The Daily Signal - How Extended COVID-19 Lockdowns Pose a Serious Threat to Mental Health

Episode Date: July 6, 2020

Americans' mental and emotional health can't be ignored in the fight against COVID-19. Dr. Elinore McCance-Katz, assistant secretary of the Department of Health and Human Services for mental health and substance use, joins the show to explain the physiological effects of extended isolation.   McCance-Katz is both an epidemiologist and a psychiatrist. That enables her to have a uniquely holistic perspective about the most effective way to protect the whole health of Americans during the pandemic.  If you are struggling with anxiety or depression, check out these resources: SAMHSA’s National Helpline Mental Health First Aid We also read your letters to the editor and share the words of President Ronald Reagan on July 4, 1986, as he reminded Americans of where we came from and the importance of unity to maintain our national strength.   Enjoy the show! Hosted on Acast. See acast.com/privacy for more information. Learn more about your ad choices. Visit megaphone.fm/adchoices

This is the Daily Signal podcast for Monday, July 6th. I'm Robert Blewey. And I'm Virginia Allen. On today's show, we share my recent conversation with Dr. Eleanor McCants-Cats, Assistant Secretary of Health and Human Services for Mental Health and Substance Use. Dr. McCants-Cats joined me on Problematic Women in June to discuss the mental and emotional effects of extended quarantine and social distancing on Americans. And we want to share that conversation with you all today.

Dr. McCants Katz is both an epidemiologist and a psychiatrist. So I found her perspective really insightful as we continue to navigate and fight the virus, but also seek to get Americans back to work. We also have your letters to the editor, and we take a few minutes to listen to the words of President Ronald Reagan on July 4, 1986, as he reminded all Americans of where we have come from and the importance of unity in order to maintain our strength. Before we get to today's show, we want to tell you about the most popular resource on the Heritage Foundation website, the guide to the Constitution.

More than 100 scholars have contributed to create a unique line-by-line analysis of our Constitution. The guide is intended to provide a brief and accurate explanation of each clause of the Constitution as envisioned by the framers and as applied in contemporary law. If you want to gain a deeper understanding of our founding document, visitHeritage.org. ORG slash Constitution or simply search for heritage guide to the Constitution. Well, Virginia, there's certainly no better time to take a closer look at our founding document. That's right. That is right. Now, stay tuned for today's show. Coming up next. I am joined by Dr. Eleanor McCants Katz, Assistant Secretary of Health and Human Services

for Mental Health and Substance Use at the Department of Health and Human Services. Dr. McCants, Katz, thank you so much for being here today. I'm happy to be here. Thank you for inviting me. You are an epidemiologist, but you're also a psychiatrist, which gives you a very holistic perspective on all the risks of COVID-19, from infection to what social distancing and, you know, those quarantine measures mean for mental health. Can you tell us a little bit about your background in both the field of epidemiology and psychiatry and how your education in both of these fields affects your views of how America should respond to COVID-19? Sure. Well, I started out my graduate

career at Yale University. I attended the Yale School of Public Health where I got a PhD in infectious disease epidemiology. Part of the training that I received at Yale was didactics in epidemiology, and the study of viral infections. And so I do have a background in molecular virology. I have a background in epidemiology as a science and some of the statistical methods to address epidemiological questions. I wanted a career in clinical research, and for many, many years I have been a clinical researcher prior to coming into federal service, but I decided to go to medical school because I wanted to do research on human pathological conditions, and having a medical doctor degree would be helpful with that. So when I went to medical school,

I thought I would end up going into infectious diseases, but I became quite interested in psychiatry and in the care and treatment of mental illness and substance use disorders. And so I pursued a career in psychiatry and for many years I worked at the intersection of HIV disease and addiction medicine, specifically opioid addiction and injection drug use. So I spent many years looking at medications development for opioid use. disorders. I also spent many years studying medications that were used to treat HIV disease, as well as opioid therapies used to treat opioid use disorder, helping to determine what the best ways were to consider the clinical needs of patients so that they would have the best outcomes

in being treated for HIV and opioid use disorder if those conditions co-occurred, which is not, unfortunately, not an uncommon situation. So at various times, because of the kind of work I was doing, I provided some consultation in state government and ultimately ended up in the position I'm in now in federal government. The issue with coronavirus, of course, is one that has never been seen before. It's a new virus. It's a virus that because it's new, we really don't know.

