Effects of COVID-19 on the mental health of black and brown racialized populations in the U.S.

“Before this crisis there was already a crisis”

Anton Seals Jr., Chicago's COVID-19 Recovery Task Force

The two of us live and work in different roles and different regions of the U.S. The populations we serve, however, are similar in their long-time lack of access to the spectrum of health services that is required and expected from the U.S. health service and all its divisions: including comprehensive prevention, treatment, and supportive services to aid recovery as needed. At the time of this writing, COVID-19 deaths are five times higher in black populations in Chicago than in white (“American inequality meets Covid-19”, n.d.). In April 2020, the CDC reported that nationwide, 33% of patients hospitalized for COVID-19 were African American, although this group comprises 13% of the U.S. population; this is contrasted with the white population, who make up 76% of the U.S. yet accounted for 45% of these hospitalizations (Aubrey, 2020). The Hispanic and Latino communities are also harder hit by the COVID-19 outbreak. For instance, in New York City, 34% of the New Yorkers who have died of COVID-19 are Latino, despite making up 29% of its total population (Mays & Newman, 2020). This alarming disparity in COVID-19 mortality rates cannot be surprising considering that chronic health conditions, such as heart failure, asthma, hypertension, diabetes mellitus and HIV, are at much higher rates, begin earlier and are treated later in the black population community than in the white population (Williams et al., 2010).

Native Americans, especially those who live in rural areas and reservations such as the Navajo Nation, have been especially hard hit from pandemics: NBC News calls the Navajo Nation's health services, managed by the U.S. Indian Health Services (IHS), “limited,”(Abou-Sabe et al., 2020, para. 1). A quarter, or 25% of the Diné population died from the “Spanish flu” of 1918; During the swine flu epidemic, Dinė or Navajo people, died from that flu at a rate “4–5 times higher than other Americans”; currently, the Nation's COVID-19 infection rate is “ten times higher per capita than its neighboring state, Arizona” (Lange, 2020, para. 4).

These and other chronic conditions such as higher rates of diabetes, asthma, stroke, hypertension, depression, and severe psychosis (Ignaczak & Hobbes, 2020) increase risk for poorer outcomes from, and vulnerability to, COVID-19 in black and brown racialized populations. These health risks are compounded by the food deserts, wage earning disparities, increased and pervasive social stressors, still-segregated housing, cultural mistrust born of centuries of enslavement, oppression and racism, and lack of comprehensive insurance coverage, to name just a few determinants of health (Social determinants of health, 2020; Williams et al., 2010). Protracted periods of isolation, multigenerational living and over-crowded residential spaces, unrelenting levels of increased stress and anxiety, in addition to financial difficulties, anguish, loss and strained relationships are pervasive and heightened for racial minority populations with disproportionately fewer resources compared to racially white populations. This health crisis will intensify the behavioral health, mental health (PTSD, anxiety and depression) and emotional health (loss, loneliness, and grief) needs of everyone, but especially for marginalized populations. Psychiatric mental health providers are challenged by and with these disparities as they strive to keep their patients stable, steady, and on a path to wellness during this pandemic. Inequities in health stems from all of these factors; now especially is a time for major changes in treatment delivery, and in resource allocation, especially in black and brown racialized populations that are disproportionally hardest hit by this pandemic.

At the same time, there are new working models of successful health and wellness programs for populations at increased risk for health inequities. These programs use health impact assessment strategies to design programs and provide comprehensive treatments that address these social determinants of health of diverse populations. Two of these are briefly presented here as examples of how comprehensive services for those populations at increased risk for poorer health outcomes, especially during this most recent pandemic, can be designed and provided.

Case example one

Situated around four housing developments in North Philadelphia, the Stephen and Sandra Sheller Family Health Services Center of Drexel University, operated in partnership with the Family Planning and Counseling Network (FPCN), serves nearly 6000 patients with an array of clinical and health promotion services. As a NCQA certified level III patient centered medical home, it serves as a safety net for its patients and many community members. Like many other health care organizations, it experiences delays in receiving needed testing supplies for COVID-19 however this testing is currently underway. Clinical services however quickly transitioned to enable access to care for patients. Telehealth for clinical services for primary care, dental and behavioral health were rolled out after its partner, FPCN obtained the necessary approvals from insurance companies and department of state, bureau of professional and occupational affairs licensing boards. Specifically, psychiatric services in primary care including integrated behavioral health consultants and the psychiatric nurse practitioner were able to maintain their transdisciplinary team orientation with all providers in primary care to attend to the needs of patients across the lifespan. Likewise, the larger behavioral health department shifted to operating at full capacity using telehealth including HIPPA compliant Zoom. On average, 95% of sessions are now virtual, therefore, routine van services were placed on hold; however increased delivery drivers were hired for the health centers pharmacy which delivers medications for free within a 2-hour time frame to any patient living in Philadelphia. Similarly, its mind-body services for both patients, community members and staff were all converted to virtual sessions including programming for fitness, yoga, and mindfulness meditation. Additionally, Zumba and Pound classes were offered to staff. These services are integral to mitigating and managing stress and promote engagement with others. Social services have also enhanced their work at the health center by starting a COVID-19 Hope Hotline dedicated to assist with available food resources and medical-legal services.

Case example two

At the city government level, Chicago's mayor has just convened a panel to improve healthcare service delivery for those communities affected disproportionately by COVID-19. The goal is to develop “hyperlocal” (neighborhood level) strategies to slow the spread of coronavirus and improve health outcomes for residents of those communities hardest hit by this crisis. These communities have struggled with limited access to healthcare services and insufficient primary care providers, long standing unemployment, a dearth of businesses in the community, chronic illnesses, and a panoply of health risks and stressors that contribute to the pronounced lifespan gap between white and black Chicago residents (Pratt, 2020) The panel consists of not only the usual business leaders and healthcare experts, but a representative from NAMI and community advocates such as Mr. Anton Seals Jr., whose words are quoted at the beginning of this piece. As Mayor Lightfoot said, “This cannot be temporary scaffolding. It's got to be laying a foundation for a permanent fix to many of the problems that for too long we have ignored or said, they are too big to solve” (Pratt, 2020, p. 4).

Conclusion

We will be watching what happens to the Chicago panel and its work after the pandemic is over. We hope the work of the panel and these other models will be used as best practice guides to change the economic maps and social injustices that foster these health disparities still, especially for the black and brown racialized populations in this country. The new normal they can create should include better distribution of resources, such as clean water, more primary care providers, telehealth and telecounseling services, to people who need them…wherever they live. This should not be a matter of “if you pay, then you can play”, but a best practices model of incorporating the major social determinants of health into assessment and treatment services for all needing health services, now during the pandemic and afterward.

Inequities in health are fueled by cultural and societal norms based on racism and racist practices in the United States particularly during the COVID-19 pandemic, and will be evident in its aftermath. Health equity, a process which assures conditions of optimal health for all peoples, requires needed attention to the social determinants of health: economic stability, education, community services and safety, healthcare, respectful communications, and affordable decent housing, for all populations. Racial diversity has greatly increased in the U.S., and the needs of our diverse population should inform health care practices and policy making in order to preclude disparities in these determinants, as well as the healthcare inequities that persist most pointedly along racial lines. But knowing this is not enough: doing is what is called for.