Niklas Rietsch

Grade: 10

University School - Hunting Valley

Instructor: Molly Klaisner

The Crumbling Keystone of Our Existence

Critical Essay

The Crumbling Keystone of Our Existence

Mental health is a cornerstone of our existence; therefore, when services that help preserve it are lacking, especially in trying circumstances such as the Covid-19 pandemic, there are drastic consequences. Thus, given the massive lack of mental health services, addressing this problem is of the utmost importance. However, to solve such a significant problem, it is essential to first understand what caused it. According to Tiffany Alexander's article, "Mental health worker shortage grows in Ohio," Data from the Ohio Department of Mental Health and Addiction Services shows that from 2013 to 2019, demand for behavioral health services rose 353% across Ohio (Alexander). However, despite the massive rise in demand from 2013 to 2019, what truly broke the mental health services industry was how demand spiked in 2021, with providers reporting a 70% hike in need for adult and youth mental health services and a 60% increase in the need for addiction services (Alexander). The other major cause of the lack of mental health services is the decreased supply resulting from mental health professionals leaving the field in droves. This lack of supply has caused a litany of impacts on every level of society, from increasing wait times for essential services to rapid increases in drug overdose deaths during the pandemic. In a survey conducted by the Ohio Council between August to October of 2021, 60% of respondents said that wait times for mental health care were longer than before the pandemic (Breaking Point). Moreover, since the start of the pandemic, the number of overdose deaths has risen by 30%, to 91,799 annually, as people turned to substance abuse as a way to cope with the mental health damage caused by the Covid-19 pandemic instead of getting the help that they needed (Tanz). However, we shouldn't blame the victims for turning to substance abuse, as it is not so much their fault as it is that of the mental health services system at large. People had very little choice in what they could do to cope with the mental stress and anxiety of the pandemic, as mental health services were out of the question, especially for those less well-off. Their lack of access to telehealth services and mental health workers to serve them drastically limit their options. Yet, steps can be taken to mitigate these problems. These steps include: increasing funding for mental health services across the board, reforming telehealth policies as well as improving poorer communities' access to telehealth services, creating a workforce pipeline for the industry to supply future demand, and lastly, mitigating the consequences that the Covid-19 pandemic had on people, especially with regard to substance abuse disorders.

The rapid and massive rise in demand for mental health services due to the Covid-19 pandemic can be attributed to multiple factors. The first factor is the breaking down of the stigma surrounding seeking mental health therapy. The collective acknowledgment that we have all been hurt by the pandemic has been a major factor in breaking down this stigma. Whether it be the loss of a loved one due to Covid, the loss of a job, or the impact of socially isolating for so long, everyone has been negatively affected by the Covid-19 pandemic. This sentiment of societal hurt is well put by Dr. Janata, a professor of Psychiatry at University Hospitals: "There is less shame associated with feeling isolated, stressed or depressed by the pandemic because it's so ubiquitous" (Janata). Beyond societal acceptance, the increasing prevalence of telehealth services and online drug rehabilitation therapies have also played a role in the rising number of people willing to seek mental health therapy. In addition, hospitals have shifted online for their mental health services due to Telehealth's increased convenience and privacy (Washington). Nowadays, about 70% of behavioral health visits at the Cleveland Clinic are done virtually, compared with 2% before the pandemic, and at University Hospitals, about 95% of psychiatry appointments are telehealth (Washington; Chacon et al.). However, when it comes to seeking out help for substance abuse disorder (SUD), telehealth services were restricted to patients with only mild cases of SUD (Chacon et al.). This policy directly led to increased overdose hospitalization and death rates, as those who needed the service the most were, and still are, unable to get the help they need through telehealth services (Chacon et al.). The surge in demand due to the pandemic has stretched the field to its limits.

