Just the Facts…. Words Matter: How post-COVID public policy has already begun to leave many behind.

Words matter. The words we choose inform the points that we are trying to make, and the feelings we are trying to convey. In public policy, words represent our priorities. They form the legal constructs through which we engage with society. Such words regulate both our public and private lives and may do so for generations to come. There are those among us, like myself, who spend their days and nights scrutinizing the complex web of policy jargon that forms our laws. We attribute meaning to each “may” and to each“shall,” and we agonize over the string of words that create the definition of an action or population. However, as advocates, our job is not only about analyzing words already transcribed, but also finding opportunities to create new words. To identify those moments when policies are being created and to work to ensure that the words that are chosen represent the priorities we are charged with fighting for. For me, and the thousands of others who strive to attain equity and parity for those with mental illness, that moment is now. Many advocates have already emphasized the toll that the COVID pandemic has had on our nation’s mental health. This is a tremendous step forward as historically mental health has not been a part of our mainstream dialogue. In fact, only recently have mental health, and the various words ascribed to define it become part of our daily vernacular. And yet, as we emerge from the pandemic, public policy is not inclusive of the mental health emergency COVID leaves in its wake. It may seem a bit audacious of me to say such a thing when quite recently, policymakers have identified certain mental health diagnoses as underlying conditions that can lead to acute COVID responses and have identified “Long COVID” as a potential disability, linking it to federal resources and supports. But that’s just the point. Our laws are shaped through a partnership between public priorities and the priorities and abilities of our lawmakers. At the moment, one of our collective priorities is “Long-COVID.” Although there remains no clear definition of what “Long-COVID” actually is— how it is diagnosed, treated, and paid for— these two words have already consumed legislators’ attention, secured federal funding, and become a possible disability under Section 504 of the Americans

with Disabilities Act. It is critically important that we gain a greater understanding of the constellation of symptoms that define Long COVID, and how we will provide relief to those who continue to suffer from the virus long after receiving a negative test. But our collective emphasis on this consequence of COVID has left seemingly little public and/or political will to legislate on behalf of those who may not have contracted the virus itself but have no doubt suffered irreparable harm. Words matter. While fortunately there are those who have been spared the physical impacts of COVID and have remained virus-free, not a single person has been unscarred emotionally by the last 18 months. Trauma, grief, loss, isolation, and insecurity are just some of the circumstances and emotions that we all have in common when we think about COVID’simpact and the words and numbers prove this to be true. If we look at the status of children’s mental health, a population that has not contracted the virus at nearly the same levels as adults of any age, my contention is undeniable. Over the last year, mental health-related emergency room visits rose 24 percent for children aged 5-11, and even higher, 31 percent, for youth ages 12-17.) From February to March of 2021, the mean weekly number of emergency room department visits for suspected suicide attempts was 50.6 percent higher than during the same period in 2020. Additionally, during the pandemic, 25% of young adults reported starting or increasing substance use while the number of those diagnosed with an eating disorder increased at the same rate. Perhaps even more alarming is the data recently released in the Journal of Pediatrics. The CDC estimates that 140,000 children who were orphaned by the pandemic during the period of April 1, 2020, to June 30, 2021. This figure does not even include the rising number of cases from the Delta variant, suggesting the total could now exceed 175,000. The emotional and psychological toll however is incalculable. So, as an advocate for children and youth in need of mental health services, I’m left wondering: where are the appropriate words to address this crisis? Where is the COVID public policy that would create more access to mental health care? The policy that would help alleviate the workforce shortages and expand insurance coverage given this dramatic increase in need? Why instead have our legislators chosen to codify support for conditions lacking definition when the words and numbers illustrating the dire circumstances that our children and youth face leave no room for interpretation? What does the lack of these words say about our collective priorities? What does this suggest about “post-pandemic” COVID policy? A pandemic is defined as “an outbreak of a disease that occurs over a wide geographic area and typically affects a significant proportion of the population: a pandemic outbreak of a disease.” Moving forward, we must be diligent in ensuring that the words “affect” and “population” are interpreted to include all of those who have been impacted by the COVID pandemic. Not a small task given that even those who have been spared from the physical disease, have been left to mourn what was, to live with loss, and to move forward carrying the emotional scars that none of us have escaped. Words matter more than ever.

Author: Brooke Lehmann MSW, JD

Contributing Authors:Molly Hayes, Abigail Hawkins