Octavio N. Martinez, Jr., Executive Director, Hogg Foundation for Mental Health
How can something so small, naked to the human eye, cause so much grief? The culprit is a virus, SARS-CoV-2, and the disease COVID-19. The grief grows day by day around the world as people get sick and as people die. The virus does not discriminate and it knows no boundaries. It doesn’t care if you are Black or White, Hispanic or Protestant, live in North Carolina or Texas. It does care if you are human, a host to exploit, and it needs us to replicate. However, the amount of morbidity and mortality it inflicts depends on us. How we treat and respect each other are critical variables in how COVID-19 impacts us.
COVID-19 is unmasking our shortcomings, gaps, disinvestments, disparities, inequities, and discrimination towards each other. Because COVID-19 is now so pervasive, this unmasking is playing out in multiple arenas simultaneously. One of the major ones is behavioral health. In truth, the United States of America was not doing all that well in taking care of our behavioral health issues before COVID-19. For example, according to Health Affairs, one in every eight visits to an emergency department is due to individuals with mental health and substance use disorders (Laderman et al. 2018); and according to the National Alliance on Mental Illness, untreated mental illness costs the United States approximately $300 billion annually in lost productivity (Sperling 2018). Even more disturbing are the statistics released by the Centers for Disease Control and Prevention which showed a more than 30 percent increase in suicide rates in 25 states since 1999 (CDC 2018).
As concerning as these statistics and trends are, equally alarming are the behavioral health disparities and inequities created by decades of bias, discrimination, and racism that permeates our health care system. Research continues to show that we over diagnose African American males with schizophrenia, Latina teens have the highest rate of suicide attempts in the United States, jails and prisons have become the nation’s largest psychiatric facilities, and a culturally and linguistically competent behavioral health workforce continues to elude us. From a policy standpoint, we have underfunded and undervalued mental health and substance use services, especially for Native Americans. And even though we passed the Mental Health Parity and Addiction Equity Act in 2008, we still do not have parity between physical, mental health, and substance use services in this country. As you can see, we already had plenty of grief to go around.
However, philanthropy has not remained silent or uncaring. For example, the Robert Wood Johnson Foundation has been building a “Culture of Health,” The Colorado Health Foundation works at the community level to create health equity, and The Rapides Foundation is working to reduce health disparities for Central Louisiana. But now it is even more imperative that health philanthropy doubles down on eliminating behavioral health disparities and achieving health equity for marginalized, historically excluded communities. Not only for the reasons I have already mentioned, but also because the crisis at hand is affecting the entire country’s mental health. The need for mental health and substance use services will only continue to grow fueled by COVID-19. The U.S. economy has taken a huge hit and the impact will be felt for years to come. According to research by Aaron Reeves of the University of Cambridge and Sanjay Basu of Stanford, for every one percent rise in unemployment there will be an approximately one percent rise in the suicide rate (Carey 2012). This sets up the potential scenario where most behavioral health services and supports will be dedicated to the majority population, thereby exacerbating existing mental health disparities and inequities. However, this doesn’t have to be a given if we approach this crisis and its ongoing impact through a health equity lens.
We now have evidence-based research that has helped us understand the importance of the social determinants of health. We must remember there is no health without mental health. Simply addressing social determinants, such as housing, built environment, transportation, and food deserts, as well as understanding their impact on mental and physical health is insufficient. We must also combine our efforts with truly understanding the root causes: power, privilege, and systems of covert and overt oppression. This is the hard work that we have subconsciously avoided, but that we must tackle together to create an equitable society.
To help tackle the root causes, The National Committee of Responsive Philanthropy has identified the following steps:
- Develop a theory of change that includes how power and oppression constrain or support policy, systems, and environmental change.
- Learn from, ally with, and support those who believe in power-building to make headway on the issues you care about.
- Uphold a narrative within (mental) health philanthropy that is about building power to advance health equity, which acknowledges entrenched systems of oppression.
- Create a framework for measuring outcomes and progress. Fund the development of appropriate metrics for organizing and advocacy that advances health equity (Farhang 2018).
And I would add that working with and partnering with community is a must. Funding and building capacity to ensure that community is at the table and is part of the governance structure helps to ensure transparency and accountability from the grassroots level to the policy levels of government.
COVID-19 is challenging us like no other crisis has this century. It is unmasking our short-sightedness, pettiness, and prejudiced nature. It is also revealing our empathy, compassion, and humanity. Now is our time to stand up. We must not shy away from this assault to our humanity, because together we have the power to alter adversity and create an equitable future for all.
Laderman, Mara, Amrita Dasgupta, Robin Henderson, and Arpan Waghray. “Tackling the Mental Health Crisis in Emergency Departments: Look Upstream for Solutions.” Health Affairs Blog, January 26, 2018.
Sperling, Andrew. “FY 2018 Funding for Mental Health.” National Alliance on Mental Health, 2018.
Centers for Disease Control and Prevention (CDC). “Suicide Rates Rising Across the U.S.” June 7, 2018.
Carey, Benedict. “Increase Seen in U.S. Suicide Rate Since Recession.” The New York Times, Nov. 4, 2012.
Farhang, Lili. “Centering Power: The Leading Edge in Health Equity Philanthropy.” National Committee for Responsive Philanthropy Blog, April 17, 2018.
Auerbach, John and Miller, Benjamin F. “COVID-19 Exposes the Cracks in Our Already Fragile Mental Health System,” American Journal of Public Health. July 2020, Vol. 110 No. 7: pp. e1-e2.
Sederer, Lloyd I., et al., “Lessons Learned From the New York State Mental Health Response to the September 11, 2001, Attacks.” Psychiatric Services. September 2011, Vol. 62 No. 9: pp. 1085 – 1089.