• AMN Healthcare

The Pandemic and Mental Health: Yes, Pyramids Can Crumble


By Cathy Massaro, MSW, CCM, ACM-SW, Candidate Specialist, AMN Healthcare


When the ball dropped in New York’s Times Square at midnight on December 31, 2019, it signaled the start of a new year. This iconic symbol was an indicator of fresh starts and hopes along with resolutions and plans for a bright new year. While it will be debated among the health care experts as to who knew what when, or who should have known what when, the average Joe could never have predicted at that moment where 2020 would take their life.


As the new year got underway, people were still plugging along with routine life. Loved ones needed care and affection, the boss wanted their deadlines met, two new tires were needed for the car, the children were due for their annual health assessments, the Christmas bills were added to the usual ones to be paid, and weekly errands to keep the house running were waiting.


This is life. Real life that real people experience every day. The kind of daily work that provides an interconnection as well as social determinants of health that can determine one’s level of success.


These are known routines and patterns that get everyone through their day, and impact other aspects of one’s life. The job that provides financial security was earned through the education made possible by the car that got someone to classes. The comfort of a home to raise their children in was also made possible by that job, and now provides the optimal study environment for the next generation to pursue their own education.


Our lives are often like a pyramid of personal social determinants of health that build upon each other.


Then the COVID-19 pandemic of 2020 happened, and this pyramid has been shaken to its foundation. Now there is fear, uncertainly and confusion concerning the most basic of our routines. Maintaining personal relationships that are critical to enriching our lives are put on hold. Yet how does one put a hold on a heart?


The positive energy received from connecting with those we love is priceless and can make a difference in how we deal with challenges. How does one meet the challenge of a pandemic without the hug of a loved one? How does one watch their strong, beloved father fall victim to a disease that prevents others from being at their bedside to ease the fear of death? And what if the same disease prevents even holding a proper funeral?


The stress of the pandemic escalates when decisions regarding the education of our children come into light. Most children had a plan that involved going to a brick-and-mortar building Monday through Friday. They were taught by professional teachers, socialized with their friends and had out of the home experiences in their own world.


Parents also benefited from this simple plan, allowing them to work, care for younger siblings and explore their own world. Now there are less desirable options, each with their own risks. Should children attend school in person, online, or in some hybrid combination? The decision affects their education, which effects their future. It also affects their mental well-being.


The pyramid of basic social determinants of health has become a pyramid of stress.


As these stressors continue, they might impact an individual’s ability to function. Even in some very well-functioning individuals, depression may set in, fueled by over- or under-eating, poor sleep habits, and lack of movement and personal connections. The individual who had all the plates spinning in perfect harmony is now seeing those plates shatter when they fall and hit the ground.


Going through the motions is no longer possible because the individual can’t function at their prior level of competency. This individual may be faced with accessing mental health services for the first time, setting up another level of stress.


Finding Help

Admitting the need for mental health services is the first and biggest step towards regaining control. Mental health continues to have a stigma surrounding it and those who need the services are often viewed as weak. People need to feel safe and supported in their efforts to get their pyramid back in order.


Finding a mental health provider that is within the individual’s financial means or covered under insurance is a tall order for someone who has never experienced the need for mental health services. If the individual has insurance, the carrier may provide in-network options or their primary care physician may have choices for the individual.


However, if the individual does not have insurance or a primary care physician, where should they start to pick a mental health provider? What matters in a situation that the individual knows nothing about? Shared gender, religious or cultural backgrounds, location of office, level of education, or years of experience? In a pandemic, these specific criteria points may conflict with increased demand, especially as some mental health providers may be cutting back on client time or not even accepting new patients. It can leave the individual in need with little flexibility.


Transportation is one of the most impactful social determinants of health facing an individual and is exacerbated in a pandemic. Without affordable and reliable transportation, an individual’s world becomes very small. If any needed services are outside this circle, they become an obstacle to healing. This can include mental health appointments, follow-up treatment and prescriptions. If the individual does not have a personal car, the fear of using public transportation could also be escalated in the current environment.


Once an individual gets to meet a mental health care provider, they will need to determine if he or she is it the right one. Is the provider sensitive to individual religious and cultural beliefs and customs? Does the individual feel comfortable with the provider, and if not, are there any options? It is not uncommon for an individual to work with a few mental health providers until they find one that they feel compatible with for treatment. In a pandemic, however, an individual may have limited options given the fact that many providers are overbooked.


An individual’s financial status is a critical social determinant of health and can also be threatened during a pandemic, creating more uncertainty in their previously well-ordered world. Losing a job or working in one that is below their level of expertise can heighten anyone’s stress level, especially when that person is expected to provide life’s essentials for others in the family.


These are just a few of the social determinants of health that can be disrupted during a pandemic. The world may have a proven safe COVID-19 vaccine available to the general public any day now, but the devastation created to individual lives and their mental health is sure to last much longer.



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