The Ohio Department of Mental Health and Addiction Services (OhioMHAS ) has released a new resource to aid behavioral health providers in re-opening in-person services. Click HERE to download the Guidance on Reopening In-Person Behavioral Health Services resource guide.
The coronavirus pandemic is pushing America into a mental health crisis
Anxiety and depression are rising. The U.S. is ill-prepared, with some clinics already on the brink of collapse.
May 4, 2020 at 10:00 a.m. EDT
Three months into the coronavirus pandemic, America is on the verge of another health crisis, with daily doses of death, isolation and fear generating widespread psychological trauma.
Federal agencies and experts warn that a historic wave of mental health problems is approaching: depression, substance abuse, post-traumatic stress disorder and suicide. Just as the initial coronavirus outbreak caught hospitals unprepared, the country’s mental health system — vastly underfunded, fragmented and difficult to access before the pandemic — is even less prepared to handle this coming surge. “That’s what is keeping me up at night,” said Susan Borja, who leads the traumatic stress research program at the National Institute of Mental Health. “I worry about the people the system just won’t absorb or won’t reach. I worry about the suffering that’s going to go untreated on such a large scale.”
Data show depression and anxiety are already roiling the nation. Nearly half of Americans report the coronavirus crisis is harming their mental health, according to a Kaiser Family Foundation poll. A federal emergency hotline for people in emotional distress registered a more than 1,000 percent increase in April compared with the same time last year. Roughly 20,000 people texted that hotline, run by the Substance Abuse and Mental Health Services Administration, last month. Online therapy company Talkspace reported a 65 percent jump in clients since mid-February. Text messages and transcribed therapy sessions collected anonymously by the company show coronavirus-related anxiety dominating patients’ concerns.
“People are really afraid,” Talkspace co-founder and CEO Oren Frank said. The increasing demand for services, he said, follows almost exactly the geographic march of the virus across the United States. “What’s shocking to me is how little leaders are talking about this. There are no White House briefings about it. There is no plan. ”The suicides of two New York health-care workers highlight the risks, especially to those combating the pandemic. Lorna Breen, a top New York emergency room doctor, had spent weeks contending with coronavirus patients flooding her hospital and sometimes dying before they could be removed from ambulances. She had no history of mental illness, her relatives have said in interviews, but struggled increasingly with the emotional weight of the outbreak before she died. Days later, reports emerged that a Bronx EMT also killed himself.
Researchers have created models — based on data collected after natural disasters, terrorist attacks and economic downturns — that show a likely increase in suicides, overdose deaths and substance use disorders.
And yet, out of the trillions of dollars Congress passed in emergency coronavirus funding, only a tiny portion is allocated for mental health. At the same time, therapists have struggled to bring their practices online and to reach vulnerable groups because of restrictions on licensing and reimbursement. Community behavioral health centers — which treat populations most at risk — are struggling to stay financially solvent and have begun closing programs. “If we don’t do something about it now, people are going to be suffering from these mental health impacts for years to come,” said Paul Gionfriddo, president of the advocacy group Mental Health America. That could further harm the economy as stress and anxiety debilitate some workers and further strain the medical system as people go to emergency rooms with panic attacks, overdoses and depression, he said.
Just as the country took drastic steps to prevent hospitals from being overwhelmed by infections, experts say, it needs to brace for the coming wave of behavioral health needs by providing widespread mental health screenings, better access to services through telehealth, and a sizable infusion of federal dollars. When diseases strike, experts say, they cast a shadow pandemic of psychological and societal injuries. The shadow often trails the disease by weeks, months, even years. And it receives scant attention compared with the disease, even though it, too, wreaks carnage, devastates families, harms and kills.
Mental health experts are especially worried about the ongoing economic devastation. Research has established a strong link between economic upheaval and suicide and substance use. A study of the Great Recession that began in late 2007 found that for every percentage point increase in the unemployment rate, there was about a 1.6 percent increase in the suicide rate. Using such estimations, a Texas nonprofit — Meadows Mental Health Policy Institute — created models that suggest if unemployment amid the coronavirus pandemic ends up rising 5 percentage points to a level similar to the Great Recession, an additional 4,000 people could die from suicide and an additional 4,800 from drug overdoses. But if unemployment rises by 20 percentage points — to levels recorded during the 1930s Great Depression — suicides could increase by 18,000 and overdose deaths by more than 22,000, according to Meadows. “These projections are not intended to question the necessity of virus mitigation efforts,” cautioned authors of the Meadows report, “but rather to inform health system planning.” “Could the numbers go up? Yes, but it isn’t inevitable. We know suicide is preventable,” said Christine Moutier, chief medical officer for the American Foundation for Suicide Prevention.
