The trauma avalanche is coming

Our mental health system is not prepared for the upcoming avalanche of need once we get a handle on our current COVID-19 pandemic. Our mental health system is already feeling the deepening effects of new waves of folks experiencing mental health issues. Additionally, the pandemic has exacerbated existing mental health conditions.

One could easily argue that our mental health and substance use treatment system in the United States was never prepared to fully meet the need of the times. From the times of de-institutionalizing patients in psychiatric hospitals, to the time of developing community-based services that  functioned more like multiple separate systems rather than an interconnected system of care, to where we are today — which seems grossly understaffed, with a patchwork of services and without a clear, overarching vision — our system has been ill-equipped.

Prior to the COVID-19 pandemic, people were going without mental health services for many reasons. One, there aren’t enough providers and institutions to accommodate the need for the variety of mental health needs — especially in rural areas or service deserts. Two, stigma remains so strong that the vast majority of people will never seek mental health services who truly need it. Three, we don’t provide enough education and promote self-awareness to understand when any of us should reach out for help.

Then, overlay a pandemic, which encourages or forces us to develop a new life, new expectations and new goals without a way to contextualize or process what those changes mean. This is the definition of post-traumatic stress disorder (PTSD). We experienced a traumatic event (impact of the pandemic) but we can’t take the time in the moment to understand the true impact, so we stash it away for later. The impact is burrowed in us, both emotionally and physically. We go on about our lives and then are surprised when we notice we now need wine each night to “wind down.” Or we stop contacting our friends because we simply cannot do another “Zoom meetup.” COVID is a traumatic event.

Trauma is rooted in anxiety and the surfacing of symptoms may be delayed. Trauma symptoms often emerge once the person is out of an acute crisis situation. PTSD emerges once a person is in a safer, predictable and supportive place. When we can exhale again, our trauma memories surface more easily. This may look like increased anxiety, deeper depression, a feeling of complete hopelessness or thoughts of suicide.

According to the Centers for Disease Control and Prevention (CDC), in the fall of 2020 the prevalence of anxiety disorder symptoms were approximately three times those reported in the second quarter of 2019 (25.5% versus 8.1%), and prevalence of depressive disorder was approximately four times that reported in the second quarter of 2019 (24.3% versus 6.5%). If we understand the mechanisms of the brain, body and how our feelings surface even more after the traumatic event, we can only expect these numbers to increase. Dramatically.

The Mayo Clinic describes the symptoms of PTSD as experiencing intrusive memories of the traumatic event or reliving the traumatic event as if it were happening again (flashbacks). It may also include upsetting dreams or nightmares about the traumatic event or severe emotional distress or physical reactions to something that reminds one of the traumatic events.

Mayo says we may have negative thoughts about ourselves, other people or the world or feel hopelessness about the future. People might have memory problems and some may experience difficulty maintaining close relationships, feeling detached from family and friends or lacking interest in activities once enjoyed. We may feel easily startled or frightened, being on guard for danger or demonstrating self-destructive behavior, such as drinking too much or driving too fast. One may have trouble sleeping, trouble concentrating or feel irritable. Lastly, we may have angry outbursts or aggressive behavior.

Even though our systems are stretched thin, we should reach out for help. One can call the National Suicide Prevention Lifeline at 1-800-273-8255, contact your local mental health center for therapy or talk with your primary care physician or a psychiatrist for prescription medications. The point is taking a step for your own mental health.

Are we fully prepared for this avalanche? No. Must we still try to prepare the best we can? Yes. We need to come together to develop a national operational strategy to combat behavioral health problems. This means understanding the mental health impact COVID has had on all of us, designing national objectives and developing a way to operationalize and support local providers to meet the need. Our lives depend on it.

Gary Norman, MSW, LICSW, is the chief operating officer at Twin Cities Health Services in Minneapolis and an instructor of social work at Augsburg University.

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