APA Member Urges Congress to Act Now to Provide MH Help for People Impacted by Pandemic

During a recent hearing before a Congressional subcommittee, Lisa Fortuna, M.D., M.P.H., shared a story. She spoke of a patient, whom she called “Gloria,” who was hit hard by the COVID-19 pandemic. Gloria was forced to stop working in her home health job because she was afraid of contracting COVID-19 and infecting her children; her brother contracted COVID-19 and could not work for six months; and she experienced six COVID-19–related deaths within her extended family.

Gloria’s 11-year-old daughter developed severe anxiety because she was afraid her mother would contract COVID-19 and die. Gloria, too, suffered a relapse of major depression. “The stress and anxiety and grief from the pandemic have very real mental health repercussions for this one family—and they’re not the only ones,” said Fortuna, a member of APA’s Council on Children, Adolescents, and Their Families; a professor of clinical psychiatry and vice chair at the University of California San Francisco Department of Psychiatry and Behavioral Sciences and Weill Institute for Neurosciences; and chief of psychiatry at the Zuckerberg San Francisco General Hospital.

Fortuna spoke to the House Energy and Commerce’s Subcommittee on Oversight and Investigations during a hearing titled “Americans in Need: Responding to the National Mental Health Crisis.” The subcommittee’s goal was to gain a better understanding of the mental health challenges Americans are experiencing since the onset of the COVID-19 pandemic, especially among youth, people of color, and the LGBTQ+ community.

“Now it is more critical than ever that we understand the drivers behind the mental health crisis facing Americans and explore what more must be done to further the shared goal of supporting their mental health and well-being,” said Rep. Diana DeGette (D-Colo.), the subcommittee’s chair.

Fortuna emphasized that depression and anxiety symptoms have doubled for youth during the pandemic and emergency department visits for suspected suicide attempts are likewise increasing at alarming rates.

“As families like Gloria’s continue to grapple with the direct and downstream effects of the pandemic, we encourage the committee to pursue policies that promote access to needed behavioral health services with particular focus on extending care to vulnerable populations, including racial and ethnic minorities, and LGBTQ+ youth, among others,” she said.

She highlighted several immediate actions that Congress could take to support families and address the ongoing mental health crisis, including the following:

• Support policies that permanently expand telehealth flexibilities allowed to practitioners under the COVID-19 Public Health Emergency.

• Address health equity by focusing on policies that increase the culturally competent workforce of mental and substance use disorder practitioners.

• Prioritize workforce-building programs administered by the Health Resources and Services Administration, specifically the Mental and Substance Use Disorder Workforce Training Demonstration Program.

• Support policies and funding allocations that help federal and state enforcement agencies bring insurers into compliance with the federal parity law (Psychiatric News).

• Ensure states and local communities are prepared for the launch of the new three-digit number (988) for suicide prevention and other mental health crises in July.

• Consider funding streams to assist with the implementation of the Collaborative Care Model in primary care offices so patients can receive mental health or substance use disorder treatment in a primary care office.

Responding to a question about substance use, Fortuna emphasized that the COVID-19 pandemic has exacerbated and escalated substance use problems. The Zuckerberg San Francisco General Hospital, a public hospital, treats the city’s homeless population, she explained. “There have been more deaths due to overdoses as compared with COVID-19, which we were very worried about in our homeless population,” she said. “It is in part due to escalating stressors that people have been experiencing throughout the pandemic, but it’s also related to issues that we’ve had being able to provide continuous access to substance use treatment throughout the pandemic.”

During the hearing, Fortuna was joined by Amit Paley, M.B.A., CEO and executive director of the Trevor Project; Jacqueline Nesi, Ph.D., an assistant professor of psychiatry and human behavior at Brown University; Christopher Thomas, co-founder of The Defensive Line; and Elinore McCance-Katz, M.D., Ph.D., former assistant secretary for mental health and substance use.

The topic of how LGBTQ+ youth, in particular, have been impacted by the pandemic came up several times during the hearing. In her written testimony, Fortuna referenced Mental Health America’s online screening tool, a collection of 10 free, anonymous, and confidential mental health screens that over two million people took in 2020. Fortuna noted that among LGBTQ+ youth who took the screening, 95% screened positive for moderate to severe depression symptoms, and 88% screened positive for moderate to severe anxiety.

“Having just one accepting adult in an LGBTQ+ young person’s life can reduce their risk of suicide by 40%,” Paley told the subcommittee. “All of us here today—each of you—can be that person and can help save lives. We each have the power to make the world a more accepting place and to show our children, all of them, that they are deserving of love and respect, and that they are not alone.” ■