The Impact of COVID-19: Mental Healthcare Workers and the Future of Psychology

Since the COVID-19 pandemic, state officials have focused mainly on preventing infections. However, another serious threat to public health looms: the psychiatric epidemic.

Economic hardship, social isolation, fear of infection, and grief over lost loved ones have led to global increases in anxiety, depression, insomnia, and posttraumatic stress disorder (PTSD). Almost half of Americans report the pandemic is damaging their mental health, according to a Kaiser Family Foundation poll.

The ripple effect has led to an increased demand for mental healthcare and the wide-scale use of teletherapy. Are these temporary trends, or has psychology changed forever?

The Pandemic's Impact on Demand for Therapy

Countless studies have measured COVID's psychological impact on society, and the results show that certain groups are more vulnerable than others. People of color, young adults, essential workers, mothers and guardians of young children, and low-income individuals have been hit especially hard when it comes to mental health.

According to data from UC Berkeley's Labor Center, almost half of essential workers are under the age of 24. Latino/a individuals represent the majority of essential employees at 55%, followed closely by Black workers at 48%.

Essential workers are also a significant share of the low-wage workforce. Individuals who fall into more than one of these demographics are more likely to experience stress and burnout.

Drug and alcohol misuse has also increased. A study from the Centers for Disease Control and Prevention found that 13% of Americans began using substances to deal with pandemic-related stress. Overdose rates also rose by 18% since 2019, and more than 40 states report growing concerns about substance misuse.

Intimate partner violence has risen during the pandemic. The American Journal of Emergency Medicine collected data from police departments in several U.S. cities. All observed cities experienced a 10-30% increase in domestic violence calls after stay-at-home orders.

These are just some factors driving the demand for therapy. According to a survey from the American Psychological Association (APA), 84% of psychologists who treat anxiety disorders reported an increase in demand for dealing with coronavirus anxiety. Seventy-two percent of those who treat depressive disorders also saw an increase in new patients.

In a country with only 30 psychologists for every 100,000 people, many therapists feel pressured to take on more clients. About two-fifths of therapists said they were unable to meet the demand — a 30% increase in 2020, according to the APA.

Tiffany Brown, Ph.D., a Pennsylvania-based psychologist, adjunct professor, and consultant, says these reports ring true for her and other therapists in her network.

"More people are asking for treatment or requesting mental health support. A lot of providers are full or they have wait lists that are a couple of months out. So, it's harder for people to get the treatment that they need right now," she said.

Brown continued, "You try your hardest to accommodate everyone, but it's just a time where the demand is greater than the amount of providers that are available."

The Rise of Teletherapy

The sudden spike in demand isn't the only change that mental health professionals have endured during COVID. Due to the need to socially distance, the majority of therapists moved from in-person to teletherapy.

Lawmakers and insurance companies aided the transition by temporarily loosening long-standing restrictions on practicing across state lines and allowing coverage for telehealth. This encouraged patients and therapists who may have been uninterested in virtual therapy to give it a try.

While teletherapy existed before the pandemic, it was less popular. According to a recent study, before COVID-19, less than 40% of therapists used telehealth, which shot to 98% by the end of 2020.

"When the pandemic hit, I transitioned all of my private patients to virtual work. But I never expected that would be the way in which I provide psychotherapy," Brown said.

According to Fortune Business Insights, the global telehealth market grew 135% in 2020. The trend doesn't show any sign of slowing down.

Telehealth is projected to grow another 600% from 2021-28, or about $91 billion to $636 billion.

In the past, therapists may have hesitated to offer teletherapy. They typically cited legal concerns or the idea that virtual therapy was less effective. However, many therapists have grown comfortable with the new medium.

"I thought meeting new patients virtually would be difficult, but it was actually pretty easy," Brown said.

Pros and Cons

Many clients and therapists enjoy the flexibility of meeting virtually. For clients, the option saves time commuting to the therapist's office. This could be crucial for people who live in rural areas or individuals with disabilities whose ability to travel is limited.

