Anxiety Further Fueled by Pandemic and Police Violence: Where Mental Health Stands in the US

What’s happening – May is Mental Health Awareness Month, and recent surveys show how Americans are continuing to struggle with their mental health. Anxiety levels are high due to the COVID-19 pandemic and exposure to police violence, according to a recent poll and a study presented at the American Psychiatric Association’s annual meeting. Results of a national poll of 1,000 adults revealed that fewer people reported higher anxiety compared to last year but that overall levels remain high (41% reported more anxiety in 2021 compared to 62% in 2020). Young adults reported more anxiety than those over age 65. Worry about loved ones catching the coronavirus was up from last year, and 53% of parents said they were concerned for their children’s mental health.

Motley et al found that anxiety among young Black adults (ages 18 to 29) is rising, in part because of exposure to police violence. Police-contact anxiety was moderately high because of being a victim of, witnessing, or seeing a video of police force in the media in a survey of 300 young Black adults. According to a news release, participants had been a victim of police use of force nearly two times; had witnessed in-person police use of force against someone more than seven times; and had seen video in the media of police use of force more than 34 times, on average.

Why it’s complicated – In addition to increasing anxiety in America, Time reported that suicide among Black girls is rising, and suicide death rates increased by 182% from 2001 to 2017 for Black girls ages 13 to 19. The author explores possible reasons for the rise in suicide attempts and deaths among Black youth, including racial discrimination, reluctance to seek help, cyberbullying and social media pressures, bias and stigmatization of mental health in Black communities. More on mental health care disparities, including racial targeting, in our special BIPOC Mental Health Awareness series.

Rising Anxiety in the United States: Reports & Perspectives

  • Psycom Pro has released a special report featuring a cross-disciplinary expert panel that discusses whether there should be an annual mental health assessment, using current depression screening and gaps in follow-up as a model.
  • A new series produced by Oprah Winfrey and Prince Harry will discuss mental health issues with the goal of destigmatizing conversations about struggles and mental well-being. High-profile guests (such as Lady Gaga, Glenn Close, and DeMar DeRozan) and mental health experts will share their stories and information about treatment.
  • The Spring 2021 Harvard Youth Poll, which surveyed 2,513 young adults ages 18-29, found that 51% of participants said they felt “down, depressed, or hopeless” in the past two weeks; 19% said they feel that way more than half the time. Additionally, 34% of college students surveyed said their mental health has been negatively impacted by the coronavirus.
  • Anxiety about ending pandemic precautions regarding mask-wearing and returning to the office is “not an unnatural reaction.”
  • Employers can support employee mental health by being flexible, says the American Psychological Association.
  • @NBCBLK (Stories, issues, and opinions from the African American perspective) linked to an article about policing and trauma, tweeting, “Psychologist Brandon Gamble says anxiety among Black Americans related to policing and racism is so prevalent that a friend’s 17-year-old son did not want a driver’s license ‘because of the way police might treat me.’”
  • @APA (American Psychological Association) tweeted, “As American offices slowly begin to reopen, psychologists are using new and existing research to help make these spaces feel safer for returning employees.”
  • @vibrantforall (Vibrant Emotional Health, formerly the Mental Health Association of New York City) tweeted about its event on May 18, to … “discuss #COVID19, its effects on #mentalhealth & ways to cope as areas begin to open up again.”

Psychiatric Disorders & Medical Conditions: Assessing Comorbidities

Schizophrenia Treatment: Cognitive Remediation May be More Effective than Previously Thought

What’s happening – Cognitive remediation (CR), a behavioral training-based approach to improving cognitive function in individuals with psychiatric disorders may offer benefits for more patients with schizophrenia than previously thought, according to a study by Vita et al in JAMA Psychiatry. This systematic review and meta-analysis, which included 130 trials with 8,851 participants, found that CR had a positive effect on global cognition and functioning. Additionally, CR was demonstrated to be more effective with the “crucial ingredients” of an active and trained therapist, structured development of cognitive strategies, and integration with rehabilitation. The authors recommend cognitive remediation therapy for all patients with schizophrenia, rather than as an optional intervention for certain patients as previously supposed. Dr. Vita’s team concluded that CR has the potential to be a “game-changer” for patients and could be part of standard care for schizophrenia (see his Q&A on identifying patients for CR therapy in the Psy-Q below).

