September 17, 2020 – By Phil Wyzik
After the COVID-19 pandemic passes, and it will eventually, it is easy to understand the hope people have that our nation and the world will slowly get back to normal.
Who could deny that our lives were far simpler before the virus first surfaced? The subsequent months of tragedy and massive disruption have taxed us all and brought many people and economies to their knees. So it’s natural to long for an end to the pandemic so that we can put the masks, the physical distance, the worries, and uncertainties behind us.
However, as a professional in the field of mental health these past several decades, I really don’t want to go back to the pre-COVID normal. From my point of view, that world had insufficient consideration, support and acceptance of issues that challenge people’s mental well-being. That normal was when mental illness was pushed to the fringes of health care and society at large. Go back there? No thank you.
In 2017 a landmark report titled “Pain in the Nation” was issued by the Trust for America’s Health and the Well Being Trust. It documented that deaths due to suicide, alcohol, and drug use totaled up to 127,500 in 2015. They computed that the number might be between 178,000 and 287,000 by 2025; and coined the term “deaths of despair” to describe this epidemic and the tragic consequence of emotional pain, disconnection, and lack of opportunity.
If that’s what was going on before COVID-19, I suggest we go someplace better than the recent past when all this is over so that people suffering from the afflictions of substance abuse or depression won’t feel that death is a better alternative to the insufferable pain they are experiencing. In the meantime, this epidemic continues to escalate within the global health crisis we’re fighting and is getting more serious every day.
Even before the virus raced across the globe, the United Nations called statistics on mental health worldwide “stark”: 265 million people suffering from depression, 76% to 85% of people in low- or middle-income nations with mental health conditions receive no treatment, one mental health professional for every 10,000 people, and human rights violations against people with severe mental health conditions widespread in all countries of the world. That’s another reason we might not want to get things back the way they were.
Know clearly, too, that in the United States, people in poverty and people of color already carry the burden of the toxic stress and trauma of racism. They were suffering from health disparities even before the virus hammered down. National protests about racial injustice exploding in cities all over America have arisen from deep and systemic problems that have been in our culture for centuries. That’s not a “normal” we should be proud of nor aspire to.
Consider, too, that before the public ever heard the term “coronavirus,” the U.S. health care system divided physical health on one side and mental health on the other. The separation was cultural and structural dating back to the Kennedy administration in the early 1960s. Efforts to connect these two systems of care were sparse and considered “cutting edge.” Perhaps that’s why people with mental health challenges have life expectancy that is decades shorter than those who don’t.
But today, the link between the physical and psychological impact of COVID on people is easy to see, even on those not infected with the virus. Ask anyone who’s unemployed, alone, and isolated, or stressed to their breaking point as a consequence of a physical virus we have been thus far powerless to stop. After COVID, I hope we can find the right path to use a whole-person approach to health that will benefit everyone.
To me, there’s nothing nostalgic about how our nation has built the majority of its fragmented health care system on an employer-based business model in which providers of health care are paid fees dependent upon the specific service they render. Not only does this fail when unemployment strikes or when an employer can’t offer insurance to workers, this system rewards the volume of services provided and not the value in the health outcomes achieved. Thus, hospitals and other providers needed to build lean operations that used every resource to the maximum efficiency but had little room for surplus beds or supplies or staff – the exact things needed when a surge in demand from a health emergency happens.
In the early months of 2020, we saw states scrambling for things like PPE and ventilators and the personnel needed to address the crisis. In some places, while the Emergency Departments were overflowing, other staff in the same hospital were being laid off or furloughed because non-COVID patients were avoiding care. I’m sure we don’t want to go back to the financing models for health care that are so fragile and incomplete.
Lastly, realize that the federal government and many states viewed public health as a less important aspect of government, an easy target for budget cuts. Considering the massive amount the United States spends on health care, a measly 2.5% goes to the public health services that prevent illnesses and will prepare us for the next pandemic, according to Ed Yong in the recent issue of The Atlantic Monthly. Given what we’ve experienced with COVID-19, that “normal” does not seem wise. He eloquently sums up what this crisis might teach us: COVID‑19 is an assault on America’s body, and a referendum on the ideas that animate its culture. Recovery is possible, but it demands radical introspection. America would be wise to help reverse the ruination of the natural world, a process that continues to shunt animal diseases into human bodies. It should strive to prevent sickness instead of profiting from it. It should build a health-care system that prizes resilience over brittle efficiency, and an information system that favors light over heat. It should rebuild its international alliances, its social safety net, and its trust in empiricism. It should address the health inequities that flow from its history.
Along with introspection, it might also take courage. Let’s hope that what lies ahead after COVID-19 is crushed is a nation that really has found its way to a far better normal.
Phil Wyzik is CEO of Monadnock Family Services in Keene