Disasters, Including Infectious Disease Outbreaks, are the Absolute Worst Time to Cut Funding to Behavioral Health Services

• Public statements from the CDC emphasize that the “outbreak of coronavirus disease 2019 (COVID-19) is stressful for people. Fear and anxiety about a disease can be overwhelming and cause strong emotions in adults and children.” Vulnerable populations are disproportionately impacted by infectious disease outbreaks such as the COVID-19 pandemic.
  
  
• Evidence strongly supports that with sports seasons suspended, events canceled, businesses closed and travel discouraged, the pandemic will boost the demand for behavioral health services, which is already grappling with widespread workforce shortages and resource limitations. There is a proven linkage: Fear and Distress Response From Pandemic → Behavior Change → Mental Illness / Substance Misuse. This cascade is in addition to social determinants, such as income, education, employment, and social support, that will influence the health of individuals and communities during and after the acute phase of the pandemic. 
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• Social distancing worsens mental health and substance misuse through additional stress (financial instability etc.) combined with diminished support systems (canceled non-emergency health services, canceled alcoholics anonymous (AA) / narcotics anonymous (NA) meetings, closed community-based treatment centers, etc.).
  
  
• There is a strong evidence base focused on the mental health impact of disasters (including infectious disease outbreaks). Concerns related to immediate physical health and community infrastructure risks in the thrall and aftermath of disasters such as the COVID-19 pandemic often overshadow considerations of the short and long-term mental health consequences of such disasters.
  
  
• The data from the SARS outbreaks indicated that upwards of 40% of the community population experienced increased stress in family and work settings during the outbreak; 16% showed signs of traumatic stress levels; and high percentages of the population felt helpless, apprehensive, and horrified by the outbreak. Emergency Departments saw an uptick in visits for people needing treatment for psychiatric and substance use disorders, as people found themselves unable to get their usual substance use or psychiatric treatment.
  
  
• Public mental health measures must address numerous areas of potential distress, health risk behaviors, and psychiatric disease. In anticipation of significant disruption and loss, promoting health-protective behaviors and health response behaviors is imperative. Areas of special attention include:
  
  
  • (1) the role of risk communication
  • (2) the role of safety communication through public/private collaboration
  • (3) psychological, emotional, and behavioral responses to public education, public health surveillance and early detection efforts
  • (4) psychological responses to community containment strategies (quarantine, movement restrictions, school/work/other community closures)
  • (5) health care service surge and continuity
  • (6) responses to mass prophylaxis strategies using vaccines and antiviral medication
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• It is critical that mental health and substance use-related problems receive expanded funding to address PTSD, depression and substance misuse as well as psychosocial needs (e.g. housing, transportation, schools, employment) and the loss of critical infrastructure necessary to sustaining community function.