America's shadow epidemic
America’s mental health crisis began long before the coronavirus pandemic did, but a year and a half of loss, stress, isolation and treatment disruption has only increased the number of Americans struggling with their mental health.
Why it matters: As demand rises well beyond pre-pandemic levels, the system is facing burned-out providers and staffing shortages, and even more people who need care aren’t getting it.
The big picture: Mental health care was already inequitable and in short supply before the pandemic.
But the number of people reporting symptoms of anxiety or depression skyrocketed during the pandemic and has remained high.
Substance use has increased as well, and an alarming number of children and adolescents are showing up in emergency rooms seeking mental or behavioral health treatment.
"The pandemic has created an extraordinary sense of loss in many people's lives, and it's created abrupt change with great uncertainty about when that change is going to end. And that has really turned many people’s lives upside down," Surgeon General Vivek Murthy said in an interview.
Driving the news: A group of children's health care organizations this month declared a national emergency in children's mental health.
The Biden administration this month released a set of recommendations for schools and providers on how to support students with behavioral health needs. It also put out a new overdose prevention strategy.
Meanwhile, many state psychiatric facilities are short-staffed and running out of beds, Kaiser Health News recently reported.
State of play: Not everyone will bounce back once the stress of the pandemic fades.
"The pandemic has been a source of trauma for many people, and when you think about it in that context, the effects of trauma take time to resolve," Murthy said. "And they don’t always resolve on their own — they don’t always resolve by removing the source of the trauma."
"As things start to get normal, the full brunt of the trauma they’ve been through starts to surface in their lives, and they have to deal with that," he added. "So that’s why I think this is the right time for our country to have a conversation about mental health."
What we're watching: Plenty of people who are struggling with anxiety or depression will be OK if they learn effective coping skills or gain access to treatment.
But public experts fear that if left unaddressed, some people's mental health struggles will only get worse.
"All mental illness tends to make people more vulnerable to addiction, partly because people find that a lot of these medications and substances that can be addictive are helpful in dealing with the mental health issues they’re having," said Marcus Plescia, chief medical officer of the Association of State and Territorial Health Officials.
And not everyone has equal access to care. In fact, some of the same people hit hardest by the stresses of the pandemic — like low-income families or people of color — may be most at risk of not getting the mental health treatment they need.
The bottom line: We may be exiting the worst part of the coronavirus pandemic, but we're just beginning to grapple with the subsequent mental health epidemic.
We have the opportunity now to do better than just go back to how things were in 2019, Murthy said.
"If we just flip back to how we were pre-pandemic, we will have lost a powerful and important lesson from this pandemic, which is [that] we have to invest in our mental well-being.”