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We’re now in a new year and new presidential administration. At least three companies are producing effective COVID-19 vaccines, which are being administered to healthcare workers, teachers, and the elderly. By summer, hopefully a large majority of the population in most countries will be vaccinated. From where the world now stands, we can see an end to prolonged isolation, trauma, fear, grief, and economic torpor.

But out of the woods, we are not.

The virus mutates, perhaps more rapidly than expected. Maybe the existing vaccines will handle all variants. One can hope.

Of course, as everyone knows, hope is not a strategy, so strategy divided up into carefully analyzed tactics are a very good idea about now. One of those tactics needs to be dealing effectively with the mental health fallout from almost a year of living in the world COVID-19 has created.

What does that fallout look like?

Back in August, the CDC compared anxiety and depression from 2019 to mid-2020 and found the former had tripled and the latter had quadrupled. Similar studies by the Boston University School of Public Health and Johns Hopkins found that depressive symptoms and psychological distress were higher than during Hurricane Katrina and similar devastations.

If you have a fairly mobile job like software developer or marketing manager—the kind of job that requires little more than a cell phone and an internet connection—your sense of stability may not be all that upended. However, if your job is customer-facing and garners hourly wages, your life has probably been shaken up dramatically, making those already most vulnerable even more so.

According to mental health professionals, however, what you do for a living may not be the primary concern when it comes to how people respond to COVID-19. The invisibility of the virus makes it more pernicious. When a tornado or hurricane pass, life can return to normal, but a virus enables some to deny its very existence and others to fear and resent both the virus deniers and the virus itself.

“You can’t see it, you can’t taste it, you just don’t know,” said Charles Benight, an academic who specializes in post-disaster trauma. “You look outside, and it seems fine.”

Evaluating the COVID-19 pandemic from a behavioral health perspective elevates two questions: How will the economy get back to normal if people are still afraid to engage in normal daily activity? AND What does COVID-19 reveal about our existing mental health system?

It’s the Virus, Stupid

As a campaign consult for presidential candidate Bill Clinton in 1992, James Carville boiled the keys to winning down to three short messages, one of which was, “It’s the economy, stupid.”

In 2021 we might say, “It’s the virus, stupid.” Getting the American economy back up and running requires managing the virus in both real and perceived ways related to public and mental health.

Even while the federal government can fund programs that provide counseling and treatment on an individual basis (the stimulus bill Congress passed in December includes $4.25 billion for substance abuse and mental health treatment), the primary concern related to the economy is creating confidence in the safety of the public sphere.

“Consumer confidence matters,” writes Christos Makridis in Forbes. “… concerns about getting infected are closely linked with spending behavior, including going out to eat, going to the gym, and traveling. For example, 22 percent of those who are very confident that they can protect against the virus went out to eat in the past 24 hours, whereas only 11 percent of those who were less than very confident went out.”

In other words, remove the anxiety and fear from basic decisions like going out to eat and people will more often go out. This comes as a surprise to no one. So how do we do that?

In a nutshell, by pressing forward with a comprehensive program that promotes masks and social distancing while rolling out vaccines as rapidly as possible. These efforts require at least several more months of hunkering down.

But a full psychological recovery from COVID-19 is a much longer project and dovetails with how the virus may have exposed the disconnection and ad-hoc nature of our existing mental health system.

A Leaky Boat in a Typhoon

Those who spend every day working in America’s behavioral health sector have been telling us for a long time that the system, as it is sometimes called, has few systemic traits. The sizeable homeless populations in virtually every American city attest to the fact that the mentally ill and addicted fall through the cracks all the time.

So, a boat that was only kept afloat by the furious bailing of committed crew members is now in a powerful typhoon.

“If history is any indicator,” says the American Psychiatric Association’s Joshua Morganstein, “we should expect a significant tail of mental-health effects, and those could be extraordinary.” 

In a position paper on the repercussions of COVID-19, the Lancet says, “The economic breakdown that is likely to occur in the aftermath of the pandemic could exacerbate healthcare disparities and will probably disproportionately affect socially disadvantaged patients … Sooner or later, health systems will be faced with widespread demand to address these COVID-19-related mental health needs.”

Also, note a few complicating factors unmentioned in the previous perspectives, namely that the country has been roiled by months of protests, political unrest and questionable tweets.

Admittedly, leaning on a broken mental health system to reduce fear and anxiety enough that citizens feel comfortable enough to fully engage economically is not a great place to be. Still, with the existing federal funding, states can take the lead in creating consumer confidence.

The first course of action is probably to expand facilities and providers. In many of America’s more rural areas—Alaska and Oregon, as well as most of the Rocky Mountain states and much of the deep south—services are few and far between.

The Center for American Progress calls for the continuation of expanded funding even after the virus abates, and also a more concerted effort to make sure all citizens have health insurance and that insurance includes mental health care.

These are only a few of the numerous recommendations made for improving America’s healthcare system. Of course, those recommendations have been made countless times before. Will this time be different? Maybe, because of dollars. This time it looks like the healing of America’s economy has to also include also healing America’s psyche.