The COVID-19 pandemic has exposed and exacerbated crises that were quietly brewing in America, including a nationwide mental health emergency. Before coronavirus forced millions into lockdown and unemployment, huge numbers of Americans were already struggling with mental health.
In the U.S. in 2017 about 11 million adults and 3.2 million adolescents were affected by depression. That same year, alcohol- and drug-induced fatalities and suicide claimed the lives of more than 150,000 Americans, the highest number in history. It is sobering to consider that those numbers may grow larger as the impact of COVID-19 makes itself known across our society. Countless households are coping with profound economic anxiety – tens of millions have lost their jobs, and millions more teeter in uncertainty – while also facing the grim reality of an insidious virus that is killing more than a thousand Americans every day.
Stress surveys show dramatic upticks in rates of mental health conditions and substance misuse. One of the most disturbing findings is a study that showed the rate of depression has nearly tripled since the beginning of the crisis, with almost one in four Americans experiencing symptoms of depression. Meanwhile, alcohol sales are up sharply and a survey in July found some of the steepest increases in alcohol consumption among parents and the unemployed.
COVID-19 has amplified the racial disparities in health outcomes in the United States, and promoting policies that address the foundations of community health with a focus on equity is vital to the success of cities’ COVID-19 responses. Much of the mental pain caused by the pandemic has also been concentrated in Black and Hispanic communities, which have been hit especially hard by the virus, unemployment, anguish over police brutality, systemic racism, and injustice.
It is very possible that these mental health figures will end up reflected in mortality statistics. According to a CDC study, the number of Americans seriously contemplating suicide has more than doubled since last year, with especially higher increases among Black and Latinx respondents.
Local governments are on the front lines of the response to the coronavirus pandemic, which has indelibly changed the political, economic, and social landscapes of many cities across the country. COVID-19’s economic toll is significant, as many cities face record budget deficits due to a combination of high unemployment and dwindling tax revenues. Cities are absolutely essential to the nation’s economic recovery, which is why more state and federal aid is needed to ensure that city leaders are not forced to slash vital city services and programs.
Mental health crises do more than just cause suffering among the afflicted, they can be a major impediment to economic recovery. Small business may continue to struggle as they try to get back on their feet as employees grapple with their emotional health. These crises can also cause a ripple effect for years to come as the stress of a mother or father trapped in depression can extend to children trying to learn. Without effective interventions, cities may well see a feedback loop in which mental health issues aggravate and extend the economic problems that precipitated the crisis to begin with.
Some policies that cities have been considering, or in some cases have already implemented, include:
- Developing contingency plans for behavioral health providers on how to continue services for youth who would normally receive services in schools.
- Establishing COVID-19 call centers that double as counseling call centers with mental health clinicians on site to advise as needed.
- New York City has supplied free access to a suite of mental health apps, supports and services throughout the length of the pandemic.
- Los Angeles also released free mental health resources for residents, including content customized for children, families, and providers.
These are all incredibly important responses to a serious issue within our society. However, to make real, lasting change, cities need to think beyond just the provision of services. Rather than be reactionary, cities have an opportunity to put upstream policies in place to prevent or lessen the downstream mental health challenges that many Americans are now facing. To address the root causes of poor mental health, cities can do the following:
- Increase access to quality affordable housing. The link between housing and health has become increasingly clear, and cities can adopt policies such as Affordable Housing Trusts to ensure that residents can access safe, healthy, affordable homes. Hundreds of cities and counties across the nation have established housing trust funds, which means the residents of those jurisdictions have the benefit of a housing market supported by targeted investments in preserving and producing affordable housing. Housing trust funds are a proven idea with a long track record of success; many were started as early as the 1980s, as in San Antonio, Seattle, Boston, and Chicago.
- Housing First policies have also been utilized to address homelessness, and can lead to significant returns for both the health and safety of residents.
- The link between income and mental health is also very strong, and many psychologists have advocated for a higher minimum wage. Having a Living Wage ordinance can help all members of a community thrive. Cities large and small, from Petaluma, California to New York City, have started implementing minimum wages above $15 per hour, and the data have shown an increase in service workers’ incomes, with no corresponding drop in overall employment.
- The evidence base for having access to green space is also growing. Having regular, safe access to natural spaces can have a profound impact on one’s health and mental wellbeing. One study found that urban greening of previously vacant land significantly decreased feelings of depression and worthlessness among surveyed adults. Cities can expand both the available park acreage and the number of green spaces in a city, which could yield significant benefits for residents.
Mental health is a complex and multifaceted issue. However, complex does not mean abstract. Cities can and should take concrete steps to improve the lives of their residents, by raising living standards, helping families move into affordable housing, and connecting the most vulnerable with counseling and therapy. Through concerted action and real investment in these priorities, cities can both address the immediate mental health needs of their residents, and improve the trajectory of future mental health crises. There are no easy fixes, but there are effective approaches backed by experience and data. It’s time to get started.