However, the real problem is that there are simply not enough workers available to meet it. The United States is not new to this shortage of laborers, as even before the pandemic, The United States only had around 8,300 child and adolescent psychiatrists and 4,000 child and adolescent clinical psychologists for about 7.7 million kids with treatable mental health issues (Washington). However, similar to how demand spiked due to the pandemic, the supply of mental health workers reached all-time lows. According to a survey conducted by the Ohio Council between August and October of 2021, 98% of survey respondents reported that front-line clinical and medical staff such as psychiatrists, therapists, and case managers were becoming harder to find in sufficient numbers to meet the growing demand ("Breaking Point"). However, they wouldn't stick around for long, even when new workers could be found. According to a survey conducted by the Ohio Council between August and October of 2021, 88% of respondents said that front-line mental health staff had become more likely to leave their jobs or exit the field altogether, leaving many positions open for two to six months at a time ("Breaking Point"). But, the front-line mental health workers shouldn't be seen as the problem here, as they are not. The fact is that behavioral health care can be extremely stressful, not to mention the long and irregular hours that accompany it (Gupta et al.). The pandemic has only worsened these factors by lengthening already stretched hours and adding a layer of Covid-19-related stress and anxiety to their work ("Breaking Point"; Gupta et al.). The loss of mental health workers has increased wait times, among many other impacts. According to the same survey by the Ohio Council, over 60% of survey respondents reported longer wait times for adult and youth mental health services, and more than 50% reported longer wait times for adult substance use disorder treatment ("Breaking Point"), barring people from getting the help they need when they need it most. To put the sheer scale of this issue into perspective, imagine if the suicide hotline was on a month-long backlog of calls. That extremely long wait time would mean that by the time it reached people farther back in the queue, it would probably be too late to help them.

However, this is not to say that this shortage is spread out evenly throughout the field of mental health services. Smaller community-based practices are disproportionately affected by the increased turnover rates as they cannot offer the same benefits for their employees that larger private employers can and do offer ("Breaking Point"). As a result, they cannot adequately compete for workers ("Breaking Point"), depriving care of the often underserved and vulnerable communities that these practices serve ("The Solution to America's Mental Health Crisis"). Furthermore, as a result of them oftentimes serving financially poorer communities that tend to rely very heavily on Medicaid programs to pay for their health, these community-based practices also suffer from the abysmal reimbursement rates that these plans provide. To the point where community-based mental health practices only get 60 to 70 cents on the dollar ("The Solution to America's Mental Health Crisis"). The reimbursement rates of Medicaid plans are so abysmal that these practices end up losing money on every service they provide. However, these community-based practices still play an integral role in providing mental health services for poorer communities. Thus, they ought to be able to stay open regardless of how little they get paid for the vital services that they provide.

Yet, none of these problems address the heart of the issue; Where are all these workers that are so sorely needed going to come from? First, extensive professional licensing and education requirements restrict recruits from being able to enter the field ("Breaking Point"). State rules usually require people to have a master's degree to be able to hold a behavioral health license, and opportunities in the field without one are limited ("Breaking Point"). These requirements serve as a barrier for people interested in the field, as the debt incurred due to the process of getting a master's degree discourages people from entering the field. To combat these barriers, more and less costly entry points into the field are necessary to increase the future workforce's size to meet demand ("Breaking Point").

The lack of mental health services during the Covid-19 pandemic also greatly affected people concerning substance abuse disorders due in large part to how mental health and stress directly correlate with the prevalence of substance abuse (Chacon et al.). Factors such as social isolation, economic burdens such as the loss of one's job, limited access to treatment, especially for poorer communities, regulatory barriers in telehealth, and stress from the Covid-19 pandemic are some of the critical factors behind people turning to substance abuse (Chacon et al.). To put this in perspective, since the start of the pandemic, roughly 13% of former addicts fell back into their old addictions as a coping mechanism, while those who were still addicted at the start of the pandemic began to take more drugs to help cope (Chacon et al.). The increased amounts of drugs being taken and the increasing number of people taking them have led to massive increases in the number of drug overdose deaths since the start of the pandemic (Chacon et al.). In Cleveland, for example, according to the Community needs Assessment of 2020, since the beginning of the pandemic, the number of people overdosing has risen to over nine people per day from the pre-pandemic level of seven per day (Community Needs Assessment of 2020). Unless people recognize and respond to the extent of overdose-related deaths, people will continue to die of drug overdoses at an accelerated rate.

To combat the lack of mental health services nationwide, I recommend a fourfold plan: First, increasing funding for mental health services is essential to help lower treatment costs and keep vital mental health providers open. Second, reforming telehealth policies and making telehealth services more widely available in poorer areas would allow those who need help to receive it. Third, by creating a workforce pipeline for the mental health services industry, the government would ensure a long-term solution to the problem. Fourth, increasing the availability of medications that help people recover from SUDs and funding initiatives to educate communities on the harms of substance abuse would mitigate the damages caused by the Covid-19 pandemic.