Research has shown interventions make a marked difference, such as limiting access to guns and lethal drugs, screening patients for suicidal thoughts, treating underlying mental conditions and ensuring access to therapy and crisis lines to call and text. “That’s why we need to act now,” Moutier said. On Wednesday, a coalition representing more than 250 mental health groups announced it was convening a national response to the problem of pandemic suicide — an effort that will include at least one federal agency, the National Institute for Mental Health.
“We’re used to dealing with sick people and seeing terrible things, but what’s devastating with covid is the sheer volume. It’s like drinking from a poisonous fire hydrant,” said Flavia Nobay, an emergency room doctor. As infections soared in March in New York, Nobay took leave from her duties at the University of Rochester Medical Center to volunteer as an ER doctor in Queens. Weeks later, the experience still haunts her: Watching families crumple in the ambulance bay knowing they may never see relatives again. Hearing the relentless alerts every few minutes of crashing patients and respiratory arrest. Sending patients home because they weren’t quite sick enough, knowing they may be coming right back. Or even worse, the chance they may not make it back. “It chips away at your soul,” Nobay said. “You have to hold on to the positive and how you’re helping in the ways you can. That hope is like medicine. It’s as important and tangible as Tylenol.”
A study of 1,257 doctors and nurses in China during that country’s coronavirus peak found that half reported depression, 45 percent anxiety and 34 percent insomnia. Pre-pandemic, doctors and nurses were already acutely prone to burnout, research shows, because of the workload, pressure, chaos and increasingly dysfunctional health-care system. “We’re now hitting a period of uncertainty where a lot of people are asking themselves how long they can keep it up,” said Liselotte Dyrbye, a Mayo Clinic doctor and leading researcher on burnout. “The teapot can only boil for so long.”
A broken system when it’s needed the most: This approaching wave of mental injuries will be met in coming months by a severely broken system. In the United States, 1 in 5 adults endure the consequences of mental illness each year. Yet less than half receive treatment, federal statistics show. As suicide rates have fallen around the world, the rate in the United States has climbed every year since 1999, increasing 33 percent in the past two decades.
Part of the problem, experts say, is the markedly different way the United States treats mental illness compared to physical illness. In normal times, a heart attack patient rarely has trouble securing a cardiologist, operating table and hospital bed. But patients in mental crises, studies show, consistently struggle to get their insurance to pay for care. Even with insurance, they struggle to find therapists and psychiatrists willing to take that payment. Those who can afford it often end up paying out of pocket. Experts warn that such parity and access problems may only worsen with the pandemic, which has upended the functions of hospitals, insurance companies and mental health centers.
In a joint letter Wednesday, leaders in mental health and substance abuse treatment pleaded for the Trump administration’s help. The letter — signed by the American Psychological Association, the American Psychiatric Association, the National Alliance on Mental Illness and 12 other organizations — asked federal officials to save community mental health centers facing financial collapse. The letter also asked the government to lift reimbursement restrictions that have prevented therapists from using phone calls to treat patients. On Thursday, the Trump administration indicated it would do so.
A survey of local mental health and drug addiction centers showed the pandemic has already left many on the brink of financial collapse, preventing them from providing services that generate much of their reimbursement revenue. More than 60 percent said they would run out of funding in less than three months and had already closed some programs. In a letter to Congress in early April, mental health organizations estimated that $38.5 billion is needed to save treatment providers and centers and that $10 billion more is needed to respond to the coronavirus pandemic. On Friday, the federal substance abuse and mental health agency said it had been allocated less than 1 percent of the amount advocated by mental health groups — $425 million in emergency funding — and has awarded $375 million to states and local organizations.
While Congress recently authorized $100 billion in emergency funds for hospitals and medical providers, very little will go to mental health and addiction service providers because they mainly receive funding through Medicaid. And most of the emergency provider money is being distributed through Medicare. “We are facing the loss of mental health centers and programs at a time when we are going to need them more than ever,” said Chuck Ingoglia, president of the National Council for Behavioral Health, which represents 3,326 treatment organizations.
Glimmers of hope – The sudden push into telemedicine could make services more accessible in years to come. And the national mental health crisis could spark reforms and movement toward better treatment.
