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Unmasking mental illness and addiction in a post-pandemic world

As the COVID-19 positivity rates are again surging, so too are the under-acknowledged rates of mental illness, thoughts of suicide, and drug and alcohol misuse across the United States. Prior to the coronavirus outbreak, an estimated 1 in 5 Americans struggled with mental health issues, which have only been exacerbated by the pandemic. COVID-19 and its aftermath continue to disproportionately affect vulnerable segments of the population, from Native Americans, Blacks, and Hispanics to the elderly and those with underlying health conditions. While mental illness, substance misuse, addiction, and overdose are particularly tough on teens and young adults, no segments of the population are spared.

New York City struggled and then regained its footing after becoming the epicenter of the COVID-19 pandemic last spring. Like the rest of the United States, it is again experiencing a spike in the number of new cases, increased hospitalizations, and deaths. The first vaccines have now gone into the arms of American essential care workers, but the pandemic will continue to inflict disease and death on thousands more citizens over the next few months. New York City is a bellwether for the United States as social isolation and economic despair threatens lives and livelihoods amidst the already half a million unemployed in New York City and millions across the United States. Nearly a year of physical restrictions between friends and family have increased anxiety and depression, as fallout of this public and mental health crisis.

The Mayor of New York City, Bill de Blasio, and his wife, First Lady Chirlane McCray recently welcomed the Morning Joe Field Team onto the porch of their home at the historic Gracie Mansion. Our discussion focused on the devastation the past year has wrought on those with mental illnesses and addiction issues. Just over five years before the first COVID-19 case was identified in New York City, Chirlane McCray spearheaded the launch of ThriveNYC. It was an unprecedented commitment by the City of New York to work towards a mental health system for all, regardless of means. At the foundation of the initiative is the acceptance and understanding that mental illness is pervasive, but treatable. “I think during the coronavirus, people have come to understand mental health challenges reach into every American family,” Mayor de Blasio said. “It is astounding, figures are that one in five Americans deal with some kind of mental health challenge. And when you think about something that pervasive, how is it that it is not front and center in our healthcare approach? People need a place to turn to. We need a hotline with trained counselors, 24-7, in multiple languages, where people get immediate help…The sad reality we have seen in the opioid crisis is people without any kind of guide in the wilderness, Thrive seeks to change, to give people a connection point.”

As Chirlane explains it, ThriveNYC is a diverse coalition of programs poised to remove roadblocks to mental health and substance misuse and addiction services, as well as reverse the stigma around seeking such services. “There has been total agreement between our public health leadership and our police leadership, that you cannot arrest yourself out of the substance challenges,” Mayor de Blasio said. Chirlane also cited the family’s own awakening to mental health struggles as a pivotal moment when a close family member confided in them that she was suffering from addiction, depression, and anxiety. “I felt everything you’d expect a mother to feel,” she wrote back then. “Love, sadness, fear, and a whole lot of uncertainty. But I didn’t know where to turn. There was not an established series of steps for us to refer to. Bill and I had to trust the recommendations of people we didn’t really know and make some major decisions on faith alone.” The de Blasio’s were not alone with their frustration and desperation while dealing with a loved one’s mental illness and substance use disorder.

The coronavirus pandemic has put a spotlight on the quiet crisis of mental illness and substance use disorders, like no public health crisis in the past. It has exposed a fragile, uncoordinated, poorly accessible, inequitable and fragmented system of care for some of the most vulnerable people in the United States. The diseases of despair are spiking across the country as the pandemic surges. Increased alcohol consumption, drug use and thoughts of suicide continue to threaten large swathes of the United States. Public trust in the government to mount a safe and effective response to the pandemic and its mental health fallout has been eroded. The de Blasio’s are emissaries of hope lighting the way for those smothered by the fog of addiction and despair.

The Morning Joe team also spoke with directors of the Covenant House New York, New York City’s largest provider serving youth experiencing homelessness, the director of Hazelden Betty Ford New York, a center providing mental health and substance use disorder treatment and Dr. Emmanuel Fombu, a brilliant physician, scientist, and gifted communicator in the battle against mental illness and addiction.

Covenant House had been supporting New York’s endangered youth long before the pandemic covered the homeless youth in the City with a blanket of gloom and danger. At least one in five of the over 33,000 homeless youth in the City have been victims of human trafficking. The stigma of homelessness, like that of mental illness and addiction, has disenfranchised them from mainstream consciousness. The staff of Covenant House New York raises up this fragile and hidden segment of society with empathy and compassion. Sister Nancy Downing is an attorney by profession and a nun by the calling of faith. After a career in corporate America, she followed her faith to become a religious sister and brings that commitment, resilience and resolve to the homeless youth served by Covenant House New York as the Executive Director.

