The global coronavirus (COVID-19) pandemic has taken a dramatic toll on virtually all aspects of life, from the economy, to employment, relationships, public health, and personal health.
In the United States, more than 200,000 individuals have died of the coronavirus. As of October, hundreds of thousands of Americans are filing unemployment claims each week. For all of us, the pandemic has become a time marked by uncertainty, fear, and grief.
According to a survey conducted by the Centers for Disease Control and Prevention (CDC), about 40 percent of US adults reported struggling with mental health or substance use issues.
Although much of the general population has admitted to feeling more anxious and depressed during the pandemic, those with substance use and mental health issues face unique challenges.
What’s important to know during this time is that everyone responds to stressful situations differently. There is no wrong way to feel or to react to the changes you may see around you, or in people you love.
Since March 2020, numerous resource guides and directories have been developed in the wake of the coronavirus pandemic to fill the gaps the pandemic has created in access to care, social support, and ensuring quality and affordable treatment.
Here you’ll find information on:
- The effects of the COVID-19 pandemic on mental health and substance use
- List of mental health and addiction resources
- Frequently asked questions (FAQ) about telehealth
- caring for a loved one who is struggling
Why Are People Struggling More During The Pandemic?
Mental health difficulties that people are experiencing during the pandemic are not something that can be traced back to a single source. For most people, it’s likely a combination of factors.
The ways that people are impacted by sources of coronavirus-related stress can also differ depending on mental health history, the hardship they’ve personally experienced during the pandemic, and other personal risk factors.
Sources of stress related to the coronavirus pandemic might include:
- changes in employment
- housing instability
- economic insecurity
- domestic abuse
- being an essential worker (or worrying about a loved one who is)
- being high-risk for COVID-19 complications
- substance use/mental health relapse
- severed access to medical and behavioral health services
- reduced social support
- living alone
- uncertainty of the timeline of the pandemic
- returning to school or work (for yourself or loved ones)
- increased attention towards germs/spreading disease
There are a whole host of social, economic, and cultural forces that have driven increases in mental health symptoms in the general population and those with pre-existing mental health issues.
In addition to the pandemic, people are also currently grappling with stress associated with racism, racial discrimination, police violence, and the presidential election.
These various sources of stress can pervade our interpersonal lives, our professional lives, and our interactions with our individual communities and the nation at large. We can see these struggles show up in the workplace—physically, or on digital platforms like Zoom—in the home, on the streets, in educational settings, and in online interactions.
You might find yourself and the people around you demonstrating a short temper, isolating from others, lashing out, and acting in other uncharacteristic ways.
Not all of us feel comfortable sharing the ways we’ve been negatively affected by the pandemic. This is true whether this concerns the loss of a loved one to the coronavirus, or how the pandemic has influenced our mental health and coping habits.
What We Know About Mental Health And The Pandemic
Multiple health agencies, such as the Centers for Disease Control (CDC) and the World Health Organization (WHO), have reported the effects of the COVID-19 pandemic on mental health in the United States and globally.
Effects On Mental Health In The General Population
Many people without pre-existing mental health conditions are reporting feelings of increased stress, anxiety, and depression.
In early October, Dr. Joseph Gorden—the director of the National Institute on Mental Health—told CNN that this increase in mental health symptoms has previously been seen in the aftermath of other crises, such as 9/11 and extreme weather events.
One difference with COVID-19 is that the crisis is ongoing, and extends beyond a singular event. The American Psychiatric Association, which surveys Americans every year, recently released their 2020 findings on the state of mental health in America, which included the following:
- Nearly 8 in 10 adults say the coronavirus pandemic has been a significant source of stress in their lives
- Two in three adults report feeling increased stress during the pandemic
- Nearly one in five adults say their mental health is worse than this time last year
- More than 75 percent of adults say the future of the nation is a significant source of stress
- Generation Z teenagers (ages 13 to 17) and Generation Z adults (18-23) are experiencing elevated stress and depression that may have long-term consequences on health and well-being
According to the Kaiser Family Foundation (KFF), which conducted a poll in July, many adults are also reporting increases in alcohol or drug use, difficulty sleeping, changes in appetite, and worsened chronic health conditions.
