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Markkula Center for Applied Ethics

Coronavirus, Covid-19, and Ethical Challenges of Mental and Behavioral Health

Pandemic stresses on mental health:

The worldwide Covid-19 pandemic has increased global mental health burdens as people face a spectrum of unanticipated long-term challenges:

  • mass sudden illness and death;
  • infection-control constraints on normal practices of caring for dying loved ones (whether of Covid-19 or other causes), and memorializing them after death;
  • fear of infection; 
  • fear of disease stigma;
  • job loss and other economic disruptions including food insecurity, investment losses, elimination of possibilities for financial advancement;
  • challenges of staying at home in confined spaces, for long periods of times, with families and loved ones; 
  • social isolation resulting from infection-control practices such as sheltering-in-place and social distancing. 

Effects on Mental and Behavioral Health:

For millions of people these stresses increase the risk of: 

  • depression, 
  • anxiety, 
  • addictions of all kinds, and overdose, 
  • domestic abuse and violence,
  • triggering of pre-existing psychiatric conditions,
  • suicide.

Ethical questions related to mental and behavioral health highlighted by the pandemic:

  • Do we need ethical policies for mental health emergency triage and allocation just as much as we do for ventilators and other scarce medical resources?
  • How should we negotiate ethical tradeoffs between the risks to mental health of prolonged economic shutdown and the risks of the virus?
  • How can we provide continuous mental and behavioral healthcare to populations that are under lockdown or have been displaced geographically by the virus?
  • How can we mitigate disruption to mental health, behavioral health, and addiction services caused by insurance loss during the pandemic?
  • Given overwhelming evidence that the pandemic magnifies existing inequalities in the healthcare system, how can we track, and respond, to disproportionate negative effects on the mental health of specific vulnerable populations?
  • How far are we from the goal of “mental health parity” and how does that affect national experience in a pandemic?  Should the pandemic reframe understandings or metrics of mental health parity? (Mental health parity flags an intent to treat mental health and mental illness equitably within insurance plans, with no greater coverage limitations than placed on other kinds of illness. Landmark 2008 legislation reduced but did not eliminate the ability of insurers to discriminate against mental illness, without protecting un- and under-insured.)  
  • How can we inculcate personal and social habits that support mental health resilience in emergency circumstance?
  • How can we best prepare for mental health needs in future public health emergencies?

Innovative responses:

  • Billing policies have been changed to enable reimbursement for teletherapy and -therapy.  Some adjoining states have changed licensing policies to allow mental health professionals to practice across former state licensing boundaries, as people’s residential locale and geographic movement changed in response to the pandemic.
  • New forms of lay-support organizations have arisen, often incorporating training to help volunteers discern which clients need to be referred to expert services.  Mental health providers have volunteered uncompensated service as free referral resources for several of these endeavors. Examples include: The Crisis Textline; NYCWell
  • Numerous celebrities tapped media and social media to acknowledge mental health burdens of the pandemic, and to flag supportive strategies and resources, including Kelly Clarkson, Noah Trevor, Taylor Swift, and Ben Affleck. Other celebrities have spoken publicly about their own mental health struggles associated with the pandemic. 
  • Hospitals with high Covid-19 caseloads initiated a variety of responses to address the trauma of frontline providers. The U.S. Department of Defense is developing programs to address trauma of frontline responders, given parallel symptoms to the trauma of wartime medics. Internationally, the World Health Organization’s report on mental health in the pandemic includes recognition of the toll on health workers.
  • Public health emergency planners have increased priority on the inclusion of mental health needs in future planning.