Nate Morsches: Mental illness is the second pandemic (Column)

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We are in the midst of a global pandemic that is overwhelming our hospitals and ruining lives and families. People are dying and households are collapsing.

I’m not talking about COVID-19. I’m talking about mental health.

I am a registered nurse who has worked in hospitals for the better part of the past 10 years, including as a frontline ER and ICU nurse since COVID came on scene a year ago. I’ve seen cruel deaths at the hands of the virus: young people with no health problems on ventilators and succumbing to respiratory arrest; the elderly fighting for their lives on all kinds of vasopressor medicines and sedatives; and people with comorbidities intubated and postured in a prone position, appearing bloated like someone who has drowned.

COVID is real and it is dangerous. It has taken far too many lives, and it isn’t done yet.

However, from all external indicators, we have achieved our goal from last year of flattening the curve. Our hospitals are not being overrun by critical COVID patients.

At my hospital we reached a peak number of concurrent COVID patients receiving inpatient care of about 70 at one time. Today, we have between five and 10 at any given time. This is obviously a dramatic decrease, which I attribute to our increased knowledge about the virus and its prevention and treatment.

The problem is that despite our efforts to stop the pathophysiological problems associated with COVID, our hospitals still are being overrun — not by COVID patients, but by mental health patients.

What I mean by that are patients who have come to the emergency department with the chief complaint of suicidal ideation, homicidal ideation, drug or alcohol detox, psychosis, behavioral health assessment or depression. Domestic assault victims might also be added to that list, even though that is not directly a mental health problem, but rather an indirect result of a mental health problem of someone in the household. These patients may or may not be admitted to the hospital, but they have come to the ER with any one or more than one of these chief complaints.

Prior to the pandemic, in a 24-hour period on any given day we might see five to 10 mental health patients out of a total of approximately 180 patients per day in my ER. In contrast, last week when I went to work a shift in the ER, I grabbed a snapshot of the statistics of the prior 24 hours. In that period, we had 150 patients come in the door. There were 21 suicidal ideation, five domestic assault cases and five drug or alcohol detox patients. That’s a total of 31 mental health patients — at least triple the usual maximum number.

In addition, every medical floor is being filled to capacity by patients with mental illness. For example, our ICU was literally half full of alcohol detox patients on that same day last week. Another example is that there are so many patients who have been deemed a risk to their own safety that they are placed on what is called an “involuntary hold,” meaning that they are held in the ER until inpatient placement for them can be found. Sometimes, this takes two hours, but sometimes it can take seven or 10 days. The patients are left sitting in their ER room without comfortable accommodations, because an ER room is meant to hold someone for a few hours maximum.

This problem consumes many resources. Not only do doctors, nurses, pharmacists, radiology techs and the entire healthcare team need to care for these patients who would otherwise not be at the hospital, but when a patient has suicidal ideation or becomes aggressive in behavior from withdrawal symptoms or psychosis, one staff member must stay with the patient at all times to ensure their safety.

Our hospitals are not equipped to handle this kind of demand over the long term, in addition to all of our typical patients. We don’t have the resources to cope with this influx of patients with mental issues.

Why are we seeing such a severe increase in the number of mental health problems? What has changed to cause this societal problem? Why do we have this second pandemic on our hands?

And why is almost no one talking about it?

To answer the first three questions, I think we can point to the initial stay-at-home orders, the new work-from-home norm and public restrictions on social interaction. We’re stuck in our houses with a lot of time on our hands, away from our friends and family, despite being made to be social creatures, and I believe that’s literally making us mentally ill.

As for the final question: Why is no one talking about it? I believe this comes from our people’s great intentions. We had great intentions to stop the spread of COVID. Great intentions to protect vulnerable populations. Great intentions to have compassion on our neighbors by keeping them from exposure to the virus. 

Much of that involves what we’ve come to call “social distancing.” I don’t doubt the sincerity of the American people to continue and in some cases even increase the restrictions for social distancing. But we have to consider that the cost of social distancing is a natural inclination toward mental health decay. It’s no one’s fault, but it is reality. Humans are social creatures, and by restricting our ability to be social, we are literally making some of ourselves mentally ill.

However, given the recent decrease in COVID, and the exponential increase of mental illness, I believe it is time to reconsider our stance on social distancing.

Don’t get me wrong. I’m not suggesting that all social distancing should be stopped immediately. But there must be some kind of balance between taking care of COVID and taking care of our collective mental well-being. Governments around the United States are reducing restrictions now, so there is evidence that many in power already believe that a balance must be struck.

I believe we must acknowledge that the mental health costs of long-term social distancing are very real. We must acknowledge the facts around us: COVID is on a decline, and mental illness is exponentially growing. A balance between COVID protections and mental health protections is possible. The only way we can achieve that balance, however, is through the recent and continuing easing up of restrictions in Douglas County and elsewhere, and community acceptance of the easing of these restrictions.

We must not shame our neighbors for considering our mental health crisis and wanting the restrictions to be loosened. We must, instead, take care of our neighbors’ mental health by accepting our inherent need to be around people.

There is a long road ahead of us for the recovery from these two pandemics, but we can do it. We’ll do it by the strength of our love for one another and the hands we use to pick each other back up.

— Nate Morsches (he/him) is an entrepreneur, president and co-founder of RPG on Mass Street, a registered nurse at a Kansas City-area hospital as a frontlines ER and ICU nurse throughout the pandemic, sits on the boards of the Lawrence Restaurant Association and Trinity In-Home Care, is a graduate of the Leadership Lawrence class of 2020, and is a Network Leader and Elder at CityChurch Lawrence. 

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