And while almost everyone is experiencing increased stress, the effect for many will be transient — trouble sleeping, shorter fuses. The difficulty is identifying and treating those who develop deeper, worrisome mental problems such as post-traumatic stress disorder and severe depression. “To control the virus, it’s all about testing, testing, testing. And for the mental health problems ahead, it’s gonna be all about screening, screening, screening,” said Gionfriddo of Mental Health America.
For years, Gionfriddo’s nonprofit has offered questionnaires on its website — widely used in medicine — to help people screen themselves for mental health problems. Since the pandemic began, those daily screenings have jumped 60 to 70 percent. And since February, the number of people screening positive for moderate to severe anxiety and depression has jumped by an additional 18,000 people compared with January.
Speaking from her parents’ home in Pittsburgh, Ananya Cleetus said she has felt the increased strain. First came the closure of her school, the University of Illinois at Urbana-Champaign, bringing to an end her ambitious plans for the semester in computer engineering. Then came the loss of her therapist, forbidden by licensing rules from treating her across state lines. And social media didn’t help — all those posts of people baking bread and living their best #quarantinelife, making hers feel all the more pitiful. It was getting increasingly hard to get out of bed, said Cleetus, 23, who has a bipolar disorder and helps lead a student advocacy group. “It took me a few weeks and talking to friends to finally realize this wasn’t just something wrong with me,” Cleetus said. Since then, she has poured her energies into creating a daily routine and an online guide for fellow students struggling with the pandemic and mental health. “This virus is messing with everyone. The anxiety, isolation, uncertainty,” she said. “Everyone’s struggling with it in one way or another.”
If you or someone you know needs help, call the National Suicide Prevention Lifeline at 800-273-TALK (8255). Crisis Text Line also provides free, 24/7, confidential support via text message to people in crisis when they text to 741741.
Each year millions of Americans face the reality of living with a mental illness. During May, NAMI Ohio joins the national movement to raise awareness about mental health. Each year we fight stigma, provide support, educate the public and advocate for policies that support people with mental illness and their families.
This year for Mental Health Month, NAMI Ohio invites you to share what NAMI means to you.
Everyone in the NAMI family has their own story about how NAMI has impacted their lives and we want to know your stories. Maybe you have attended a Family-to-Family or Basics class or you have found support at a group meeting. Maybe you made your voice heard with your legislators on advocacy day or participated in a NAMI event. No matter how you came to know NAMI, we are happy you are here.
To participate, upload a video to social media using the hastags #MyNAMI and #NAMIOhio. Remember to tag us @NAMIOhio. Or you can send us an email or direct message with what NAMI means to you.
We will be sharing these stories on our social media and NAMI Ohio blog throughout Mental Health Month.
Please share with your post with your friends and communities and help people learn more about all of the great things happening throughout Ohio with NAMI and stay tuned to our social media channels throughout the month of May for more information.
Ohio Launches Toll-Free ‘COVID Careline’ to Provide Emotional Support for Ohioans Amid Coronavirus Pandemic: 1-800-720-9616
COLUMBUS –The Ohio Department of Mental Health and Addiction Services (OhioMHAS) today joined with Governor Mike DeWine and RecoveryOhio to launch a new, toll-free Careline to provide emotional support for Ohioans who are experiencing stress, anxiety, fear, sadness and loneliness amid the COVID-19 pandemic. Ohioans may call 1-800-720-9616 to connect with trained counselors for 24/7 support.
“Coronavirus has undoubtedly affected how Ohioans are living their lives,” said Governor Mike DeWine. “Fear and anxiety about a disease can be overwhelming and cause strong emotional reactions in adults and children. Reaching out for help to cope with that stress will make you, the people you care about, and Ohio stronger.”
Common signs of stress during an infectious disease outbreak include: Fear and worry about your own health and the health of your loved ones Changes in sleep or eating patterns Difficulty sleeping or concentrating Worsening of chronic health problems Worsening of mental health conditions Increased use of alcohol, tobacco, or other drugs Difficulty coping with changes in daily routines Feelings of isolation and loneliness Financial worries
“It is completely natural to feel stress, anxiety, grief, and worry during and after a disaster,” said OhioMHAS Director Lori Criss. “Taking care of your emotional health during an emergency will help you think clearly and respond in ways that help you and your family remain healthy now and in the future. Our hope is that the Careline will help thousands of Ohioans connect with resources and services they need to create wellness in these uncertain times.”
The Careline is staffed by credentialed counselors who have been trained to provide free, confidential support for a wide range of needs, including mental health concerns, substance use, problem gambling, and more. Individuals experiencing an acute crisis can still reach out to the Ohio Crisis Text Line (keyword 4HOPE to 741 741) or the National Suicide Prevention Lifeline (1-800-273-8255).
