The coronavirus pandemic has created the greatest waiting game of all time. Waiting in line six feet apart in front of the pharmacy. Waiting to return to cubicles or feel comfortable riding the subway. Waiting on stimulus checks, or the unemployment website to even process your requests. And, of course, we’re waiting for all of this to be over. And yet, there are so many of us who cannot keep up with this treacherous game. Time has run out.
The epidemic of unhoused people span cities like New York, Los Angeles, and San Francisco. Such crises have been triggered by lack of affordable housing or fair wages, but also lack of accessible treatment for mental health and addiction. Treatment for those with serious need has transformed due to COVID-19. Federal and state guidelines for inpatient treatment have been released. Still, it is largely at the discretion of individual facilities to screen who comes through the door.
At smaller treatment centers like Pride Institute in Minnesota, it’s more or less business as usual. With three locations specializing in addiction care for LGBTQ+ individuals, they’re following CDC guidelines, but also are taking extra precautions to ensure the safety of their patients and staff. Temperatures are taken at the door. Newly admitted patients are tested for COVID-19 upon arrival and stay in a specific “quarantine room” until their results arrive.
Unsurprisingly, outpatient numbers have grown. Their outpatient facilities rely on telehealth via Zoom, allowing treatment from home. “I think [patients] are utilizing what feels safe to them,” says Luke Miller, the director of marketing and communications at Pride. Their intensive outpatient program includes hours of weekly therapy.
When we turn to more crisis-themed care however, the situation is far more grim. “Dee,” a social worker on the psychiatric floor of a Florida hospital, expressed less than satisfactory conditions. “[Management is] doing the bare minimum,” she said. “They’re doing the most possible to make sure they don’t have to pay people for being exposed in the hospital or need time off.”
Dee, who is using a pseudonym, works in a for-profit hospital, where she says money-making seems to be the driving force in decision-making. When a nurse tested positive for COVID-19, the facility did not expect staff to self-quarantine, dancing around the disclosure of when the nurse was exposed to the disease.
While the hospital is doing daily temperature checks, medical clearance for patients does not involve a COVID-19 test. They simply check for active symptoms, with no concern for potentially asymptomatic carriers. The facility imposes universal masking, and provides masks to patients, but more than half are choosing not to wear them.
Dee notes two distinctive groups coming to her crisis stabilization unit: “The people who are functional, go to therapy, are on medication, and they’re very anxious or depressed due to COVID. Their routine has changed, maybe they’ve been furloughed or they’re stuck at home trying to school [and parent] kids. We’ve had a lot of people on the spectrum with autism. …They live on their own but they have staff. And the staff has had to pull back due to COVID.”
With less help at home and changed routines, this group ends up in the psychiatric ward to stabilize. Those patients are typically discharged relatively quickly.
The second group is experiencing more long-term issues: “The other category [is] people who are more acute with psychosis or severe bipolar disorder or a serious addiction,” Dee said. “We have a lot of people we know really well in the community that are homeless. Because of COVID they have been cycling in and out.”
Dee claims the local homeless shelter is no longer taking new folks into their care, and thus, they’re having to discharge people to the street.
Call COVID-19 the great equalizer all you want, but statistics display differently. With higher infection and mortality rates, the majority of those affected by COVID-19 are people within the Black and Latinx community. Unsurprisingly, treatment and mortality rates concerning substance abuse and mental illness are also significantly higher. The Substance Abuse and Mental Health Services Administration released a resource defining the double jeopardy of this fact, as well as what we can do to address this issue.
In confronting these disparities, it’s important to understand that while clinical help is important, the cultural aspect of these issues must also be addressed. Stepping into the gap of aid left by these disparities are organizations like Project LETS.
Project LETS is a national grassroots organization that focuses on building peer-led communities of support outside of professional or state-sanctioned systems of care. “We’re looking to develop community-based noncarceral responses to mental illness and emotional crisis,” says Stefanie Lyn Kaufman-Mthimkhulu, the founder of Project LETS.
In approaching mental health as a crisis, they state, “If we name it a mental health crisis, our solution is therapy. If we call it a socioeconomic crisis, then our solutions are economic.” The goal is to address the deep-rooted problems American institutions bring about in attempting to care for Black and brown people. It is no doubt that crises of mental illness are often onset by outside forces like financial difficulty, unemployment, and housing instability. All of these factors have been exacerbated by the pandemic. This is where Project LETS’ mutual aid program comes into effect.
“While people were waiting for these $1,200 checks that people still haven’t gotten, mutual aid groups were stepping up and doing the work,” said Kaufman-Mthimkhulu. “I think it’s important to recognize that Black communities, Indigenous communities, and disabled communities have always done this work. It’s not just for moments of crisis, it’s something that sustains these communities always.”
Marginalized communities trust the government and healthcare facilities increasingly less. Grassroots organizations can address the needs of those facing acute mental health issues and addiction at a peer to peer level.
There certainly is cause for concern in a post-pandemic world. For those who cannot access resources like mutual aid, hospitalization or residential care, they must bide their time until treatment comes. Miller, from Pride, resounded this sentient. “I fear when this is all over, there will be a huge need for treatment programs all over the country because people are creating really bad habits right now,” he said.