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Introduction

COVID-19 is a complex and devastating virus that has shaken society to its core. It has required extensive changes in everyone’s daily lives. For college students, these changes are readily apparent, as learning has become remote, and many students have been forced to move back with their families. For many, the idea of contracting COVID-19 is a terrifying and potentially deadly prospect. While many college students are young, healthy adults that are unlikely to have preexisting conditions that may worsen the symptoms of COVID-19, many of these same students have family or friends that are vulnerable to contracting it. Because of this, many college students have shown increased levels of anxiety and stress, and have been found to fear more for their loved ones, such as parents or grandparents, than they do for themselves (Cohen, et al., 2020). This worry brings about an important question in relation to college students: If we can protect vulnerable populations, would it ultimately lead to less stress and anxiety for college students in regards to COVID-19?

One population in society fits this description has been hit especially hard by this pandemic. A frequently overlooked population, mentally ill older adults, the likes of whom include the parents and grandparents of many college students, must brave tremendous challenges in the wake of COVID-19. Generally, older adults who already suffer from mental illness are already more prone to severe symptoms due to COVID-19, but the challenging stigma around mental health and the availability of virtual health visits has made it even more difficult for these individuals to get the help that they need.

Connection to STS Theory

Social Constructionism, or the idea that reality is jointly constructed by the world due to social and interpersonal experiences, has led to significant social strain on older adults with a mental illness (Galbin, 2014). It is pervasive in many aspects of our society, from the aforementioned increased risk of exposure due to societal neglect, to the societal stigma that contributes to ostracism. Social constructionism explains that the societal view of mental illness is not entirely based on fact, but instead is built upon a vastly complex network of individual perceptions that openly influences others until a societal consensus is built (Galbin, 2014). In other words, it is a slowly built perception that, even if it is not based on truth, influences how society views a particular subject. In the case of mental illness in older adults, this perception has led to a societal stigma that makes it difficult for these individuals to seek the care that they need.

High Risk of Severe Symptoms

Older adults are already disproportionately affected by COVID-19, having exceptionally large morbidity and mortality rates (Vahia, 2020). Having a mental illness, a comorbidity, only exacerbates the risk of severe complications. This elevated risk is attributed to a variety of factors, from a weakened immune system to the inability to care for themselves, among others. Patients with a mental illness, such as bipolar disorder or schizophrenia, have shown to have a lower health literacy than the general population, meaning that these patients have difficulty obtaining, deciphering, and adopting strategies to to reduce the risk of exposure to the virus (Shinn & Viron, 2020). With the vast amount of false information available, along with the rapidly changing facts being found by scientists worldwide, older adults with a mental illness can have extraordinary difficulty understanding how to best protect themselves. Additionally, COVID-19 has been shown to cause an increase in depression, confusion, and psychosis in those that have contracted the virus, which can be especially dangerous for an older adult that already has a mental illness (Szcześniak, et al., 2020). This detail is of the utmost importance, as it truly illustrates the dire circumstances this population faces. Not only are these adults at a higher risk of severe complications from the disease itself, such as cardiovascular complications, but the additional effects that the virus has on mental health can further impact their mental illness, creating a devastating attack on both the body and the mind (Shinn & Viron, 2020).

To combat the potential spread of the virus, one of the most common preventative strategies is self-isolation, as it lowers the possibility of being exposed to an infected individual. Even for young adults with no mental illnesses, self-isolation can be taxing, especially in the midst of a highly stressful pandemic, but for older adults that have a mental illness, self-isolation is a near impossible task. First, older adults with mental illnesses have been shown to have a higher risk for severe anxiety, depression, and suicide, meaning that the tactic meant to protect them from a life-

threatening virus can be just as dangerous to their overall health (Epstein, et al., 2020). In addition to the risk of worsening their mental health, patients with a mental illness also face socially constructed barriers to even be able to self-isolate. Individuals with a mental illness have a higher rate of homelessness and unstable housing, meaning that many of these individuals do not even have a safe or secure location to self-isolate at all (Shinn & Viron, 2020). There is also a considerable portion of this population that live in communal settings, such as psychiatric wards or shelters, that make it difficult to self-isolate and can increase the risk of potential exposure, meaning that even if these individuals are in a position where the intention is to receive care, they face a higher risk of infection (Shinn & Viron, 2020). This begs the question, why are individuals with mental illness socially outcast, and how has the world’s socially constructed perception of mental illness contributed to this?

