Could COVID-19 accelerate improvements in mental health and wellbeing?

The COVID-19 pandemic has both highlighted and worsened the world’s underlying mental health challenges. Prolonged social isolation, loss of employment, financial stress, increased trauma for essential workers, increased severity for existing conditions and anxiety about us and our loved ones acquiring COVID-19 have placed a tremendous strain on all of us.^[1],[2] Government agencies around the world have warned that a wave of depression, substance abuse, post-traumatic stress disorder, suicide, and other mental ill-health issues could be on the horizon as a result of the pandemic.^{[3], [4].} Prior to COVID-19, an estimated 1 in 4 people experienced a significant mental illness at some point in life,^[5] and about 1 in 5 working-age adults were affected by mild-to-moderate disorders at any given moment.^[6] These challenges are now being exacerbated. Mental distress during the pandemic is three times higher than it was in 2018.^[7]

Prior to COVID-19, we projected that by 2040 there would be far more emphasis on early detection and prevention strategies for mental and wellbeing issues compared to today. The recent health crisis, however, likely accelerated that timeline by 10 years or more.

Our work on Disruptive Technologies in Mental Health with the World Economic Forum shows a convergence of social, political, and technological disruptions is increasing many societies’ acceptance of, and strategies for, mental ill-health, even whilst others argue that these structural changes are to blame for increasing prevalence. While this transforming landscape will look different for mental health organisations, health providers, and major employer groups, we expect that some of the same six drivers of change will help shape mental and wellbeing health in the post-pandemic era:

1. Cultural and behavioural change: Mental health disorders are often under-reported due to long-held social stigma and discrimination. An openness about such illnesses could make it easier for people to confront and manage their challenges. This change appeared to be underway before COVID-19—particularly among members of Generation Z. A study from the American Anxiety and Depression Association found that 60 percent of young Americans (between the ages of 18 and 25) consider seeing a mental-health professional as a sign of strength—compared to only 35 percent for adults over the age of 26.^[8] As stigma and discrimination fade, preventing, maintaining and treating mental ill-health will likely become an ingrained part of our daily health dialogue, including in school and at work. Employers are already growing increasingly interested in the physical and mental health of their employees. There is an understanding that healthy employees are more productive, and we expect more employers will be held accountable for helping their employees maintain a level of mental health over time. As a result of lowering stigmas—and an increased emphasis on mental health and wellbeing from employers—the paradigm can shift to a focus on prevention vs. treatment.
2. Scientific and technological advancement: Scientists and researchers are learning more about the role of genetics, neuroscience, endocrinology, and other factors might play in mental health and wellbeing. Some studies have even uncovered connections between the gut microbiome and the brain.^[9] An increased understanding of what drives mental illness could lead to new therapeutic breakthroughs and treatments. Such tools could include genomic testing and screenings for mental health conditions, mass-customised diagnosis and treatment modalities (e.g., psychedelics, neuromodulation, always-on digital phenotyping and virtual-reality treatment and diagnosis), and machine-learning-enabled systems that improve individual outcomes by leveraging patient histories to improve triaging and tailor treatment and prevention strategies.
3. Increased access: The reduction in stigma and discrimination, combined with scientific breakthroughs, could help drive low-cost access to mental health services. The expansion of telehealth—which accelerated during the COVID-19 pandemic—will be one path to expanded access. The Federal Government has temporarily removed barriers to ensure that health providers are paid for virtual visits and indicated that this is likely to be permanent for mental health consultations.
   Meanwhile, start-ups including Smiling Minds, Hello Sunday Morning and MindSpot are now offering direct-to-consumer virtual treatment choices. But the emphasis on virtual health is only one mechanism by which access can increase. We also anticipate that mental health and wellbeing will become more tightly integrated into primary care, and that targeted testing and screenings for mental health conditions will become accessible to everyone. This could help ensure that issues can be addressed early. All of this will likely be enabled by accessible insurance cover. Increased availability of virtual mental health care can lead to higher use, which could create a feedback loop that further reduces stigma and discrimination.
4. Data sharing: Smartphones, wearable technology, and always-on sensors have given consumers an opportunity to collect, analyse, and share sensitive mental health and wellbeing data, such as stress and anxiety levels. While consumers have become accustomed to capturing information about their physical health, data sharing could also make it possible for mental health-related data to be passively collected via sensing technologies connected to both physiological and social-sharing data. This data-sharing could enable tracking of early warning signs about the state of individuals’ mental health and give providers a clearer picture of their patients’ needs. We could also see employers begin to aggregate and compete on the overall mental health of their employee population. Healthier employees tend to be more productive, engaged, and positive, which yields a financial return on investment for the employer.^{[12], [13]} This also could be used as a recruitment tactic if employers can demonstrate their commitment to mental health and wellbeing.
5. Interoperable data: As data is increasingly shared by consumers, it is also likely to be increasingly interoperable. Individual health records will be able to travel easily across data systems as a result of shared data standards and access to secure and centralised databases. In turn, we expect data will be more easily aggregated into data lakes, which can allow for effective development of analytics. This process is already underway: four of the largest tech giants have all recently committed to supporting data interoperability in health care by publishing open-source, cloud-based software solutions to allow for greater interoperability, according to Deloitte’s recent report on Radical Interoperability. Health data interoperability is a priority for global governments, as exemplified as one of the six strategic priorities in the Australian National Digital Health Strategy^[14] and, in early March, the US Department of Health and Human Services released final rules for interoperability. The interoperability of the data could combine with improved data collection to make it possible for health organisations to more effectively screen, model, and forecast potential mental health issues: to help address them before they emerge and empower consumers to choose and change their service modality and providers.
6. Empowered consumers: Consumers are already taking advantage of personalised wellbeing tools to practice self-help and sustain health independently, while efficient pricing and robust access to high quality services can help ensure that everyone can pursue the help they need. This has become even more apparent during the COVID-19 crisis. While choices have become more limited, people are finding ways (like the utilisation of apps for meditation and exercise) to maintain their wellbeing through self-care. Social media platforms are beginning to offer mental health and wellbeing support, disrupting traditional care modalities and increasingly shifting power into the hands of consumers.^[10] This transition is happening as the medical system is also adapting provider systems and placing increased importance on consumer-centricity to be successful.