It's epidemiology. We don't know. A lot of information that is critical to care and treatment of individuals who may become infected. And we don't know the spectrum of what those infections look like, nor do we have complete data on transmissibility of the virus. What we did know back in February and March was that we had a viral illness that was quite severe and making many people so sick that they were dying from this illness. And while that is leveling off now, continues to the present time, with that kind of

increase in the numbers of people with infections of becoming so ill they needed hospitalization and in a time when we had to very quickly learn how to care for people, it was necessary to take the actions that were taken at the level of the federal government from President Trump and within the state governments. That helped to level off the spread of the virus. And during that time, we've been able to learn a lot about medical care for people. We've been able to get testing much more widely available, and that continues to be an issue that's worked on every single day at the Department of Health and Human Services. We now have a system that's being rapidly put in place to do contact tracing. I mention these things because these are really

very standard epidemiological approaches to understand. outstanding illnesses and particularly infectious diseases that are now up and running in this country. And that puts us in a different place in terms of how we look at things going forward. The other side of that coin, though, is that for millions of Americans, when we say stay at home, home is safer. home is not safer for millions of Americans. There are millions of Americans who suffer domestic violence.

There are millions of children who suffer child abuse and neglect. And when our schools are closed and children are at home with their caretakers 24-7, and their caretakers are being asked to homeschool, things they have never been asked to do, This puts vulnerable children at great risk. We don't have our usual reporters available, our teachers, our school staff, our doctors that would be mandated reporters for these kinds of situations. They simply aren't seeing those children. For many people, women and in some cases men as well, they are victims.

of domestic violence and because of stay-at-home orders, they can't escape. They can't escape the abuser. These are very serious issues. And there's a literature. There's a literature on what the effects of stay-at-home kind of lockdown or quarantine, whatever you'd like to call it, what the effects are on people. And what those effects are is that in as little as nine days, people can develop mental health problems, anxiety, depression, anxiety.

Anger. Anger is one that is mentioned quite frequently. Numbing. People experience this as trauma. Some people will develop post-traumatic stress disorder, and these can be long-lasting conditions. What we don't know, what we don't know is what is the effect of having stay-at-home orders or situations where we are prohibiting people from going about their daily activities, which includes for, millions of Americans job loss and income loss. What are the effects of doing this for two to three months in some places still with no end in sight? The literature actually doesn't show lockdowns that have ever lasted this long. And so we're quite concerned about that, particularly at the agency I leave, the Substance Abuse and Mental Health Services Administration, we are very concerned. concerned about the mental health effects on people who are subjected to these very severe policies and who have lost the structure of their lives, the social supports and contacts that keep them going.

We are very concerned about people who have existing mental and substance use disorders who cannot get care because care across the country to a great extent has been canceled, at least the in-person piece of it, our agency has taken major steps to put telehealth services, telemedicine in place for those needing help with mental and substance use disorders. This is not something that is familiar to much of our practitioners in behavioral health. And the reason for that is because, as the term implies, behavioral health, we do our work by interacting with people. We want to see our patients. We want to interact with them.

Usually there are symptoms or behaviors or problem types of responses that people have that we address through individual settings, through group therapies, through therapeutic milieu, that for millions of Americans, these are ongoing needs. and they are everyday needs and they aren't getting that care. So we are very concerned about that. We're concerned about the link between unemployment and suicide. That's been documented in the literature as well. We already know that suicide is one of the 10 leading causes of death in the United States before we ever saw coronavirus. Now we're very concerned that there will be an increase in suicide deaths.

because of the additional stressors that have been placed on our people for months on end. And for millions of Americans, that lack of assurance that their job will be there for them when they come back or that they'll be able to go back to a full-time job. One of the things I'm hearing from colleagues across the country in my own field is that people's hours are being cut, they're being laid off, they're being furloughed, They're being asked to use their vacation time to cover reduced salaries that their employer gives them because of the lack of service provision that's going on in the country right now. While telemedicine is critically important, it can be life-saving. It's a way of making an acute intervention.

It's not going to be ever the full answer. people need that therapeutic interaction that occurs between others that share similar issues and their clinicians that have the experience of years and training and background to help people to address these kinds of conditions. So we're quite concerned about the mental health and substance use disorder fallout from COVID-19, and that's before thinking. about the fact that we have 58 million Americans prior to this virus, 58 million with mental and substance use disorders,

many with what we call co-occurring disorders, mental disorders and substance use disorder in the same person. We know that people who have substance problems usually have problems with more than one substance. We know that people with substance use disorders, only about 10% of them, get treated. That was before coronavirus. We know that people with mental illness, only about 55% of them get treatment. That's before coronavirus.

