The Hidden Cost of Neglect: How covid exposed a broken system

When we think about how people struggle emotionally, it’s easy to assume it just “happened out of nowhere.” But just like how tears aren’t always straightforward—sometimes we cry out of relief instead of joy—mental health challenges rarely arise without deeper reasons, and the COVID-19 pandemic only magnified these reasons. The COVID-19 pandemic didn’t suddenly invent all the problems we’ve been seeing in marginalized communities. Instead, it tossed extra weight onto their shoulders, making issues that had been there all along stand out in painful relief. Economic struggles, limited access to healthcare, and racial discrimination have been simmering for years, and when the pandemic hit, it was like pouring fuel on an already burning fire.

The point is, we can’t look at today’s mental health crisis without acknowledging the long, messy history that made certain groups more vulnerable in the first place. For instance, redlining practices in the 20th century not only segregated housing but also cut off communities of color from essential services, including health care. This exclusion created significant gaps in access to care that still need to be addressed. The Tuskegee Syphilis Study, for example, involved Black men in Alabama who were misled into thinking they were receiving free healthcare when in reality researchers deliberately withheld care to study the disease progression. This unethical study fueled a level of distrust that lingers even into today .

Picture a family in a low-income neighborhood before anyone had even heard of COVID-19. Maybe they’re juggling two or three jobs, barely making rent, and certainly not able to pay for therapy sessions or costly mental health care. Sure, they might be stressed, but they’ve gotten used to a steady grind of making do with less. Now fast-forward to the pandemic. Suddenly, job security vanishes overnight, schools close, and everyone’s packed into a small apartment with no space and no quiet. Stress isn’t just stress anymore—it’s a crushing sense of “How will we afford next month’s bills?” and “Who will help us if one of us gets sick?” Their mental health deteriorates fast, and it’s not some random coincidence. It’s the direct outcome of years of being on shaky ground.

An important factor that gets overlooked in these discussions of inequalities is the role of community resilience and the ways marginalized groups have historically relied on informal networks for support. While networks such as churches or extended families can be a source of strength, they should not be a replacement for systemic care. For example, throughout the pandemic, aid groups in neighborhoods provided food and financial help to those who could not rely on the official channels of “help,” if you can even call it that. While these efforts demonstrate human compassion and solidarity, they underscore the failure that these systems are. Expecting communities to fill in these gaps isn’t just unrealistic; it’s also unjust.

Immigrant communities know this story well, too. Even before the virus spread, many immigrants struggled with language barriers, limited trust in the healthcare system, and fear that seeking help might raise questions about their legal status. When COVID-19 hit, those fears and challenges multiplied. Confusing public health messages and uneven financial help made it harder than ever to stay calm and hopeful. Feeling anxious or depressed in that situation isn’t just about COVID-19—it’s about living in a place that never truly felt safe or supportive to begin with.

For many immigrants, legal status created significant barriers to accessing mental health care during the pandemic. Undocumented individuals often faced overwhelming fear that seeking help might expose their status and lead to deportation. A study by Page et al. (2020) found that undocumented immigrants were much less likely to seek healthcare services because they worried Immigration and Customs Enforcement (ICE) might get involved, even when those fears were unfounded. Policies like the 2019 Public Charge rule made the situation worse by penalizing immigrants who used public benefits like Medicaid, causing even greater hesitation. Fear alone prevented families from getting the help they needed, turning treatable mental health issues into long-term crises.

Language barriers also kept many immigrant families from accessing mental health care during the pandemic. Nearly 25 million individuals in the U.S. speak limited English; this, in turn, makes it difficult to navigate such a complex healthcare system. Translation services do exist however, they fail to completely and accurately translate the emotional complexities of mental health conversations. Even as telehealth expanded, it left behind families without access to multilingual providers, forcing many to give up on treatment. These barriers don’t just delay care; they leave entire communities behind and abandoned (Đoàn et al., 2021).

Another key issue we need to address is stigma within communities and outside of them and the role they play in accessing care. These communities often face two problems: not just accessing the care they need but also the problem that is tied to their racial identity. There are certain cultural expectations in some immigrant families that discourage the conversation of mental health and frame seeking help as a sign of weakness. At the same time, however, systemic bias means that when individuals from these groups finally seek care, they are met by judgment from healthcare providers who, unfortunately, cannot understand their situation. Addressing these issues means not only tackling access but also tackling the stigma behind these unfair judgments. Culturally tailored outreach programs and training that prioritize empathy and understanding could change the direction of someone’s life completely (Thomeer et al., 2023).

The pandemic’s impact on children’s education exposed just how deeply inequality affects underprivileged communities. When schools shut down, many low-income families found themselves without devices or reliable internet, which made remote learning almost impossible. Not only did the pandemic disrupt academics, but it also cut children off from critical mental health resources like school counselors that they previously relied on for support. According to the Pew Research Center (2020), 59% of low-income households with children lacked adequate internet access, leaving them disconnected from both education and emotional help. Imagine being a child feeling stressed, anxious, or isolated, with no one to turn to simply because your family can’t afford Wi-Fi or a laptop.

