“A pandemic within the pandemic” is how one psychiatrist recently depicted the country’s mental health quandary in the Boston Globe. The contention is that the COVID-19 crisis, with its isolating social restrictions, heated up toxic stress that exacerbated the demand for psychiatric services. The byline states that “access to care must be dramatically expanded.” This medical insider passionately pleads for legislators, insurance companies, regulators, and medical boards to respond “boldly and swiftly” to counteract a crisis of pandemic proportions.
It is no surprise that the appeal for relief is exclusively to those who oversee medical systems. If a patient’s presenting symptoms are tagged as a mental illness, the solution lies with healthcare. In this post, I will explore the upsurge in symptomatology associated with mental illness. Rather than arguing for another pitch to dramatically increase psychological and psychiatric services, I will apply lessons learned from the Covid-19 pandemic management strategy. Specifically, I assert that community prevention by enhancing population-level resistance is equally as important as preparing for effective intervention for those adversely impacted. The intent is to embolden local ministries to care for their local population with insight, targeted objectives and biblical compassion. Could it be that our Lord once again envisions the fields around us as “ripe for harvest” when many Christian ministries are grasping to survive (Jn 4:35–36)?
In short, strategies that promote mental health are as vital as treatments that address mental illness. In addition to primary prevention (preventing a disease before it starts), secondary prevention (early detection and protective efforts for those at high risk) and tertiary prevention (clinical remediation and rehabilitation), the term “primordial” prevention has gained attention. Primordial prevention addresses risk factors at the population level through policies, laws, social contracts, and social movements. Masking-up during the peak of the pandemic may have been inconvenient and unpopular, but it displays an example of primordial prevention.
Is the clamor regarding an uptick in untreated mental health cases an absurd prophecy or another conspiracy theory? The data would suggest otherwise. There is reputable evidence that increasing numbers of people are inwardly perturbed and exhibit symptoms such as sleep disturbance, suicidal ideation, and addictive behaviors. The COVID-19 pandemic itself brought evidence-based epidemiology -the data driven study of patterns in health and disease- into the public spotlight. Rapid survey techniques have been applied to related spheres. For example, the U.S. Census Bureau partnered with the Centers for Disease Control (CDC) to launch the Household Pulse Survey. This undertaking produced data in real time to track how adults across the American landscape coped with social upheaval and quarantine requirements. The results: symptoms of an anxiety or depressive disorder increased from 36.4% to 41.5% between August 2020 and February 2021. Beyond the surge, the data reveals that select population subgroups were hit harder than others. For example, young adults with less education were at greater risk. It is the specificity of the data that makes it particularly useful to target prevention efforts. Secondary prevention efforts can arise when vulnerable subgroups are identified and the intersecting risk factor is understood.
Further, recent survey findings suggest that while the focus was on preventing a severe physical illness, the effort itself was a strain that stimulated fear, deepened social isolation, and reduced optimism. This means that when the masks come off post-pandemic, expect that our faces will display the distress that accompanies mental illness. This burden translates into concrete health vulnerabilities. There is lower resiliency to remain emotionally, relationally, and functionally buoyant. Signs do point to a grim finding that deaths from substance abuse and suicide are on the rise. The World Health Organization (WHO) is alert to evidence that mental health and well-being of population groups across the globe have been adversely impacted. These forecasts were made prior to the invasion of Ukraine and the all too disturbing threat of WWIII. The COVID-19 health pandemic may fade to endemic status; nevertheless, the swell in mental health disturbances poses a peril in terms of incidence, prevalence, and mortality. When it comes to the mental health of the nation, it is accurate to state that conditions are stormy and the warning level appears to be shifting from yellow (significant risk) to orange (high risk).
As a psychologist and seminary-based counselor educator, taking in the epidemiological evidence leaves much to process. The agencies and clinicians in my own contact sphere are pressed to their limits in terms of demand. If lessons can be learned from the COVID response, battling a pandemic demands a multilayered strategy from contact tracing to social distancing and from vaccine development to population compliance. When it comes to curbing the onset of mental illness, it is wise to ponder the resilience stimulated by social cohesion, relationality, and connectedness. Musing in this direction is not unique. In fact, Vice Admiral Vivek H. Murthy, MD, the 19th and 21 United States Surgeon General, authored Together: The Healing Power of Human Connection in a Sometimes Lonely World in 2020. In essence, loneliness is known to be a significant risk factor for heart disease and premature death as well a mental health contaminant that can result in dementia, depression, anxiety, and sleep disruptions. Human connections soothe pain and reduce stress; loneliness coincides with a chronic state of stress that is detrimental to bodily functioning and emotional health.
Ministry leaders, it is time to open our eyes and see the ripeness of human hearts for authentic community. Since Pentecost, followers of Jesus Christ promoted spiritual community where love is the binding force (Acts 2:42–47). Admittedly, this may not be the reputation of ministries in our day, for too often good intentions fall short and church hurt is an all too frequent experience. Nevertheless, conditions are right to reopen our doors to offer in-person, high-touch grief groups or issue-targeted self-help gatherings. It is time to refresh the Christ-centered 12 step program Celebrate Recovery, revamp formation groups, and foster open fellowship experiences of all types.
This example from my local Pennysaver, a weekly must-read in our rural village, did cause me to cheer. A local ministry is posting ads and stories with post-pandemic tag lines such as “Looking for a place to belong? Searching for a church family? We would love to welcome you.” These phrases cause me to pray for the success of their appeal. This outreach aims to achieve spiritual benefits. Beyond the ministry objective, these gatherings are a worthy effort to reverse the impersonal and isolationist trends contributing to an emptiness of life and hope. Virtual community does have promise and mental health services need to expand at the tertiary level. Still, vital and proximate Christian community is a preserving grace that is restorative for a culture that has lost its sense of unity, community, and well-being. Let’s contribute to primordial prevention via the Christian expression of authentic human connection. The next installment of this post will ponder three Ps that promote well-being and mental health: people- a human network of allies; place- a safe sanctuary; and purpose- a fulfilling and meaningful activity.
 Maurizio Fava, “The Country’s Mental Health Crisis: A Pandemic within the Pandemic, The Boston Globe, December 13, 2021, https://www.bostonglobe.com/2021/12/13/opinion/countrys-mental-health-crisis-pandemic-within-pandemic/.
 Anjel Vahratian et al., “Symptoms of Anxiety or Depressive Disorder and Use of Mental Health Care among Adults during the COVID-19 Pandemic—United States, August 2020–February 2021,” Morbidity and Mortality Weekly Report (MMWR) 70, no. 13 (2021): 490–94, https://doi.org/10.15585/mmwr.mm7013e2.
 Vivek H. Murthy, Together: The Healing Power of Human Connection in a Sometimes Lonely World (New York: Harper Collins, 2020).
 The next post will address what American mental health care needs and how churches can help. It builds on themes in the new release by Thomas Insel (2022). Healing: Our path from mental illness to mental health. New York: Penguin Press.
Stephen P. Greggo, "The Pandemic Mental Illness Outbreak: A Ministry Perspective," Intersections, May 20, 2022.