🚨 🧵 Re COVID-19 recovery: we are to face a mental health crisis that will disproportionately affect Black, Hispanic, Native, Philippine ppl. In this @TheLancetPsych piece led by @ShawnJohnsonBOS we focus on Post-ICU syndrome (PICS) + key solutions.thelancet.com/journals/lanps… 1/11 
What is PICS? It’s an ensemble of mental and neuopsychiatric disorders that affect people who have been in the ICU, and their families too. Includes delirium, depression, anxiety, PTSD. People who are intubated (pretty common w/ COVID) have it the worst. 2/11
We are starting to learn that irrespective of ICU stays, COVID-19 can leave people with neuropsychiatric sequelae. So we have a collision of two phenomenons here. There’s not a lot of data on PICS-related disparities, but it leads to financial ruin cc (@KatieHauschildt) 3/11
We also know that Black trauma victims have worse mental health outcomes after ICU stints. (@koneillmed). But as you may guess, mental health access is a huge issue for all but particularly among Non-White ppl for a host of reasons 4/11
the system wasn’t doing great before, and the *quality* of mental health care for Black, Latinx & Native patients is also worse when they do access it. There will be/already is a surge of people with complex presentations needing robust, multidisciplinary support. now what? 5/11
First, low-hanging fruit: there are 14 states that have yet to expand medicaid (larger payer of mental health care). Most of them in the South, disproportionately Black, and currently getting WRECKED by COVID. EXPAND MEDICAID @RonDeSantisFL @GregAbbott_TX @BrianKempGA et al 6/11
As we now know, COVID can manifest clinically for a while, and have a long-lasting, disabling effects on survivors. A history of mild to severe COVID-19 should (if not yet, idk tbh) be included among disabilities that qualify for Medicare to expand access 7/11
Health systems need to prepare themselves for this surge and leverage technology (telemed)—> create special post-COVID clinics, bolster their interpreter service & invest in community health workers that will help ppl navigate the complexities of recovery (@ShreyaKangovi). 8/11
But forget not, that a lot of people who can’t come to in-person clinics may also have broadband/phone access issues. We need to expand existing programs (npr.org/sections/thetw… + #ObamaPhones, Thanks, @BarackObama!) giving folks tablets etc. educate clinical staff on this 9/11
As/if you create these clinics, it’s an opportunity to build infrastructure for PICS care QI: data collection needs to be intentional, well thought out, & the research process should be democratized. consider building a national registry/extending currents ones to recovery. 10/11
TLDR: Covid sucks, recovery for survivors might suck more esp if they were in the ICU, family be affected too, there’s a looming mental health crisis & we need to pull all the stops 2 ⬆️⬆️ access & improve quality of care. Universal, single payer would be nice bt here we are. Fin
