
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Even before the pandemic, one in five Americans had a diagnosable mental health condition, according to the Substance Abuse and Mental Health Services Administration.
More than half received no treatment, according to a report by the nonprofit Mental Health America.
Inattention exacerbates the consequences of mental illness.
With nearly 41% of Americans struggling with pandemic-related mental health problems, according to a survey by the US Centers for Disease Control and Prevention, treatment is an increasingly scarce resource.
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Whether you find help may depend on where you live, who you are, and how much you can afford.
How is it for providers?
"In the beginning, I increased my hours significantly," said Akua K. Boateng, a psychotherapist in Philadelphia.
“I still have a waiting list of one to two months.
That had never happened to me before.
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As civil unrest escalated in the wake of George Floyd's death in May, Boateng received even more calls, many from people suffering from racial anxiety and trauma.
"It has been a great challenge for people of color to find and partner with like-minded and culturally sensitive professionals," he said.
"The covid has amplified that for many people."
Eventually, Boateng realized that he couldn't keep working any longer hours indefinitely, something he heard from other professional colleagues.
"I started to get a little exhausted," he said.
"I was doing all of that while I was still in a pandemic and experiencing all the things that everyone else was going through."
Everyone is working as hard as they can
"Everyone has been working as hard as they can," agreed Todd Essig, a clinical psychologist and psychoanalyst who is part of the covid-19 advisory team at the American Psychoanalytic Association.
When Essig turns down a potential patient, he offers suggestions from other doctors.
These days, they often return empty-handed.
"They come back several weeks later and check if I have any vacancies, because they haven't had better luck elsewhere," he says.
"That had never happened to me before the pandemic."
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Like Boateng, Essig emphasized that problems in mental health care predate COVID-19.
He noted declining reimbursements from insurance companies to in-network providers, which has led some professionals to decline in-network status, pushing their prices beyond the reach of many seeking care.
"The pandemic is exposing flaws that should have been fixed years and years ago," Essig said.
Disparities in care
While people in any community may face obstacles in seeking mental health care, the shortage is not evenly distributed.
"In more than half the counties, and most of them were rural, there were no mental health providers," said Paul Gionfriddo, president of Mental Health America, a nonprofit organization with a mission to serve the needs of people with mental illness.
Even in urban areas where care is theoretically available, finding a provider can be difficult.
"We have seen consistent patterns where, even if people were listed as available and accepting new patients, they were often unavailable or accepting new patients," Gionfriddo added.
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The people of rural areas are not the only people who lack it.
"There are many differences based on race, gender and age," Gionfriddo said.
Young people are the group most likely to miss out on mental health treatment.
"We often overlook children's problems," he said.
"Historically they have been the most needy populations and historically the least served."
Men are also less likely to receive the care they need, Gionfriddo said, in part because they wait longer to seek help.
And despite a greater willingness to seek care, Gionfriddo said that blacks in the United States have less access to mental health services than whites.
The LGBTQ population is also at especially high risk, Gionfriddo explained.
"People who identify themselves in that population are significantly more affected by mental health problems," he said.
"They have some of the greatest needs, but they are the least understood, recognized, and met."
Is technology the solution to the crisis?
Mental health care was in short supply before the pandemic.
Now, increased demand has made the shortage worse.
But in the fight to adapt mental health care delivery to COVID-19, remote healthcare can be a silver lining.
"It is helping by providing greater access in areas that normally had no or limited access," Gionfriddo said.
"We have advanced about 10 years in telehealth in one year."
The pandemic has also forced some changes to insurance.
"Until the pandemic, the Medicare program did not cover a telephone conversation," he explained.
"Phone calls are now refundable."
Telephone support is important because video chat may not be available to people without broadband internet.
In rural areas, that includes nearly a quarter of the population, according to the US Federal Communications Commission.
New technologies, such as text or chat therapy, are also promising, Gionfriddo said.
Different groups need different types of care and new technologies facilitate the diffusion of services among a relatively diffuse population.
"This gives us the ability to micro-focus information and resources and, indeed, generate sufficient demand within smaller communities," he added.
"It will not have to be done only at the local level."
Remote medical care will not solve all problems
But while remote medical appointments may serve areas with few providers, they will not solve America's mental health care shortage.
"It does not expand the number of providers," argued Gionfriddo.
"He just distributes them a little bit differently."
Underscoring the importance of long-term, sustainable solutions, he noted that the emotional distress related to the pandemic could last much longer than a vaccine.
"The mental health impacts of this that are being felt today will continue for many years to come," Gionfriddo said.
And, he explained, some of the most serious consequences of untreated suffering, including suicide, can take a long time to appear.
"No one will know if the suicide rate increased as a result of the pandemic for at least a couple of years," he said.
But to focus on 2020 suicide rates would be a completely wrong question, he added, because suicide is often a late-stage event that can occur after years of suffering.
"In fact, you have to look at suicide rates over the next 15 years to get an idea of how deeply the pandemic affected the mental health of the nation," Gionfriddo said.
Find and ask for the help you need
If you're looking for mental health care, experts say it's important to start right away.
Despite the shortage, help is available.
If you have health insurance, a good place to start is by calling the insurer's information line to request contact information for in-network providers.
Otherwise, community mental health centers are an important resource.
Referrals are also available through the Substance Abuse and Mental Health Services Administration.
After weeks of phone calls and delays, Siracusa found a psychiatrist who could prescribe a new prescription for antidepressants.
It made the difference.
"Since I changed my medication, I felt 100 times better," he said.
"Not everything is as difficult as it used to be, which is a great relief."
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One problem, Siracusa said, is that symptoms of depression and other mental illnesses can make it difficult to stay motivated while seeking care.
It's easy to give up when things feel so difficult.
If that's what you're struggling with, Syracuse recommended asking a loved one for logistical support.
When he told his wife about the care shortage, she volunteered to make calls on his behalf.
"That was really useful," he said.
It took the burden off me.
Referrals to mental health services in your area are available, in Spanish and English, from the Substance Abuse and Mental Health Services Administration (SAMHSA) hotline: 1-800-662-4357 .
coronaviruscovid-19 Mental Health