The Intersection of COVID-19 and Mental Health and Wellness

In our last edition of this Guide, we recognized the numerous consequences the COVID-19 pandemic had on individuals, families, communities, and our country. Two years later, we continue to express our heartfelt sadness and offer our sympathies to those with first-hand experience of COVID-19, especially those who have lost family members and friends. We know that your world has changed forever and the losses you have experienced are profound.

It is not our intent in this guide to duplicate the multitude of information and data that is already available. The following information and data are intended to highlight the enormous impact of COVID 19 on our individual and collective mental health and well-being, both its immediate impact and what has transpired in the following years.

The increased need for treatment and services has stressed our current mental health and substance use systems that were already experiencing workforce shortages and challenges with access to care . The 87th Legislature faced the intersection of an under resourced system with an insufficient provider base, as well as an increased demand for mental health and substance use services and supports. Funding from the American Rescue Plan (ARPA) has addressed some of the gaps in need from the pandemic, but further efforts will be needed in the 88th legislative session.

HHSC should be commended for initial actions taken early in the pandemic to enhance access to mental health services. In March 2020, a Mental Health Support Line was created to provide all Texans access to time-limited mental health support, which fielded more than 17,000 calls as of 2021. 1Additionally, telemedicine and telehealth regulations were relaxed by both the federal and state governments to allow for remote provision and receipt of mental health and substance use services. The authorization of audio only behavioral health services was a flexibility during the pandemic and is now permanent in Medicaid due to the legislature passing H.B. 4 (Price/Buckingham) during the 87th regular session.

Mental Health Consequences

Researchers previously predicted that the social isolation and stress related to the COVID-19 pandemic would worsen mental health across multiple populations. As of 2022, about 4 in 10 adults have reported mental health concerns during the pandemic.2 The World Health Organization (WHO) recently reported that the global prevalence of anxiety and depression increased by 25 percent in tandem with the pandemic.

Evidence of increased need for mental health and substance use services continues to be heavily documented. A 2020 study published in the Morbidity and Mortality Weekly Report and highlighted on the Centers for Disease Control and Prevention (CDC) website offers insight into the mental health impact of the COVID-19 pandemic on communities. The study indicated that:

Adults in the U.S. are experiencing considerably elevated adverse mental health conditions associated with COVID-19. Younger adults, racial/ethnic minorities, essential workers and unpaid adult caregivers reported having experienced disproportionately worse mental health outcomes, increased substance use, and elevated suicidal ideation.

Some notable indicators revealed through the study include:

  • 40.9 percent of American adults reported having at least one adverse mental/behavioral health consequence resulting from the pandemic. In most pre-COVID analyses that number was typically reported as being between 20–25 percent.
  • The primary mental health/substance use problems identified by survey participants in the study included:
    • High levels of anxiety and/or depression (30.9 percent)
    • Significant trauma (26.3 percent)
    • Increased substance use (13.3 percent)
    • Consideration of suicide (10.7 percent)

Racial and Ethnic Disparities

The study also highlights the mental health impact on certain populations, including:

  • 74.9 percent of young adults aged 18-24
  • 51.9 percent of adults aged 25-44
  • 52.1 percent of Hispanics
  • 54 percent of essential workers
  • 61.6 percent of unpaid caregivers
  • 66.2 percent of individuals with less than a high school diploma.

As has been shown in many parts of the country, the impact of COVID-19 was and often continues to be worse for people of color with less access to resources due to socioeconomic status, less access to health care, and increased exposure due to occupations not conducive to working from home. The table below provides a representation of cases, hospitalizations, and death rates by race/ethnicity.

Table 1. COVID-19 Hospitalization and Death by Race/Ethnicity


The consequences of COVID-19 on people of color provides further evidence of the damage caused by health disparities and inequities. The pandemic has provided stark evidence of the need for Texas to utilize the new Office of Health Equity Policy and Performance (OHEPP) to build awareness, provide education, develop strategies, and assist with implementing corrective measures to mitigate the impact and eliminate the causes of disparities based on race, ethnicity, gender, socioeconomic status, sexual orientation, disability, and more.

Continuing Impacts on Youth Mental Health

While the mental health effects have impacted many demographics throughout the world, there has been significant cause for concern of youth mental health in the United States. In the past two years of the pandemic, reports show that children have developed an increased risk in depression, anxiety, suicide, sleep disorders, and substance use.8 Further, as of November 2022, it is estimated that over 260,000 children have lost parents and other in-home caregivers to COVID.9 Concern for youth mental health in the age of COVID-19 has caught the attention of both the state and federal government. In December of 2021, the U.S. Surgeon General issued a special advisory on youth mental health and the consequences of the COVID-19 pandemic.

Within this subset of children and youth, the report found that certain populations were at higher risk of developing mental health conditions in response to stressors of the pandemic.

  • Youth with Intellectual and Developmental Disabilities (IDD), who may have lost important services upon the closing of their schools
  • Racial and ethnic minority youth
  • LGBTQ+ youth
  • Low-income youth
  • Youth in rural areas
  • Youth in immigrant households
  • Youth involved in the child welfare system or the juvenile justice system
  • Youth who hold multiple identities

The effects of social isolation, environments with peers, and fear of the virus have impacted the mental health of our children and young people. The CDC data from the 2021 Adolescent Behaviors and Experiences Survey (ABES) stated that 37.1 percent of U.S. high school students reported poor mental health during the COVID-19 pandemic, with 19.9 percent seriously considering suicide and 9.0 percent attempting suicide in 2020.

Ongoing Challenges

While many challenges of the early pandemic have shifted, COVID-19 continues to present lingering challenges to Texas and the nation. Additional considerations when analyzing future needs and the impact on mental health include:

  • Ongoing financial stressors and unemployment;
  • Future loss of health care coverage after the unwinding of the Public Health Emergency (PHE);
  • Youth mental health and behavioral issues in schools following the pandemic;
  • Trauma and grief over lost loved ones;
  • Disproportionate behavioral health impact of the COVID-19 pandemic on People of Color;
  • Non-profit fallout due to restructuring, overburdened resources, and high community needs during the pandemic;
  • Challenges families face in managing children, school options, employment, food insecurity, potential eviction, loss of employment, isolation, and lack of emotional support;
  • Ongoing mental health impact to older Texans in nursing and assisted living
    facilities, as well as those living alone with little external contact and minimal
    support;
  • Loss of health insurance and the inability to obtain health care when needed; and
  • Over representation of people of color in case counts, hospitalizations, and
    deaths.

Mental health and substance use supports, services, and treatment will continue to be needed by Texans in the months and years to come as a result of the pandemic fall-out.

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