Incorporating Mental Health And Substance Abuse Screening Into COVID-19 Contact Tracing
In the face of the global pandemic, a key first step in returning to normalcy involves contact tracing: identifying who has COVID-19, who has been exposed to the novel coronavirus, and who is immune to contracting COVID-19. These are critical elements required to keep our communities healthy and economies open as we manage current infections and plan for future waves of the disease.
Cities, states, and organizations nationwide have created robust strategies for designing and implementing the necessary COVID-19 Contact Tracing workforce. Plans call for tens of thousands of newly trained public health workers to conduct contact tracing of COVID-19 infections. This new workforce is necessary because of decades of declining public health support and funding. Those cutbacks have left many public health agencies unequipped to respond to the current pandemic.
COVID-19-Related Mental Illness
In addition to the COVID-19 infection control measures, there is the rapidly rising risk for COVID-19-related mental illness, including depression, post-traumatic stress disorder, suicide, and alcohol and drug misuse. High unemployment coupled with widespread social isolation is projected to contribute to tens of thousands of “deaths of despair.” While the initial COVID-19 response has appropriately focused on containing the infection, this emerging mental health epidemic within the pandemic requires immediate attention if we are to avoid additional suffering and death. Several solutions come to mind, notably asking contact tracers to screen those they contact for mental illness, including substance abuse disorder (SUD), and make appropriate treatment referrals.
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Implementing COVID-19 Mental Health Tracing Requires A Multidisciplinary Effort
First, we must engage primary care providers and clinics that are perfectly poised to support public health agencies in tracing patients with COVID-19 infection and exposure. Primary care practices are particularly well equipped, as they have been the first point of contact for many patients with COVID-19 symptoms, infections, and questions.
Primary care practices are also well positioned to help identify and treat those suffering from declining mental health and substance use challenges stemming from the COVID-19-related economic downturn, unemployment, and social isolation. Many primary care practices include a diverse team of providers, including physicians, social workers, nurses, medical assistants, counselors, and others. These varied teams can support the mental health needs of their patients at a variety of levels.
Second, we should include primary care practices in legislative solutions, funding, and national organizational efforts to increase COVID-19 contact tracing. To implement interprofessional training and inclusion of primary care clinicians and practices in the growing COVID-19 tracing workforce, we encourage national primary care organizations—such as the Primary Care Collaborative, American Academy of Family Physicians, American Academy of Pediatrics, American Psychological Association, and Society for General Internal Medicine—to engage local and national public health organizations such as the National Association of County and City Health Officials, the Association of State and Territorial Health Officials, and the American Public Health Association.
Third, we should engage the new public health workforce, primarily contact tracers, in screening and referral for mental health issues, including substance use disorder (SUD). The new workforce will require education and training on COVID-19 contact tracing recommendations and guidelines. Basic clinical education in mental health and SUD screening and referral for care should be included in national training programs.
As with current contact tracing, mental health screening would be voluntary with an aim towards stigma reduction, educating people about symptoms and assisting them in seeking help. Privacy must be a top priority. Because contact tracers are not mental health professionals, screening and referral would be peer-to-peer communication to help those suffering mental health problems access care in their local community. It might be most effective to engage local mental health providers to train contact tracers in basic mental health screening and SUD screening to assure questions and referrals are relevant to the local community.
COVID-19 contact tracers call and interact with dozens of people each day. The time necessary for mental health screening and referral would increase the duration of contact-tracing calls; however, it could identify people at risk of depression, drug or alcohol misuse, and suicide. Local communities would be best equipped to determine the balance of effort applied to contact tracing and mental health tracing—in areas of higher infection rates, it might be important to use the limited resources available to trace infections. As communities begin to recover, contact tracing might be able to spend more time in mental health and SUD screening. The extra time in screening and referral would be worth it.
We Need Policies That Support Coordinated Public Health, Primary Care, And Mental Health
COVID-19 offers an unprecedented opportunity to rebuild our community health infrastructure so that primary care, public health, and mental health professionals are a unified team supporting and promoting the health of the population. Such a team could deliver the needed robust tracing of COVID-19 infection and COVID-19-related mental health issues. These combined efforts could lead to further collaborative work that addresses community health as a whole, leading to local, multisector communities of solution and moving beyond historically siloed, transactional medical offices and health agencies. If we focus solely on contact tracing of COVID-19 infection and ignore the rising surge of mental illness, we miss an important opportunity to prevent a new wave of morbidity and mortality.
Two specific solutions for aligning public health, primary care, and mental health moving forward are to improve our interprofessional education and use existing resources for addressing mental health challenges, particularly those that utilize non-mental health professionals. Medical Schools, public health schools, graduate medical education, and community health worker training should implement interprofessional education regarding COVID-19 contact and mental health tracing as part of their core curricula. Federal funding for COVID-19 contact tracing should include training in mental health screening and referral and incorporate current primary care providers in COVID-19 contact tracing efforts. States should incorporate primary care and mental health into local COVID-19 contact tracing efforts and funding initiatives.
Systems for identifying and treating mental illness have been successfully implemented in communities around the nation and internationally. We can draw from elements in these models as we create our public health-primary care communities of solution. Mental Health First Aid, an international mental health training program, has been used to train non-mental health professionals to respond to mental health crises, and can be used as a model for training our new public health workforce. In response to suicide clusters found in Palo Alto, CA and Fairfax, VA, community members joined forces to create a coordinated response to identifying and offering resources to teens suffering with mental illness. Both localities used an Epi-Aid team from the Centers for Disease Control and Prevention to offer technical assistance for their multi-sector approach, something states should consider as they deploy their public health-primary care partnerships.
COVID-19 Mental Health Call To Action
It is essential to contain the COVID-19 infection through robust contact tracing. We call on those implementing COVID-19 contact tracing to train this workforce to also address the projected rise in mental illness and SUD. We call on federal and state policy makers to include funding for mental health education and training for COVID-19 contact tracers. We call on local public health departments to include primary care and mental health providers in current COVID-19 contact tracing efforts, to improve mental health outcomes over the coming months.
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