Why it’s complicated – Cognitive remediation therapy is an evidence-based, nonpharmacological treatment that should have more widespread use, according to Vita et al. His team wrote that CR is an important approach because of the limited effects of pharmacological treatment on cognitive deficits and that remission “does not necessarily result in functional recovery.”

Psy-Q Challenge

How do I know if my patient is a good candidate for cognitive remediation for schizophrenia? Antonio Vita, MD, PhD, answers

Get the Answer

How Well Does Cognitive Remediation Work for Schizophrenia: Reports & Perspectives

  • Another recent meta-analysis of CR for schizophrenia, this one by Lejeune et al, also found that cognitive remediation improved cognition and function in a study of 73 trials and 4,594 participants. The team also found that CRT programs with discussion groups and coaching had larger effects on memory.
  • A meta-analysis by Thérond et al looked at data from eight studies that used CR for adults with major depressive disorder, finding that the psychotherapy improved global cognition, verbal memory, attention/processing speed, working memory, and executive functioning.
  • @TilWykes (professor Dame Til Wykes of King’s College London and last author on the JAMA study) tweeted, “Out today our paper on cognitive remediation – nearly 9,000 participants showing CR works and that therapists are important for therapeutic improvements – well done Antonio Vita …”
  • @Synthia_Guimond (assistant professor in psychology at the University of Quebec and in psychiatry at the University of Ottawa, and last author in the Thérond et al study) retweeted @TilWykes, adding the clapping-hands emoji to this quote from the article: “This analysis demonstrates that cognitive remediation is an evidence-based intervention, which should be recommended and implemented more widely in the standard treatment of schizophrenia.”
  • @profbowie (Christopher Bowie, a professor at Queen’s University in Canada, and co-author on the Thérond et al study) tweeted in reference to the Vita et al article, “Time for cognitive remediation to be in all treatment guidelines (looking at you, [Canadian flag emoji]). Need to break free from overweighting illness management and acknowledge that those with schizophrenia deserve recovery-based treatments. @CPA_APC”

Practice Guidelines for Treating Schizophrenia, Memory, and Function

CVS Joins Walmart, Walgreens, and Rite Aid in Offering On-Demand Mental Health Services

What’s happening – The CVS drugstore chain has launched a pilot counseling program to offer mental health services at select stores across several states. Licensed social workers will provide assessments and counseling services in stores or via telehealth, and they will provide referrals to higher levels of care if necessary. CVS highlights the convenience and reduced cost of the program over traditional counseling services.

CVS is not the first drugstore to offer in-store mental health care. Walmart Health launched in 2019 a counseling program as part of its primary care, dental, optical, imaging, and lab services. The company announced last week that it will acquire MeMD, a telehealth company, and provide virtual medical and mental health services as well. Other retail chains that provide or coordinate mental health care include Rite Aid and Walgreens, according to a New York Times report.

Why it’s complicated – Two common threads in reports about retail chains entering the therapy space are that traditional therapists are overbooked (more on the psychiatrist shortage) particularly because of the stress and demand for mental health services in the pandemic and that the cost is out of reach for some patients. Retail pharmacies are trying to alleviate these barriers for patients in addition to helping to reduce biases around seeking mental health care.

Drugstore Therapy and Mental Health Services: Reports & Perspectives

  • NPR’s report on CVS’s counseling services profiles a patient and her struggle to find a therapist before turning to the pharmacy chain for help.
  • Improving care by redesigning public mental health systems is discussed by Smith et al in the current issue of Psychiatric Services. The authors reviewed the effects of the pandemic on New York State’s mental health authority, describing the lessons learned and identifying opportunities for redesigning New York’s and other systems post–COVID-19.
  • @StevieBoy_MD (child & adolescent psychiatrist Stephen Tourjee, MD) tweeted, “Interesting to see that CVS will be offering therapy soon. Hopefully, this will increase access to mental health services and decrease stigma!”
  • @SarahBlazonis (a reporter for Bay News 9 in Tampa Bay) tweeted, “@MentalHealthAm says #Florida ranks 48th nationwide in access to mental health services. #Tampa is among first spots in the #US @CVSHealth is launching counseling. People can meet with licensed clinical social workers, like Cathi Bedy, for assessments, referrals, and more.”
  • More on Private Companies Trying to Improve Mental Health Care Access

Teletherapy and Meeting Client Demand in Clinical Practice

Last Updated: Aug 26, 2021