I am delighted to be taking the pen on authorship for these newsletters from my friend, former colleague, and current White House staffer Erika Poethig. Though the voice will change, the focus remains the same: sharing insights on how to drive inclusive recovery in cities and address inequities as we emerge from the COVID-19 crisis. I welcome your reflections, thoughts, and reactions via email anytime.
—Justin Milner, Acting Vice President, Research to Action Lab
Mental Health and Inclusive Recovery
The past 12 months have been straight-up exhausting. After almost a full year of managing the uncertainties of the pandemic and endeavoring to protect ourselves and our loved ones from infection, there’s little surprise that the latest research shows Americans self-reporting increased levels of anxiety, depression, and emotional distress. Mental health has emerged as a critical issue in communities looking to move forward. But how do we begin to think about the enormous stressors—economic and emotional—that the past 12 months have visited on almost every household? And how do we recover in a way that accounts for deep disparities experienced across communities?
With these questions in mind, I spoke with Urban Institute senior vice president and clinical psychologist Kimberlyn Leary about the devastating effect the pandemic is having on mental health and why this conversation is essential to achieving a truly inclusive recovery.
What does the mental health landscape look like now?
The pandemic constitutes a macro-level stressor that is perhaps unlike anything we’ve seen in our lifetimes. Where most natural or human-caused disasters typically are situated in a specific place, the coronavirus travels with us and throughout the global economy.
This is also new territory at an individual level. There isn’t anyone who hasn’t faced uncertainty and disruption because of the pandemic, though some face more than others. Yet all of this has been a part of our lives for almost a year. So it’s entirely reasonable that we, our family members, neighbors, and coworkers are suffering with feelings of stress, anxiety, and sadness. It’s a lot to bear.
Now, let’s add on what we understand about the traumatic effects of prolonged and unpredictable stress. Typically, stress and anxiety serve as signals for some kind of corrective action. When people are stressed, they step back from the thing that’s causing them anxiety, or they step forward with social support. And then they are better positioned to cope. That’s when our signaling system is working at its best.
But in the face of events that are negative, uncontrollable, and unpredictable and require continuous adaptation, the normal levers for relief simply don’t work. And one of the particular dimensions we’re living through is that the very things that protect you from harm—social distancing and stepping back from social connections—are likely the source of new anxiety. People have less or no access to their usual supports.
In this broad environment of heightened stress, who is affected the most?
We all know the pandemic has had different impacts on vulnerable constituencies and communities of color. We don’t yet have a full data picture, but there are signals that women— women of color especially—are bearing a disproportionate economic and social burden. In January, for example, total net job loss (PDF) in the US was 140,000 jobs, all from women.
There are certainly some outside tensions at play here; job losses among women of color were more likely to be in areas hardest hit by the pandemic, like hospitality and education. But there are deeper reasons to consider as well, especially in families with children. In many communities, gender defaults mean child care falls to women. And if there has to be some give in family responsibilities—if kids need to be educated at home or cared for—those unpaid jobs typically fall to women.
For single women parenting children, the predicaments are even more stark, including, for some, feeling forced to leave kids unattended in order to work. Child care, even if affordable, has become less available during the pandemic. For some, taking the economic hit of exiting the workforce feels like the only alternative.
And when you say we have an incomplete data picture right now, what are some trends we should be watching?
Many mental health professionals believe we haven’t yet experienced the surge of pent-up demand. With the loss of 500,000 lives, millions of Americans are processing bereavement, often without the typical rituals and services that allow people to have some structure for their grief. Many more who had COVID-19 have initially recovered but have long-term cognitive, pulmonary, and cardiac injuries caused by the virus.
Early data also suggest that calls to help lines and mental health crisis lines have increased by several fold. And now, as kids start to go back to school, we might anticipate that the drop in child abuse reports we saw at the start of the pandemic reverses, as teachers, coaches, and other adults who have eyes on kids can report concerning behaviors or injuries. Similarly, reports of intimate partner and family violence in the home escalated during the pandemic, and “stay-at-home" protocols have reduced options for women to seek services outside of their homes.
All of this suggests that people are in need of care for alarming levels of stress and emotional trauma. I think we’ll continue to see a surge in mental health needs overall and a more granular picture of the care gap as the illness itself becomes more manageable. And this will be particularly important to track in vulnerable communities and communities of color.
How can we use this opportunity to expand our conversations on mental health and what city leaders can do in this context?
We need more comprehensive language to discuss mental health as a goal and mental health as a care condition. Last year, I talked with 50 mayors about supporting mental health in their communities, and I recommended more effective communication around available resources, plus a renewed focus on destigmatizing the need for ongoing services. People with psychological and psychiatric disabilities have struggled to have their needs recognized in public policy even before the pandemic and certainly since it started. Too often, those with serious forms of mental illness are rendered invisible when we think about economic recovery efforts. So, when it comes to protecting mental health, we need to elevate the conversation to include mental health as a component of population-level health and public policy.
Mental health supports are imperative for inclusive recovery
This is a critical conversation as we enter a new phase of economic recovery. If our goal is to ensure marginalized communities can contribute to and benefit from economic growth, we have to think carefully about mental health and how to support workers moving forward. I think Kim is absolutely right: as we start to emerge and recover from the pandemic, we will face another set of challenges about who wants to return to work and what jobs are available to them. The degree to which race and gender continue to play a role remains to be seen.
We face the fundamental challenge of how COVID-19 has shifted people’s life trajectories and prospects. As city leaders think about recovery, it will be crucial to integrate plans for more responsive mental health services as they consider enhanced flexibilities, access to learning, and employment. It’s unchartered territory, to be sure. But a truly inclusive recovery demands that we create new pathways for people to return to work and to the overall economy, while supporting their mental health needs.