Social Stigma Around Mental Health

These members of our society not only face the difficult proposition of a worldwide pandemic, but also must battle with an especially complicated role in society. Despite being a uniquely high risk population, mentally ill older adults often find it difficult to receive adequate care due to an overwhelming societal stigma towards mental health. This stigma is pervasive in many aspects of our society, affecting our personal beliefs and even influencing our health systems (Druss, 2020). Older adults with mental illness are often discouraged from seeking care due to fear of being shamed, ostracized, or ridiculed for their conditions. Furthermore, stigma towards mental health leads to others doubting the validity of mental disorders, and causes people to avoid socializing, employing, or otherwise interacting with individuals with a mental illness (Graham, et al., 2003). Stigma also leads to an increased sense of hopelessness and often deprives older adults with a mental illness of their dignity and place in society (Graham, et al., 2003).

Additionally, stigma has been found to not only reduce help-seeking behavior, but also affected adherence to treatment plans, meaning that stigma was a significant barrier to adequate care. In other words, even if an individual is able to garner enough courage to challenge social stigma and seek help, it is unlikely that they will continue treatment due to the pressure they face from that same social stigma (Clement, et al., 2015). Unfortunately, starting treatment but discontinuing due to social stigma can have adverse effects on the patient, leading to a potential increase in depression or anxiety (Clement, et al., 2015). Thus, our socially constructed stigma towards mental health creates significant, complex barriers that are truly damaging to these members of our society.

The Challenges of Telemedicine

Even in the event that a mentally ill adult does exhibit help-seeking behavior, receiving adequate care can be extraordinarily difficult. In the wake of COVID-19, making a trip to the doctor can be risky for anyone, but for the high-risk population of older adults with a mental illness, this task is even more unrealistic. This situation forces many members of this population to resort to telemedicine to receive care. Unfortunately, telemedicine can be extremely difficult to use for members of this population, as they are now forced to use technology that they may have difficulty using or understanding (Gould & Hantke, 2020). While many older adults own and operate a device that can be used to access telehealth care, this does not necessarily translate to comfort or knowledge on how to use the device in a new way.

When a physician is using medical jargon or trying to communicate a complex issue, it can be difficult for older adults with mental illnesses to truly comprehend and engage with the material, lowering the chances of adhering to treatment (Gould & Hanke, 2020). In addition to these difficulties, as mentioned previously, many older adults with a mental illness struggle with homelessness or unstable housing, meaning that access to this equipment is a barrier in itself. Now, these adults most not only overcome the barrier of societal stigma, but also a newfound technological barrier, turning a bleak situation into one that is even more destitute.

If an older adult with a mental illness is able to access telemedicine, many still struggle to openly communicate how they are struggling, ultimately receiving lackluster care even if they can operate the technology well enough to seek help (Gould & Hanke, 2020). In the event that the patient is able to use the technology and communicate effectively, telehealth has shown to be a viable treatment option, but it is certainly reliant on the individual having access to a support system to aid in adherence to the treatment plan (Zhou, et al., 2020) Though many older adults with mental illness do not have access to a support system of this nature, it is encouraging to know that telemedicine can be effective under the right circumstances.

Conclusion

With this in mind, it is vital to ask the question: How can I help make these circumstances viable for a larger portion of this population? While this is a multi-faceted issue that requires a complex answer, it begins with understanding and empathizing with this population. Older adults with mental illnesses are valuable members of our society, and if properly supported, can continue to live vibrant and impactful lives. At Clemson University, there is a great deal of pride in the “Clemson Family”. Older adults with mental illnesses could be professors, employees, or alumni. While this is an excellent start, the idea of commitment to those around us should expand beyond university ties, and should inspire compassionate and empathetic living. Challenging societal stigma and fighting for this population is vital to ensuring an equitable experience for this population.

