The COVID-19 pandemic had severe consequences for the entire US population. It is imperative to consider reduced access to health services for racial and ethnic minorities, an increased percentage of mental illnesses among minorities, and the fact that social problems caused by COVID-19 cause mental illnesses that put people at greater risk of infection. This paper aims to present policy analysis and develop recommendations on the course of actions for the NY state legislators.
Due to the COVID-19 pandemic, vulnerable populations, including people with mental disorders and ethnic and racial minorities, are at increased risk of the disease. The problems faced by these groups indicate the existence of a syndemic when there is an epidemic spread and the growth of various interrelated negative health tendencies.
Background of the Problem
Scientists have documented the emergence of a new phenomenon, syndemic, due to the interaction between the COVID-19 pandemic, structural racism, and mental health inequalities (Shim & Starks, 2021). They also note that COVID-19 is associated with increased mental health problems such as anxiety disorders, suicide, depression, and substance use. People with mental illness, oppressed and marginalized communities are at significantly greater risk of contracting COVID-19. Hispanics, Aboriginal people, and African Americans have higher infection rates, hospitalization, and death (Shim & Starks, 2021). Essential workers who occupy positions with high work demands and low decision-making freedom are more likely to have mental health problems and fall into the risk group (Shim & Starks, 2021). People living in nursing homes, long-term care facilities, and prisons deserve special attention, especially given the high percentage of ethnic minorities and people with mental illness.
Notably, the mental health impairment caused by COVID-19 is most commonly associated with concerns about economic impact. Fears about the health effects of the virus and fears of social distancing are less related to symptoms of depression and anxiety (Kämpfen et al., 2020). Scientists predict a severe mental health crisis that will occur concurrently with a pandemic. Nielsen and Levkovich (2020) highlight that lockdown and social isolation, job loss, and fear are associated with increased anxiety and depressive disorder symptoms among US citizens.
Twenge and Joiner (2020) cited research data, according to which, compared to 2018, adults in the United States in April 2020 were eight times more likely to show symptoms that met the criteria for a serious mental disorder – 27.7% versus 3.4%. The participants were also three times more likely to meet the criteria for moderate mental disorder – 70.4% versus 22.0% (Twenge & Joiner, 2020). Due to greater economic impact, stigma, and discrimination, the most vulnerable groups were young people without children, parents of children under 18, black Americans, and Asian Americans. Twenge and Joiner (2020) mentioned the link between social isolation, job loss, physical health problems, and mental health problems such as major depressive disorder, anxiety disorders, and suicidal behavior, including suicide. Scientists have also recorded an increase in the number of psychiatrists and the suicide helpline.
Turchioe et al. (2020) reported mental health symptoms among US adults in the early stages of the pandemic. The most common symptoms included high levels of anxiety and depression, followed by anger, fear, cognitive problems, depression, and fatigue. Millennials and Generation X, those with insufficient or sufficient and more than adequate resources, people with self-reported disabilities, and people with inadequate health literacy were the group with the greatest worsening of mental health symptoms. Berkowitz and Basu (2021) confirmed the link between the risk of malnutrition, symptoms of depression and anxiety, and the discontinuation of FPUC unemployment benefits, which ended in July 2020. Donnelly and Farina (2020) confirmed that “depression and anxiety rates are highest in adults with an income shock” (p. 269). Other vulnerabilities associated with mental health and the COVID-19 pandemic are food security, the stress of financial insecurity, and the unexpected death of a loved one (Nagata et al., 2021; Purtle, 2020).
Landscape of the Problem
Key stakeholders relevant to the policy analysis are federal and state legislators, lobbies, groups, and organizations advocating for mental health. These are organizations like Mental Health America and National Alliance on Mental Illness. Noteworthy, Mental Health America “advocates for legislation that affects people with mental health conditions and their families” (“Public policy,” 2021, par. 1). Key factors that create difficulties in implementing adequate policies that will help the vulnerable populations amid the COVID-19 pandemic include the lack of money, lack of laws that would regulate work with these groups, and lack of laws guaranteeing the financing of programs and projects. The economic crisis is a global problem that comprehensively affects the issue and leads to a lack of resources to finance any assistance programs. Political confrontation on the eve of the presidential elections and the irresponsible policy of the previous president is another negative factor. Finally, there are difficulties associated with the practical implementation of assistance programs due to lockdown.
