COVID Exacerbates Loss of Hope, Solution in Leading Causes of Life

Seeding Hope and Belonging

As a public leader, it can be daunting to consider how to adequately address the factors driving increases in deaths of despair. With so much at stake for individuals and their communities, it is essential to seed hope and to foster belonging.  Gary Gunderson, Vice President for Faith and Health at Wake Forest Baptist Medical Center, was interviewed in June 2014 by Stakeholder Health (a group of non-profit hospital leaders committed to transforming health through community partnership). In this interview, he talks about “The Leading Causes of Life” and said “the urgent … work no longer lies in understanding the leading cause of death; it’s to understand the leading causes of life.”[i] He goes onto talk about the five essential elements that contribute to a full life, which include:

  • Connection – the way we humans are linked to each other;
  • Coherence – the deep-gut level feeling that life makes sense;
  • Agency – the human capacity to choose and do, to move towards life;
  • Generativity – the quality of knowing our relationship to those who have come before us and after us will benefit from our life; and
  • Hope – the future and possibilities you see clearly enough that you can take risks to make it happen.

These are the elements that create equitable opportunities that build social capital and ultimately, foster hope. So, as we think about people struggling through barriers – addiction, mental health challenges, incarceration, domestic violence, systemic racism and structural inequities, and other trauma – how do we better advance the leading causes of life?  First, it is important to understand the context.

What is Driving Despair?

Mental health, substance use, stress and deaths of despair are all on the rise in cities throughout the country. As COVID-19 and the racism pandemics have interrupted life in so many ways, associated impacts are everywhere. From job loss and fear for loved ones working on the front lines, to parents stretched to juggle work and children at home, isolation is keeping friends and family apart. These are just a few examples of the stress, uncertainty and trauma affecting each of us in different ways. For those who were on the brink before the crisis, their worst fears have been realized.  The result? People experiencing higher rates of mental health issues and not knowing where to turn. According to a new report from the Well Being Trust, ‘’deaths of despair have been on the rise for the last decade, and in the context of COVID-19, deaths of despair should be seen as the epidemic within the pandemic.”

Before 2020

Prior to COVID-19 and the murder of George Floyd in Minneapolis, our already stretched systems of behavioral health were unable to meet the demand.  In 2017, more than 46 million adults in the United States lived with a mental illness, including over 11 million with a serious mental illness. Meanwhile, more than 20 million adults in the United States met the criteria for substance use disorder in 2014. Simultaneously, the number of individuals entering the criminal justice system has also increased, particularly populations with behavioral health conditions. The Substance Abuse and Mental Health Services Administration (SAMHSA) attributes this increase, in part, due to lack of access to services for those with mental illness, substance use disorder, and/or experiencing homelessness, and drug laws which can lead to increased contact with law enforcement, arrests, and jail bookings. Unfortunately, many of these individuals, both within and outside of the criminal justice system, continue to enter into uncoordinated systems that do not connect individuals to appropriate care and support services.

Economic-associated Impact

A September 2018 brief from the Assistant Secretary for Planning and Evaluation (ASPE) at the US Department of Health & Human Services (HHS), found that poverty, unemployment rates, and the employment-to-population ratio are highly correlated with the prevalence of prescription opioids and with substance use measures. On average, counties with worse economic prospects are more likely to have higher rates of opioid prescriptions, opioid-related hospitalizations, and drug overdose deaths.

Now, with COVID shutdowns pushing more people out of work and struggling to pay for health insurance, the gaps will only widen.  Meadows Mental Health Policy Institute released a report in April, that looked at the impact of job loss in Texas associated with the significant drop in oil and gas production. Their main findings included a projection that for every five-percentage point increase in unemployment in Texas during the COVID recession across a year, an additional 725 Texans could die each year from suicide (300) and drug overdose (425).

So, as city leaders, how do we even begin to meet this moment with so many pressing demands on our time? How do we operationalize the leading causes of life? What and where are the strengths you can build from?

Advancing the Leading Causes of Life

When we ask city leaders for their best examples of efforts aimed at addressing these challenging issues, they always point to the value of partnerships. Below are a variety of examples — some that include city leadership and others city leaders may want to consider based on leadership from other sectors.

Spurring Agency: Expanding entrepreneurship, social enterprise, and anchor institution approaches

Perhaps at no other time has there been a greater need and urgency to spur economic growth, to simultaneously manage all of the fallout from current pandemics and restore hope for those most impacted by COVID-19, including job losses, and systemic racism. An American Journal of Psychiatry study found that a strong sense of purpose may be the single most significant factor in determining ongoing recovery from addiction and other behavioral and mental health challenges.  Employment and its associated benefits can play an important role in creating that sense of purpose for those in recovery from substance use disorders (SUDs) or other addiction challenges.  Jobs provide more than an income. They also offer daily structured activity and instill a sense of accomplishment.