We know that 34% of people with serious mental illness, that's mental illness that is of a severity that people cannot carry out the normal, routine, daily life functions that the rest of us do because of impairments by their mental illness. 34% of them get no treatment at all. That's before coronavirus. We know that since coronavirus has started, appointments and visits have been stopped, that therapeutic interventions such as intensive outpatient services, partial hospital programs, have been stopped.

We know that people are at home, bored and stressed, and that alcohol sales have skyrocketed in this country. We are hearing from the lay press that law enforcement, is very reluctant in some states to administer naloxone in an opioid overdose. If you don't administer naloxone to a person who is overdosed on opioids, they will die. And there's no need for that. There are safe ways to administer naloxone. We're trying to work on that right now.

But I mention all of these things because what it says is that before coronavirus, we had huge gaps in care and huge needs on the part of Americans for, care and treatment of mental health issues and substance problems, which are only being exacerbated by COVID-19. Wow. Yeah. Weady. Very, very, very weighty. Let's talk for just a second about what actually happens in the human brain. If someone goes, you know, weeks or months without meaningful social interaction, whether maybe they've already been struggling with anxiety or depression, or maybe they weren't at all before, but now they're in this place of isolation. Are there actually chemical changes that begin to take place in the brain?

There are chemical changes that take place in the brain, and these chemical changes have been associated with various types of mental illnesses, such as anxiety disorders, such as depressive disorders, such as post-traumatic stress disorders. your brain is involved in stress responses. And stress responses are mediated by a variety of different types of chemicals in the brain that also travel through the body. And when a person experiences stressors that they cannot address situations of isolation and anxiety that they cannot change, then those chemicals that stay in balance, which is how all of us go about our daily activities, and we are able to manage the normal requirements of our lives because our chemical structures

and our brain are in balance, when that changes, that places a person at risk for developing mental disorders. And the thing is that when these imbalances occur, it will take time to rebalance the stress reactions, if you will. So when that happens, a person may need medication treatment, they may need psychotherapeutic interventions, a combination of those kinds of of interventions, those resources are how we address these kinds of mental illnesses. But yes, exactly. And this is why I have said that the isolation of the stay-at-home orders are ones that in a relatively short period of time, and again, documented in the literature, in a relatively short amount of time, will be

manifest as symptoms of anxiety, symptoms of depression, angry outbursts, and behaviors that may go along with those kinds of feelings, what lies below that are changes that are occurring in the brain and the rest of the body. Now, not everybody experiences that. It's important to really point out that most of us are able to cope with even very severe stressors and the resilience of people, I think I want to make sure people understand that the majority of people will be able to withstand these stresses. But the people I'm talking about are people who just aren't able to. Some of us are more vulnerable than others to mental disorders and substance use disorders. These are genetically mediated illnesses. And so for that minority of people, which is a

sizable number in the millions, but it's still, it's still relative to our population, a small number of people, those folks are going to need help. Yeah. And the thing is we need to get to them before there is a terrible outcome, such as a suicide, such as some kind of behavior that harms others, harms themselves, makes it impossible for them to attend to their physical health needs. There are any variety of different ways that these symptoms can make themselves known. You spoke with the president and a number of other leaders at the White House in May.

What are the recommendations that you are offering to national and state leaders right now as it relates to reopening the economy and kind of trying to get life back to some resemblance of normal? So what I have said is that we have to think about more than viral infection. We have to think about whole health. We have to think about the needs of a person in their totality. We can't just think about the possibility of a viral infection. What I have said is that if we fail to do that, we will lose many more lives. We have so many thousands of deaths, over 116,000 deaths related to suicide and drug overdoses.

If you add alcohol into that, some estimates approach 180,000 people a year dying of these very preventable conditions. In addition, with COVID, we've got a situation where people, medical. problems are not being addressed. So people aren't getting cancer screenings. They're not able to see their doctors for existing medical conditions like hypertension, like heart disease, like pulmonary disease, rheumatoid arthritis. There are many serious medical conditions that we must continue to address. And there is no reason not to do that. If we fail to do that, we will have many more deaths than we would see from COVID virus.

So what I have said is we have to think about whole health and we have to think about what we've learned. And we have learned a lot about this virus. It's amazing how much we've learned in a period of three months. We have learned how to better manage people who do get so ill with the virus that they have to be hospital. We now have an FDA approved treatment for very ill people who have coronavirus infection. We now have increased testing for coronavirus greatly. Millions of tests have now been completed, and we are setting up a system in this country that will continue to test regularly for high-risk groups.