Effects On Mental Health In People With Mental Health And Substance Use Disorders
Trauma and stress can be major risk factors for substance use and mental health relapse. In the context of the coronavirus pandemic, it’s very reasonable to identify this experience as a form of trauma. Across the world, people are facing immense uncertainty, loss of life, and reduced access to supportive resources.
While many sources of pandemic-related stress might be similar to those of the general population, the impact of this stress can have different implications for people with pre-existing mental health and substance use disorders.
This includes people who have:
- major depression
- anxiety disorders
- post-traumatic stress disorder (PTSD)
- bipolar disorder
- obsessive-compulsive disorder (OCD)
- psychotic disorders (e.g. schizophrenia)
- eating disorders
- substance use disorders
Compared to the general population, people with mental health and substance disorders might face unique challenges.
These could include difficulties accessing mental health services (including medications), severed access to substance use services and related social services, and enhanced reactions to the lack of social support and isolation generated by the pandemic.
Mental Health And Drug Relapse
The effects of the pandemic may provoke drug or alcohol relapse, which can be troubling both for the individual struggling as well as those around them.
This might increase tension in the household, or provoke significant worry and concern among loved ones who aren’t able to visit their struggling loved one due to safety concerns.
Effects of substance use or mental health relapse might include:
- increased agitation or hostility
- suicidal thoughts and behaviors
- domestic troubles
- forgoing treatment (including medication regimens)
- effects on work performance or studies
- increased panic attacks or flashbacks
Increase In Drug Overdoses
Drug overdoses have also been on the rise, as reported by the American Medical Association (AMA). According to the AMA, more than 40 states nationwide have reported increased drug overdose rates in 2020 compared to 2019.
This is significant, as the United States reached an all-time high in total drug overdose deaths in 2019, after seeing a decline from 2017 to 2018.
As reported by NBC, the month of May was the deadliest month for drug overdoses in five years. And according to national data from August, this year is on its way to reaching an all-time high in drug overdoses, with data already showing an 18 percent increase from this time last year.
During the pandemic, several barriers to treatment services—including harm reduction services, such as safe needle exchanges—have emerged, blocking pathways towards seeking help.
People with active substance use issues may have also been cut off from their usual dealers. This might sound positive on the surface. However, this could very well lead to the sort of desperation that might result in seeking drugs from more dangerous sources, where drugs might be laced with other substances or otherwise put the drug user in danger.
Mental Health And Addiction Resources During COVID-19
As millions of people across the United States face greater stress and depression during the pandemic, many existing organizations—national, state, and local—have created and shared resources for mental health and substance use prevention.
The following is a non-exhaustive list of organizations that provide resources for people with mental health and substance use disorders, and their loved ones:
Centers for Disease Control and Prevention (CDC)
The Centers for Disease Control and Prevention (CDC) has created an exhaustive resource page for mental health during COVID-19.
The agency has compiled a comprehensive list of national helplines, and resources specific to families and children, teens, healthcare workers and first responders, and people in the high risk category for COVID complications.
General resources include:
- Coping with a Disaster or Traumatic Event
- Coronavirus Tax Relief and Economic Impact Payments
- Resources to Support People Experiencing Homelessness
- COVID-19 American Sign Language (ASL) Videos
- COVID-19 Federal Rural Resource Guide
- Resources in Languages Other than English
National Institute on Drug Abuse
The National Institute on Drug Abuse (NIDA) is a government-run organization and resource for individuals, families, and communities impacted by substance abuse. They have compiled a list of COVID-19 resources and resources specific to helping individuals with substance use disorders.
National Alliance on Mental Illness
The National Alliance on Mental Illness is the nation’s leading grassroots advocacy organization for individuals and families affected by mental illness. They’ve released an extensive resource guide, featuring information on how to cope with stress, how to seek treatment, and seeking help for loved ones who are incarcerated.
Substance Abuse and Mental Health Services Administration
The Substance Abuse and Mental Health Services Administration (SAMHSA) is a government-run agency that has released a COVID-19 guide for drug abuse treatment providers, individuals, and families affected by substance use and mental health issues.
