Fund efforts to combat COVID-19-driven suicide, overdose
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Politicians continue to present a false choice between two health pandemics unleashed by COVID-19, arguing that we must either fight the virus or stem the mental health fallout triggered by record unemployment and strict lockdowns. Our modeling warns that tens of thousands more Americans could lose their lives from suicide and overdose, including thousands more military veterans, if our leaders fail to fight both fronts of this battle.
The mental health and addiction front has been visible for months. A Cohen Veterans Network survey in April found that nine in 10 Americans believed the pandemic made access to mental health care more important. Later in April, the Meadows Institute projected that — based on what happened following the 2008 recession — for every 5% increase in unemployment, America could lose 4,000 more people to suicide and 4,800 to overdose each year. A deeper recession on par with the Great Depression — which seems more possible if the virus again spirals out of control — could lead to 40,000 in combined lives lost.
While unemployment-driven suicide and overdose mortality projections have been criticized because rates of death do not go down when employment improves, unfortunately the effects of toxic stress and trauma generally on health — and on suicide specifically — are not bidirectional. As is the case with smoking and lung cancer, as well as combat and post-traumatic stress, illness can still manifest even after the smoker quits or the veteran returns home.
While the potential mental health and addiction risks related to COVID-19 have been brought to national attention, policymakers have yet to invest in efforts to prevent suicide and overdose deaths proportionate to their efforts to fight the virus. Trillions of dollars have been invested by Congress to respond to COVID-19, yet no legislation to date supports capacity ramp-ups to prevent suicide and overdose.
Future action looks inadequate, as well. The House’s HEROES Act dedicates only just over $1 billion for new mental health and addiction needs for every $1 trillion already spent on COVID-19. Out of this, only $25 million is set aside for suicide response, with nothing dedicated to Americans at higher risk, such as military veterans.
To highlight the risks posed to veterans and — more importantly — the need to ramp up effective care to mitigate these risks, we collaborated to extend our modeling to veterans. Our new study found that for every 5% increase in unemployment, over 500 additional U.S. veteran lives could be lost to suicide annually, and 20,000 more could suffer from substance use disorders.
Unlike COVID-19, for which we lack effective treatments, the only lack for veterans and other Americans at risk for suicide and overdose is the will to act. Congress and the Trump administration have acted effectively in the past, coming together to blunt rising opioid deaths. But total deaths from overdose and suicide topped 120,000 last year and risk crossing the 160,000-mark due to COVID-19 without action equal to the challenge.
The administration’s existing plan for veterans is a good start. This past June, the administration released its nationwide plan to reduce veteran suicide through the President’s Roadmap to Empower Veterans and End a National Tragedy of Suicide (PREVENTS). Fortifying that plan with $1 billion in more spending could expand needed community options for the 11 million veterans not receiving care from the Department of Veterans Affairs.
There are also proven treatments available for Americans more broadly. In April, the American Psychiatric Association offered a bold plan to invest $10 billion over five years to fight depression and addiction in primary care. It is backed by groups representing America’s leading employers and is already paid for by Medicare and most commercial insurance plans, but it is not yet available in most health systems.
As Congress considers future COVID-19 bills, it should invest in the mental health of Americans on par with the other health effects of the virus. Prior to COVID-19, suicide and overdose took the lives of over 120,000 Americans, including 10,000 veterans, each year. Millions more suffered lost productivity and health costs exceeding $200 billion a year.
We believe that America can fight both the virus and its emotional consequences. Absent serious action, over 100,000 veterans and over 1 million Americans will lose their lives in the next decade. It is not yet too late for them, and we choose now to take action to provide accessible mental health care for all, particularly those who have already sacrificed so much for our country.
Andy Keller is president and CEO of Meadows Mental Health Policy Institute in Texas, where he holds the Linda Perryman Evans Presidential Chair. Anthony M. Hassan is president and CEO of Cohen Veterans Network. Jennifer Gonzalez and Timothy Dittmer, of the Meadows Mental Health Policy Institute, led the modeling studies referenced within this column, and Carl Castro, of the University of California and an Army veteran, collaborated with them on the modeling for military veterans.