Hospitals and health systems, community and government organisations, and employers have different perspectives about where mental health is headed, and how it will get there. Providers, for example, are seeing more care shift from the inpatient setting to the outpatient setting, and now toward more virtual care. Community organisations are increasingly focused on prevention and resilience building activities; and employers are beginning to consider mental health and wellbeing as essential to maintaining the health and productivity of their employees.^[11] Over the long run, we anticipate that stakeholders will work with federal and state government and regulators to address mental health needs.

The COVID-19 pandemic, the Australian bushfires, and 2020’s numerous other challenges, have shined a spotlight on mental health and wellbeing like never before. These crises may also be accelerating the process of change toward a world in which prevention, resilience, early detection, and effective treatment will enable far more people to maintain their health while reducing stigma and discrimination.

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Endnotes

[1] COVID-19 Impacting Mental Well-Being: Americans Feeling Anxious, Especially for Loved Ones; Older Adults are Less Anxious, American Psychiatric Association, May 25, 2020

[2] Mental Health Ramifications of COVID-19: The Australian context, Black Dog Institute, March 19, 2020

[3] What We Must Do to Prevent a Global COVID-19 Depression, Time, April 9, 2020

[4] The coronavirus pandemic is pushing America into a mental health crisis, The Washington Post, May 4, 2020

[5] Mental disorders affect one in four people, World Health Report, World Health Organization

[6] Making Mental Health Count, OECD Publishing, 2014

[7] COVID-19's Psychological Toll: Mental Distress Among Americans Has Tripled During the Pandemic Compared to 2018, Time, May 7, 2020

[8] A Survey about Mental Health and Suicide in the United States, Anxiety and Depression Association of America, 2015

[9] Evidence mounts that gut bacteria can influence mood, prevent depression, Science, February 4, 2019

[10] Snapchat Is Ready to Disrupt the Health Care Conversation, American Hospital Association

[11] Employers are planning to grow their virtual mental health services, Business Insider, May 12, 2020

[12] The ROI in workplace mental health programs: Good for people, good for business, A blueprint for workplace mental health programs, Deloitte, 2019

[13] Thriving at Work, the Stevenson / Farmer review of mental health and employers, October, 2017

[14] Australia’s National Digital Health Strategy, Australian Digital Health Agency, January 2020