woman in despair
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The Covid pandemic may appear to be on the decline in the United States, but some experts are saying we have yet to witness another, still unfolding wave of illness and death — the mental health crisis that has been called the fourth wave of the pandemic.

ClearHealthCosts spoke to patients and experts around the country for a snapshot of Covid’s developing mental health effects.

There’s a long wait for mental health services

For months, Padraic Harrison knew he needed counseling for preexisting post-traumatic stress disorder, but without insurance, he knew he couldn’t afford it. When Harrison, an actor in Chicago, finally got health insurance through the HealthCare.gov marketplace in June of 2020, he thought the wait was over. It wasn’t.

“I called two places. One, the phone just rang and rang and rang and then it hung up on me. The other said ‘leave a message and we’ll get back to you,’” he said. “I left a message. No one got back to me.”

Harrison is not alone. Millions of Americans are having to wait months to access professional help from a therapist or psychiatrist, while some never do.

Lack of access to mental health providers is not new, but the pandemic made it worse.

Likewise, America’s mental health has been a problem for years, but it worsened in the Covid-19 pandemic.

“The lack of behavioral health support and infrastructure in the United States is like a core component of our broken infrastructure,” Joe Grundy, a healthcare industry consultant in Washington, D.C., said in a video interview.

Even before the pandemic, 19% of U.S. adults experienced mental illness, according to a report from the nonprofit, Mental Health America. The same report estimated that nearly a quarter of those people were not able to receive the treatment they need — a number that has not declined since 2011. And a 2018 report from the National Council for Mental Wellbeing, a nonprofit that represents practitioners and treatment organizations, said that the number of certified psychiatrists per person in the U.S. declined by 10% between 2003 and 2013.

Then, early last year, the already-stressed system got slammed by the pandemic and the resulting devastation on the economy.

Researchers at Pew found there was a spike in mental distress as early as the first month of the pandemic among adults without pre-existing mental health conditions. By early 2021, the share of adults reporting symptoms of anxiety or depression had jumped to 41% according to data from the U.S. Census Bureau and the Kaiser Family Foundation. That’s nearly quadruple the share from 2019.

“Suddenly, there was this ramped-up demand,” Grundy said. “And it just tipped the scale.”

The problem is not affecting everyone equally

The Covid crisis is exacerbating another pre-existing trend in mental healthcare: the divergence between those who can and can’t afford intervention.

“There’s a broad trend towards — psychiatrists, specifically but I would say, all behavioral health services — moving to cash-based pay,” Grundy said. “Which makes it really hard for a good majority of our country to access those services.”

That means even people with insurance have trouble accessing counseling or psychiatric care because those providers are not likely to accept insurance.

In 2014, an investigation in the Journal of the American Medical Association found that only 55% of psychiatrists accepted insurance, compared with 89% of doctors in general.

Kids and teens

While almost all segments of the population have seen a deterioration in their mental health, children and adolescents, certain ethnic minorities and people who can’t afford to pay for psychiatric treatment have fared worse than average.

The Centers for Disease Control reported that emergency room visits for kids with psychiatric complaints rose to alarming levels in 2020. Between April and October, the share of mental health-related visits for children jumped by 24% and for adolescents jumped by 31% compared to the previous year. Another CDC report found that emergency room visits for teenagers who attempted suicide rose in 2020 and 2021.

There are other things that worry doctors besides the published numbers.

“Most of the abuse that children encounter growing up is in the home,” Dr. Stan Sonu, physician and faculty member at Emory University, said in a telephone interview. The lockdowns of 2020 and 2021 translated to kids spending more time at home, where they are most at risk.

“The data isn’t out there yet, but we’re anticipating that there’s been a significant increase in childhood maltreatment across the board.”

Sonu said this especially worries doctors because childhood maltreatment can have long-term effects on not only children’s mental health but also on their physical health and even social wellbeing — how well people do in society.

“We know that people with a high number of adverse childhood experiences are more likely to not finish high school. They’re more likely to be unemployed. They’re more likely to have financial instability,” Sonu said.

Racial and ethnic disparities

The mental health toll from the pandemic is hitting vulnerable groups harder, just like the virus did.

A Mental Health America study found that while rates of anxiety and depression increased during the pandemic for almost all racial and ethnic groups surveyed, African Americans had the greatest jump.

And while many were relieved by early data suggesting suicides were actually down overall in the first year of pandemic, that was not the case for all groups. Research at the state level is beginning to paint a devastating picture for some.

Doctors at Yale University found that the suicide rate increased among racial minorities in Connecticut. Researchers at Johns Hopkins University found that, in Maryland, suicides for African-Americans appeared to double during the lockdowns of 2020. At the same time, suicides among white Marylanders dropped dramatically. The authors suggest higher suicide rates reflect the harsher impact Covid had on these communities in terms of infection rates, deaths and economic impact compared to white people.

Disproportionate rates of Covid-related traumas like suicide can in turn set the stage for future distress, driving mental health outcomes for these groups further apart, Dr. Sonu said.

“People who’ve experienced trauma have a lower threshold by which they then become activated or frustrated or, in an extreme case, have a panic attack or get really anxious or depressed,” he said.

“The entire world has just gone through that [trauma], right? But not equally. People who were already in a vulnerable position, are that much more vulnerable now.”

Virginia Jeffries

Virginia Jeffries is a journalist in New York City. Since 2020, she has reported on long...