Holiday season turns up needle on mental anguish

Nine long, deadly months into the pandemic, Americans report psychic distress. It’s dark, we’re stuck inside and we’re isolated. Politics is fevered, the economy continues to struggle and the coronavirus rages on. According to a new Gallup survey, Americans’ assessment of our mental health is “worse than it has been at any point in the last two decades.”

But now comes winter and the holidays. Even in ordinary years, this season turns up the needle on stress. The pandemic winter promises a new layer to our mental anguish. The next three months could bring a level of grief, anxiety, depression and overall stress that may eclipse all that we’ve experienced so far this terrible year.

“This year is very unlikely to be a good year for you if have had a history” of mental health issues, Ken Duckworth, the chief medical officer of the National Alliance on Mental Illness, said. “You’re going to have fewer connections, more isolation and more uncertainty.”

Yet we might be as ill prepared for the mental toll of the pandemic as we were for its physical toll. I spent the past few days talking to experts about Americans’ mental health needs. The picture is bleak. Even before the pandemic, the United States had too few mental health professionals. The shortage is most dire in rural areas and in urban communities that are home to marginalized groups. Demand for treatment has skyrocketed, but supply has not.

“It takes eight months to explode demand,” Duckworth said, but several years to make a social worker.

Worse, there has not been a real focus on the toll on our mental health — not from the Trump administration and not from the incoming Biden administration. Last month the president- elect announced a COVID-19 task force that was praised for its deep expertise. None of its members, though, is an expert on mental health.

That’s a big mistake, according to Luana Marques, a clinical psychologist who directs Community Psychiatry PRIDE, a program at the Massachusetts General Hospital that offers care to underserved populations. She predicted that mental health issues could create a kind of “fourth wave” of the pandemic.

“Once we get the pandemic under control, people are going to come up for air and they will not be OK,” Marques said. “I think we need a national force to help us guide this and have a coordinated effort toward mental health.”

The coronavirus winter will bring challenges for our battered psyches. Many of the ways that people have been counseled to keep up their spirits during the pandemic — maintaining connections, getting lots of exercise, going outdoors — are more challenging in the winter. There is also winter’s singular misery: darkness. Millions of Americans suffer from seasonal affective disorder, a kind of depression thought to be exacerbated, in part, by reduced exposure to sunlight.

Then there are the holidays themselves, which create their own wellknown difficulties.

“There’s often a disconnect between the idealized portraits of what we might expect from the holiday season and what actually happens,” said Joshua Gordon, the director of the National Institute of Mental Health.

The mental health system is already struggling to keep up. In June, the Centers for Disease Control and Prevention found that 40% of U.S. adults reported at least one adverse mental or behavioral health condition, including experiencing symptoms of mental illness or substance abuse related to the pandemic. The CDC also reported that like COVID-19, mental health conditions were disproportionately affecting marginalized communities.

The mental health effects of the pandemic will be dire. For people who’ve lost loved ones, become sick, lost jobs, endured long periods of isolation or have witnessed untold suffering while serving on the front lines, trauma will endure long after the vaccine has rid us of the virus. Winter is coming: We need a real plan to address Americans’ unraveling mental health, and we need it fast.