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Behavioral health crisis in the United States: The fallout from the COVID-19 pandemic

The adverse impact of COVID-19 on behavioral health—which comprises both mental health and substance use—presents additional challenges and opportunities for industry leaders.

The COVID-19 pandemic is a human tragedy that affects not only the global economy but also the global psyche, exacerbating behavioral health conditions around the world. During a McKinsey Live webinar, Erica Coe and Kana Enomoto shared research on the pandemic’s effects on behavioral health and articulated key actions industry leaders can take to address this impact.

In the post-COVID-19 period, traumatic stress, unemployment, and social isolation will aggravate existing behavioral health conditions and result in new conditions. People with mental and substance-use disorders are often among the most vulnerable in our society. They are two to six times more likely to have co-occurring chronic physical conditions, such as diabetes and hypertension, than individuals without behavioral health conditions. They are also more likely to have unmet social needs such as stable housing and employment. Individuals with behavioral health conditions also incur greater medical costs for the same chronic condition. For example, the cost to treat the diabetes of a patient with depression is, on average, almost $20,000 higher than for a patient without depression, due to factors such as medical complications, reduced access to preventive care, and challenges with illness self-management. That said, with effective prevention, treatment, and recovery services, we can mitigate the burden of mental illnesses and substance-use disorders on individuals, families, employers, and communities.

In addition to the human toll, there is a cost to the healthcare system: Behavioral health conditions affect about a quarter of Americans each year and cost the economy about $900 billion annually. Due to COVID-19, more than 35 million additional Americans—including the 1.6 million–plus affected directly by severe COVID-19 illness or loss—could experience behavioral health issues. In addition to the human cost, the increase in behavioral health conditions may drive an additional $100 billion to $140 billion in healthcare spending in the first year following the onset of the pandemic.

These potential results of COVID-19, however, are not a foregone conclusion. Industry leaders now have an opportunity to change their organizations, the healthcare system, and society in meaningful ways by taking four types of action to address the pandemic’s impact on behavioral health:

Strengthen community prevention. Many early-intervention and prevention programs have proved cost effective, some with returns as high as $65 per $1 invested. Such programs are critical to mitigating behavioral health needs. Putting public and private resources behind crisis counseling, behavioral health screening, and early-intervention services would particularly support those with an elevated risk for COVID-19-related behavioral health conditions: frontline healthcare and essential workers, long-term-care residents, individuals who contracted or lost a loved one to COVID-19, and the newly unemployed.

Leverage data and analytics. Advanced analytics and data sets have made it possible to determine at-risk subsets of individuals and target prevention and treatment efforts more effectively. Predictive multivariate modeling can be used at the individual-patient level to identify those who would benefit from specific interventions, such as collaborative care or crisis management.

Integrate behavioral and physical health. To address the pandemic’s impact on behavioral health, it is critical to initiate or accelerate efforts to reduce stigma and encourage understanding of behavioral health as fundamental to overall health. Integrating universal screening for behavioral health conditions into primary and specialty healthcare services, including COVID-19 care, would accelerate recent shifts toward more extensive connections among and collaboration of different types of caregivers, resulting in the treatment of the whole person. Increasing the behavioral health competence of primary care providers and strengthening the broader behavioral health workforce would support greater integration of care and improve patient access to care.

Address unmet health-related basic needs. People with poor mental health are twice as likely as those with good mental health to have three or more unmet basic needs—among them safety, food, employment, education, and transportation. Stable housing, always important for obtaining good health outcomes, is even more important now, when homelessness greatly increases the risk of contracting COVID-19. Providing safe temporary housing to individuals affected by the economic fallout of the pandemic and, in the long term, investing in affordable-housing models, could have a significant effect on their behavioral health. Enabling data sharing and increased connectivity between providers and community-based organizations would help to integrate the integration of behavioral healthcare and human services and ultimately improve the outcomes of patients with health-related basic needs.

The health and economic crisis has already spurred a rise in mental health and substance-use issues that will have consequences for years to come. But it has also sparked innovation and flexibility in the health system, from sophisticated data analytics to telehealth and virtual care, that could otherwise have been a longer time coming. Leaders who take the opportunity to make meaningful changes could save lives and, ultimately, mitigate the burden of the pandemic.

For more on this topic, please watch the webinar recording , read the articles “Returning to resilience: The impact of COVID-19 on mental health and substance use,” “COVID-19: Investing in Black lives and livelihoods,” and “A holistic approach to the US behavioral health crisis during the COVID-19 pandemic,” explore an interactive map of vulnerable populations, and visit McKinsey’s Center for Societal Benefit Through Healthcare.

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