Telehealth could have been a lifeline during the pandemic; unfortunately, for many families, it was just out of reach like online schooling. Without a stable connection or the right technology, many students from underprivileged backgrounds were forced to suffer and manage overwhelming emotions from the pandemic on their own. This digital divide not only affected their schooling but it also deepened the mental health crisis. The pandemic pushed children further into cycles of struggle. If we’re serious about addressing these issues, making telehealth more accessible is the first step. Telehealth should be available to address mental health crises no matter the resources or the zip code to make sure both children and adults have a chance to thrive academically and emotionally.

The effects of untreated mental health often extend past the individual. Left untreated, these issues can affect communities and, more importantly, families. A parent who is struggling emotionally or mentally can have devastating effects on a child’s well-being. A parent struggling with a disorder like depression or anxiety may find it harder to support their children, whether that be financially or emotionally. This, in turn, creates a pattern of instability that could very well impact generations to come. For immigrant families, these challenges are amplified by the burden of many language and cultural barriers. Children in these families often take on the role of the unofficial translator or caregiver, adding stress to their already vulnerable mental health (Đoàn et al., 2021). When communities are left to cope without receiving the necessary support, the cost extends past emotional it becomes both an economic and social problem as well.

We have actual research showing that the pandemic made existing inequalities worse. For example, Rathore, Connolly, and Karter (2020) point out that COVID-19 “deepened pre-existing socioeconomic and related inequities.” This means everything we’ve been seeing—the rise in stress, anxiety, and depression—was pretty much set in motion by older problems no one fixed in time. 

While personal responsibility matters, it can’t overcome the systemic barriers that block access to mental health care for marginalized communities. Take Dr. Sally Satel’s argument: she claims disparities are mostly driven by factors like income and education, but this view overlooks the deeply ingrained effects of structural racism and implicit bias. For example, Black Americans in urban areas face hurdles like racial profiling and housing segregation, which make it harder to access even basic healthcare. These challenges aren’t just about personal effort—they’re the result of a system built to disadvantage certain groups. Even when income gaps are addressed, implicit biases within healthcare still leave marginalized patients underserved. Expecting personal effort to fix such a broken system is like asking someone to climb a mountain with their hands tied. Real change requires systemic solutions that level the playing field .

Government action also isn’t about replacing personal responsibility—it’s about breaking down the barriers people can’t overcome on their own. The pandemic exposed how deeply inequalities are embedded in healthcare systems, leaving the most vulnerable populations to fend for themselves. The cost of this neglect is staggering. The U.S. loses $1.03 trillion annually due to health inequities, with $421.1 billion linked directly to racial and ethnic disparities (LaVeist et al., 2023). But this isn’t just a financial failure—it’s a moral one. Policies like expanding Medicaid or funding culturally sensitive mental health programs aren’t handouts; instead, they’re tools to give everyone a fair shot at proper care. When the government steps in to address these systemic issues, it doesn’t diminish personal responsibility it simply empowers communities to thrive. Addressing health inequities isn’t just a policy choice it’s a matter of justice and humanity.

Picture walking into a doctor’s office with pain and not being taken seriously enough. For many Black Americans, this isn’t a rare occurrence but a recurrence. Research shows that African American patients with schizophrenia are more likely than White patients to show symptoms of major depression, but those symptoms often go unnoticed or untreated (Thomeer et al., 2023). This is the sign of a system that fails to see everyone equally. The problem extends past a few bad doctors—it’s based on a system that repeatedly fails those who need it most. Part of the issue lies in implicit biases among healthcare providers, which can lead to misdiagnosis or outright dismissal of symptoms. Imagine being in excruciating pain, only to have your suffering minimized simply because of the color of your skin. Studies show that Black patients are 40% less likely than White patients to receive adequate pain management for the same conditions (Crowe,Kennel, 2023). This isn’t just a statistic—it’s a painful reminder. A reminder that injustice stems from inaction. The problem is not about receiving special treatment but about confronting a system that continues to treat pain as less real simply because of who is feeling it.

We must also recognize the intersectionality of mental health disparities, particularly for those who belong to multiple marginalized groups. For example, members of the LGBTQ+ community who are also people of color face a unique set of challenges. Oftentimes, they can face discrimination not only at a societal level but also from those within their own community. Intersectionality is not just an abstract concept—it’s a reality that demands intervention tailored to these groups. In this way, we can begin to dismantle a system of inequality that leaves some groups more vulnerable than others.

Immigrant communities faced a similar pile-up of issues. According to Đoàn et al. (2021), limited financial resources, confusion around health services, and cultural barriers made it even tougher for immigrants to deal with the pandemic’s emotional toll. This is a classic example of how a crisis exposes old wounds. Without clear support and understanding, stress skyrockets. We can’t blame COVID-19 alone for that; we have to see the pandemic’s impact as part of a chain reaction set off by long-standing inequities.