Increased funding for mental health services would allow more people to afford the mental health care they might need and keep vital medical providers open. First, it would enable government-run Medicaid plans to reimburse for the full cost and range of necessary mental health services. In doing so, the government would be increasing the availability and accessibility of mental health services for those most disadvantaged while, by extension, helping fund the practices that provide their care. Nonetheless, by increasing funding, maintaining unprofitable but necessary mental health centers would already be a given, but that would not be all. Increasing funding for mental health services doesn't just encompass hospitals and other medical institutions. It would also impact other sectors, such as schools. This phenomenon is well explored in an article by Tori Utley, a reporter for Forbes Magazine. She writes, "The state of California found that increasing funding and providing better access to mental health services within the university system yielded positive outcomes. In fact, this increase in funding led to over 300 additional graduates at schools where programs and funding were implemented" (Utley). From helping people achieve their dreams by graduating college to keeping necessary but unprofitable psychiatric centers open, increasing funding for mental health services would benefit society greatly.

However, making mental health services more affordable is meaningless if the services are inaccessible. Reforming telehealth policies and increasing their availability are two essential recommendations that would ultimately save lives. Improving telehealth policies regarding substance abuse disorders could save many lives by allowing those who need help the most, i.e., people with severe substance abuse disorders, to get the help they need (Chacon et al.). Secondly, the massive shift to telehealth services that mental health services have taken since the Covid-19 pandemic excludes many people who lack internet access to get the help they need. To amend this oversight, funding should be put toward increasing high-speed internet access in poorer communities so they can also have access to the mental health services they require. Despite only being short-term fixes, these recommendations are still vitally important to implement since the worst of the effects of the lack of mental health services will be felt in the short term.

Nevertheless, it is still essential to have a long-term solution to the problem of the lack of mental health services, and the only real long-term solution is increasing the number of mental health workers. To facilitate this, the Ohio Council recommends that the government create a workforce pipeline for mental health services ("Breaking Point"). A specific recommendation on how to accomplish this is for the government to provide loans, similar to career impact bonds, for those interested in the field of mental health services ("Breaking Point"), which means that the state would provide loans to fund people's education, that would be repaid in the future through minor wage deductions. Lowering the barriers to entry into the field would foster current interest in it and would most likely empower those interested in pursuing a career in the field of mental health services to do so. Second, the Ohio Council also recommends that education programs for mental health services should be required to prioritize coursework that reflects current mental health practices ("Breaking Point"). To achieve this, they suggest that coursework cover education and licensure requirements while keeping pace with emerging evidence-based practices ("Breaking Point"). However, to fully accomplish this, the Ohio Council recommends that dedicated funding programs to the community-based behavioral health organizations that provide training for behavioral health trainees in the field be created ("Breaking Point"). These measures would make it easier and more streamlined for people to enter the field, providing a long-term solution to the critical labor shortage.

To reduce the number of people with SUDs due to the Covid-19 pandemic, steps should be taken to reduce the number of people who have SUDs and ensure that nobody else gets one. One medication that can help people recover from their SUDs is methadone (Chacon et al.). Physicians frequently recommend methadone to their patients with SUDs as it is a powerful, long-acting medication that has proven to be very effective at curing opioid addiction (Chacon et al.). However, a few studies say that the drug is risky as it is very powerful, so providers are hesitant when prescribing it (Chacon et al.). Though if deemed safe, increasing its availability could help cure people of the SUDs they might have gained from the Covid-19 pandemic. Second, they recommend introducing drug harm protection programs for entire communities, not just schools, preventing people from getting a SUD in the future by educating them on the harms of drugs, up to and including death. The fact is that the socio-economic factors responsible for health disparity in substance use vary immensely. However, public health and harm reduction programs can help by reducing and de-stigmatizing community and societal factors regarding substance abuse, lowering the number of people that would go on to have SUDs (Chacon et al.). Therefore, their third recommendation is to increase funding for community outreach programs (Chacon et al.). Investments in community outreach programs that increase access to mental and drug addiction treatment will be useful during potential future pandemics while lessening the disparities regarding mental health problems between the top and bottom of the income bracket (Chacon et al.). Until the government mitigates the damage done by the Covid-19 pandemic concerning people with SUDs, people will continue to turn to substance abuse instead of seeking the help they need.

Our lives are based upon our mental health; therefore, we should protect and preserve it as much as possible. Without intervention, people will continue to die of drug overdoses at an increased rate, and longer wait times will continue to deprive people of the mental health services they desperately need. But that is not to say that there is no hope. To combat the lack of mental health workers, the Governor of Ohio, Mike DeWine, proposed an 85 million dollar investment into Ohio's Mental Health Workforce (Oelslager). This plan would give Ohio students paid internships in the field and cover the costs of residency and training while creating a hiring and retention bonus to help grow and retain Ohio's current workforce. However, whether or not these efforts are enough to mitigate the lack of mental health services remains to be seen. Nonetheless, action is still required as there is too much at stake. Failing to address the issue of the lack of mental health services would only degrade this keystone of our existence further and further until it falls apart altogether.