COVID-19 Pandemic Perspectives: Will COVID-19 Change the Way We Look at Mental Health and Substance Misuse?

Disclaimer: The views presented here are of the authors and do not necessarily reflect the views of United Hospital Fund, its staff, or its board of directors. 

For at least 60 years, behavioral health leaders have been educating, advocating, and at times, pleading with the physical health care system to see people for who we are—beings with biological, psychological, and social needs (a concept known as “biopsychosocial”). We’ve gained ground over that time and have found ways to connect these needs through work that advances a “whole health approach.” Yet, we have fallen short. Stigma surrounding mental health and substance use is a powerful force that drives people away from accessing care and into the shadows. The U.S. health care system has failed to connect the dots and to see the emotional dimensions of health care that make us human; these aspects influence the choices we make every day and can all too often lead to illness and early death. Social determinants and behavioral health interventions are mascots on the field of health care but are not really seen as players. 

Starting on March 1, 2020, COVID-19 changed everything. A pandemic of epic proportions in New York City is creating a major shift in behavioral health that no one saw coming. In this seminal moment, our leaders are speaking with as much zeal about the emotional effects of COVID-19 as the physical effects.  Almost overnight, several major changes have taken place. 

Virtual Behavioral Health Care for All People, All Payers

In an amazing feat, government has created unprecedented access to care via telephone or video for all New Yorkers. This capability has long been requested and is of great interest to providers and patients.  All health care providers are working to figure out this new normal. Virtual care is different. Techniques and tools need to be adapted, and importantly our patients need time and support in adjusting to virtual care. The crucial message here: We are struggling as one health care system, simultaneously learning how to scale virtual care. Collaboration and care integration are changing in a virtual care world in new and exciting ways.  

Social Distancing Is Creating Social Isolation

Pandemics are not very discerning. They affect everyone—none of us is immune. Our societal need to socially distance, the risks for frontline caregivers of exposing themselves and their families to COVID-19, and a never-ending barrage of news have led to fear, anxiety, grief, and vulnerability. People are talking about their emotional reactions and feelings of helplessness. As Dr. Brené Brown so eloquently reminds us: “We are hardwired to connect with others—it's what gives purpose and meaning to our lives, and without it there is suffering.” The pandemic has shed more light on the psychosocial elements of our well-being. New York governor Andrew Cuomo speaks to the emotional aspects of COVID at nearly all his daily briefings. Across the city and state, support, treatment, and pathways to recovery are being recognized as highly valued elements of good health care.

COVID is a Mighty Foe and has Depleted our Supplies, Tools, and Options

We are coming together in New York State to ensure that our hospital system will see us through and not be overwhelmed. We are doing what we can to gather needed space and supplies. Both are constantly falling short, yet we are doing the best we can with what we have—to save every life that we can. This is our collective calling. The hospitals have rightly been a keen focus, but it is critical to see that all players on the health care field have made heroic contributions. Our crisis teams, 24/7 staff in residential programs, and our homeless shelter teams have been showing up every day—mostly without protective gear—to continue to take care of those who are ill and most at-risk. Let us not forget to clap for these heroes too. Without them, our hospitals would have experienced a much greater surge.  

There is no playbook as we move through COVID-19. It is a blessing that we have a clean slate to work with going forward. It is in our DNA as Americans to find opportunity in adversity: the American Revolution was the birth of our nation, the Great Depression spawned Social Security, and President Johnson’s Great Society in the 1960s was a response to profound poverty. 

I see an E Pluribus Unum (“from many, one”) moment making itself available to our health care system. That system is starting to become more responsive to the biopsychosocial needs of our heroic workers, very ill patients, and their socially distant loved ones.

What will we learn from this? What will each of us do? What will we collectively do to act on this moment of unity and become better for it?

Kristin Woodlock is CEO of Woodlock & Associates and a consultant at the National Council for Behavioral Health. 

United Hospital Fund has a long history of bringing together diverse perspectives to address critical challenges in health care in New York. In the current crisis, it’s more important than ever to hear from all parts of the health care system. Today’s commentary from Kristin Woodlock, CEO of Woodlock & Associates, offers a look at how COVID-19 is shaping attitudes toward behavioral health – UHF President Tony Shih


April 13, 2020