We have now put in place contact tracing, and we will be following up people to determine who else might have contracted coronavirus when we identify a case. We now know who the most vulnerable populations are, our elderly, those that are in nursing homes, those that have significant conditions that affect their own. overall health, and we need to protect them. But in doing that, we also need to pay attention to the needs of the general public. And the general public needs to go back to regular life, but they need to understand that it's safe to do that. And so I've also urged that rather than focusing on deaths that occur from coronavirus, which CDC has now said are much less, and overall in terms of the total number of cases are going to be much less than 1%. We look at the number of people who have had the virus and recover fully,

and that number is quite high. And it will be even higher as we do more testing and learn about the great number of people who have had the virus who have had either very mild symptoms or no symptoms, it's very important not to spend so much time talking about a virus and emphasizing the negative aspects of illness with that virus that people become paralyzed and can't go about their lives. And I think that our media has done a great job with that. And that's not something that I feel good about saying.

It's time to start talking about. the progress we've made it's time to start talking about the fact that almost everyone recovers from this virus and we know who the vulnerable people are and we can protect them and if we keep in place good hygiene practices social distancing mask wearing as possible for people to do then we can get back to normal life and people should feel confident about that we should not shut down again because we know how to deal with this problem. We should send our children to school. They need to be around other children. They need social

interaction and they need the opportunity to learn and they need to be with teachers and others who can tell how their health and mental health is and let us know if those children need help. So it's really quite important that we stop talking about COVID as though it's a death sentence if people get the virus. It is not. And we go back to normal life because we know how to deal with this as a country. Wow. Thank you so much. It's so insightful. And I think your holistic approach is incredibly helpful for perspective. I want to take just a second and ask you, for those who might be listening and who are thinking, you know what, I think I am really struggling with depression in this season with

anxiety. And maybe they're concerned about a loved one and a loved one's mental health. Do you have any practical tips for things that they can do to get their own brain and mind or a loved ones back to a healthier and better state so that they can keep living life? Yes. It's really very important that as much as possible people stay in contact with their loved ones, with their social connections. They can do that by telephone, by social media. It's important for people really to get outdoors, to get some exercise that can be remarkably soothing and helpful. Those are, and to the greatest extent possible, keep a daily routine. It is so difficult for people when they lose their daily structure as in stay-at-home orders

where your daily activity, you get up in the morning, you take a shower, you get dressed, you go to work, you come home, you make dinner, you take care of your family, your pets, and have your evening activities. When that's taken away, that is so disorienting for people. It really takes a toll. Even people who are able to telework,

it takes a toll on them as well. And for people who are completely out of work, it is extremely stressful and very difficult to cope with. So take care of yourself. And if you are feeling extremely sad, if your appetite goes off, if you can't sleep, if you're experiencing very severe anxiety, it's really important that you see,

help and there are ways to do that. We have helplines at SAMHSA, we have the suicide prevention lifeline, we have a disaster distress helpline, and we have a national helpline that helps people to find treatment. They can talk with a person that will help them to find a treatment outlet to treatment resource near them. You can also find SAMHSA resources online at findtreatment.gov. It's f-I-N-D-T-R-E-A-T-M-E-N-T-T-M-T-T-M-T-T-M-T-T-M-T-E-N-T-O-G that will help in finding help for substance problems. All you have to do is put in your city, your state, your zip code, and you can find resources in your area. And we also have a way of finding mental health services. It's called findtreatment. samsa, S-M-H-N-H-N-A.

and again, that is a way to find resources for mental health issues. It's important that people take an inventory of how they're feeling and if they're having trouble coping, seek help, seek support from those that care about you. And if that isn't enough, then seek professional help. We'll be sure to link some of those resources and the show notes for it day. Dr. McCants, Katz, thank you so much for your insight. It has been incredibly helpful and profound. We really appreciate your time today. Thank you so much. Americans have almost entirely forgotten their history. That's right. And if we want to keep

our republic, this needs to change. I'm Jared Stepman. And I'm Fred Lucas. We host the Right Side of History, a podcast dedicated to restoring informed patriotism and busting the negative narratives about America's past. Hollywood, the media, and academia have failed a generation. We're here to set the record straight on the ideas and people who've made this country great. Subscribe to the right side of history on Apple Podcasts, SoundCloud, and Stitcher Today. Thanks for sending us your letters to the editor. Each Monday, we feature our favorites on this show.