“It has been a long nine months for everyone around the world,” Sister Nancy said. “For our staff, since they are essential workers, they come in every day to take care of our young people. For many of them, that has meant they need to quarantine when they get back home…They are not sure what they may been exposed to. But these staff have been amazing. We can count on them to be here for our young people. Being able to come in here every day, to see the resilience of our young people, to see the spirit of our staff, that raises my spirit.” Speaking with Sister Nancy illustrated the reality of life as a front-line worker during the pandemic. “I have not been able to live in my religious community for these last nine months,” she said. “So, I have been living in an apartment and coming to work. But it has been my faith in God certainly that has helped me in this time.” She has several fellow sisters living in that community that are older and have underlying health conditions making their risk of severe COVID-19 too high to take any avoidable risks.

Sacrifices in her own life have allowed Sister Nancy to continue her daily care of the hundreds of at-risk young people that she calls her children. Many at Covenant House have seen the pandemic take away their first jobs, or the security of a college that provides a dorm and meal plan. She emphasized her mission to not only provide the youth in need with support, safety, and counseling, but also a renewed sense of self and agency in their lives. “It is really important for people in the United States to realize that youth homelessness is real here,” she said. “One in ten young people in any given year in the United States will become homeless, on their own, not with a parent or family member. The other thing is that once on the streets, they are subject to being exploited. Approximately twenty-five percent that come to Covenant House will have experienced sexual or labor exploitation. It is important to know that young people cannot be left on the streets. We cannot do that to our young people.”

Eliana Leve is Director of Hazelden Betty Ford New York. The mission of this respected institution is to provide outpatient addiction treatment and mental health services in New York. The needs of their clients, especially those most disenfranchised and stigmatized, have never been greater. If there is one thing the pandemic has taught her, it is to encourage those suffering from mental illness or substance misuse and addiction to reach out for help early—before crisis strikes. As with many diseases, treatment is more effective before mental health problems and substance misuse escalate. She also learned that the clinic’s necessary rollout of new virtual mental health care services was met with a surprising but encouraging adoption rate by the adult clients of the clinic.

This stands in sharp contrast to the request for face-to-face interactions by the 16 to 24, year-old demographic of homeless youth at Covenant House. While one might expect Zoom meetings to fit the needs of the digital-native generation, the Director of Mental Health at the Covenant House, Samantha Alvarez Benowitz, told us that they have seen an overwhelming demand for not only in-person counseling therapy, but group therapy. This has necessitated additional safety logistics, but the peer-to-peer counseling sessions have proven to provide immense support to the residents. Even under the care of Covenant House, COVID testing and unexpected episodes of mental distress underscore the challenges facing the youth every day.

Prevention and treatment of mental illness and substance use disorders is close to the heart and mind of the renowned, Dr. Emmanuel Fombu, who has been branded as “The Medical Futurist.” He is a brilliant physician and gifted communicator with a vision of digital and precision medicine. What many call artificial intelligence and machine-learning, he calls augmented intelligence, to emphasize the importance of combining data-driven science with the compassion and humanity of healthcare providers. He extends his expertise from the halls of the hospital and the laboratories of science by serving on the board of directors of Half The Story, a non-profit organization committed to promoting the healthy use of social media and technology in the next generation by way of advocacy, education, and providing access to resources for youth. Dr. Fombu’s work creates a bright future for mental healthcare and addiction prevention and treatment.

While Bill De Blasio approaches the end of his second term as Mayor of New York City, his and his wife’s mental health initiative has the potential to create lasting legacy. Chirlane still remembers when people were afraid to say “breast” and “cancer” out loud, a disease that was “only discussed between sisters and girlfriends in stolen whispers.” She is thankful that women are now proud to tell their stories, in and outside of the large, tight-knit community of breast cancer survivors. With high-visibility efforts in New York around mental health paving the way, a similar hope is on the horizon for those suffering from diseases of the brain. People in the United States can seize upon opportunities for mental health and addiction treatment programs, not just in New York City, but across the country.

With compassionate programs like ThriveNYC, Covenant House, and Hazeldon Betty Ford leading the charge, the United States is well-positioned to finally work towards eradicating the shame and treating the pervasive mental health issues and addiction in our post-pandemic country. Mayor de Blasio stated, “I think there will be a silver-lining for this pandemic. I think it will wake us up to things that we have to do differently starting with our kids. We have to reach every child in school with mental health support.” Dr. Fombu’s visions of augmented intelligence and personalized medicine brings even more hope that through modern science and enhanced healthcare, a skeptical public can be enlightened that diseases of the mind are treatable. They are not character flaws. Mental illness or addiction can strike anyone at any age, at any time.

If there is, indeed, a silver lining to be found in the cloud of this coronavirus pandemic, it will be our ability as a nation to learn from the experiences and compassion of our front-line workers, scientists, and clinicians. Even when Dr. Anthony Fauci finally tells the American people it is safe to return to a mask-free life and rebuild a sense of normalcy, the lessons of the pandemic must not be forgotten. It is time for the quiet crises of mental illness and addiction to be spoken of at the kitchen table without remorse, stigma, or shame. As we approach a new day of empathy and honesty in the United States, the nation can get down to the business of rebuilding trust. Hope can spring from the ground broken in New York City and flow throughout the United States.

The ThriveNYC hotline can be reached at 1-888-NYCWELL.

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