“As Ohio moves toward recovery from the pandemic, we encourage our citizens to reach out for help if they need someone to talk to,” said RecoveryOhio Director Alisha Nelson. “We cannot underestimate the importance of our mental health during this crisis and beyond. If you are having a difficult time, please take care of yourself and call the Careline.”
For more information about the Careline, visit: http://mha.ohio.gov/careline
The below letter was sent to NAMI Ohio from former Ohio Senator Bob Spada. Please read below.
A letter to NAMI friends:
This covid-19 virus has turned much of our way of life upside down.
As you can imagine, some of the hardest hit are those that NAMI serves.
If you normally give to charity and are considered a senior, do it with “Qualified Charitable Distribution” (QCD) from your IRA. In using the QCD your distribution goes directly from your IRA to NAMI Ohio, your local NAMI affiliate or other charity of your choice. In doing so it is not included in your income for federal or state taxes. Most brokerage firms and mutual fund organizations have the ability to issue your donation directly to your charity.
If this may interest you we have included in this notice an article from a CPA that details current changes to law.
The section that details Charity Benefit below includes comments on the tax saving benefits of a QCD.
Here is an article from Ed Slott:
How will the coronavirus bill deal with required minimum distributions? What advantages/disadvantages are there in skipping a year’s RMDs?
Among the numerous provisions of the massive aid package, the Coronavirus Aid, Relief, and Economic Security Act or CARES Act, are waivers for 2020 required minimum distributions (RMDs).
Waiver of RMDs — How the new rules will work
We saw this in 2009, and now here again Congress has provided relief by allowing all RMDs due in 2020 to be waived. You don’t have to take them, which in turn will reduce your 2020 tax bill.
Ask Ed Slott, CPA
Confused about IRAs, 401(k)’s, Roths, taxes and more related to saving for retirement? Ed has the answers. Email your questions to IRAHelp@aarp.org.
Who can qualify?
Anyone with an RMD due in 2020 from a company plan — like your 401(k) or 403(b) plan, or an IRA — qualifies, including beneficiaries, and including those who turned age 70 1/2 in 2019 and had to take their first RMD by April 1, 2020.
This will provide great help, because most 2020 RMDs are based on the retirement account value on December 31, 2019, when the Dow was 28,462 compared, to where it is today; around 22,000 as of this writing. But as we all know, this can swing wildly as we are still in an uncertain economic situation.
If the 2020 RMDs had not been waived, you likely would have had to withdraw a greater percentage of your IRA or plan balance and pay a big tax bill on value that no longer exists. So, it is good Congress gave us all a year off to sit this out and see what happens, and hopefully have more time to recover losses. Bottom line: We can take a breath on RMDs for a while.
Any downside to a waiver of RMDs?
No. Remember that the RMD is a minimum required distribution. You can always take more, so even though RMDs are waived, you can still withdraw any amount you need. Not only is there no downside here, the RMD suspension puts control back in your hands. You can withdraw or not, depending on your own situation. There are no rules to worry about.
That said, the question might be, is there is any benefit to withdrawing even if you are not required to? After all, why would anyone withdraw and pay tax on that withdrawal if they didn’t have to?
You might look at your tax situation and realize that for 2020, you may be in a very low tax bracket. It might pay to get some of that IRA money out to take advantage of today’s historically low tax rates. You generally don’t want to waste a low tax bracket. If you don’t use it to the max, you lose it.
Not only are tax rates low, but market values are low, too, right now, and that combination is perfect for a Roth IRA conversion, especially since both market values and tax rates are likely to increase in the future.
Normally, RMDs cannot be converted to Roth IRAs, but now since there are no RMDs, you can withdraw IRA funds at low values and low tax rates and convert them to your Roth IRA. Yes, you pay taxes on the conversion, just like you would have on your RMD. But your RMD could not be converted to a Roth, so even though you paid the tax, you could not get the conversion benefit. Now, under this 2020 RMD waiver period, you can get more for the tax you pay by being able to convert the funds you withdraw to your Roth IRA at a relatively low tax cost.
There are several additional benefits to this:
First, any amount converted removes those funds from your IRA, lowering the balance that will be subject to future RMDs, and in turn lowers your income and tax bill for future years. Lowering your income in the future could also lower the tax on your Social Security benefits and lower your Medicare IRMAA (income related monthly adjustment amount) surcharges.
In addition, once the funds are in your Roth IRA, there are no more lifetime RMDs, and anything you withdraw will likely be tax free. The Roth funds will also pass income tax-free to your beneficiaries.