Among other things, this guide includes guidance on safely administering naloxone for opioid overdose, virtual recovery resources, and information on telehealth services.
Mental Health America
Mental Health America is a leading national nonprofit organization that has created a COVID-19 specific resource page for individuals and their loved ones affected by mental illness.
This resource page offers general information about mental health and the coronavirus, as well as coping tools, screening tools, and informational sessions on mental health and COVID-19. MHA’s guide also offers resources specific to certain populations.
This includes mental health resources for:
- Frontline workers
- Black, Indigenous, and People of Color (BIPOC)
- LGBTQ+ communities
Psychology Today has an online directory of clinical professionals, psychiatrists, and treatment centers across the United States. Through this website, individuals can search for nearby treatment centers and providers.
Filters for accepted insurance, types of treatment, and preferred treatment modality are also available. This includes specific search functions for finding teletherapy services.
Narcotics Anonymous (NA) has moved their meetings online (also accessible by phone) to support current and former addicts across the country. Information about their meetings, how to get connected, and related resources are available here.
Cocaine Anonymous, like NA, is also offering free services for individuals impacted by cocaine use. This includes email support and voice-only online meetings.
National Institute on Alcohol Abuse and Alcoholism (NIAAA)
The NIAAA has created a resource page specifically for people navigating the challenges of COVID-19 with a current or previous history of alcohol abuse and addiction. This includes information on virtual support meetings, frequently asked questions about alcohol and the coronavirus, and updates on alcohol sales.
National Support Hotlines For Mental Health, Abuse, And Addiction
Many national and local hotlines exist in the United States to provide support and treatment for individuals in crisis.
During the COVID-19 pandemic, several leading behavioral health organizations have reported receiving enormous spikes in calls from individuals struggling with mental health and substance use issues. If you need immediate help for mental health or substance use-related struggles, you’re not alone.
For immediate support, consider these hotlines:
- National Suicide Prevention: 1-800-273-TALK (8255) for English, 1-888-628-9454 for Spanish
- National Eating Disorders Association (NEDA) Helpline: 1-800-931-2237
- National Alliance on Mental Illness Helpline: 1-800-950-6264
- Crisis Text Line: text HOME to 741741
- National Domestic Violence Hotline: 1-800-799-7233 or text LOVEIS to 22522
- Veterans Crisis Line (National): 1-800-273-TALK (8255) or text: 8388255
- National Sexual Assault Hotline: 1-800-656-HOPE (4673)
- National Child Abuse Hotline: 1-800-4AChild (1-800-422-4453) or text 1-800-422-4453
- Teen Line: 1-800-852-8336 or text “TEEN” to 839863
To find local treatment centers, treatment providers, and Telehealth services:
- SAMHSA National Hotline: 1-800-662-HELP (4357) and TTY 1-800-487-4889
- Psychology Today Treatment Provider Directory
- SAMHSA Treatment Services Locator
You can also check your state and county health departments to find localized resources and treatment. Many state and local health departments have existing substance abuse prevention and behavioral health departments.
Local health departments may have additional information on how to report an overdose, where to find safe sharps disposal sites near you, and how to access social support services during COVID-19.
Are Mental Health And Substance Abuse Treatment Centers Open?
Many substance abuse and mental health treatment centers across the United States have remained open at full or partial operation during the COVID-19 pandemic to ensure continued care during these difficult times. The types of services currently offered may vary according to the center.
Early on in the pandemic, organizations like the CDC and the American Psychiatric Association (APA) released recommendations for how to safely treat patients in psychiatric settings during this time.
These recommendations pertain to certain safety protocols as well as guidelines for maintaining HIPAA privacy standards while delivering telehealth services.
COVID-19 And TeleHealth Services
Since March, many mental health and substance abuse treatment providers have shifted their services online or by phone to prevent COVID-19 exposure.
Telehealth services have become one solution to the safety concerns of in-person interactions between providers and patients. Telehealth refers to digital health services that are conducted by phone, text message, live chat, or video.
