Daniel Crowe, MD, FACP
Texas Health Institute Board of Trustees

The coronavirus pandemic of 2020-2021 has had a profound impact on the mental health and well-being of Texans, as well as the rest of the US. The pandemic highlighted the need to revitalize the infrastructure of our public health system and to protect it from political influence at all levels. The trauma inflicted by the pandemic has touched all of us. Many have lost family members or friends. Other stresses include loss of employment, insurance coverage, housing, and access to healthcare. Children have lost more than a year of seeing their classmates and friends in person and have had to learn how to learn through a virtual school environment. Many small business owners lost their sole source of income due to restrictions required to minimize the spread of the virus.

The CDC reports that as a result of all of this, there has been a 27% increase in symptoms of anxiety and depression between April 2020 and February 2021. Emergency room visits due to overdoses and suicide attempts were up 36% and 26%, respectively. More than 87,000 Americans died of drug overdoses in the year ending in September 2020, representing a profound increase. Behavioral health service providers reported increased demand at the same time that they were decreasing staff sizes and closing clinics. Although the use of telehealth has risen dramatically, the effect on providing care for those with behavioral health and substance use disorders (SUD) has yet to be determined. The impact of the pandemic has disproportionately affected our communities of color. It has highlighted how a system that prioritizes a law enforcement and criminal justice approach to psychiatric crises often results in unnecessary injuries and deaths.

The health care community has responded rapidly to the new environment created by the pandemic. Some best practices have emerged:

• Increased access to behavioral health and SUD providers via telehealth
• Integration of behavioral health into primary care practices
• Integration of evidence-based treatment of SUD into behavioral health and primary care practices (medication-assisted therapy or MAT)
• Use of mobile applications to support healthier behaviors and activities including use of rewards when individuals are behaving in ways that support improvement in mental health symptoms and maintenance of recovery (contingency management)

There has also been a significant increase in enrollment in Medicaid and the Healthcare Exchange during the pandemic leading to many gaining or regaining access to health care.

As the public health institute of Texas, Texas Health Institute (THI) is committed to helping Texas overcome the trauma from the pandemic through their continued devotion to advancing the health of all Texans and their communities. THI’s dedicated staff continues to produce outstanding research and translational activities such as the recent work on health equity through the HOPE Initiative that is featured by the New England Journal of Medicine. THI works with the Texas Primary Care Consortium to integrate behavioral health into primary care practices throughout Texas. THI has been a leader in advancing collaborative action on chronic pain, SUD, obesity, oral health, genetic disorders and other topics important to Texans. To quote THI, “We strive to advance the health of all.”