Ultimately, older adults that already suffer from mental illness face more severe symptoms because of COVID-19, but the changing stigma around mental health and the availability of virtual health visits has made it even more difficult for them to get the help that they need and deserve. From great health risks to both societal and technological barriers, mentally ill older adults must overcome a near insurmountable challenge to receive adequate care. It is especially devastating that this population is impeded by socially constructed bias, as our society chooses to neglect these members of our population. As a society, we have a choice: challenge and breakdown these barriers of our own construction, or continue on our pathway of negligent destruction. Ultimately, the fate of this widely forgotten population lies in our hands: what will we choose?

References

Clement, S., Schauman, O., Graham, T., Maggioni, F., Evans-Lacko, S., Bezborodovs, N., Morgan, C., Rüsch, N., Brown, J. S., & Thornicroft, G. (2015). What is the impact of mental health-related stigma on help-seeking? A systematic review of quantitative and qualitative studies. Psychological medicine, 45(1), 11–27. https://doi.org/10.1017/S0033291714000129

Cohen, A. K., Hoyt, L. T., & Dull, B. (2020). A Descriptive Study of COVID-19-Related Experiences and Perspectives of a National Sample of College Students in Spring 2020. The Journal of adolescent health : official publication of the Society for Adolescent Medicine, 67(3), 369–375. https://doi.org/10.1016/j.jadohealth.2020.06.009

Epstein, D., Andrawis, W., Lipsky, A. M., Ziad, H. A., & Matan, M. (2020). Anxiety and Suicidality in a Hospitalized Patient with COVID-19 Infection. European journal of case reports in internal medicine, 7(5), 001651. https://doi.org/10.12890/2020_001651

Druss, B. G. (2020). Addressing the COVID-19 pandemic in populations with serious mental illness. JAMA psychiatry, 77(9):891-892. https://doi.org/10.1001/jamapsychiatry.2020.0894

Galbin, A. (2014). An introduction to social constructionism. Social Research Reports, 6(26), 82–92. https://www.researchreports.ro/an-introduction-to-social-constructionism 

Gould, C. E., & Hantke, N. C. (2020). Promoting Technology and Virtual Visits to Improve Older Adult Mental Health in the Face of COVID-19. The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry, 28(8), 889–890. https://doi.org/10.1016/j.jagp.2020.05.011

Graham, N., Lindesay, J., Katona, C., Bertolote, J.M., Camus, V., Copeland, J.R.M., de Mendonça Lima, C.A., Gaillard, M., Gély Nargeot, M.C., Gray, J., Jacobsson, L., Kingma, M., Kühne, N., O’Loughlin, A., Rutz, W., Saraceno, B., Taintor, Z. and Wancata, J. (2003), Reducing stigma and discrimination against older people with mental disorders: a technical consensus statement. Int. J. Geriat. Psychiatry, 18: 670-678. https://doi.org/10.1002/gps.876

Shinn, A. K., & Viron, M. (2020). Perspectives on the COVID-19 Pandemic and Individuals With Serious Mental Illness. The Journal of clinical psychiatry, 81(3).  https://doi.org/10.4088/JCP.20com13412

Szcześniak, D., Gładka, A., Misiak, B., Cyran, A., & Rymaszewska, J. (2021). The SARS-CoV-2 and mental health: From biological mechanisms to social consequences. Progress in Neuro-Psychopharmacology & Biological Psychiatry, 104, N.PAG. https://doi-org.libproxy.clemson.edu/10.1016/j.pnpbp.2020.110046

Vahia I. V. (2020). COVID-19, Aging, and Mental Health: Lessons From the First Six Months. The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry, 28(7), 691–694. https://doi.org/10.1016/j.jagp.2020.05.029

Zhou, X., Snoswell, C. L., Harding, L. E., Bambling, M., Edirippulige, S., Bai, X., & Smith, A. C. (2020). The Role of Telehealth in Reducing the Mental Health Burden from COVID-19. Telemedicine journal and e-health : the official journal of the American Telemedicine Association, 26(4), 377–379. https://doi.org/10.1089/tmj.2020.0068

Images

Image 1: “One and Other-Mental Health” by Feggy Art is licensed under CC BY-NC-ND 2.0

Image 2: “20180921-RD-PJK-1266_TONED” by USDAgov is marked with CC PDM 1.0