By Nate Blackford, Mosaic Medical Center – Maryville president

Since the beginning of the COVID-19 pandemic this past spring, we have been laser-focused on preparing for, mitigating and addressing the physical impacts of the virus. I believe these collective efforts have helped us “flatten the curve,” enabling our organization to appropriately care for those impacted by COVID, especially those that have required hospitalization. While these efforts will, and should, remain a critical part of our battle with COVID, over the past several months it has become clear we are facing another potential pandemic: a mental health pandemic.

Long before COVID-19, we were seeing an increase in mental-health-related illnesses and the resulting impacts. But it has become clear over the past several months that COVID-19 and the associated stress and anxiety are also impacting individuals’ mental health. Although we have known this for a while and we have had a number of conversations both internally and with our key community partners about how to best address, I have struggled with a way to clearly and succinctly articulate this challenge to a broader audience.

Coincidentally, this past Friday, healthcare leaders around the state received an e-mail from Herb Kuhn, president of the Missouri Hospital Association, addressing the topic of COVID-19 and mental health. So instead of trying to draft a message of my own, I thought I would share a few key excerpts from his important communication.

Humans tend to personify. We see faces and familiar shapes in clouds, and attribute human virtues and vices to objects. It’s hard-wired into our survival systems and DNA. COVID-19 has a biology, but it doesn’t have a psychology. Nonetheless, its biology can and will have short- and long-term consequences on our psychology.

COVID-19 is known to cause fatigue. However, through the long arc of our response, there is another COVID-19 fatigue that we expect to be more pernicious. Our response has reduced many of the most human of activities and, in the worst cases, resulted in lonely deaths, isolation, a reduced sense of community and limits on our interaction with even the most intimate of family and friends.

The American Psychological Association this [past] week released their “Stress in America 2020: A National Mental Health Crisis” report. The report, “found that nearly eight in ten adults (78%) say the coronavirus pandemic is a significant source of stress in their lives, while three in five (60%) say the number of issues America faces is overwhelming them.” The report goes on to say that, “nearly one in five adults (19%) say their mental health is worse than it was at this time last year.”

The challenge to everyone is evident, but for health care providers it is two-fold. First, members of the hospital team have been responding to COVID-19 for months, and the significant stress related to the duration of the response, patient care and organizational dynamics, and the challenges that they feel at home as members of our communities has been overwhelming. Second, we know that Missouri was experiencing a variety of behavioral health challenges before COVID-19 — provider shortages, substance use disorders and significant demand for all types of behavioral health services.

As we move into late fall and winter — with reduced opportunities for time outside, socially distanced interactions and the holiday season — these behavioral health challenges are likely to compound… The pressures on our workforce and communities will multiply in late 2020 and throughout 2021.

The COVID-19 crisis now is especially acute in rural parts of the state. While the virus had limited impact on rural Missouri initially, despite several outbreaks in meat packing and other agricultural processing facilities, it now has taken hold on a much larger scale. Hospitals that provide local and regional hub care for these communities are significantly stressed. And, many rural communities have yet to put strong public health protections in place to limit the spread.

There are no easy solutions to the behavioral crisis that is lurking immediately below the surface of the COVID-19 crisis. It will not be limited to rural communities or members of the health care family. It will, however, persist.

As I’ve been thinking about where we are with the crisis — especially in our health care system and among our rural communities — I’ve been reminded of the words on the Missouri State Flag. “United We Stand. Divided We Fall.”

Humans see faces everywhere, even where there are none. We make judgments using primitive parts of our brain, even when situations are complex. We can’t often tell by the simple signals whether something important is happening behind an expression — and now that expression may be behind both a literal and figurative mask.

As leaders, we endeavor to take care of our people and our communities. We know what’s coming or even what is already here. The virus is running roughshod on our physical health in communities throughout Missouri. But, it’s also influencing our mental health. Let’s not let our work healing bodies mask the next challenge.

On Saturday morning, I sent a message on this topic to our key mental health partners and select community leaders. I closed my note with this comment: Mental health will continue to be a focus of our efforts as we move forward. That said, it will take a community working together to adequately address.

I look forward to continued conversations and collaboration. We can’t ignore the impacts of COVID-19, including those that may be more disguised.