24:1, St. Louis, Missouri – A collaboration across 24 municipal governments rooted in addressing long-standing health and economic disparities in the Normandy school district in North St. Louis County. Over $100 million has been raised and invested in the community since 2010, resulting in a new grocery store in the Pagedale neighborhood – the first in 40 years, along with a bank, lending institution (to offer an alternative to payday lending), a movie theater, coffee house, etc. Beyond Housing, a community development financial institution is the backbone supporting the transformation in this area.

Fostering Connection: Engaging the Most Vulnerable

Cities are finding ways to support their most vulnerable who are struggling with further trauma, stress, and uncertainty.

PROACT, Huntington, West Virginia – To provide for comprehensive support for people struggling with addiction and to ensure better individual and community outcomes, the Provider Response Organization for Addiction Care and Treatment (PROACT), provides outpatient substance use disorder treatment that brings together behavioral, social and medical resources from the community . PROACT was founded to address a need for immediate linkage to addiction services in Huntington, as many people who sought help at emergency departments or hospitals were being turned away due to capacity or capability constraints.  A joint effort between health systems and centers with support from the city has enabled this collaboration which is supporting COVID-related impacts as well – among a broader set of efforts.

Creating Coherence: Operationalizing Trauma-Informed Care

As cities have grappled with increases in violence, mental health issues, and other traumatic events, many have implemented trauma-informed care approaches. All the more critical today in the COVID landscape, these models can be applied more broadly to better support communities.

Trauma-Informed Care Coalition, San Antonio, TX – The South Texas Trauma-Informed Care Consortium is a collaboration between the city health department of community non-profits. The consortium brings together community partners across all sectors who are committed to addressing the impact of trauma. The consortium’s initial priorities include gathering data to understand community needs; connecting with existing coalitions within the community; developing community training; and developing an advocacy plan.  Ultimately, by better addressing the trauma individuals experience you ensure greater resiliency and enable people to live better lives.

Cultivating Hope and Building Generativity: “Finding the Helpers in Plain Sight” and Offering a Hand Up

Every community has assets and resources hiding in plain sight. The question is, how do you draw them out and into action?  We have seen Governor’s and Mayor’s calling out retired health professionals to support the increasing needs in communities. This can be applied to behavioral health specialists, faith leaders, social workers, community health workers, non-profits, among others, in addressing unmet needs. Additionally, giving people a way to engage positively and rebuild their lives, also fosters hope. Ultimately, if people who are struggling feel supported, it fosters a greater sense of hope and belonging. Below are examples for consideration.

  • New York City – Calling on Retired Healthcare Professionals
  • SERV-OR Volunteers – A volunteer program in Oregon to meet a diverse array of needs based on COVID pandemic, including behavioral health specialists.
  • Clean Turn, Ohio – providing training and employment opportunities for people facing significant barriers to employment while building economic mobility.
  • Johns Hopkins Medicine in Baltimore partnered with a reentry organization, Turnaround Tuesday, to hire hundreds of people with criminal records – many for critical jobs involving patient care.


Additional Resources

  • The Enterprise Center, Philadelphia, PA: The Enterprise Center has a rich and diverse practice supporting minority entrepreneurs and under-resourced communities spanning more than three decades. The goal is to build transformative economic development connected to minority business growth cycles and community wealth-building initiatives.
  • Article: Food & Anchor Institutions: Long Struggles, Small Victories and Big Lessons –
  • The Hatchery, Chicago, IL – The Hatchery Chicago enables local entrepreneurs to build and grow successful food and beverage businesses and provides job training and placement programs, which in turn create sustainable economic growth and new job opportunities.
  • Resource: Faith and Community Roadmap: Getting Back to Work –
  • Work-Tech Program, The Salvation Army, Philadelphia, PA – provides hands-on training to prepare students for jobs in the cable networking/telecommunications industry. The 12-15-week course, designed by industry-recognized C-Tech Industries, is free to low-income individuals over the age of 18 who have earned a high school diploma or GED.

Mental Health Resources from the Centers for Disease Control and Prevention

Trauma-Informed Care Approaches


About the Author


Sue Pechilio Polis is the Director of Health & Wellness in the National League of Cities Institute for Youth, Education, and Families.