• Research on the social consequences of large-scale disasters – both human-made and natural – tells us that we can expect spikes in depression, PTSD, substance use, domestic violence, and a broad range of other issues.
  • Dynamic delivery and triage systems for mental health sufferers have been boosted by COVID-19. The momentum should continue.

With most illnesses comes the small consolation that others share an experience like your own. Less so with COVID-19. The symptoms of the SARS-COV-2 virus run the gamut; in one person, they could manifest as a head cold and a muted sense of smell. Another might experience nausea and chills. A third could feel a tightness in their chest that only becomes worse with time until they find themselves on a ventilator, terrified and profoundly alone.

The idiosyncratic nature of COVID-19 only adds to the eerie feeling of isolation the world is currently experiencing. And though the physical symptoms will blessedly pass for most who contract the virus, the shared psychological damage of social distancing may not be so quick to heal.

We humans are deeply social creatures, and even after the disruption comes to an end, history tells us that the ghost of COVID-19 will stay with us for much longer. This is the long tail of COVID-19 – an increased mental health burden that will be felt the world over and must be addressed in concert with the virus itself if we are to emerge from this crisis stronger, more resilient, and more connected.

Though the literature on past pandemics is limited, research on the social consequences of large-scale disasters – both human-made and natural – tells us that we can expect spikes in depression, PTSD, substance use, domestic violence, and a broad range of other issues.

Yet we have learned important lessons from these events, and we are now equipped with the know-how and technical ability to blunt many of the worst outcomes.

If we act with speed, determination, and empathy, our response to COVID-19 could serve as an opportunity to rethink how we handle mental health in the future.

We spoke with Dr Sandro Galea, Dean of the Boston University School of Public Health, on how to move toward this goal. He suggested we begin with the following three steps, which are detailed here.

“This difficult moment in time nonetheless offers the opportunity to advance our understanding of how to provide prevention-focused, population-level, and indeed national-level psychological first aid and mental health care, and to emerge from this pandemic with new ways of doing so. The worldwide COVID-19 pandemic, and efforts to contain it, represent a unique threat, and we must recognize the pandemic that will quickly follow it—that of mental and behavioural illness—and implement the steps needed to mitigate it.”

— Dr Sandro Galea, Dean of the Boston University School of Public Health

1. Digital solutions used early can help with loneliness and isolation

We are fortunate enough to live in an era where physical distancing does not inevitably mean isolation. Myriad innovative solutions have sprung up to replace normal interactions, both in and out of the workplace.

These exemplars should be built on. Extra efforts must be made to reach vulnerable populations such as the elderly, undocumented immigrants, and homeless populations who may not have easy access to digital tools, as well as those who were already experiencing mental illness, depression or loneliness prior to the pandemic. Furthermore, it is essential to develop and maintain routines, even if they have been switched to digital, for example for children and students learning without physical interaction.

2. Build systems of observation, reporting, and intervention

Tragically, one of the well-documented consequences of shelter-in-place requirements is an increase in domestic violence and child abuse. The global increase in domestic violence is often referred to as a “shadow pandemic”, arising from Covid-19 related confinement with abusers, during a time of increased tension over financial and health security, and with fewer safe spaces available for victims.

In response, international organizations, governments and civil society have launched awareness campaigns, increased funding to domestic violence prevention and enlisted essential workers to look for and help those abused.

We must ensure that physical distancing does not come at the cost of safe spaces and discreet reporting mechanisms for vulnerable populations who need assistance escaping their current situation. These services will be relevant long after the pandemic ends to support those facing domestic violence.

3. Bolster our mental health capacity using ‘stepped care’

Globally, mental health systems were already straining before COVID-19, and it will be essential that we consider novel approaches to triage care in the coming months. ‘Stepped care’ is the practice of “delivering the most effective, least resource-heavy treatment to patients in need, and then stepping up to more resource-heavy treatment based on patients’ needs.”

This method can encompass several innovative practices. Training in psychological first aid for communities and individuals who have not traditionally been part of the mental health ecosystem could help take some of the burden off the shoulders of overworked professionals. Telemedicine and virtual psychological and psychiatric visits could cut down on the necessity of in-person visits and ensure care is delivered as rapidly as possible. Dynamic delivery systems can be created to make sure medications are consistently available for those who need them.

The first half of 2020 has shown how in a few short months, health systems have adapted to the new normal by breaking down regulatory barriers that were previously seen as insurmountable, reaching out and caring for patients in new and innovative ways.

Our shared solitude has shown us that we are not alone, that we are all deeply and inevitably connected. If we can build on this with radical empathy and innovation, the prevention of mental health problems and the efficient distribution of treatments offer an opportunity to not only minimize the damage, but improve outcomes.