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Mental health care has become even more crucial with the traumas of 2020 — but resources are stretched thin

Questions remain as to whether systems will change enough to normalize mental health care following a year of collective trauma.
Image: Scenes of coronavirus and racial injustice in the United States in a composition of concentric circles forming a target, on a red background.
Chelsea Stahl / NBC News

Maryorie Delgado, 23, a senior at Brigham Young University, has always considered herself to be an emotionally strong person, but she began to feel overwhelmed during the early days of the coronavirus pandemic.

Delgado moved to the United States with her family from Peru when she was 8 years old. She’s not only a student: She helps her parents with their family business, helps them translate and handles her brother’s immigration status in addition to her studies. It’s a lot for any young person to manage, but Delgado felt confident she had a handle on all of it. Then the pandemic hit.

A few months ago, Delgado said, the family had to shut down their business due to Covid-19 procedures at the same time they hit a bump in the road for her brother’s immigration proceedings. She felt like the world was ending.

“I kind of lost the balance and I lost the rhythm that I had,” Delgado said. “It was just hard for me to feel that anxiety during that time, because I felt like I had gotten a grip of that. So it was just really stressful to me that I thought I couldn't handle it.”

In a year of more than 300,000 deaths from a pandemic, job insecurity, a looming eviction crisis and a renewed focus on racial injustice, mental health has been pushed into the public discourse across the country.

Politicians have implemented new strategies to acknowledge disparities in quality of care for people seeking health providers and have attempted to address mental health through policy.

Colorado launched its Behavioral Health Task Force in April 2019 and has since identified a "blueprint for reform" to improve mental health infrastructure in the state. New York Gov. Andrew Cuomo announced new regulations in October to ensure parity for mental health coverage that are set to go into effect by the end of the year. And in April, a group of U.S. senators sent a letter to congressional leadership asking them to address disparities in care and a shortage of mental health providers.

Though these acknowledgments have been made, questions remain as to whether systems will change enough to normalize mental health care following a year of collective trauma.

In June, an estimated 40 percent of U.S. adults reported struggling with some form of mental health or substance abuse issues, according to a Centers for Disease Control and Prevention report published in August. There was a threefold increase in adults reporting anxiety and four times the reports of feelings of depression compared to the same time the year before, the CDC found.

Even prior to the pandemic, 38 percent of adults were not able to receive needed treatment for mental health issues, according to Mental Health America. If the steady rise of adults reporting anxiety and depression remains consistent, mental illness could become a common pre-existing condition, the Kaiser Family Foundation said in an October report.

Some of these people are exhibiting normal feelings caused by stressful circumstances, but there is certainly a group of people who will face long-term consequences of trauma, according to Rachel Garfield, co-director for the Kaiser Family Foundation’s Program on Medicaid and the Uninsured.

“There is some subset of those people who will experience sort of like a clinically diagnosable mental illness,” Garfield said. “So, you know, major depressive disorder, anxiety disorder and things like that, which is a slightly different thing than, you know, exhibiting that I'm feeling anxious.”

There are still many unknowns about how 2020 will affect people for the long term, but there is likely going to be a strain on the mental health industry that was already struggling to keep up with the unmet needs of people facing emotional disorders, Garfield said.

Last year, Delgado had begun taking advantage of a school counseling program that allowed her to see a therapist, but when she temporarily moved out of state, she was no longer able to continue therapy during the pandemic due to licensing issues.

She still tried to take advantage of the tools she used in her sessions to calm herself, adjust her perspective and handle her anxiety.

“My therapist focused a lot on just breathing exercises and being able to sleep well and, you know, just taking care of myself first,” Delgado said. “And I feel like that has taught me a lot and it's made me a lot better, like, mentally, or more mentally stable and healthier because I've learned to take care of myself. And that's something that I feel like my therapist helped me understand.”

But Delgado won’t be able to see her school-provided therapist after she graduates in a few weeks, and she’s unaware of many resources that would allow her to continue therapy afterward. She wishes that during the pandemic there had been more programs that targeted minority communities, like her own Latinx community, to help them access mental health programs.

