As we fail to reopen the economy and focus only on cases of coronavirus, a wave of mental illness and deaths of despair is swelling.

Uncertainty, aggravated by health threats and wavering government policies has resulted in more than 33% of the people in Pennsylvania reporting symptoms of anxiety disorder. In July of 2019, that number was 8.5 percent.

While we have not seen a pandemic or economic shutdown as severe as the one we face now, the world has suffered similar situations in the past. So far, in the 21^st century, people have suffered H1N1, SARS and Ebola. Each strained health care systems and disrupted local economies. The impact of these crises on mental health has been well-researched.

While deaths from infectious diseases such as Covid-19 steal the headlines, the mental health effects of economic disruptions and quarantines last for years.

The most significant negative factor in past quarantines was when the shutdown end date came and was then extended.  Facing the prospect of extending shutdowns or even closing parts of the economy that have reopened makes this information vital to reconsider.

A study published in The Lancet summarizes a number of research reports which investigated populations who were quarantined. For many, it was a bad experience with repercussions lasting long after the quarantine ended.

In the three-year period following quarantine, incidence of PTSD in the quarantined population was four times that of people who were not affected. As many as 60 percent of those who experienced quarantine reported symptoms of depression.

An average projection of unemployment as a result of the Covid-19 crisis of 15 percent will result in an increase in the suicide rate of 20 per 100,000 people over the next 10 years.

Even more troubling is the experience of people put out of work due to pandemic-inspired government mandated shutdowns and the unemployment and business failures that result.

In these crises, people who are out of work and lack purposeful, in-person relationships with others – which are often forged through work – kill themselves at alarmingly high rates.

Deaths of despair are defined as suicides and drug overdoses. In 2018, the rate of deaths of despair was 55.5 per 100,000 people, or 101,686 lives lost in the United States. An average projection of unemployment as a result of the Covid-19 crisis of 15 percent will result in an increase in the suicide rate of 20 per 100,000 people over the next 10 years.

That’s 65,998 additional lives lost due to suicide as a result of the increase in unemployment.

This projection does not include suicides and overdoses sure to result from cuts in services that will inevitably follow the reduction in public funds caused by lower income, business and sales tax revenues to the local governments that provide so many behavioral health services.

Unemployment and budget cuts will impact those in lower income brackets much more severely than people with higher incomes and more access to private mental healthcare. People in this lower socioeconomic group also have fewer opportunities for virtual social connections than those in higher income brackets. This group, underrepresented and often left out of policy decisions, bears the largest burden of deaths of despair.

It appears the estimates of increases in deaths of despair caused by the poor handling of the pandemic and the contradictions from state and local governments about reopening the economy may be conservative.

Calls to the National Suicide Prevention hotline in April 2020 were up 891 percent over April 2019.

Fear and anxiety, social isolation and lack of work lurk behind most suicides. Our inability to confidently reopen the economy greatly contributes to these factors. In fact, government avoidance of reopening makes the fear felt by so many seem strangely inevitable and acceptable. But 65,998 deaths are not inevitable nor acceptable.

This looming mental health crisis can be avoided. There are ways to safely reopen the economy much more aggressively than we are now. In short, we have to set a date for reopening and stick to it. The impact on mental health of extending the shutdown period is extreme. When information about the reasons for suffering and sacrifice is clear, kept to a minimum, and presented as a positive, people recover when shutdowns end. However, when a public health crisis is mishandled, the impact can be tragic.

George Hofmann is the author of Resilience: Handling Anxiety in a Time of Crisis from Changemakers Books, and lives in Philadelphia with his wife, their daughter and two poorly behaved dogs.

From the writer: If you are thinking of suicide, please call the National Suicide Prevention hotline at 800-273-8255