‘I’m on my last rope:’ COVID-19 strains Georgia mental health resources

WASHINGTON — On a recent telephone town hall hosted by Georgia Democratic Rep. Hank Johnson, Gwendolyn sounded desperate. 

She’s homeless, unemployed and a survivor of domestic violence. But she doesn’t know how to get help. 

“I’m on my last rope right now trying to figure out which way to go in,” said Gwendolyn, who didn’t give her last name. “My depression is over the top. … I worry about everything. … I just don’t know which direction to go in.”

Experts on the call urged her to contact her primary health care provider and call mental health and safety hotlines.

Johnson chimed in: “Don’t give out, don’t give in and don’t give up.” 

But some officials fear that an already strained mental and behavioral health system won’t be enough to address a spike in mental illness during the COVID-19 pandemic. 

“We are facing a shortage of mental health workers in America, and providers may already be stretched thin due to increased demand for mental health services,” Rep. Lucy McBath, a Democratic member of the Congressional Mental Health Caucus, said in a statement.

More than 2 million Georgians live with mental illness, according to Mental Health America of Georgia. That number is expected to rise as the virus spreads, social isolation continues and unemployment mounts. A recent poll found that nearly half of U.S adults say the virus has negatively affected their mental health.

At the same time, many people with mental illness lack access to treatment and care. More than half of adults with mental illness did not receive treatment in the previous year, and the percentage is higher among people of color, according to the national mental health group.

Georgians are at particular risk. Georgia ranks 47th when it comes to access to mental health care, resources and insurance, according to Mental Health America of Georgia. The state’s low ranking is due in part to insufficient funding for mental health services, said Kim Jones, executive director of the Georgia chapter of the National Alliance on Mental Illness.

Georgians who don’t speak English face even higher barriers.

Federal law requires health providers that receive federal funds to offer language services, but many meet only minimum standards, according to Pierluigi Mancini, a health equity consultant in the Atlanta area. 

Telephone translation services help patients weather crises, but aren’t able to provide ongoing care. Onsite interpreters are expensive and often lack training in behavioral health. What’s more, information about language services offered by providers is difficult to find, he added.

Essentially, access to behavioral health care in Georgia requires English fluency, he said.

Reduced stigma?

The prevalence of mental illness during the pandemic, however, could lead to greater awareness and understanding of the issue, which could lessen the stigma, Jones said. 

“What we are experiencing right now is what people with a mental health condition experience their whole life,” she added. “I think it would be hard for anyone, after COVID-19, to not relate to it.”

Another possible positive: A federal coronavirus relief law could increase access to mental health care via virtual delivery of health services.

Enacted in March, the Coronavirus Aid, Relief and Economic Security (CARES) Act lifts restrictions on telehealth and expands it under Medicare. It also set aside $425 million for the Substance Abuse and Mental Health Services Association, including aid for behavioral health clinics, emergency support, suicide prevention programs and outreach to tribal communities.

“We want to keep people sheltered in place, we don’t want them going to hospitals and to doctors’ offices,” said Rep. Buddy Carter, a Pooler Republican, pharmacist and Congressional Mental Health Caucus member, in an interview with the Georgia Recorder. “That’s where telehealth really does help.”

But Carter and others say more is needed to address the issue during and after the crisis.

He cited efforts that would further increase funding for telehealth services and possibly relax some telehealth restrictions for good. “If we can get funding through Medicare for telehealth services during this pandemic, why can’t we get funding during regular times?” he said.

McBath, meanwhile, joined a bipartisan letter sent to congressional leaders urging passage of legislation that would ensure that health insurance plans provide equal coverage for mental and physical health. And she said she’s working with mental health caucus members to raise reimbursement rates for mental health telehealth providers and to increase funding for trauma-informed care initiatives during the pandemic.

National organizations, meanwhile, are asking Congress for nearly $40 billion to save the nation’s behavioral health system from collapse due to lost revenue during the pandemic.

They also want $10 billion for suicide prevention, grief counseling, addiction, support for endangered nonprofit organizations, mental health parity, and more. 

Beyond that, Mancini wants more support for non-native English speakers. “If we’re going to really address the linguistic barrier that’s keeping thousands of people from seeking mental health and addiction services all over the country, we need to make it a priority at the highest levels,” he said.