by Sandhira Wijayaratne

In 1918, as the world collapsed under the weight of a different #pandemic, a simultaneous #mentalhealth toll rose from underneath. While the influenza #pandemic of that era infected 500 million people — taking  the lives of 50 million globally and 675,000 in the #UnitedStates – many survivors suffered a “post-influenzal #depression.” Historians noted how their lives became “unbearable, even after the infection had passed.” Today, we are seeing similar trends among #COVID survivors.

When #pandemic flu took hold, a novel clinical entity called “encephalitis lethargica” also surged. Despite unclear evidence, #doctors connected it to influenza. The syndrome’s constellation of vague neuropsychiatric symptoms sounds eerily similar to long #COVID.

#Psychiatrists, then, also linked new episodes of psychosis to influenza infection, as we have seen with #COVID. One oft-cited study indicates that #suicide rates in the U.S. increased during the 1918 influenza epidemic. So far, data from 2020 shows that overall #suicide rates declined by three percent compared to 2019, but increased among racially minoritized #men.

While the clinical history of the #COVID-19 #pandemic is constantly being rewritten, these echoes of a #pandemic past are haunting. But what remains largely absent from influenza’s historical record is what I see every day as a #doctor training in psychiatry: a #mentalhealthcare system constantly fraying at re-stitched seams.

We were warned.

Though the incessant exposure to never-ending death and fear from influenza are well-documented today, accounts of how this #stress impacted community #mentalhealth at the time were scarce. The early 20th century was notorious for more severe #mentalillness stigmatization than now, so the lack of coverage on the optics of a psychiatric crisis is unsurprising.

These days, however, the signs are everywhere. For me, the biggest red flag was when a young #woman who came to the emergency room scribbled “PAY ATTENTION TO US” in black Sharpie on the glass wall separating us. She was waiting several days on a gurney for an elusive psychiatric bed. There are thousands more in the country just like her.

#James Donaldson notes:

Welcome to the “next chapter” of my life… being a voice and an advocate for #mentalhealthawarenessandsuicideprevention, especially pertaining to our younger generation of students and student-athletes.

Getting men to speak up and reach out for help and assistance is one of my passions. Us men need to not suffer in silence or drown our sorrows in alcohol, hang out at bars and strip joints, or get involved with drug use.

Having gone through a recent bout of #depression and #suicidalthoughts myself, I realize now, that I can make a huge difference in the lives of so many by sharing my story, and by sharing various resources I come across as I work in this space.  #http://bit.ly/JamesMentalHealthArticle

Order your copy of James Donaldson's latest book,

Celebrating Your Gift of Life:

From The Verge of Suicide to a Life of Purpose and Joy

Symptoms of #anxiety and #depression have skyrocketed since the first cases of #COVID appeared in the U.S., disproportionately affecting #racial minorities and low-income populations. Despite overall statistics reporting a decline in suicides, #COVID’s first wave saw more #patients come into the emergency room after #suicideattempts and overdoses than in the year prior, and emergency psychiatric care overall increased after #COVID surges. Amid cycles of #school closures and virtual learning, the #mentalhealth of #children and #adolescents has been uniquely impacted, with pediatric emergency rooms overwhelmed with psychiatric crises. As the country’s #mentalhealth worsened and more patients required hospitalized treatment, the media was consumed by stories of excessive wait times for an inpatient psychiatric bed.

On shifts when I work in the psychiatric emergency room, each morning begins walking past a row of #patients resting in stretchers against the wall adjacent to the staff entrance. Many of them wait in a metaphorical line for admission to an inpatient unit for further care. Before #COVID, that line moved forward gradually as admitted #patients were discharged. When #COVID hit, that linear process was upended – moving less in an efficient, Tetris-like fashion, and more like a game of Pacman with an everchanging maze and triple the ghosts chasing you. Except the ghosts are #COVID.

Much of the bottleneck in inpatient #mentalhealthcare during #COVID revolves around the social nature of treatment. Despite popular but inaccurate depictions of psychiatric units, a core piece of healing is engaging in activities with other #patients and #healthcareproviders. The infectious nature of #COVID paralyzes this crucial part of recovery. Infected #patients are moved from psychiatric wards and onto a medical floor, where they do not receive the much-needed social supports built into the unit they left. Affected psychiatric wards then undergo a quarantine period that suspends them from admissions, further straining emergency departments.

While comparisons of the #mentalhealth toll of #pandemic flu to that of #pandemic #COVID can only be traced so far, the writing is on the wall. And given the untenable psychiatric crisis we are facing today, it appears leaders are taking notice.

In his State of the Union address in March, President Biden pledged support for stronger #mentalhealth investments. His strategy includes financial commitments to build a more robust #mentalhealth workforce, broader access to treatment, and the launch of a federal crisis line. While the President’s plan is commendable, his overall blueprint must also address the chronic shortage of psychiatric beds plaguing this country for decades, which has directly led to the backlog in #mentalhealthcare witnessed over the last two years. His strategy should also consider the much needed expansion of supportive housing programs critical to discharging #patients safely from the psychiatric ward, and protecting them from returning to the emergency room.

Federal policy formulations serve as a necessary first step to turn the tide against our nation’s psychiatric emergency. Adopting them into the appropriate actions will determine the difference between being prepared for the next spiral in this #mentalhealthcrisis, or ignoring the lessons from the far and recent past.

If you or a loved one is experiencing a #mentalhealthcrisis, call Connecticut’s crisis line at 211 or go to your nearest emergency room. The #NationalSuicidePreventionLifeline is also available at 1-800-273-8255. You can also text with a crisis counselor by texting “CT” or “TALK” to 741741.  Additional resources are available online at the #AmericanFoundationforSuicidePrevention in the U.S., or the International Association for #SuicidePrevention outside the U.S.

Sandhira Wijayaratne is a psychiatry resident at the Yale School of Medicine.
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