After COVID-19, we’re going to need more than therapy

At the beginning of Avengers: Endgame, there’s a surprisingly prescient scene. Captain America, the valorous soldier who wields an indestructible shield, appears plain-clothed while leading a support group. He’s there to help survivors of the Snap, an event triggered by the villain Thanos in which billions of people die without warning or explanation. Still stricken by the sudden loss five years later, the support group participants are looking for answers about how to live with their pain.

When one man says he just went on a date for the first time, Captain America replies: “That’s it. That’s those little brave baby steps we gotta take to try to become whole again, try to find purpose.”

Though the Marvel movie premiered in 2019, I’ve kept coming back to that scene in my mind since the COVID-19 pandemic began. The dimly-lit room, the somber voices, the sign on the wall that reads: “Where do we go, now that they’re gone?” It was a minute-long glimpse of what healing might look like in an imaginary world defined by mass death.

Now, here we are, after at least four million unexpected deaths around the world, trying to find some semblance of normal as COVID variants of concern upend our expectations. Investors and entrepreneurs have looked at the scale of this suffering and seen a business opportunity. In 2020, investors poured $2.4 billion into digital behavioral health companies, many of which aim to take the therapy model of one-on-treatment and make it more accessible through virtual platforms. Some are trying to automate mental health care using chatbots that talk to users about their emotions.

These connections can sustain us in vital ways.

These services are important and can be useful, but as strange as it is to say it, the support group in Endgame offers a model that’s perhaps more realistic and meaningful. It demonstrates the irreplaceable value of peer support and community when coping with disaster. As we navigate the post-vaccine period of the pandemic and learn more about the emotional and psychological distress we’re still feeling — along with our friends, family, neighbors, and coworkers — we should prioritize some form of healing that draws on existing social bonds and helps us build new relationships.

These connections can’t replace high-quality, accessible therapy, but they can sustain us in vital ways. They make us feel less alone, help us collectively process grief and trauma, aid in problem-solving practical or emotional challenges, and bring communities closer together. We’ll continue to need this support as we face future waves of trauma brought on by climate change, and research suggests such social capital can lead to better mental health outcomes following disasters.

While venture capital dumps billions of dollars into efforts that will largely expand an infrastructure of paid services that keep people in silos with a therapist, behavioral health coach, chatbot, or automated tool, imagine a major nationwide, federal initiative to fund community-led support groups. A small pilot project that’s bringing support groups to farmworkers could provide a blueprint. In one format of these groups, trusted mental health professionals lead conversations about well-being with an emphasis on empowering participants to support each other rather than diagnosing them.

Educational workshops that help people learn basic information about mental illness, how to identify signs and symptoms, and how to engage in empathic conversations should be another important element of recovery resources made available to everyone. We already have a model in Mental Health First Aid, a nationwide peer-reviewed program that teaches people about mental health and wellness. However, the workshop is often promoted to first responders, teachers, social workers, and other professionals who more frequently encounter people experiencing mental illness or crises. Expanding access to and knowledge of MHFA could significantly boost people’s ability to understand their own mental health and respond sensitively to others who are struggling.

With increased federal funding, community mental health centers, which typically operate as small hospitals or therapy clinics, could serve as hubs for support groups and workshops. They could also add social programming that brings people together to enjoy hobbies and activities like baking and basketball. If this doesn’t sound like mental health care, Dawn Belkin Martinez, associate dean for equity and inclusion and clinical associate professor at Boston University’s School of Social Work, disagrees.

“I think that community is a healing intervention,” she says.

“I think that community is a healing intervention.”

Belkin Martinez applies a “liberation health” philosophy to her work with students and clients. The goal is not just to help people cope better with stressors and mental health conditions. It’s to also help them understand how the systems that rule their lives — think capitalism, structural racism, misogyny, and so on — affect their well-being, and then take action to change these external conditions while deconstructing the negative messages about their self-worth they’ve internalized as a result. By adopting a different framework for viewing their problems while tapping into community networks and support to thrive, they can chart a path forward.

Unfortunately, this is what’s missing from many therapy experiences. Belkin Martinez says traditional training doesn’t teach therapists how to collaboratively identify and discuss the connections between mental health and socio-political factors. Psychology as a workforce also isn’t diverse, which means therapists can be culturally incompetent depending on their client’s background. In particular, people of color, those with disabilities, and those who identify as lesbian, gay, bisexual, or transgender who’ve sought help but had to battle stereotypes or discrimination know this obstacle well.

Even though talented therapists and psychiatrists have valuable skills and expertise, not everyone wants such treatment, nor can they afford or access it. A long-standing shortage of mental health providers makes appointments scarce, especially now given increased demand. The problems we face with affordability, access, and quality can’t be answered with internet therapy, which has boomed during the pandemic. Some may prefer the anonymity and convenience yet still fail to find the right therapist for them.

Community leaders are developing creative approaches to the problem of quality and access. Take, for example, “PyschoHairapy,” a program that certifies barbers and stylists in providing “culturally-informed mental health first aid.” Founded by a Black clinical psychologist who is also a natural hairstylist, the program trains participants in “microcounseling” skills like active listening, mindfulness, and narrative therapy.

The organization Estoy Aquí (I’m Here) aims to reach Latino/Latinx and Black communities in western Massachusetts with a “community care” model of suicide prevention called La Cultura Sana, or The Culture Cures. Its founder, Ysabel Garcia, told me the model focuses on dismantling factors like systemic racism and white supremacy, which she says contributes to suicide risk and mental health challenges. Beginning in August, Garcia plans to offer workshops to Latino/Latinx and Black businesses that double as a communal gathering place, like hair salons, bodegas, and laundromats. Her hope is that by offering mental health awareness education to business owners and their staff, they’ll be better equipped to identify signs of emotional distress, know what cultural strengths they can draw on to support others, and respond with thoughtfulness and sensitivity.

Some will still need the expertise of therapists and psychiatrists, especially as we learn more about the mental health conditions and psychosis that can accompany a COVID-19 infection. But think of what might happen if the private sector and the government invested in us, regular people who need community in the wake of tragedy, and who love their neighbors, coworkers, friends, and family, and want to help but often don’t know how.

We actually don’t need Captain America, but we could sure use each other.

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If you want to talk to someone or are experiencing suicidal thoughts, Crisis Text Line provides free, confidential support 24/7. Text CRISIS to 741741 to be connected to a crisis counselor. Contact the NAMI HelpLine at 1-800-950-NAMI, Monday through Friday from 10:00 a.m. – 8:00 p.m. ET, or email [email protected]. You can also call the National Suicide Prevention Lifeline at 1-800-273-8255. Here is a list of international resources.