Colleen Carr, MPH, is the director of the National Action Alliance for Suicide Prevention at the Education Development Center. Even at the start of the COVID-19 pandemic, Carr noticed news media coverage quickly began discussing the potential impacts on mental health and suicide. The inclusion of mental health and suicide prevention in our vernacular during a collective tragedy is societal progress she and other experts have long worked toward but didn’t necessarily anticipate. It was a refreshing and positive development. “It’s not something we would have seen if facing a global pandemic 10 years ago, which speaks to cultural progress, but more work needs to be done to make sure mental health and physical health are treated equally.”
Six months into the pandemic, there are lessons learned Carr hopes will be integrated into intervention and prevention—not just during the disaster, but long-term. She notes that because so many people within the U.S. and across the globe have felt the impact, the ongoing virus and corresponding physical distancing mandates have presented unique opportunities for compassion. “While the effects of the pandemic have varied geographically and socio-economically, there’s a shared experience of feeling that day-to-day life has changed. We’ve witnessed how quickly life can alter, and the shoes that were someone else’s can suddenly become our own.”
The pandemic and the associated mental health implications have resulted in a collective experience, which is vastly different from how mental health has typically been viewed in the past. “Previously, mental health has been seen as an individual issue or biologically-driven with little focus on social environment.” A recent national survey of American adults found that, as a result of the pandemic, the majority of those surveyed (81%) believe suicide prevention should be a national priority, and over half (52%) are more open to talking about their mental health. Carr says that for some people, this is the first time they’ve faced mental health challenges, changing the dialogue from them to us. “We are all on the mental health continuum. The pandemic illustrates that where we are can change based on what’s happening in the world, the culture in which we are living, social context, or environmental factors.”
Changes in Service Delivery
The mental health and suicide prevention field adapted quickly to the new COVID-19 pandemic environment, with telehealth becoming the norm, says Carr, not the exception. Regulatory and policy changes suddenly removed barriers to service delivery that experts have pushed toward for over the better part of a decade. “In a matter of weeks, those changes were made.” This has allowed service providers to reach populations they couldn’t have otherwise because of impediments like distance, work hours, and transportation. It’s easier for people to log in remotely to an appointment during lunch than take time off work to go in person. Carr says the move from brick and mortar to virtual for call centers, and to telehealth for service providers, was innovative and rapid, which isn’t typically a hallmark of the behavioral health field. She hopes that the momentum, drive, and creativity remain even as the virus slows down. “There’s an opportunity to study and research the delivery of care that’s taken place over these last few months. We want to maintain increased points of access and flexibility when we return to ordinary life, whatever that might look like.”
Carr points out that many people’s access to healthcare is tied to their jobs. The unemployment rate in the U.S. spiked from 3.5% in February to 14.7% in April. Since then, it has decreased by 4.5% but still hovers far above where we started before the pandemic. Even if services are adapting and increasingly flexible, she says people still might not be able to obtain them because of a change in employment. “We need to be thinking about how to support those most vulnerable at the time of transition who are losing their networks, supports, and financial stability. It’s not just about the delivery of care but making it accessible in a timely way to those who need it throughout these shifts.”
Also, while it’s true that many people are experiencing interruption and disruption related to the pandemic, some racial and ethnic minority communities are disproportionately affected, highlighting systemic social and health inequities that people of color face. Communities, Carr notes, that the mental health and suicide prevention field often haven’t adequately engaged. “By shining a light on the gaps, hopefully, we can work alongside populations who don’t have equitable access to the care they need. As we address the pandemic’s mental health impacts—both now and in the future—we need to ensure we’re listening to and including diverse communities in all of our efforts, not just those related to COVID-19.”
The Problem with Predictions
Early on, says Carr, there was a desire among mental health experts to forecast what was next, resulting in skyrocketing predictions, including how many suicides would result from the pandemic. She points out that while there are adverse impacts, just because a person is struggling right now doesn’t mean they will always struggle, and what people need from service providers will vary. Some people, notes Carr, will bounce back on their own, while others will require a range of support from minimal to intensive, “which means we need to build a continuum that’s accessible so that everyone can get the level of care they need when and how they need it.”
