MENTAL HEALTH

It is easy to understand the hope people have that our nation and the world will slowly get back to normal after the Covid-19 pandemic passes, and it will eventually.

However, as a mental health professional, I really don’t want to go back to the pre-Covid normal. That world had insufficient consideration, support and acceptance of issues that challenge people’s mental well-being. That normal was when mental illness was pushed to the fringes of healthcare and society at large. Go back there? No thank you.

Even before the virus raced across the globe, the United Nations called statistics on mental health worldwide “stark”: 265 million people suffering from depression, 76% to 85% of people in lowor middle-income nations with mental health conditions receive no treatment, with one mental health professional for every 10,000 people, and human rights violations against people with severe mental health conditions was widespread in all countries of the world.

In the U.S., people in poverty and people of color already carry the burden of the toxic stress and trauma of racism. They were suffering from health disparities even before the virus hammered down. National protests about racial injustice exploding in cities all over America have arisen from deep and systemic problems that have been in our culture for centuries. That’s not a “normal” we should be proud of nor aspire to.

Consider too that before the public ever heard the term “coronavirus,” the United States healthcare system divided physical health on one side and mental health on the other. The separation was cultural and structural dating back to the Kennedy administration in the early ‘60s. Efforts to connect these two systems of care were sparse and considered “cutting-edge.” Perhaps that’s why people with mental health challenges have life expectancy that is decades shorter than those who don’t.

But today, the link between the physical and psychological impact of Covid on people is easy to see, even on those not infected with the virus. Ask anyone who’s unemployed, alone and isolated, or stressed to their breaking point as a consequence of a physical virus we have been, thus far, powerless to stop.

There’s nothing nostalgic about a fragmented healthcare system built on an employer-based business model in which providers of healthcare are paid fees dependent on the specific service they render. Not only does this fail when unemployment strikes or when an employer can’t offer insurance to workers, this system rewards the volume of services provided and not the value in the health outcomes achieved.

Thus, hospitals and other providers needed to build lean operations that used every resource to the maximum efficiency but had little room for surplus beds or supplies or staff — the exact things needed when a surge in demand from a health emergency happens.

Lastly, the federal government and many states viewed public health as a less important aspect of government, an easy target for budget cuts. Considering the massive amount the U.S. spends on healthcare, a measly 2.5% goes to public health services that prevent illnesses and will prepare us for the next pandemic, according to Ed Yong in the recent issue of The Atlantic.

He sums up what this crisis might teach us:

Covid-19 is an assault on America’s body and a referendum on the ideas that animate its culture. Recovery is possible, but it demands radical introspection. America would be wise to help reverse the ruination of the natural world, a process that continues to shunt animal diseases into human bodies. It should strive to prevent sickness instead of profiting from it. It should build a healthcare system that prizes resilience over brittle efficiency, and an information system that favors light over heat. It should rebuild its international alliances, its social safety net and its trust in empiricism. It should address the health inequities that flow from its history.

Let’s hope that what lies ahead after Covid-19 is crushed is a nation that really has found its way to a far better normal.

Phil Wyzik is CEO of Monadnock Family Services in Keene.