Blog July 27, 2020

COVID-19 and Mental Health

As the coronavirus pandemic continues, a different set of serious health problems has been exacerbated. COVID-19 infections, social distancing necessities, and shutdowns of schools, jobs and businesses have led to a surge in mental health issues, including severe anxiety, increased substance abuse, depression and domestic violence. Moreover, the stresses induced by the pandemic have been further multiplied by the national social protests and unrests in the United States during June, triggered by the death of George Floyd.

Frontline health workers in particular have faced extraordinary levels of stress, leading to job burnout, high incidence of depression and post-traumatic stress disorder, and increased suicide risk. Shift workers in low-paid but essential jobs have been forced to jeopardize their health (and endure much higher infection rates according to a San Francisco population study) for a paycheck, and millions have lost jobs. Social isolation and separation from family and friends have affected most people. Those facing long-standing health inequities – minorities, the elderly, rural residents, disabled individuals, and the impoverished – have also seen their situation worsen.

The National Center for Health Statistics (NCHS), partnered with the U.S. Census Bureau’s Household Pulse Survey, reported at the end of May that 30-31.2% of adults age 18 and older had symptoms of anxiety and/or depression since January 2020, compared to 8.2% of adults during the same period of 2019. Younger adults, ages 18-29, appeared to be suffering the worst, with 40.5–43.9% reporting symptoms. Black Americans were more likely to be affected than the white population, with 40.5% reporting symptoms compared to 33.1%. Since May, the incidence of coronavirus infections within the United States — and related stresses — have continued to increase. Many experts say the full psychological fallout of COVID-19 has yet to show itself.

Even before the arrival of COVID-19, mental health issues in the United States had reached crisis status. Suicide rates rose 33% between 1999 and 2017, and in 2018, 1.7 million people were reported to have an opioid use disorder.

The ability of those affected to find help has been mixed. Residential and outpatient mental health and addiction treatment centers have been struggling, and according to a survey by the National Counsel for Behavioral Health, 92.6% of both residential and outpatient centers have had to cut programs and furlough employees. Nearly two-thirds of those surveyed have only enough cash to last three months or less, and very little federal financial aid has been forthcoming for such treatment centers.

So, what has been done to respond to these needs?

Telehealth and Mental Health Needs

As we reported earlier in our coronavirus series, telehealth has filled some of the gaps in care, enabling virtual visits for some with physicians and other mental health professionals, as well as other group mental health support. The Centers for Medicare and Medicaid Services have announced they will reimburse for both video and audio-only telehealth visits, and the Department of Health and Human Services have stopped enforcing certain privacy laws to enable health providers to communicate with patients using commercial video chat apps instead of specialized, private compliant services to which many patients have no access. 

In the area of addiction medicine, federal officials have expanded access to care for many with opioid use disorders through new regulations that enable physicians to more easily provide buprenorphine to patients in need and provide methadone patients with a 28-day take-home supply rather than requiring them to visit a clinic daily to get treatment.

Digital Health Involvement

The field of digital health is also stepping up with new apps addressed to mental health needs. Market intelligence firm Zion Market Research projects the digital mental health market to grow from $1.7 billion in 2017 to $4.6 billion by 2026. Mobile phone apps for mental health management have soared in popularity, according to research firm SensorTower, with over two million downloads of the world’s top 10 English language mental wellness apps reported in April. Digital mental health platforms Kara Connect and BioBeats cite a strong increase in usage of their platforms since the pandemic’s start, and a number of new digital health companies focused on mental health needs including anxiety, sleep disturbance, and addiction have recent launched new products or gained financing for product development.  An interesting example is AbleTo, Inc., whose offerings combine digital cognitive behavior therapy tools with access to one-on-one human support from mental health providers specially trained on their digital system, enabling the company to provide treatment customized to a patient’s needs. 

Digital apps are also finding usage in the field of addiction medicine, with companies like Chess Health, whose digital tools address substance abuse disorders with help for both patients and affected families, ranging from personalized interventions to treatment, recovery, and the prevention of relapse.

Drug Therapies on the Horizon

With respect to new drug therapies for mental health and substance abuse issues, psychedelics are increasingly getting a new look from academic and corporate researchers – spurred in part by the FDA’s approval of Spravato (esketamine) for major depression in 2019. Clinical trials are underway or are in preparation to explore such substances as psilocybin, MDMA, LSD in the treatment of severe anxiety, post-traumatic stress, addiction and other mental health disorders. Moreover, Introspect Digital Therapeutics, an ATAI Life Sciences company, is developing digital tools aimed at tracking compliance and magnifying the therapeutic effects of psychedelic drugs being investigated by other ATAI companies focused on depression, anxiety, and addiction.

Clearly there is a need for the development of new therapeutics and other tools to address mental health and substance abuse needs. Anna Lembke, Associate Professor of Psychiatry and Chief of the Stanford Addiction Medicine Dual Diagnosis Clinic, participating on a panel during the BIO Digital Conference, called for more new therapeutics, including those that address new mechanisms of action and treatments that enable repetitive control, allowing patients to moderate their use rather than abstain altogether. She also called for technologies that could provide more objective data on mental health conditions and the efficacy of treatment, as well as tools to track harbingers of relapse.