Not Sick Does Not Mean Well

Every morning, I check the daily stats on COVID-19 cases, hospitalizations, and deaths in my area. Like many others, I’m trying to discern patterns: Are the upward or downward trends continuing? Are we peaking or is the trough turning upwards? How is the health care delivery system holding up? I’m trying to make sense of the data to inform decisions: whether to open the office, host an in-person event, take the subway, or dine indoors. 

Of course, there are real people and families behind every statistic. Yet, New York’s strikingly high numbers—over 2.6 million cases and 58,000 deaths so far —vastly under-represent the actual pain New Yorkers have encountered. Even for those who haven’t directly suffered the physical consequences of COVID-19, the mental health impact can be significant and has left virtually no one untouched. It’s grieving for loved ones; loneliness and social isolation; anxiety from economic insecurity; constant exposure to death and dying for our health care workers; persistent fear of contracting COVID; adjusting to in-person school or work—and the list goes on.


So even if we’re not physically sick with COVID, it doesn’t mean we are okay or “well.” Although definitions vary, one’s well-being generally requires both physical and mental health. Even before the pandemic, approximately one in five adults suffered from mental illness, and it was a leading cause of premature death and disability. Countless others experience symptoms of stress, depression, and anxiety that may not meet the criteria for illness but are nevertheless impediments to well-being. 

The pandemic has introduced a whole new set of stressors, and now we’re seeing the devastating consequences unfold. For instance, since the start of the pandemic, drug overdose deaths have risen sharply after a two-year period of relative stability. Several months into the pandemic, there was marked rise in adults with symptoms of anxiety and depression. And in our own research at UHF, we have quantified the long-term impact on children of the mental health trauma of parental death due to COVID-19. Just as there are long-haul COVID cases, there will likely be long-term mental health effects—even after we emerge from the acute phase of the pandemic. 


Before the pandemic, less than half of U.S. adults with mental illness were receiving treatment each year. There are a variety of reasons for this. As with physical health issues, cost, insurance coverage, and other problems related to access and accessibility can be real barriers. However, unlike most physical health issues, stigma is an additional impediment to seeking mental health care. Prejudice and discrimination against people with mental illness are substantial and pervasive in our society. Stigma around mental illness can be especially strong in some already underserved cultures and communities. In addition to preventing people from seeking care, it can exacerbate symptoms and worsen prognosis.   

Addressing stigma requires a multi-pronged approach, including encouraging open dialogue about mental health. That’s one reason United Hospital Fund was so pleased to recently honor Kenneth Cole and his work with The Mental Health Coalition to end the stigma surrounding mental health. (Please see a story on our Gala here.)


Beyond reducing stigma and encouraging people to seek help, health care providers have a special responsibility to proactively screen for and address mental health issues. Children have been exceptionally vulnerable to the mental health effects of the pandemic, with many having difficulty coping with the disruptions to learning and socialization. Supporting their mental health needs now is critically important for promoting life-long health and wellness. In our statewide Pediatrics for an Equitable Developmental Start Learning Network, integrating behavioral health screening into routine well-child visits is one of the five core building blocks for change. This contributes to prior work we have supported involving a framework for integrating behavioral health screening and treatment into adult primary care practices. On a policy level, changes can be made to better fund and support mental health care, improve access and accessibility, and address social issues that affect mental health.

We are all familiar with the newsreel scenes of the COVID-19 pandemic showing patients crowding overwhelmed hospitals. As we follow these stories and the accompanying numbers and charts, let us not forget about a parallel mental health crisis that may not be as visible but nonetheless also demands our attention and compassion. 

Oct. 22, 2021