Even well-meant solutions didn’t always fix things. Take telehealth, for example. Sure, it helped some people get therapy during lockdown. But what if you don’t have a stable internet connection or speak the same language as the counselor? Thomeer, Moody, and Yahirun (2023) showed that racial and ethnic disparities in mental health care got wider during the pandemic, proving that “one-size-fits-all” solutions just aren’t enough. If the ground is uneven to start with, giving everyone the same tool doesn’t level it out.

Seeing a community in crisis without understanding the systemic barriers they face—poverty, inequity, and neglect—is like seeing someone cry without knowing the months of pain that led them there. We might shrug it off or feel annoyed because we don’t get it. Similarly, when confronted with the stats and stories of mental health struggles in certain communities during COVID-19, some folks might say, “Well, everyone’s stressed.” But that misses the point. Not everyone had the same chances to stay afloat before the pandemic hit. If you were already on the edge, something like COVID-19 is going to hit you ten times harder. The big takeaway? We can’t treat this mental health crisis as a fluke or a one-time emergency. We need policies that actually acknowledge these built-in inequalities. Expanding health coverage, making sure mental health services are easy to find and culturally sensitive, and improving basic living conditions would help prevent future disasters from pushing these communities over the brink. When we understand why the tears are flowing, we’re more likely to show compassion and work on the root causes instead of just handing out tissues .

When we are faced with big, systemic problems, we tend to react in one of three ways. We either deny the problem exists, try to tear down the entire system, or defend it as “not that bad.” The mental health disparities exposed by the COVID-19 pandemic are a perfect example of this.

Some people deny the problem altogether. They say mental health disparities are just about personal choices or cultural differences and refuse to face the overwhelming evidence that these gaps are rooted in systemic failures. Others go straight to deposing the system, demanding that we scrap the whole thing and start over. While this is bold, this approach often overlooks the reality that people are suffering now and need immediate help. And then there are the defenders, the ones who claim the system is mostly fine and just needs a few tweaks. They ignore how deeply these inequities are embedded and how much damage it continues to cause.

Denying the problem is just plain dishonest, tearing down the system without a plan leaves people stranded, and defending what’s broken just supports failure and injustice. The only way forward is to acknowledge what’s wrong, fix what’s broken, and rebuild a system that finally serves everyone fairly.

In moments like this of overwhelming inequity, it’s important to recognize that change is not impossible. There have been success stories that demonstrate the possibility of change. For example, California’s “Health4All” initiative expanded Medicaid access for undocumented immigrants. This program effectively gave thousands of individuals access to care that they were previously denied and excluded from, including mental health care (California Health Care Foundation, 2022). Programs like this not only work to fix the gap in healthcare access but also work to build trust between marginalized communities and the systems that have previously failed them. Similarly, New York City’s “NYC Well” program offers 24/7 multilingual mental health support, ensuring that residents can access care regardless of their language proficiency or financial situation (NYC Well, 2021). These initiatives are proof that culturally competent and accessible care can be used to get rid of barriers. If we scale these efforts nationwide, there would be a dramatic change in how mental health care is accessed for communities that have been left behind for far too long.

There is just too much at stake to do nothing. Millions of families will continue to suffer under the weight of untreated mental health issues. Cycles of poverty will continue and economic losses will grow. However, it does not need to be this way. By implementing policies that expand access and protect vulnerable populations, we can create a system that works for everyone. These changes are not only investments in care but they are investments in opportunity, dignity, and the future of our society.

In the end, the COVID-19 pandemic didn’t create mental health issues out of thin air. It exposed and intensified them, showing us who had been left behind all along. Just as understanding why a friend cries at a supposedly happy event gives us deeper empathy and better ways to help, understanding the causes behind today’s mental health disparities should drive us to fix the underlying problems. If we learn anything from this moment, it’s that we have to address the big picture—those long-standing economic, social, and racial imbalances—so that when the next crisis comes around, we’re not replaying the same painful scene.

However, understanding is only the first step. If we stop to acknowledge the issue without taking any necessary action to change the outcome, we are complicit in supporting this broken system. Imagine the possibilities if every child, regardless of zip code or economic status, had access to tools that expand their education. Imagine a system where immigrants could seek help without fear of repercussions. And imagine a system where health care providers treated every patient with the care and understanding they deserve. These aren’t far-fetched dreams—they can become an achievable reality if we commit to changing. This isn’t just about fixing a broken system; it’s about creating a society in which no one feels as if their pain is dismissed.

The question we face here is not if we can afford to make the necessary changes but if we can afford not to. The communities that we uplift, the lives that we save, and the futures we protect will shape a society we can all be proud of.

Reference List

1. California Health Care Foundation. (2022). Health4All: Expanding Medicaid for undocumented immigrants in California. California Health Care Foundation. https://health-access.org/campaigns/health4all/
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