Glaring omission from Biden’s Covid-19 task force: mental health expertise

The unprecedented spike in depression and anxiety that has accompanied the coronavirus pandemic points to a glaring omission from President-elect Biden’s Covid-19 task force: Mental health expertise is nowhere to be found among the physicians, epidemiologists, and public health experts.

Pandemic-related depression and anxiety are disproportionately affecting young people. While young adults have generally not been hard hit physically by Covid-19, the pandemic has had profound consequences for their day-to-day lives and their mental health. There is a pressing need for the federal government and individual institutions like universities and community colleges to address the challenges young adults face during — and after — Covid-19. The place to start is by including mental health expertise on the coronavirus advisory panel and ensuring investment in mental health access.

In our 50-state survey of more than 2,000 young adults aged 18 to 24 in late October, nearly half (47%) reported significant symptoms of depression. These don’t represent an occasional bad day — they reflect symptoms that would be severe enough to prompt a primary care physician to start treatment or to refer a patient for psychiatric evaluation. This number is about six times higher than rates observed in the general U.S. population over the past decade. Results from the U.S. National Center for Health Statistics for 18- to 29-year-olds show similar elevations in depression, with rates between 40% and 43%.

Depression seems to be one area where the country is united: We saw these elevations across men and women, across racial and ethnic groups, and across regions.

Some of the survey findings are especially worrisome. In response to a question about suicide, 1 in 3 of those surveyed reported thoughts of hurting themselves or believed they would be better off dead. Nearly 1 in 10 reported having these thoughts almost every day.

Our survey also offers some clues about the factors contributing to this spike in depression. When asked about how Covid-19 had affected their households, 51% of respondents reported dealing with closure of their school, 41% were working from home, 27% had absorbed a pay cut, and 26% had lost their jobs. Those who had experienced financial impacts — especially ones that affected their ability to pay rent — were even more likely to have experienced depression, anxiety, thoughts of death, and sleep disruption.

Why has this age group been so profoundly affected relative to the past, and relative to other adults? To begin with, they are often in low-wage jobs with less flexibility to work remotely and fewer reserves for absorbing a pay cut.

When their colleges and universities moved online, one underappreciated component fell by the wayside: mental health services. Colleges and universities typically provide a key source of mental health care for their students, frequently the first such care some students have received for conditions they may have struggled with for years. College health centers can provide a crucial safety net for young adults at precisely the age where mental illness is most likely to emerge. These schools can still accomplish a core element of their mission by teaching classes remotely. But other student needs, notably mental health services, are far more difficult to address via Zoom.

The temptation is high to invoke feel-good, no-cost solutions like mindfulness videos and meditation apps. These sorts of interventions may help manage mild symptoms. But they cannot provide other essential elements of mental health care: sorting out a diagnosis, assessing safety, determining whether additional treatment is needed, and making referrals to find the right care. For a student contemplating suicide, a guided meditation is woefully insufficient.

Addressing the mental health challenge posed by Covid-19 will require both public and private efforts. Families and friends need to learn the signs of depression and not be afraid to ask about them. Colleges and universities need to invest in expanding their mental health resources, embracing not only telemedicine but group interventions and supports.

What about the majority of young adults who don’t have a school connection but face the same family and financial stressors? While there are national helplines anyone can call to get urgent assistance, accessing care remains a challenge. A safety net does exist — albeit one that is chronically underfunded and under-resourced. A network of community mental health centers can provide excellent care in person, or increasingly via telemedicine. Unfortunately, these centers already have their hands full helping people with preexisting mental illness who are dealing with the added constraints of quarantine and other pandemic-related challenges. To accommodate an influx of young adults, they will need additional federal, state, and local support.

When she was a candidate for president, now-Vice President-elect Kamala Harris advocated for substantial investment in access to mental health care. Ensuring that the nation’s Covid-19 task force includes mental health expertise would be an important first step in this direction. Depression and anxiety are highly treatable, but only if young adults are able to access treatment. The incoming administration must use the bully pulpit — starting with including mental health expertise on the coronavirus advisory panel, and continuing with investment in expanded access to care — to draw attention and resources to this burgeoning mental health crisis. Otherwise, we risk missing yet another opportunity to save lives during the Covid-19 pandemic.

Roy Perlis is a psychiatrist, director of the Center for Quantitative Health at Massachusetts General Hospital, and professor of psychiatry at Harvard Medical School. Matthew A. Baum is professor of public policy at Harvard University’s John F. Kennedy School of Government and Department of Government. Katherine Ognyanova is an assistant professor of communication at Rutgers University.