Mental health and mental health services during the COVID-19 pandemic

Abstract

The COVID-19 pandemic significantly impacted mental health and mental health services in the United States. During February 2021, 42% of Americans experienced symptoms of depression or anxiety. During the pandemic, the largest and most sustained growth in telemedicine occurred in mental health services. The goal of this dissertation is to explore strategies for maintaining mental health services and promoting mental health during the COVID-19 pandemic. In this work, I review the literature on what is currently known about the impact of the COVID-19 pandemic on mental health and mental health services. I provide conceptual frameworks that posit how vulnerable populations are at highest risk for losing access to healthcare during the pandemic and how population-level strategies are needed to promote mental health recovery. In my first research paper, I use qualitative data collected from semi-structured interviews with twenty adults with serious mental illness (SMI) during the pandemic. I found that most study participants did not experience increases in unmet mental health or social service needs. However, several participants who lacked identification documents, housing, and/or a personal device reported significant increases in unmet needs, including inability to access mental health care and public benefits. As many participants in the qualitative study reported receiving audio-only telemental health services versus video telemedicine during the pandemic, I used data from the Medicare Current Beneficiary Survey COVID-19 Supplements to explore the use of audio-only telemedicine during the pandemic. Findings suggest that the high rate of audio-only telemedicine is not exclusively related to the digital divide or patient preferences, but also to provider behavior. Lastly, as the COVID-19 pandemic impacted the mental health of the entire population, I used data from the Census Bureau’s Household Pulse Survey to explore whether availability and receipt of an effective COVID-19 vaccine could promote mental health. Results suggest a reduction in the predicted probability of mental health symptoms after approval of the vaccine and a lower predicted probability of mental health symptoms among those who have been vaccinated, however these rates remain higher than what was seen prior to the pandemic. Overall findings suggest that the mental health care system has adapted fairly well to meet the needs of persons with SMI during the pandemic and mental health has improved since the approval of the vaccine, but additional work will be needed to reengage those who were disconnected from mental health services during the pandemic and to achieve pre-pandemic levels of mental health.