Mental Illness Awareness Week & World Mental Health Day

Thursday, October 8, 2020 - 9:00am

The National Alliance on Mental Illness (NAMI) website states that “mental illness affects everyone directly or indirectly through family, friends or coworkers, (but) despite mental illnesses’ reach and prevalence, stigma and misunderstanding are also, unfortunately, widespread.”

During this time of fear, anxiety and isolation stemming from the COVID-19 pandemic, it is more important than ever for people to have the information, support, connection, and help they need and deserve to navigate mental health challenges. In October, there are several awareness events to increase understanding of mental illnesses, and provide access to mental health resources. Mental Illness Awareness Week runs from Oct. 4 -10, and Oct. 10 is World Mental Health Day.

We spoke with Jordan Karp, MD, the University of Arizona’s new Department Chair of Psychiatry, to discuss the importance of mental health awareness, especially during the time of COVID-19 and the pandemic’s impacts on mental health. We include resources at the end of this Q&A that can provide assistance to people who are grappling with mental health concerns. 

What are some of the pandemic’s main impacts on mental health in the general populace?

Jordan Karp, MD, Professor and Chair, Department of PsychiatryFirst, the big picture. The pandemic has had negative impacts on social connectedness with loved ones, friends, and coworkers; regular contacts with healthcare providers; fears about our livelihoods and health; and maintaining regular sleep/activity schedules. While they may not be constant for everyone, I would say that in some ways, we have all experienced these challenges at times. We may define this condition as an increase in stress.  According to the Mental Health Foundation, stress is defined as the degree to which one feels overwhelmed or unable to cope as a result of pressures that are unmanageable.  The result of too much stress on mental health can result in either a worsening of pre-existing mental illness, or a development of a new mental illness. The most commonly worsened or new-onset conditions include anxiety, depression, insomnia, thoughts of suicide, and substance misuse. 

I am particularly concerned about three patient populations who may experience negative health effects of the pandemic. First, children may be isolated from friends, anxious about their families, health, and state of the world, and unable to participate in some sports and other enriching activities. For stressed families or those with a history of mental illness or violence, some children are at increased risk of child abuse.  Second, older adults may be especially isolated, given lower rates of “digital connection” for this group. Fear of infection may interfere with routine health care, increase loneliness, and those with cognitive decline may be at elevated risk of not having basic needs met. Third are those with severe and persistent mental illness, such as schizophrenia.  These patients may have a gap in care, are at increased risk of homelessness and poor self-care, and require special attention.

In what ways can healthcare providers help their patients seek mental health help/overcome societal stigma when their patients are struggling with issues such as depression, anxiety, isolation and other concerns?

Healthcare providers can normalize the experience by making it routine to ask about stress, anxiety, depression, insomnia, substance misuse, and if indicated, thoughts of suicide, for all their patients.  Healthcare providers can also create a nonthreatening emotional space for their patients by saying something like, “We are living in extraordinary and stressful times. Are you having problems with (and then list the symptoms to be screened)?” The use of standard screeners that patients can complete in advance of the appointment that assess depression, anxiety, and substance use can also normalize these emotions and behaviors, and make their assessment feel routine for patients, similar to having vital signs assessed. 

What are some of the main impacts on healthcare providers’ mental health?

There was a compelling article in the Journal of the American Medical Association this summer about women physicians and the pandemic, written by Linda Brubaker, MD.  It’s poignant, so I wanted to include a section from the article that really expresses how the pandemic has affected healthcare workers’ mental health (for the purposes of these questions, I changed “physician” to “healthcare worker”).  This language reflects the toll the pandemic has taken on healthcare worker’s well-being and attempts to psychically “recharge.” 

“The COVID-19 pandemic has disrupted common activities, such as meal planning and preparation, family and social activities, exercise or sport, spiritual practices, shopping, and leisure. Many of these changes disproportionately affect women, who often are leading efforts to find an acceptable new normal. Families must find new ways to express love and provide (distanced) care for aging family members.

For healthcare worker parents, school closings may require efforts to educate their children at home or form groups for home-schooling, if they have found online instruction inadequate. Providing meals is more challenging, with safety concerns at grocery stores, reduced availability of take-out food, and restaurant closures.

Even for healthcare workers who relax by cooking, the expectation of preparing three meals each day, every day for months on end can be daunting. The COVID-19 pandemic has taken away the simple act of enjoying a prepared meal at a favorite restaurant, reducing an often-used opportunity for [healthcare worker] respite and renewal.”

Burnout and depression are two of the biggest concerns I have for my healthcare worker colleagues, with the most devastating consequence being an increase in suicidal ideation and behavior. It is well-established that healthcare workers, irrespective of specialty, are at increased risk of suicide compared to the general population. In my opinion, efforts to prevent and treat mental illness and promote the physical and mental wellness of healthcare workers needs to be a national priority.

What mental health outlets are available to healthcare workers to help them cope with the stress related to working during a pandemic?

Clinical and human resource leadership at most healthcare systems, hospitals, and clinics are trying to help their employees by implementing staff-focused wellness and stress-reduction initiatives.  Examples include making sure basic human needs such as providing free and reduced-cost housing for staff who share a household with someone who is identified as high-risk by the Centers for Disease Control and Prevention (CDC), assisting with childcare and home school support, and access to online and real-time mental health resources. I encourage healthcare workers to speak with their supervisors and ask their human resources team to learn about local resources available to them. 

The World Health Organization states that “mental health is one of the most neglected areas of public health,” and is “calling for a massive scale-up in investment in mental health” as part of World Mental Health Day. What are some of the ways society can address this pressing issue?

The facts described on this link to the WHO are sobering: “Close to 1 billion people are living with a mental disorder, 3 million people die every year from the harmful use of alcohol, and one person dies every 40 seconds by suicide.”  Ways to address the epidemic of mental illness include research, access, and advocacy. 

Research: It is imperative we learn about the most effective, patient-centered, and resource-efficient ways to both prevent and treat mental illness on a large scale.  While the National Institutes of Health (NIH) invests approximately $42 billion annually in medical research for the American people, in 2019 only $578 million was spent on depression research, $233 million on anxiety research, and $62 million on substance abuse prevention. This means that these conditions receive 1% or less of the total NIH budget, despite causing misery, making other medical conditions worse, and driving up healthcare costs.  Supporting research into these conditions and allocating funds to pay for the work is especially important now during the pandemic. 

Access: There is a shortage of mental health specialists to provide clinical care. Efforts to increase the numbers of psychiatrists, psychologists, social workers, and others who work to improve mental health should be encouraged. Leveraging the tremendous reach of the internet should also be used, since there are many evidence-based online programs and apps that address depression, anxiety, insomnia, and stress. 

Advocacy: If people agree that efforts to boost research and access to care is important, they can contact their state and federal congressperson and senator, and make sure they are registered to vote.

Read more about World Mental Health Day and its associated initiatives and events, and here you can find details on Mental Illness Awareness Week from the NAMI website.