Available Options for Action
Donnelly and Farina (2020) note that many state policies have mitigated household income shocks for mental health. In this regard, NY state legislators and officials, including the NY mayor, can influence the situation by presenting an action plan to protect vulnerable populations. This plan could include developing a mental health equity and suicide prevention bill to expand the implementation of a similar federal bill (Shim & Starks, 2021). Adopting a formal bill at the state level will have a significant plus in enforcing the initiatives spelled out. Bureaucratic delays, on the other hand, can become a problem in implementing this option.
The bill may feature the need to prioritize access to testing and vaccination for vulnerable groups, financial and food support (Nagata et al., 2021; Bergquist et al., 2020). Another important point is the re-qualification of punishments for drug possession and serious crimes for misdemeanors to reduce prisons’ overcrowding. It is necessary to include a clause on the provision of telepsychiatry services as part of the package of laws aimed at combating syndemic (Shim & Starks, 2021; Nielsen & Levkovich, 2020; Pierce et al., 2021; Bergquist et al., 2020).
Equally important is addressing city-level issues related to urban transport safety, broadband internet access, and smartphones and reducing discrimination among Asian Americans (Purtle, 2020). The city must initiate more efficient transport services and free access to the Internet and smartphones or PCs for vulnerable groups. This solution is potentially successful as it will bring immediate practical benefits; the disadvantage is the lack of leverage over the responsible persons who could implement the decision. State officials should also oversee monitoring of the risks of COVID-19 infection due to race, ethnicity, and mental illness. This option is easy to implement in partnership with research centers; lack of funding and motivation may be a problem.
Based on the information and arguments outlined above, it is recommended that New York State legislators draft and vote for a bill that guarantees a range of measures to protect and support vulnerable populations. Drafting and ratifying a bill is the most effective solution, as it will utilize a top-down approach to ensure that the necessary measures are taken. Despite the possibility of bureaucratic delays associated with political issues, the bill can be easily developed based on existing scientific research and quickly adopted because of its extreme social necessity. Support from advocacy leaders can speed up the development and ratification of a bill.
Berkowitz, S. A., & Basu, S. (2021). Health Affairs, Unmet social needs and worse mental health after expiration of COVID-19 federal pandemic unemployment compensation: Study examines unmet social needs and mental health after Federal Pandemic Unemployment Compensation expired.40(3), 426-434.
Bergquist, S., Otten, T., & Sarich, N. (2020). COVID-19 pandemic in the United States. Health Policy and Technology, 9(4), 623-638.
Donnelly, R., & Farina, M. P. (2021). How do state policies shape experiences of household income shocks and mental health during the COVID-19 pandemic?. Social Science & Medicine, 269, 113557.
Goldman, M. L., et al. (2020) Mental health policy in the era of COVID-19. Psychiatric Services, 71(11), 1158-1162.
Kämpfen, F., Kohler, I. V., Ciancio, A., Bruine de Bruin, W., Maurer, J., & Kohler, H. P. (2020). Predictors of mental health during the Covid-19 pandemic in the US: Role of economic concerns, health worries, and social distancing. PloS One, 15(11), e0241895.
Nagata, J. M., Ganson, K. T., Whittle, H. J., Chu, J., Harris, O. O., Tsai, A. C., & Weiser, S. D. (2021). Food insufficiency and mental health in the US during the COVID-19 pandemic. American Journal of Preventive Medicine, 60(4), 453-461.
Nielsen, M., & Levkovich, N. (2020). COVID-19 and mental health in America: Crisis and opportunity? Families, Systems, & Health, 38(4), 482 485.
Pierce, B. S., Perrin, P. B., Tyler, C. M., McKee, G. B., & Watson, J. D. (2020). The COVID-19 telepsychology revolution: A national study of pandemic-based changes in US mental health care delivery. American Psychologist.
Public policy. (2021). Mental Health America.
Purtle, J. (2020). COVID-19 and mental health equity in the United States. Social Psychiatry and Psychiatric Epidemiology, 55(8), 969-971.
Shim, R. S., & Starks, S. M. (2021). COVID-19, structural racism, and mental health inequities: policy implications for an emerging Syndemic. Psychiatric Services, appi-ps.
Turchioe, M., Grossman, L. V., Myers, A. C., Pathak, J., & Creber, R. M. (2021). Correlates of mental health symptoms among US adults during COVID-19. Public Health Reports, 136(1), 97-106.
Twenge, J. M., & Joiner, T. E. (2020). Mental distress among US adults during the COVID‐19 pandemic. Journal of Clinical Psychology, 76(12), 2170-2182.