"My patients can go to therapy on their lunch breaks during the middle of the day, even if they're in their office," Brown said. "As a therapist, it allows me to help more people. And I enjoy the flexibility for myself — to be able to work in the comfort of my own home."

However, some critics of teletherapy worry that virtual sessions don't provide the same opportunity to build emotional rapport as in-person meetings. This is a legitimate concern for some individuals. But Brown says that for certain personalities, the opposite may be true.

"Some patients are actually more comfortable sharing this way [virtually]. You find that things that they have had a harder time saying in person, they feel more comfortable sharing online, maybe because they're in their own space," she said.

In the end, virtual therapy vs. in-person therapy comes down to personal preference. "For some of my patients, they've gotten in the habit of doing teletherapy … then, I have some who would prefer to come in person. So, at some point, I will likely offer both options so that people can come to therapy in whatever way they feel is comfortable," Brown said.

Ninety-six percent of psychologists said that using telehealth during the pandemic proved its effectiveness to them, and 93% plan to continue offering telehealth after the emergency ends.

However, insurance and government accommodations for telehealth will expire when the state of emergency is over. This could leave many clients without care.

APA has been pushing for insurance companies to maintain their telehealth policies for at least a year after the federal emergency ends. Many would like to take it a step further. They hope to make Medicare and private insurance permanently cover telehealth.

The Aftermath of the Pandemic on Mental Health

How long will this psychiatric epidemic last, and what is the extent of the damage?

Experts are looking back on how disaster situations like Chernobyl and Hurricane Katrina affected communities to measure COVID's impact. Studies show that elevated rates of depression and PTSD related to such events sometimes last years — even decades — if left untreated.

Frontline healthcare workers are especially vulnerable. Direct exposure to trauma correlates with the severity and longevity of PTSD symptoms. For example, people who witnessed the planes crash into the World Trade Center during the 9/11 attacks experienced more PTSD symptoms than those indirectly affected.

Nonessential workers and individuals without histories of mental illness are also experiencing ongoing symptoms of anxiety, depression, and insomnia.

"People want to know, when is it going to end? How is it going to be treated? Are we ever going to figure it out? Most of us are having those questions, so that anxiety is persisting," Brown said.

Research from the Well Being Trust estimates that the pandemic could lead to 75,000 deaths of despair in the U.S., including fatalities resulting from suicide and alcohol or drug misuse. However, many psychologists are hesitant to predict the severity of the fallout.

"We can predict that rates of anxiety and depression are going to continue to increase ... and I do think all of that is true, but we'll have to see what happens," Brown said.

"When it comes to traumas and disasters," Brown explains, "you don't know the aftermath until it's the aftermath. You don't know the true effect of something until it's over."

The Silver Lining

Not all of COVID's ripple effects are negative. Social distancing guidelines have fast-tracked the adoption of telehealth, started conversations about increasing access to therapy, and helped reduce the stigma associated with seeking mental healthcare.

According to a survey of more than 1,300 American adults, almost one-third have seen a therapist during the pandemic. Of these, three-fifths only began going to therapy within the past year, and 86% say it helped.

"I think [demand for therapy will continue] for some time, not only because of the pandemic, but because mental health is becoming less taboo," Brown said. "Nowadays, you have role models and people who are incredibly influential talking about mental health."

Since the pandemic, more celebrities have been vocal about their mental health. Notable examples include Michael Phelps and Meghan Markle. Recent studies indicate that when celebrities open up about their mental health struggles, it influences other people to seek help.

"More people are talking about mental health and it's becoming less stigmatized," Brown said. "And more people are willing to try mental health treatment."

According to the last survey, nearly half of men said the pandemic made them more willing to seek out help.

As Brown suggests, the extent and longevity of the pandemic's impact on our mental health remains to be seen.