13 U.S. cities most impacted by COVID-19 and mental health
On the eve of World Mental Health Day 2020, a holiday the World Health Organization says is intended to raise awareness of “what more needs to be done to make mental health care a reality for people worldwide,” the COVID-19 pandemic dominates the stage. And here in the United States, where we’re now six months into the pandemic, the effects of social distancing, stay-at-home orders, financial stress, and constant uncertainty about the future are taking a toll.
We wanted to more fully understand this growing crisis, so we collaborated with Mental Health America and leveraged our own COVID-19 Community Vulnerability Index (CCVI) to determine which United States counties are most vulnerable to the negative consequences of COVID-19 and poor mental health.
Where COVID-19 vulnerability and poor mental health collide
We suspected that in many parts of the country, the underlying vulnerability of certain communities overlaps with the mental health crises being reported. With this in mind, we evaluated data from the CDC’s 500 Cities: Local Data for Better Health project and compared it to the CCVI. The CDC data highlights which cities have the highest prevalence of poor mental health (defined by the CDC as the rates of adults in a census tract reporting at least 14 days of poor mental health in the previous 30 days). Specifically, we looked at census tracts that fell into the most vulnerable 25% of tracts in America (in terms of a community’s vulnerability to COVID-19) and the 25% of tracts with the highest rate of mental health concerns, then looked at which cities had the largest populations in these overlapping high-risk areas.
The results show that in the following thirteen cities, half or more of that city’s residents live in a census tract with both high vulnerability to the pandemic (top quartile) and high rates of poor mental health (top quartile).
Thirteen U.S. cities most impacted by COVID-19 and mental health*
- Camden, N.J. — 84% of residents live in highly COVID-vulnerable neighborhoods with high rates of poor mental health
- Reading, Pa. — 78% of residents
- Detroit, Mich. — 77% of residents
- Springdale, Ark. — 65% of residents
- Passaic, N.J. — 62% of residents
- Allentown, Pa. — 61% of residents
- Rochester, N.Y. — 60% of residents
- New Bedford, Mass.— 54% of residents
- Albany, Ga. — 54% of residents
- Buffalo, N.Y. — 54% of residents
- San Bernardino, Calif.— 51% of residents
- Syracuse, N.Y. — 51% of residents
- Trenton, N.J. — 50% of residents
A “triple threat” to mental health
Of course, the healthcare support systems in place in a community can go a long way toward mitigating the risk of a mental health crisis. Re-visiting our list of cities alongside Mental Health America’s Access to Care Rankings from their State of Mental Health in America Reports provided additional insight about which cities are experiencing a “triple threat.” These cities are especially vulnerable due to having a large proportion of residents that are both vulnerable to the effects of COVID-19 and at risk of poor mental health, and lacking the local mental healthcare access that they might need in this growing crisis.
We found that among our list of 13 high-risk cities above, some are especially vulnerable to the pandemic; demonstrate a higher rate of poor mental health; and lack access to mental health care and treatment. These cities are:
- Camden, Passaic, and Trenton (New Jersey). New Jersey ranked 33rd out of 51 states for access to mental healthcare in Mental Health America’s 2020 access to care report. On a positive note, New Jersey has shown improvement in cost and insurance coverage over time. The percentage of adults with cognitive disability who could not see a doctor due to cost decreased from 35.07% (2017) to 25.19% (2018), and the percentage of youth whose private insurance did not cover mental or emotional problems decreased from 7.3% (2017) to only 4% (2018). However, the state still faces access barriers for adults, with 60% of adults with any mental illness (AMI) not receiving mental health services.
- Springdale (Arkansas). In Springdale, 65% of the population lives in neighborhoods with a high CCVI score and high rates of poor mental health. In Mental Health America’s 2020 report, Arkansas was ranked 35th for Access to Care. The indicators that affected their Access to Care Rankings most were related to cost and coverage of care: the rate of youth with private insurance that did not cover mental or emotional problems increased from 11.8% (2017) to 14.4% (2018), and adults with cognitive disability who could not see a doctor due to cost increased from 31.42% (2017) to 34.16% (2018).
- Albany (Georgia). Georgia was ranked 50th for Access to Care in Mental Health America’s 2020 report. The indicators that affected the Access to Care Ranking most for Georgia were adults with any mental illness (AMI) who did not receive any treatment, from 60.9% (2017) to 64.9% (2018), and adults with cognitive disability who could not see a doctor due to costs, from 36.06% (2017) to 41.92% (2018). Georgia also has a high rate of youth with a past year major depressive episode (MDE) who did not receive mental health services at 70.4% (2018) compared to the national average of 59.6% (2018).
- Syracuse, Buffalo and Rochester (New York). New York was ranked 15th for Access to Care in 2020, with worsening access to care for youth. Mental Health America has found that young people in the state are also facing some of the largest impacts of COVID-19 in terms of mental health concerns. New York showed increasing rates of youth with past year MDE who did not receive mental health services, from 55.1% (2017) to 59.1% (2018), and worsening rates of youth with severe MDE who received some consistent treatment, from 27.2% (2017) of youth to only 21.9% (2018).
Each of the states mentioned above also face shortages of mental health providers that will increasingly be felt with the growing need for mental health services following the COVID-19 pandemic. Georgia has a ratio of 730 people to every 1 mental health provider, New Jersey has a ratio of 450:1, Arkansas’ ratio is 440:1 and New York’s is 350:1 (as of 2018).
We can’t ignore this crisis
The increasing mental health crisis in America’s communities represents just one of the many negative consequences of the COVID-19 pandemic, but it is a consequence that cannot be ignored. We need to act now to mitigate the exploding crisis in these 13 communities. As the virus spreads in these communities, they can be even more susceptible to negative consequences, such as faster COVID-19 case growth, increased financial burden, and poorer health and mental health outcomes — including suicide.
By leveraging publicly available resources — like our CCVI and Mental Health America’s Access to Care Rankings — policymakers, philanthropists, community based organizations, patient advocates, and others can champion more effective responses to the COVID-19 pandemic, more strategically deploy resources and support, and help alleviate the mental health burden on hundreds of thousands of Americans.
Download “The COVID Mental Health Crisis in America’s Most Vulnerable Communities” here.
This work was made possible by everyone at the Surgo Foundation, including but not limited to (in alphabetical order): Christine Campigotto, Bethany Hardy, Sema Sgaier, and Peter Smittenaar.