By Moryt Milo
Throughout the COVID-19 pandemic, El Camino Hospital’s behavioral health department never stopped admitting patients in mental health crisis, and the hospital saw a significant increase in first-time admittances. Many individuals suffered from depression and suicide ideation due to severe stress, said Dr. Kalpana Nathan, Chief Medical Director at El Camino Hospital’s Scrivner Center, Mental Health and Addiction Services.
More than 61 percent of Americans struggle with both a mental illness and substance use disorder. “Collaborative care is the key to wellness. Much more can be done if we interconnect with community services. I know we can be stronger working together,” Dr. Nathan said. For example, those entering the hospital’s detox program through a 72-hour involuntary hold, continuity of care remains problematic. After one to two days of detox, these individuals leave the hospital and discover a complicated web of community services. Oftentimes, the most vulnerable individuals relapse and land back in the hospital.
“We need a stronger integration of community services to meet the need,” Dr. Nathan said.
Dr. Kalpana Nathan
It’s a daunting task when statistically 48.6 percent of the U.S. population receives either mental health or addiction treatment, due to a siloed approach to care. This results in a greater than 40 percent lifetime prevalence of a mental health disorder with a co-existing substance use disorder.
To tackle the problem, Dr. Nathan said, psychiatric and substance use disorders should be considered a joint problem and treated simultaneously, using options that include pharmacology, psychosocial and behavioral interventions. This is how hospitals and community programs can work together to increase successful outcomes.
Strengthening these outcomes means trying to put the brakes on a new problem that has reared in recent years. The heavy use of marijuana among children age 12 and up. As of 2017, cannabis use had increased nationwide by 15 percent to 40.9 million users in this age group, according to the Substance Abuse and Mental Health Services Administration (SAMHSA).
Furthermore, based on this same data, pre-pandemic daily use of cannabis has skyrocketed by 30 percent in conjunction with major depressive episodes. With legalization increasing throughout the country, concern has grown among healthcare professionals as to the effect cannabis will have on the adolescent brain.
In the 1970s, the THC content of cannabis—the psychedelic property of the plant—ranged from 1 percent to 4 percent. Since then, advancements in growing technologies have produced plants with THC that is 57 percent to 67 percent stronger, according to the University of Mississippi’s Center for Natural Projects Research, which tested current cannabis potency.
Cannabis potency in excess of 10 percent can lead to more than a four-fold risk for being diagnosed with psychosis, Dr. Nathan said.
She noted that “up to nearly half of initial substance-induced psychosis may later change to schizophrenia.” Part of the problem is that marijuana stays in the body up to thirty days, and continuous use results in an accumulative effect with long-range ramifications. This includes cognitive impairment of attention and executive functions.
Amphetamine use, also on the rise, can alter brain behavior as well, and produce a delayed reaction—a month after its use. Individuals can become psychotic and will not respond well to antipsychotics, Dr. Nathan said.
Dr. Nathan argues that the debate “over legal versus illegal substances makes no difference because both tobacco and alcohol are addictive and legal and they will still kill you.”
Dr. Nathan argues that the debate “over legal versus illegal substances makes no difference because both tobacco and alcohol are addictive and legal and they will still kill you.” Her point being that anything used excessively will result in damage to one’s health mentally and physically, and those with a severe mental illness are especially vulnerable. Her concerns are validated in a JAMA Psychiatry 2021 study that stated that individuals diagnosed with bipolar disorder or schizophrenia are at the highest risk for COVID-related mortality.
The pandemic produced a full menu of mental health issues, but Dr. Nathan is optimistic and believes we can counter these challenges. For starters, we need to promote mental health literacy and address vaccine hesitancy. We need to find ways to develop a routine and stay connected with family and friends to reduce isolation. She emphasizes the importance of learning new coping skills such as meditation and practicing mindfulness. Plus, the need to maintain simple, basic habits—exercise, sleep, nutrition—is critical in this unprecedented situation.
She recognizes that oftentimes the simplest things can be the hardest; however, “Investing in one’s own wellbeing and promoting it is the best investment one can make. This will also benefit one’s family and work environment ,” Dr. Nathan said.
Dr. Kalpana Nathan was the presenter at the September 12, 2021 NAMI-Santa Clara County General Meeting. Watch Dr. Nathan’s presentation below:
Author: Moryt Milo serves on the board of NAMI ( National Alliance for Mental Illness) Santa Clara County. She writes and blogs regularly for the non-profit on a range of mental health topics. Additionally, she moderates NAMI-Santa Clara County events. View her blog or writings for more of her work.
