A failure to reinstate enhanced federal unemployment benefits and eviction moratoriums could contribute to a a wave of despair, drug overdoses and suicides among Americans, amid mounting fears about the long-term toll of the coronavirus pandemic.
Suicides have been rising in the US over the past two decades, with 132 people every day on average ending their lives in 2018, according to the Centers for Disease Control and Prevention (CDC). Overall, it is the 10th leading cause of death, with the highest rates among middle-aged white men and rural dwellers.
Suicide is always complex. Risk factors include untreated mental health problems, substance misuse, access to lethal methods, previous attempts, isolation, past abuse, physical health problems, long-term unemployment and hopelessness.
Protective factors include access to mental health services, family and community support, and strong religious or spiritual beliefs that discourage suicide.
But now Covid-19 has upended almost every aspect of normal life for many people, resulting in an increase in multiple suicide risk factors while also weakening some of the protective ones.
“The pandemic has already generated a combination of factors associated with increased risk, including economic recession, access to firearms, and a generalized sense of anxiety and depression. I would not be surprised if this leads to an increase in suicide deaths,” said Jonathan Singer, president of the American Association of Suicidology and associate professor of social work at Loyola University in Chicago.
In addition, emerging evidence suggests that some Covid-19 survivors may experience mental health problems such as depression, anxiety, and PTSD as part of a myriad of long-term consequences.
But the situation could get worse, according to Singer, as a moratorium on evictions and enhanced unemployment benefits had until now acted as a buffer. “In the next six months I think we’ll see a dramatic increase in suicide deaths, or at least despair,” Singer said.
There is precedent for that dire outlook. In the aftermath of the 2007 recession in North America and Europe, about 10,000 more people, mostly middle-aged and older men, died by suicide than expected in a two-year span.
Before the pandemic, almost 4 million evictions were filed annually, and one in four renters paid over half their pre-tax income to landlords, while almost 200,000 people slept in their cars, on streets or in abandoned buildings. Now, unemployment is above 10%, the federal enhanced unemployment benefit has expired amid partisan wrangling and tens of millions of families face the threat of eviction.
“Losing your home takes away an important protective factor and may lead to family splits. It increases suicide risk, no question about it,” said Steve Moore, co-chair of the Illinois chapter of the American Foundation for Suicide Prevention.
“Hope is the best protective factor … losing hope is a big problem.”
The full mental health impact of the pandemic won’t be fully understood for several years because of a data lag, but there is some cause for concern.
At least 35 states have reported a rise in fatal opioid overdoses during the pandemic, with powerful synthetic drugs like fentanyl and methamphetamine increasingly implicated, according to the American Medical Association. Access to harm reduction and life-saving medical services has been curtailed due to physical distancing requirements and pressure of emergency rooms.
“This epidemic caused 70,000 deaths last year, and it’s far from over,” said Dr Ken Duckworth, chief medical officer of the National Alliance on Mental Illness (Nami).
In Cook county, Illinois, the medical examiner last week reported 58 suicide deaths so far in 2020 – compared with a total of 56 for all of the previous year. The deaths overwhelmingly occurred in Chicago’s predominantly poor black neighborhoods – which have also disproportionately borne the brunt of Covid-19 deaths, job losses and a rise in fatal gun violence. The biggest suicide surges were among black men and younger people under the age of 30, including a nine-year-old boy in July.
“It is not surprising that the communities that have suffered the most are the ones who have the least. Disinvestment, red lining and systemic racism have culminated in a crisis that once again hits the African American community hardest,” said Toni Preckwinkle, president of the county board.
Banners are displayed on a building in Washington DC on 9 August. Photograph: Eric Baradat/AFP/Getty Images
In 2012, the then Chicago mayor, Rahm Emanuel, shut down half the city’s mental health clinics, a widely condemned policy move that disproportionately affected low income African American communities.
An uptick in suicides has also been reported by health officials in Fresno, California; Los Alamos, New Mexico; and Dougherty county, Georgia. Meanwhile, some states, including Idaho and Colorado, have reported a drop.
Experts say that while every suicide is a tragedy, it is too early to draw conclusions about trends.
Nevertheless, even before coronavirus, the suicide rate in the US increased by 35% over the past two decades, bucking a downward trend in peer countries like the UK.
Important country-specific factors that could also affect the Covid fallout include easier access to firearms. Americans own more guns than any other nation, and states with few restrictions, such as Wyoming, Alaska, Nevada, Idaho, Montana and Utah, also have the highest suicide rates.
Access to mental health services in the US is also woefully inadequate. In 2017, only two-fifths of people suffering from mental illness received services, and access was significantly lower for black and brown people. Then, almost 28m people did not have health insurance. Another 5.4m adults lost their jobs and insurance between February and June.
“The US doesn’t have a social safety net, like many countries in Europe. Instead we have the American myth of rugged individualism – that if you work hard enough you’ll achieve what you want in life, and if you don’t, it’s because of a personal failure,” said Singer.
According to the census bureau’s latest coronavirus household pulse survey, half of all adults – 105 million – reported feeling down, depressed or hopeless on at least several days during the previous week. Meanwhile, 11%, or 23 million, had relied on unemployment benefits to cover living expenses.
On the plus side, teletherapy may have helped close the gap during the pandemic, after Medicare changed its policies to include most telehealth, and many private insurers followed suit.
But many distressed people still fall through the gap.
Rebecca Henderson works with the Crisis Center in Birmingham, Alabama, part of the National Suicide Prevention Lifeline network.
In one recent call, Henderson counseled a single unemployed woman with two young children and limited social support who was feeling increasingly despondent about the future. In another call, an unemployed man in his 30s was starting to panic as he could not find work and the federal unemployment benefit had ended.
“I can help keep someone safe for now, but there are not enough resources and services for people. Honestly, this could get worse in two or three weeks when the evictions start and unemployment isn’t renewed, a lot worse,” said Henderson.
Alabama is one of 15 states to refuse federal funding to expand Medicaid, denying as many as 324,000 people healthcare and contributing to dozens of avoidable hospital closures.
Henderson added: “The pandemic has exposed our crumbling mental health system, and the biggest struggle in doing this work is knowing that we’re putting a bandaid over a gaping hole.”
In the US, the National Suicide Prevention Lifeline is 1-800-273-8255, or you can text HOME to 741741 to connect with a crisis text line counselor. In the UK, the Samaritans can be contacted on 116 123. In Australia, the crisis support service Lifeline is on 13 11 14. Other international suicide helplines can be found at www.befrienders.org