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During a crisis like the coronavirus pandemic, numbers of new cases, hospitalizations and deaths tend to get most of our attention while a secondary pandemic of mental health issues, including depression, anxiety, suicidal ideation and substance abuse disorders quietly bubbles beneath the surface.

According to a June 2020 survey conducted by the U.S. Centers for Disease Control and Prevention, nearly 41 percent of respondents reported experiencing anxiety, depression, post-traumatic stress and substance abuse. The percentage was three to four times higher than a similar survey conducted in 2019. Additionally, 10.7 percent of respondents said they had considered suicide in the last 30 days.

Experts say these issues are taken into account, discussed and planned for during preparedness and response exercises and discussions. “We call these anticipated consequences,” said Julie Crumly, Ph.D., ORAU senior scientist and research and evaluation specialist. “These are all things that should be taken into account in the planning process.”

Healthcare systems are already operating at close to full capacity during a normal day. Adding in a long-term event like the coronavirus pandemic can result in competing priorities and further stresses to healthcare systems within communities that have to juggle protecting the health of the public, continuing to provide routine care services, providing for the immediate physical health needs of residents sickened by the virus while also trying to balance out mental health needs.

ORAU experts like Crumly and Freddy Gray, MPH, MCHES, director of public health and healthcare, work with federal agencies and national organizations on the planning and implementation of preparedness education campaigns, among other capabilities. Much of their work helps local communities around the country prepare for, respond to and recover from critical incidents like pandemics, natural disasters, terrorism and other unforeseen, disruptive events. 

Gray says that while mental health issues are anticipated in community preparedness and planning, it is ultimately up to each community and the local preparedness infrastructure to partner together to develop a local plan to manage the issues that arise. The local preparedness infrastructure generally includes but is not limited to the local health care system, public health practitioners, emergency managers, mental health providers, public health, first responders, non-profit organizations, religious organizations, businesses and others.

“The value of true planning, which is what we do and have done successfully in communities around the country, is that you anticipate and plan for many possible scenarios, including the mental health issues that are likely to arise during a crisis,” he said. “The challenge for communities is they have so many competing priorities. Unemployment, social services, childcare, and so on. We can do our best to plan in advance, but during an ongoing event, it takes everyone working together to meet the community’s needs.”

Any gaps discovered during a community’s response to the pandemic are likely to be addressed in future preparedness plans and exercises. Crumly points to events such as the 9/11 terrorist attacks and Hurricane Katrina served as catalysts for reshaping the nation’s planning and preparedness infrastructure. The Homeland Security Administration was created in response to 9/11 and Katrina spurred the creation of the Office of the Assistant Secretary for Preparedness and Response at the Department of Health and Human Services.

“Mental health issues and other continuing care needs are things we’ve talked about and realized that corrections need to happen within the system, but now the pandemic has made these gaps visible to the entire world.”

Because the pandemic is an ongoing event and because many communities continue to face the imminent threat of the coronavirus, the CDC warns that existing mental health issues are likely to become chronic for some, and include comorbidities like substance abuse.

“Life as we knew it a year ago has changed unimaginably,” Gray said. “We always knew there would be multiple facets and strategies that would potentially compete as priorities. As we consider lessons learned from the response to this pandemic, the focus on mental health issues and concerns should always be one of our top tier priorities, as it has direct impact on our very being.”

Contact us

For information about ORAU’s health communication, preparedness and response solutions, contact Freddy Gray, director, Health Communication and Preparedness programs, at 865.576.0029 or

Our Expert

Julie Crumly, Ph.D.

Julie Crumly, Ph.D.

Senior Evaluation Specialist

Expertise: Health and education program evaluation, research methods and data analysis, multicultural and social psychology, evaluation of health interventions and programs, and outcome evaluations for continuing medical education

Co-author: “Non-pharmaceutical interventions for pandemic influenza: An assessment of communication, training, and guidance needs of state, tribal, local, and territorial public health officials,” 2018

Certification: Master Certified Health Education Specialist