As one of a small group of people working to develop and deploy COVID-19 testing at the very start of the pandemic, I witnessed both major blunders and genius breakthroughs, but what sticks with me most about that period is the speed and single-mindedness with which everyone took action.
While there’s nothing like a highly contagious virus bearing down on lives and economies to make people prioritize, I hope that society can now apply that same sense of urgency to another pandemic (though not yet globally recognized): the U.S. mental health crisis.
Despite the obvious differences between these two health crises, there are lessons we learned during the COVID-19 response that can and should inform our response to today’s record levels of depression, anxiety and other mental health conditions that destroy lives, hurt families and cost the global economy more than $1 trillion in lost productivity.
These are four takeaways from my experience on the front lines of the COVID response that we should use to accelerate mental health solutions.
Plan for surge capacity
While those of us standing up wide-scale COVID testing had to grapple with supply chain bottlenecks from insufficient access to chemical reagents and simple cotton swabs, the healthcare system was unable to supply therapy and psychiatry to the surge of people suddenly in need of mental healthcare.
Many providers were booked to capacity, others may have had capacity but weren’t well-equipped to move to virtual care. In some cases, payers only covered in-person care, so some people who managed to find an available therapist couldn’t afford to pay for it out of pocket. Although tele-mental health companies scaled to meet some of the demand by allowing people and providers to conveniently connect through online therapy, we know there are still unmet needs for mental health care, and we must stay prepared for future surges.
We must future-proof our mental health workforce by recruiting and retaining dedicated individuals into this critically important profession while continuing to optimize technology to help them meet demand for care. While I don’t believe AI will ever replace the human touch of a licensed mental health provider, there are no doubt uses for this technology to make providers’ work easier, and a place for clinically-backed self-guided applications to support individual mental health between therapist sessions.
Move from testing to screening
The earliest COVID tests were reserved for people with symptoms, but as medical experts learned that the virus had a significant incubation period and that pre-symptomatic transmission was occurring, it became clear that widespread screening of people without symptoms or exposures would be necessary for in-person events to resume.
We should similarly expand our search for mental health problems, by routinely screening before outward signs develop. Right now our country mainly has a symptomatic testing approach to mental health—when an individual experiences persistent symptoms or exhibits significant signs of a problem they reach out or are referred to a mental health provider and, if they’re lucky, can access appropriate care. But this process is often slower and less reliable than it should be, and by the time that person receives care their condition has often become harder to treat, and they’ve experienced unnecessary suffering.
Thankfully the USPSTF recently recommended that all adults be routinely screened for both anxiety and depression, and we must ensure that these recommendations are put into practice. However, since not everyone has access to or makes time for regular check-ups when this screening would take place, we should also be providing access to free therapy at workplaces and schools and promoting its use as routine, preventive care that identifies mental health symptoms early or even stops problems before they start.
Build public-private partnerships
When the initial roll-out of COVID testing was bungled and behind schedule, one root cause was the lack of a framework for a coordinated effort between public health, hospitals and commercial laboratories. Tackling a crisis of that scale nearly always requires both the public and private sectors working in tandem and during COVID federal, state, and local governments quickly saw that private companies would be critical to getting swabs in noses (and later, shots in arms) quickly.
Now I see a huge opportunity for municipalities, school districts and public health agencies to tap the existing infrastructure of tele-mental health companies to deliver therapy and psychiatry flexibly and cost-efficiently, taking the burden of hiring and screening providers and managing capacity off of the government. It’s going to take all of us to address the mental health epidemic, and partnerships between the public and private sectors leverage the strengths of both to achieve better outcomes.
Do more to close access gaps
The pandemic exposed inequities that left certain populations especially vulnerable to the virus’s worst effects, resulting in tragedy and creating additional stress on the system as a whole.
If better healthcare had reached these people before the pandemic, lives would have been saved and our country would have been more resilient in the face of COVID. We should take that lesson to reduce inequity in mental health and remove barriers that make mental health care a luxury or a nice-to-have.
We must make therapy available to everybody, and expand our idea of access to include specific modalities and types of therapy that meet the needs of the individual. Mental health care isn’t one-size-fits-all, or even one-size-fits-most. Tele-therapy can help us deliver culturally competent, LGBTQIA+ friendly, or trauma-informed care to populations that might never have had the opportunity to address their specific needs.
Doing more to reach people who have traditionally haven’t had the privilege of high-quality, personalized mental health care will bring up the baseline of mental health at the population level, making ours a more resilient, higher functioning, and simply happier society.
Jon Cohen, M.D. is the author of the new book, Swab: Leadership in the Race to Provide COVID Testing to America (Sky Horse Publishing) and the CEO of Talkspace, a leading provider of virtual behavioral health services.