“I understood the power of psychology and how that can still help you change and become a better person,” Delgado said. “I just wish more people would realize that right, even if a person thinks that they're very strong emotionally ... they can still get help.”

Children in particular can be affected

One area that Garfield feels has not had as much focus is the mental health of children, because data on them can be hard to collect and most children receive their services through school.

“A lot of that is also falling through the cracks right now, because that is another challenge,” Garfield said. “I think that there's probably an even bigger need than what we're seeing right now because, you know, children are not seeing that range of adults who maybe have more experience at saying, ‘Hey I recognize this as a symptom of X, Y or Z.’”

There is a widespread belief that kids and adolescents are "also really suffering in their behavioral health," Garfield said.

JuanJose Martinez, 19, had to give up his job as a security guard to become a full-time parent to four of his siblings after his mother died of the coronavirus in August. The family has continued to raise money to be able to afford more than just the bare necessities, through GoFundMe and other family support, Martinez said.

His days are full, from waking his siblings up in the morning for school, making sure they have each meal on time, helping with homework and maintaining bedtime, he said. It’s been a difficult transition for the siblings, who range in age from 7 to 15, Martinez said, and they do get emotional.

“I’m just telling my siblings that, you know, I'm always gonna be there for them,” Martinez said. “And I'm not gonna let anything happen to them.”

After his mother’s death in August, Martinez said the family did receive offers of counseling through the children’s schools, which he’s been looking at as an option.

His teenage sister has been able to get therapy, which her school found and referred Martinez to, which he said has helped.

Martinez, who also fell ill and is still recovering from the effects of his pneumonia, said he has tried to give his siblings space to share their feelings following their mother’s death.

“I feel like that's just, you know, just letting it out,” Martinez said. “That stuff that's been held in and hasn't been able to be let out. ... I look at it as we have our own little, you know, therapy sessions within each other.”

Telehealth could increase access, though barriers remain

Yuki Yamazaki, a licensed mental health counselor who works in private practice and is working on her doctorate, has learned a lot about herself and her clients this year as she’s continued to see patients for therapy.

She’s seen a mix of patients, some who have done therapy before and some who are completely new to the process, she said.

“I think people are much stronger than they thought they were,” Yamazaki said. “I think that people thought that they couldn't get through this. … Whether they're talking to me about anxiety or depression or loneliness, people have made it, people have gotten through.”

There have been new and interesting issues that have begun to pop up for Yamazaki as she’s listened and worked with people on decisions they are making for themselves during a public health crisis. She’s also managed to make solid relationships as a provider through a webcam, even though she doesn’t know what some patients look like from the waist down.

“It shows me that, like, this kind of telehealth method of doing mental health services is really functional,” Yamazaki said. “I can see a lot more people, and I can really, really build relationships in this digital way.”

With the increased access, Yamazaki has seen an increase in demand. Her inbox has been flooded with requests for new clients, which the New York-based therapist has had to reluctantly turn away. And it’s clear from the emails she’s received that she’s not the first person to have turned that person away.

"There is, like, 'I'm not the first person ever reaching out to,' and a lot of awareness, like, 'I'm sure you're getting a lot of emails right now, but like I'd really like to start seeing somebody,'" Yamazaki said. “But ... there's no availability from clinicians, I think that's one piece of it. ... We need more people providing services.”

Though federal protections require insurance providers to offer parity between medical and mental health services, the fractured system can sometimes stand in the way. A number of issues such as payment reimbursement policies and licensing requirements changing from state to state often put up barriers between patients and care.

One area where this has been prevalent is with young people who move, either away to school or back home with their parents, and lose access to consistent care from a therapist they’ve created a relationship with.

“It feels like such a big ask for people to step up and engage in services, when they're usually going through something like a life transition,” Yamazaki said. “And we don't have like a step 1-2-3 of, like, how do you connect to care.”