Crisis Prevention and Intervention in the Age of COVID-19

Since the COVID-19 pandemic hit American shores in early 2020, mental health experts have worried about its potential effects on those they serve — and with good reason. Measures like social distancing necessary to preserve our physical health took a toll on our mental well-being.

Add to that the fear of infection and economic instability that many lived through, and you have all the right conditions for poorer mental wellness. Rates of depression and anxiety among Americans skyrocketed between 2020 and 2022. As such, crisis intervention and prevention has never been more top of mind.

Left unaddressed, mental health conditions brought by this pandemic could spiral into crisis. To better understand the effects of the pandemic on crisis situations and the associated methods of prevention and intervention, we will discuss the following crisis situations:

• Substance use disorder
• Domestic violence
• Suicide

By briefly examining each of these crisis situations and how they evolved over the pandemic, we hope to offer you a primer on how to understand crisis and respond to it.

Substance Use Disorders and COVID-19

Substance use disorders (SUDs) have been a growing issue in the United States for some time. The opioid epidemic as well as the abuse of alcohol and illicit drugs has affected tens of thousands of Americans. In 2015, the Centers for Disease Control (CDC) reported that 53,356 people died of drug overdoses. By 2019, this number had risen to 72,151.

The COVID-19 pandemic has only worsened these numbers. Social isolation coupled with anxiety and fear has led to a sharp uptick in Americans reporting substance use. As of 2021, more than one in 10 adults reported that they had started or increased drug or alcohol use since the beginning of the pandemic. Additionally, 2020 saw a 30% increase in deaths due to drug overdose, with 93,331 Americans dying by overdose.

Worse still, studies have shown that those battling an SUD have a higher-than-average risk of contracting or dying from COVID-19. During the worst of the pandemic, withdrawal symptoms forced many to seek out drugs or alcohol, putting them at higher risk of infection. Additionally, many substances, such as opioids, can restrict the airway, making it difficult to breathe. This, coupled with COVID-19 symptoms, proved a dangerous combination for those with an SUD.

While crisis prevention and intervention studies are ongoing, early findings suggest that telehealth is a promising way to help those with mild SUDs. In fact, research has shown that telehealth leads to an increase in the number of patients showing up for psychotherapy appointments. For more severe SUDs, experts still suggest that individuals enter addiction treatment facilities that follow best practices regarding COVID-19.

Domestic Violence

Prior to the pandemic, domestic violence was already a worldwide issue. For example, 1-in-3 women globally have experienced abuse at the hands of a partner. With the outbreak of COVID-19 and the subsequent institution of stay-at-home orders, victims became trapped with their abusers while simultaneously becoming cut-off from support networks such as family, friends, or coworkers.

Sadly, these factors have led to an increase in domestic violence reports. In a study published in February 2021, researchers found a 7.9% global increase in reported cases of domestic violence. In the United States, they found an 8.1% increase. To help combat these rising numbers, 150 countries have put measures in place to strengthen the resources and services available to survivors of such abuse. But what crisis prevention and intervention measures can human services organizations provide?

Much like SUD protocols, several forms of crisis prevention and intervention exist to help those affected by domestic violence. The most promising methods in the post-COVID-19 world, however, revolve around community and the use of digital tools. Research suggests that training communities on the signs of domestic violence and how to report it could have a positive effect.

As lingering anxiety around COVID-19 may still be keeping victims at home with their abusers, having neighbors or community members able to report incidents on their behalf could help to prevent the abuse from reoccurring. This same research also shows that digital monitoring systems, such as hotlines, are becoming an increasingly effective tool. Speaking to its potential, one anonymous provider stated:

“We know that digital monitoring is the way forward. We are starting to develop a digital monitoring program and expect that it will help the victims soon. Note that calls are increasing day by day.”

By working to educate your community on the ways to recognize and report domestic violence, your organization can make strides in its crisis prevention and intervention goals.

Suicide Prevention and Intervention in the Time of COVID-19

Suicide has been an increasing problem in the United States for some time. Prior to the COVID-19 pandemic, the CDC reported death by suicide as the tenth highest cause of death in the country. From 1999-2018, the U.S. saw a 33% increase in suicide, which equals approximately 800,000 deaths by suicide over this period. This two-decade long trend caused understandable concern among experts that the pandemic would lead to an even larger year-over-year increase in suicide rates.

Fortunately, these fears did not come to pass. In fact, 2019 was the first year in over a decade that the suicide rate decreased, declining by 2%. The first full year of the pandemic again saw lower rates of death by suicide, as U.S. totals dropped from 47,511 in 2019 to 45,855 in 2020 — a 3% decrease. While any decrease in the suicide rate is positive, research suggests that the aftermath of a pandemic can lead to increases in suicide rates. Standards of suicide crisis prevention and intervention, therefore, must be maintained and improved.

Moving forward, many tried-and-true methods for suicide prevention will remain important, such as reducing access to lethal means. Organizations can, however, look to make strides in the way they treat mental health issues among those contemplating suicide. For one, if your organization offers primary care services, make sure your nurses and physicians are properly trained to recognize the signs of suicidal ideation and know how to handle a patient complementing suicide.

Second, work to integrate better telehealth services into your offerings. Research has shown that telehealth helps to reduce the stigma around suicidal ideation and reduce costs for patients, all while guaranteeing the same level of care. It can also help to provide care for those in rural or underserved communities, for whom travel time or lack of access have often served as deterrents for seeking help.

Additionally, as of July 2022, the National Suicide Prevention Lifeline’s three-digit code, 988, will be fully operational across the United States. 988 is meant to improve access to local assistance for suicide prevention and other mental health crises.

Tools To Consider for Crisis Prevention and Intervention

Throughout this piece, we’ve touched on the efficacy of several tools for treating mental health issues and their potential role in crisis prevention and intervention. This is because the COVID-19 pandemic and the social isolation many felt under quarantine brought newer tools, like telehealth and crisis lines, to center stage. Fortunately, these tools proved their worth, not only as a means of providing mental healthcare but also as a way of responding to crisis.

While experts admit that more research is required, current literature on the topic suggests that the use of such tools in crisis prevention and intervention has a bright future. According to Justin Strickland, PhD and postdoctoral fellow in behavioral pharmacology at the Johns Hopkins University School of Medicine:

“One clear benefit of changes in treatment infrastructure throughout the pandemic is that the availability of telehealth may have helped some folks that were on the precipice of seeking help go seek that help.”

Though this is certainly positive, what does it mean for your organization?

When it comes to crisis situations, solutions such as telehealth or crisis lines can take several forms. While the use of traditional therapy via telehealth can be a great a way to prevent a crisis, other tools such as hotlines that individuals can call or text to get help, may be more appropriate for crisis intervention.

Before adopting such a solution, determine the needs of your organization and then pick the tool that will help you resolve those needs.