Virginia, who's up first? Well, one of our podcast listeners left us a very nice review on Apple Podcasts last week, saying, this is what I always wanted NPR to be. Great interviews, great research, pro-liberty. It's never click-bady. And I feel like I understand issues more clearly without getting wrapped up and partisan political commentary. This podcast is perfect.

It's part of my daily news intake with my morning coffee. Well, we certainly love those reviews. Please keep them coming. It means a lot to all of us at The Daily Signal. And in response to last week's podcast interview with Professor Jacobson, Students, faculty, target professor for writing honest history of Black Lives Matter, Brett Gras of Milwaukee, Wisconsin writes, If we're living in a post-truth world, it doesn't diminish,

but amplifies the importance of understanding what is happening and who is causing it to happen. It's astounding to me that students of any color would not have the presence of mind to seek the truth. This is disturbing, but the work Professor Jacobson is doing is a better response than the alternatives, which might include despair, incredulity, or fear. While simple truths matter shouldn't be controversial and should not cause the challenges that he has faced, I am thankful for Professor Jacobson exercising his voice. Your letter can be featured on next week's show.

So send us an email at Letters at DailySignal.com. I'm Amy Swearer. And I'm Giancarlo Conaparo. And if you want to understand what's happening at the Supreme Court, be sure to check out Scotus 101, a Heritage Foundation podcast. We take a look at the cases, the personalities, and the gossip at the highest court in the land. It's SCOTUS 101.

Our good news story today is going to take us back to July 4, 1986, on the 100th anniversary of the Statue of Liberty's arrival in America. On that Independence Day, President Ronald Reagan stood in New York with Miss Liberty behind him and reminded of America of our past and our vision for the future. As we continue to celebrate our nation and our freedom in the days following July 4th, we invite you to remember Reagan's words and his call for unity in our nation. Take a listen. But it's worth remembering that all the celebration of this day is rooted in history. It's recorded that shortly after the Declaration of Independence was signed in Philadelphia,

celebrations took place throughout the land, And many of the former colonists, they were just starting to call themselves Americans, set off cannons and marched in fife and drum parades. What a contrast with the sober scene has taken place a short time earlier in Independence Hall. 56 men came forward to sign the parchment. It was noted at the time that they pledged their lives, their fortunes, and their sacred honors. And that was more than rhetoric. Each of those men knew the penalty for high treason to the crown.

We must all hang together, Benjamin Franklin said, or assuredly we will all hang separately. And John Hancock, it is said, wrote his signature in large script so King George could see it without his spectacles. They were brave. They stayed brave through all the bloodshed of the coming years. Their courage created a nation built on a universal claim to human dignity. on the proposition that every man, woman, and child had a right to a future of freedom.

For just a moment, let us listen to the words again. We hold these truths to be self-evident. All men are created equal, that they are endowed by their creating with certain unalienable rights, that among these are life, liberty, and the pursuit of happiness. Last night, when we rededicated Miss Liberty and relit her torch, we reflected on all the millions who came here in search of a dream of freedom, inaugurated in Independence Hall. We reflected, too, on their courage in coming great distance and settling in a foreign land and then passing on to their children and their children's children. The hope symbolized in this statue here just behind us, the hope that is America. It is a hope that someday every people and every nation of the world will know the blessings of liberty.

And it's the hope of millions all around the world. In the last few years, I've spoken at Westminster to the mother of parliaments, at Versailles where French kings and world leaders have made war and peace. I've been to the Vatican in Rome, the imperial palace in Japan, and the ancient city of Beijing. I've seen the beaches of Normandy and stood again with those boys of Pwantejoque, who long ago scaled the heights. And with at that time Lisa Zaneta Hen, who was at Omaha Beach for the father she loved,

the father who had once dreamed of seeing again the place where he and so many brave others had landed on D-Day, but he had died before he could make that trip, and she made it for him. And dad, she had said, I'll always be proud. And I've seen the successors to these brave men. The young Americans in uniform all over the world.

Young Americans like you here tonight who man the mighty USS Kennedy and the Iowa and the other ships of the line. I can assure you, you out there who are listening that these young people are like their fathers and their grandfathers just as willing, just as brave, and we can be just as proud.

But our prayer tonight is that the call for their courage will never come and that it's important for us too to be brave. Not so much the bravery of the battlefield, I mean the bravery of brotherhood. All through our history, our presidents and leaders have spoken of national unity and warned us that the real obstacle to moving forward, the boundaries of freedom, the only permanent danger of the hope that is America, comes from within. We're going to leave it there for today. You can find the Daily Signal podcast on the Rurkishay Audio Network.

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