The disaster, says Carr, has highlighted the glaring dearth of data on mental health and suicide in the U.S. Meanwhile, at 10 a.m. every day, the county where Carr lives shares the number of people who have been diagnosed, hospitalized, or died of COVID-19, and what has changed from the day before. Sure, the data isn’t perfect, she says, but what’s playing out before us is why data is needed to inform decision making. Information on the virus has helped leaders determine when to close down, open up, or move from one phase to another. “Even imperfect data has been instrumental. In mental health and suicide prevention, we often have to make decisions without updated figures. We need to do better.” Carr says that witnessing the quick turnaround of information on the virus has led people in mental health to revisit the question of what data can be produced closer to real-time. It would allow earlier intervention and timely identification of trends and upticks in suicidal behavior and indicators. “Data isn’t the add on at the end of the report, saying, ‘and we need better research and numbers.’ Statistics are instrumental in driving intervention, prevention, and innovation.”
Each year, the CDC has to wait on U.S. states and territories to report mortalities. It’s quality, vetted data, but not timely. During the pandemic, some states like Colorado, have continually released their suicide or overdose mortality rates, but, overall, the impact of COVID-19 is still unknown. “As a community, we need to find a way to get glimpses into what’s happening and start to break new ground.” Carr says the Action Alliance’s National Response and Data and Surveillance Task Force are working to find ways to apply innovations from the COVID-19 public health crisis to the public health crisis of suicide. “We need to ensure healthcare providers, prevention professionals, and policymakers have the best available numbers to inform their decision making instead of hypothesizing.”
Public Health Lens
It’s not just in the area of research and data where there should be a public health approach but also in mental health awareness and support. Carr says there’s the cultural conversation happening around the pandemic and mental health, but it needs to be operationalized locally within healthcare systems and community leadership. For example, it’s vital for employers, as part of their return to work planning, to address the mental health of employees and their families, and for schools to be implementing programming around mental health and social, emotional learning in their return to school policies. “They need to be vocal about supporting staff and students as they return to the workforce, school, or continue prolonged remote engagement.” Community influencers like employers, educators, coaches, and faith leaders can have a tremendous impact on intervention and prevention. Across the nation and around the world, leaders are starting to realize that maintaining mental health is a critical part of the equation, and they must be intentional in how they address it. Some of the impacts of the pandemic, says Carr, will be immediate, but others might not be for six months, a year, or longer, which means influencers must think of long-term recovery as well, “not just the acute stressors of quarantine and physical distancing.”
The idea, says Carr, is that community influencers become mental health and suicide prevention partners, not providers. They shouldn’t feel as though they have to solve the problem or resolve the situation to be helpful, but rather that a simple message of support—“I’m here for you, let’s get through this together”—makes all the difference. Dialogue that discusses how people are taking care of themselves during the crisis creates a safe, welcoming space for conversation. The gist is letting people know that it’s okay to struggle and that their community will be there and help them navigate finding additional support if needed. “Starting with a simple message of support is incredibly powerful. It lets people know that as much as the leader values them getting back to school, to their job, or on the field, they also value each person’s mental health.”
Empowerment During Crisis
When talking about mental health and suicide prevention, Carr says it’s necessary to highlight what people can do now—skills they can develop or support they can access or provide—to help themselves and others. “We don’t yet know how the COVID-19 pandemic will impact suicide rates and mental health crises. The story is still being written.” Our messages, says Carr, should empower people to take action and seek help if needed, particularly those who are vulnerable and experiencing financial instability, who’ve lost loved ones or are dealing with long-term recovery challenges from the virus, or are on the front lines and experiencing heightened anxiety and stress. “Motivating everyone to participate in mental health wellness is much more powerful than a few people doing a lot.” She says the danger of doom and gloom predictions is that it leads people to believe that higher suicide rates are inevitable when there is nothing etched into the future to imply so. During a time that feels so very out of people’s control, when so much is unknown, there can be a culture change toward caring for ourselves and others in our community. “This is a moment where the entire paradigm can shift in how we view mental health and suicide prevention. It’s time we move beyond just awareness and move towards action, addressing it as a nation, as communities, and as individuals.”
Learn more about the Action Alliance’s COVID-19 messaging guidance and national response.