Telehealth services may include:
- primary care
- mental health and substance abuse counseling
- virtual support groups
- psychiatrist appointments
- low-risk urgent care
- coaching services
- physical therapy and occupational therapy
- case management and care planning
How TeleHealth Works
The experience of telehealth services can look different depending on the type of service and the provider. Telehealth services can be delivered in real-time by treatment providers, or be recorded, stored, and later shared with patients.
For individuals with mental health and substance use issues, common telehealth services include: counseling, virtual support groups, and other clinical services. These services are offered by both individual treatment providers—such as a counselor—and some rehab centers.
Groups like Alcoholics Anonymous (AA) have also moved online in some communities, and on a national and regional level. You can learn more about AA’s online options for United States residents here.
Who Can Benefit From Telehealth?
Many of the same benefits that can be received through in-person services can also be received through telehealth. As reported by ABC News, telehealth may be most beneficial for people who are already engaged in care, says Dr. Caleb Banta-Green, a principal research scientist at the University of Washington Alcohol and Drug Abuse Institute.
Younger people—including children, teens, and young adults—may also be more comfortable using digital communication platforms for telehealth. Generally, younger generations are more technologically savvy and are used to communicating with friends and others through digital communication.
Telehealth may also be beneficial for:
- those in acute crisis
- people who have relapsed
- people who require regular monitoring for mental or physical health conditions
People who are seeking treatment for the first time, or are beginning treatment with a new provider, may struggle more with telehealth.
This doesn’t mean that these first-time patients can’t benefit from telehealth. But it can be more difficult for new providers to assess patients over digital platforms and get an accurate representation of the state of a person’s physical, mental, and emotional health.
Does Insurance Cover Tele-Health?
Insurers vary in their telehealth coverage policies. Where you live in the United States may also affect your coverage and telehealth availability, depending on state laws.
Some private insurers and military insurers like Tricare have moved to cover some or all telehealth services the same as they would in-person services. Medicare Part B (Medical Insurance) also covers certain telehealth services.
Medicare Advantage plans offer certain telehealth benefits in addition to those offered under original Medicare and are moving to expand.
To learn more about whether your insurance plan covers telehealth services, contact your insurance company or healthcare provider for up-to-date information.
Limitations And Challenges With Telehealth
Telehealth services have become a critical element of many people’s treatment and recovery plans. The use of these services, however, and gaining access to them has not come without its challenges.
Challenges with telehealth services might include:
- Cost: Not all insurance providers have moved to cover telehealth services the same as in-person. This means that many people who were previously able to receive coverage for certain services cannot receive the same coverage for services conducted digitally.
- Learning curve: Not everyone is technologically savvy or comfortable receiving health services virtually. This has made it more difficult for some people to access treatment services during COVID-19.
- Privacy concerns: Some people have concerns about talking about sensitive topics on certain digital platforms. This has deterred some people from accessing health services, and has complicated the process of delivering these services for providers.
- Lacking Access to Computer/Wi-Fi: Lacking consistent or stable access to the internet has been a common barrier to care for people with mental health and substance use issues. This is especially true for low-income and homeless populations in need.
Federal health agencies, treatment providers, and insurance companies are continuing to work on addressing some primary concerns of telehealth moving forward. Legislators are also working to remove barriers to telehealth services imposed by state laws and some insurance policies.
If you have questions about using telehealth with an existing provider, you may ask them directly to learn more about how to address applicable limitations.
Caring For A Loved One Who’s Struggling
Watching someone you care about struggle with mental health or substance abuse can be very stressful. With the pandemic making in-person interaction and check-ins more difficult, this can exacerbate the concerns of parents, siblings, children of addicts, friends, and romantic partners.
Taking care of yourself is the most important consideration if you are a caregiver. If you’re not taking care of yourself, you may very well struggle to care for someone else. Neglecting your own needs can also create additional stress and may lead you to become resentful and depressed about your current position.
Several of the organizations shared above offer resources specific to caregivers and parents. If you’re the loved one of someone who is experiencing a mental health-related crisis, your health and well-being matter, too. You deserve the same care and level of compassion you would show your loved one.
For more information about mental health and COVID-19, please check the websites of the CDC, the Substance Abuse and Mental Health Services Administration, and local treatment resources for ongoing updates.