Converting now when market values have dropped will mean that any future rebound will now accumulate tax free to you in your Roth IRA. If the market rebounded while the funds remained in your traditional IRA, then those gains would be eventually taxed.
The key factor in deciding whether to convert or not is the tax rate you are at now compared to what future tax rates might be. If you expect your future tax rate in retirement to be the same or higher, it pays tax-wise to convert.
Given the astounding $2 trillion dollar stimulus bill, it’s now more likely that tax rates will have to increase soon. This may be another reason to take advantage of this one-time opportunity to move what would have been your RMD into a tax-free Roth IRA.
Warning: Roth conversions cannot be undone
Of course, you should examine your own situation and review it with a professional tax or financial adviser, because once you convert to a Roth IRA, it cannot be undone. The tax will be owed. Roth conversions are permanent.
Even though RMDs are waived, you can still use your IRA to get a tax break on giving to charity. If you normally give to charity, do it with qualified charitable distributions (QCDs) from your IRA. The funds are directly transferred from your IRA to a charity and excluded from income. If there were RMDs, this would go towards satisfying the RMD, but even if there are no RMDs this year, this is a better way to give to charity and reduce your taxable IRA balance at the same time. Only IRA owners and beneficiaries who are age 70 1/2 or older qualify for this, though. This age did not change even though the age for RMDs was increased to 72. If you don’t do a QCD, your only charitable deduction is likely to be the new $300 above-the-line deduction created by the bill. (Above-the-line means it comes before you calculate your adjusted gross income). Otherwise, you probably will get no benefit from your donations, since most people take the standard deduction. QCDs give you back a tax benefit that would otherwise be lost. QCDs are another reason to withdraw from your IRA, even if you don’t have to.
If there is any downside at all to this RMD relief, it’s that, unfortunately, anyone who needs the funds and takes the RMD anyway will not benefit. According to the Treasury’s own numbers, they estimate that roughly 80 percent of IRA owners take more than the minimum, so this relief will not help a majority of those who rely on their retirement savings for annual income.
RMDs due for 2020 are waived, but you can take them if you need the funds or to take advantage of the tax planning opportunities opened for this year.
Ed Slott, CPA, is one of the nation’s top experts on retirement plans. For more than 30 years, he has educated both consumers and financial advisors on retirement tax-saving strategies. Most recently, he published Ed Slott’s Retirement Decisions Guide: 2020 Edition and is the host of several popular public television specials, including his latest, Retire Safe & Secure! With Ed
WE NEED YOUR HELP MORE THAN EVER!
Over 6,000 Ohio citizens live in adult care facilities or group homes. Right now, these homes are in DESPERATE NEED to supplies to protect their residents from the threat of COVID-19.
Many of the individuals living in these homes have co-occurring health conditions that put them at a higher risk of contracting the illness AND of having the most severe outcomes.
The operators of these homes, who house anywhere from 5 to 16 severely mentally disabled citizens, are trying to do everything they can to protect their residents, but necessary supplies are simply not available in the quantities that they need it.
Without cleaning supplies, ample amounts of food, and basic household essentials, the people living in these homes will die.
If you are able to purchase or donate any of the following items for these homes, NAMI Ohio will ensure the items get delivered to those who need it the most.
Most needed items include:
- HAND SANITIZER
- DISINFECTANT CLEANERS
- CLEANING WIPES
- NON-PERISHABLE FOOD ITEMS
- GROCERY GIFT CARDS
NAMI Ohio has decided that 100% of all donations made to our organization during this crisis will be used to purchase cleaning supplies and other much needed items for these homes.
NAMI Ohio will use our donations to purchase, collect, and distribute these items to adult care homes throughout Ohio (100% of all donations will go to this purpose).
If you have any items that you would like donate, you can do so at the NAMI Ohio office located at 1225 Dublin Road, Suite 125, Columbus, Ohio 43215. These items can be left outside the NAMI Ohio office door (Suite 125).
We are all in this together and we must protect Ohio’s most vulnerable citizens.
Anything you can do to help is greatly appreciated.
- Donate online via PayPal at www.namiohio.org/donate
- Donate with cash or check by mail to 1225 Dublin Road, Suite 125, Columbus, Ohio 43215
- Donations can be left at the NAMI Ohio office at 1225 Dublin Road, Suite 125, Columbus, Ohio 43215 in the building lobby outside the NAMI Ohio office (Suite 125)
Thank you & God Bless,
Terry L. Russell