Mental health often plays second string to physical health. Funding for behavioral health programs was slim before covid-19. The focus on overcoming the challenges of the current pandemic is leaving out the incredible cost in lives predicted to coincide with the economic shutdown and the impossibility of secure social connection predicated by our response to the virus.
In short, people who are out of work and lack purposeful in-person relationships with others which are often forged through work kill themselves at alarmingly high rates.
Calls to the National Suicide Prevention hotline, 800-273-8255 , in April 2020 were up 1,000% over April 2019.
In 2018 the rate of deaths of despair was 55.5 per 100,000 people, or 101,686 lives lost in the United States. An average projection of unemployment as a result of the covid-19 crisis of 15% will result in an increase in the suicide rate of 20.0 per 100,000 people over the next 10 years.
That’s 65,998 additional lives lost due to suicide as a result of the increase in unemployment.
This projection does not include suicides sure to result from cuts in services that will inevitably follow the reduction in public funds sure to follow the crisis as a result of lower tax revenues to the local governments that provide so many behavioral health services.
Unemployment and budget cuts will impact those in lower income brackets much more severely than people with higher incomes and more access to private mental healthcare. People in this lower socio-economic group also have fewer opportunities for virtual social connections than those in higher income brackets. Even when people in both groups lose their jobs.
Of course funding for vaccine research and services for people stricken with covid-19 must be maintained. 35.4 people per 100,000 die from this disease, and many of these are premature incremental deaths that would not have occurred if the novel coronavirus had not reached pandemic stage.
What we have is a classic question of utilitarian analysis. If we do not fund aggressive programs to get people back to work, and if we do end up cutting behavioral health programs because of decreases in public revenues paradoxically caused by an increase in unemployment, we will have judged the deaths of people due to mental health challenges to be more tolerable than the potential deaths caused by covid-19.
Once again, lives impacted by mental illness will be judged less valuable than lives impacted by physical disease.
I realize that money does not grow on trees, and I realize that difficult policy and budgetary decisions must be made. Are people with severe bipolar disorder, veterans with PTSD, and those whose lives have been decimated by substance abuse really worth less?
Decisions being made right now do not bode well for people with mental illness who are unemployed as a result of the economic shock of the pandemic. State and municipal governments are already weighing cuts to social services, and the extra unemployment compensation paid to people laid off due to the covid-19 slowdown is set to expire in July.
This is an opportunity to carefully weigh the impact of various public programs on both unemployment rates and suicide rates. If cuts must be made, we should know what publicly funded programs are less effective.
We do know for sure that when unemployment increases so does the rate of deaths of despair. As a society we can positively impact this outcome by funding programs that get people back to work.
That projection of 65,998 additional deaths due to suicide is not inevitable. We can prevent them by emphasizing and funding job creation.
It’s as much a moral imperative as preventing deaths from covid-19.
If you are thinking of suicide please call the National Suicide Prevention hotline at 800-273-8255 in the US or find a local number at samaritans.org in the UK.
George Hofmann’s new book Resilience: Handling Anxiety in a Time of Crisis is available wherever books are sold.