The federal mental health czar is calling for more money to expand services to help people suffering amid the social isolation imposed by the coronavirus pandemic, as a new study estimates related deaths from alcohol, drug overdose and suicide could reach 150,000.
"We see very troubling signs across the nation," said Dr. Elinore McCance-Katz, assistant secretary at Department of Health and Human Services and head of the Substance Abuse and Mental Health Administration. "There's more substance abuse, more overdoses, more domestic violence and neglect and abuse of children."
McCance-Katz said the agency wants more money for services to address an anticipated surge in need for mental health and addiction treatment, which was already in short supply. She cited HHS' own substance abuse and mental health research and a February report in the British journal The Lancet on the psychological effects of quarantine.
The Lancet study said the effects can include post-traumatic stress disorder and suicide and are "wide-ranging, substantial, and can be long lasting." That's especially true if there isn't a clear end in sight, like now, said McCance-Katz.
"The impetus is COVID-19, but the need was there before and it's just been increased by what's happened as a result of the virus," she said.
The new study, released Friday by the Well Being Trust and the American Academy of Family Physicians, factored in isolation and uncertainty when it calculated the expected deaths from suicide, alcohol and drugs based on nine unemployment scenarios.
The likely toll from these "deaths of despair" was the loss of an additional 75,000 lives, the study found. Death estimates ranged from 27,644 if the economy recovers quickly to 154,037 if recovery is slow.
"We already had a major problem on our hands," said psychologist Benjamin Miller, the Well Being Trust's chief strategy officer. "Now people are disconnected and lonely with a level of uncertainty, fear and dread."
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Alcohol sales have spiked since shelter in place orders were imposed. Aside from economy security, having a job provides boundaries for potential problem drinkers that help them self regulate, Miller said.
McCance-Katz also noted reports of more people seeking treatment for alcohol problems in regions where coronavirus has hit the hardest, including the Northeast. Addiction treatment centers report far higher call volumes and outpatient treatment, now typically conducted on video.
"There's a level of powerlessness with the economy, retirement funds, unemployment and trying to get unemployment checks," said Doug Tieman, CEO of Caron Treatment Centers in Pennsylvania. "All of them are anxiety causing, and people feel lousy and then don’t see a light at the end of the tunnel."
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Adults and even teens with substance abuse disorders struggle to reconcile often crushing addictions with their fears of contracting COVID-19. The chance of coronavirus transmission compounds parents' concerns when teens sneak out to buy drugs, especially when grandparents live in the home, said Dr. Joseph Lee, medical director of the Hazelden Betty Ford Foundation's youth continuum.
While April residential admissions at Hazelden' were down about 2% over April 2019, intensive outpatient admissions soared 17%, thanks to virtual services launched in March, Lee said.
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The stories leading to treatment can be startling.
New Hazelden patients include "multiple kids who drank everything in the house," and others who inhaled household products including the "air dusters" used to clean computer keyboards, said Lee.
A teenage girl addicted to heroin told her mother she would kill herself if her mother didn't buy her heroin. The girl was afraid of contracting the virus, said Lee, so the mother did.
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Lee said the girl is entering treatment despite her fear of flying to get there. As with other out of state patients, Lee said he talked through the risks of both coronavirus and addiction to help the family "problem solve."
"For anyone who didn’t believe addiction was addiction, we are seeing it in all its glory now," said Lee, who works with 14- to 25-year-olds. "You see the power of the compulsive drive and this learned pathological conditioning."
Bob Poznanovich, Hazelden's vice president of business development, added: "The needs are growing, and we’re fully expecting and prepared for a surge in demand soon,"
To prevent "a disastrous wave of deaths of despair," the new Well Being Trust and AAFP report recommends an increased focus on reducing unemployment, easier access to treatment and more mental health and addiction services integrated into the healthcare system.
“More resources for mental health is a good thing," said Miller. "Let’s just make sure that we are investing in strategies we know work for communities and that integrate mental health into the places people want it."
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SAMHSA got $425 million from the Coronavirus Aid, Relief, and Economic Security Act to boost mental health and addiction services. That compares with more than $100 billion for hospitals and is far from what critics say is needed.
"It’s embarrassing the lack of attention our Congress places on mental health in a crisis," said Miller.
The SAMHSA funding is being used for services in Certified Community Behavioral Health Clinics, which were defined in 2017 by the Excellence in Mental Health and Addiction Act as a way to boost addiction treatment services and coordinate health care to disadvantaged individuals.
The clinics offer mental health and addiction treatment, along with primary care in the same facilities. Crisis intervention services are available around the clock to keep people experiencing breakdowns out of emergency rooms.
McCance-Katz said they are an example of "where the successes are" in behavioral health and she hopes to expand them further.
"We are given the opportunity to tell the administration what we think is needed," said McCance-Katz. "I do believe they’re listening, so I’m hoping that we will get more resources."
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