You’re looking for bodies; you’re trying to save lives.
Mental health authority Debra Wentz said that was the immediate response to the Sri Lanka tsunami that she narrowly escaped during a trip for a friend’s wedding in 2004. The devastation from that event reportedly led to more than 30,000 deaths.
Wentz, CEO and president of the New Jersey Association of Mental Health and Addiction Agencies, said what came next should be taken as a lesson for the COVID-19 crisis ravaging the United States: It wasn’t until six to 18 months after the tsunami’s waves rolled back that it became apparent Sri Lanka was facing a mental health crisis.
The medical community might be dealing with a previously unknown microbe in the coronavirus, but the mental health industry knows its enemy all too well. The threats on the horizon are the same mental health issues already affecting the 500,000-some children and adults served by the members of Wentz’s trade association. The industry just expects a lot more of those already-prevalent issues.
And the grim outcome could also be a rise in so-called deaths of despair, or the loss of life due to drugs, alcohol or suicide. Mental health foundation Well Being Trust projects that the economic effects from COVID-19 alone could lead to about 65,000 more deaths of despair over the next decade, with New Jersey accounting for at least 2,000 of those — based on studies that have found correlations between rises in unemployment and these tragic deaths.
At least when it comes to drug-related deaths, the COVID-19 spike in May coincided with more overdoses than any month over the past three years, a statistic attributed to the state’s Office of the Chief Medical Examiner data.
“For a number of reasons, I believe it’s not overstating it when people say the mental health and substance use impact of COVID-19 really amounts to a second pandemic,” Wentz said.
As the spread of COVID-19 levels off in the Garden State, Wentz said mental health and addiction service providers are getting a local sample of what the pandemic’s next form might look like — as well as what some of the challenges might be. But there are two conflicting trends: Demand for mental health services is way up; providers’ revenues are way down.
After taking the bottom-line beat-down that most businesses have faced, Wentz said the providers involved with her industry group are consistently reporting revenue declines as high as 25%. As early as April, providers started having to run projections on whether their nonprofit or for-profit organization would be able to keep its doors open due to the lower volume of services being provided across the health care continuum.
In a recent survey from the state’s Association of Mental Health and Addiction Agencies, 60% of respondents anticipated closing programs if things didn’t change. The income loss — as steep as $75,000 in a two-week period for one organization, according to the association — was due to people not taking public transportation to participate in programs and other pandemic-related costs.
At the same time that programs are forced to cut back, Dr. Petros Levounis, who serves as both professor and chair of the Department of Psychiatry at Rutgers New Jersey Medical School and chief of service at University Hospital in Newark, said the pandemic is bringing new cases of post-traumatic stress disorder, or PTSD, as well as some new-onset substance use disorders.
“We’re not quite sure how many will develop these psychiatric conditions due to COVID-19, but from other crises in the past from which we can make extrapolations … what we know we’ll see a lot of is worsening of existing conditions; and we do see relapse,” he said. “That part is well-traveled.”
Wentz’s assessment of the situation agrees with that: The biggest need might come from individuals who were on a path to recovery from these issues, but stumbled during the pandemic.
“Some who previously receiving treatment and no longer needed it have returned to anxiety, stress and depression that results from the isolation the pandemic has required,” she said. “Someone early into addiction treatment, engaging with groups, having a lot of support … might’ve been having success, and then they were suddenly isolated and alone, plus, given stimulus money that they could use to go out and buy drugs.”
It’s a perfect storm, Wentz said.
And it cuts across all generations. Dr. Anita Chopra, a geriatrician who runs the Rowan New Jersey Institute for Successful Aging, added that — from what she’s seeing — New Jersey’s older population has suffered a significant mental health blow during the state’s lockdown response, one that will take years to overcome.
Also from within the industry, Dr. Carlos Rueda, chairman of the Department of Psychiatry at St. Joseph’s Health, noted that younger front-line workers have been a significant part of the recent uptick in outpatient psychotherapy visits.
When “the trauma of witnessing mass casualties,” is what Rueda cites as a reason for it, it’s a frightening indicator of what’s spawning today’s mood and anxiety disorders.
Rueda said his department is busier than he’s ever experienced. However, he added that it’s as clear to him as it is to others in the industry that, despite the increasing need for services, the pandemic hasn’t been a boon for the bottom line for behavioral health service providers.
Especially outside of health systems, Wentz said, mental health programs have been financially stressed since before the pandemic. Funding shortfalls were exacerbated when the pandemic called for a host of new expenses: telehealth platforms, more robust sanitation as well as personal protective equipment, or PPE, for staff.
“These have been huge costs, and never anticipated in budgets,” she said. “On top of that, it’s hard for some providers to obtain a sustained supply of PPE due to the shortages and the fact that everyone’s clamoring for it. And federal and state governments haven’t really recognized mental health providers as essential health care workers who are in need of these supplies.”
Wentz is hoping for more recognition. Her industry is finding some support from the government, but not enough — by far, she said — to meet the snowballing need.
She argues that the industry’s fiscal challenges — inadequate reimbursement being one of them — mean it can’t afford to be passed over in the state’s budget process.
“Our budget outlook is daunting,” she said. “We’re advocating for current funding levels to be sustained, but what we really need is increases for the continuum of services for children and adults.”
Those in the industry come back to a constant refrain: We’re in uncharted territory.
And, no matter how many cues the industry might get from past events, psychiatrists such as Levounis say those lessons can only tell you so much. This crisis is far less acute, he said.
“You get something like 9/11, which was caused major stress as a result of the event, and then you have a trajectory of recovery,” he explained. “With COVID-19, all of us were in April thinking this would be a two-month story at maximum, and then we’d pick up the pieces. Here we are in August and the pandemic is far from over.”
Helping the helpers
Michele Acito of Holy Name Medical Center is one of those on the inside, where the COVID-19-positive patients sometimes disappear to … without friends, without family.
Those on the inside — they can only tell people what happened later.
Acito said that can be an isolating feeling, but it’s something health care workers all relate to. So, the Teaneck-based care center where she’s chief nursing officer has been encouraging front-line staffers to talk about it during what the organization calls “resiliency rounds.”
“You can tell people at home what happened, but there’s a bond when you share an experience with someone who also dealt with it,” she said. “Someone else who could actually say: ‘I remember that. I had that same feeling.’ That was something we wanted staff to have the opportunity to do with each other.”
A common theme that’s emerged from these sessions is the feeling like these health care workers could have done something differently, Acito said — as much as there’s an understanding that everyone’s doing the best they can.
“We had a pulmonologist who talked about what it was like taking care of all these patients, and what it was like to realize there were just some patients who couldn’t be saved,” she said. “And all you had was to look to each other to understand that. Although we saved thousands, it’s always that one patient you remember.”
There was really no time to prepare for the psychic impact COVID-19 would have for “those on the inside,” Acito said. On the other side of an exacting surge of local infections, that’s only now starting to be addressed in a way that leaves less front-line workers feeling left out.
“And, given how positively everyone has responded to these sessions, I’m hopeful,” Acito said.