A revised version of this post was published in STAT on November 23, 2020
Many Americans were reassured to see President-elect Biden name a highly distinguished group of experts to guide his policies regarding the coronavirus pandemic. But despite our enthusiasm, we noted a glaring omission from Biden’s all-star Covid-19 task force: Mental health expertise is nowhere to be found among the physicians, epidemiologists and public health experts.
This omission seems particularly problematic given the unprecedented spike in depression and anxiety that has accompanied the pandemic, disproportionately affecting young people. For while young adults have generally not been hard-hit by Covid-19 itself, the pandemic has had profound consequences for their day-to-day lives, and their mental health. From the federal government to individual institutions like universities and community colleges, there is a pressing need to step up to the plate to address the challenges young adults face during, and after, Covid-19. The place to start is by including mental health expertise on President-elect Biden’s coronavirus advisory panel, and ensuring investment in mental health access.
In our 50-state survey of over 2,000 young adults age 18-24 in late October, nearly half (47%) reported significant symptoms of depression. These aren’t an occasional bad day - they reflect symptoms that would be severe enough to prompt referral by a primary care physician for evaluation and treatment. This number is about 6 times greater than rates observed in the general U.S. population over the past decade. Depression seems to be one area where the country is united: we see these elevations across men and women, across racial and ethnic groups, and across regions.
Some symptoms are especially worrisome. On a survey question about suicide, 1 in 3 reported thoughts of hurting themselves or the belief that they would be better off dead. Nearly 1 in 10 reported having these thoughts almost every day.
Our survey also offers some clues about why. Asked about how Covid-19 had impacted their household, 51% reported dealing with school or university closure, 41% working from home, 27% absorbing a pay cut, and 26% losing employment. Those who had experienced financial impacts - and particularly concern about ability to pay rent - were even more likely to experience depression, thoughts of death, anxiety, and sleep disruption.
Why has this group been so profoundly affected? To begin with, they are often the ones in low-wage jobs with less flexibility to work remotely and less room to absorb a pay cut.
For many of them, when their colleges moved online this fall, one underappreciated component fell by the wayside: mental health services. Typically colleges provide a key source of mental health care for many of their students - frequently the first such care these students have received for conditions they may have struggled with for years. College health centers can provide a crucial safety net for young adults at precisely the age where mental illness is most likely to emerge. These schools can still accomplish a core element of their mission by teaching classes remotely. But other student needs, notably mental health counseling, are far more difficult to address.
The temptation is high to invoke feel-good, no-cost solutions like mindfulness videos and free meditation apps. These sorts of interventions may be helpful in managing mild symptoms. However, they cannot provide other critical elements of mental health care - sorting out a diagnosis, assessing safety, determining whether additional treatment is needed, making referrals to find such care. For a student contemplating suicide, a guided meditation is woefully insufficient.
Addressing the ‘other’ public health challenge posed by Covid-19 will require both public and private efforts. Families and friends need to learn the signs of depression and not be afraid to ask about them. Universities need to invest in expanding their mental health resources, embracing not only telemedicine but group interventions and supports.
What about the majority of young adults who don’t have a university connection but face the same family and financial stressors? While there are national helplines anyone can call to get urgent assistance, accessing care remains a challenge. Luckily, there is a safety net – albeit one that is chronically underfunded and under-resourced. A network of community mental health centers can provide excellent care - either in person, or increasingly, via telemedicine. Unfortunately, these centers already have their hands full serving people with chronic illness who are dealing with the added constraints of quarantine. For them to accommodate an influx of young adults, they will need additional federal, state and local support.
As a presidential candidate, Vice President-elect Kamala Harris advocated for substantial investment in mental health care access. Ensuring that the nation’s Covid-19 task force includes mental health expertise would be an important first step in this direction. Depression and anxiety are highly treatable – but only if young adults are able to access such treatment. The incoming administration must use the bully pulpit -- beginning by including mental health expertise on the coronavirus advisory panel, and continuing with investment in expanded access -- to draw attention and resources to this burgeoning mental health crisis. Otherwise, we risk missing yet another opportunity to save lives during the Covid-19 pandemic.