Mental Health Awareness During the COVID-19 Crisis

By Contributing Editor: Margaret Watt, MPH, MA,
Co-Director, The Hub: Behavioral Health Action Organization for Southwestern CT

So far, 2020 has been marked by stress, isolation, and uncertainty, even for those lucky to have stayed healthy and financially stable. COVID-19 has changed how we recognize May as Mental Health Awareness Month, and this is the first year that virtually everyone has experienced some level of anxiety or depression. This year, instead of focusing on awareness raising and stigma busting, efforts aim to make sure everyone knows how to access support. Fortunately, there are many ways to get help and new opportunities for the future.

Challenging Times

During usual times, up to 20% of Americans—from children to seniors—experience a mental illness each year, with anxiety and depression as the most common forms. Mental illness can have severe repercussions on physical health, ability to work or go to school, and relationships with others. Those who are struggling may self-harm or attempt suicide, misuse alcohol and other drugs, or engage in other risky behaviors. The struggles are also painful for loved ones trying to provide support, navigate the system, and preserve the wellbeing of other household members. Typically, about half of those who are in need actually get help.

What about now? Social isolation, changes in daily routines, fear of getting ill, struggles to balance work and family while at home, lack of privacy, loneliness, boredom, information overload, loss of milestones such as graduation, feeling caged-in, and for too many, bereavement have all become daily challenges. A local therapist noted common themes expressed by clients in recent months, and an initial phase of fear of the virus, then a stage of worry about financial security, and later a stage of relationship conflicts among household members.

The current phase is anxiety about the uncertainties of the coming year. When my son asks me whether school will be back to normal in September, I hear an underlying message: I can make it as long as I know there’s an end date in sight. The reality that’s hard to accept is that there is no end on the horizon, but rather recurring waves of illness, society opening and closing, and change.

Interestingly, despite these challenges, there has not yet been a measurable increase in people experiencing mental health crisis. Humans are resilient and most of us have adapted to the new normal, found ways to cope, and are reaching out to each other, often more than in the past. Calls to mental health hotlines such as the National Suicide Lifeline and emergency mobile crisis only began to creep upwards in April (still within usual ranges). Crisis lines do report that callers are expressing more acute needs, however, and the Connecticut Chapter of the National Alliance on Mental Illness (NAMI), which serves families with severe mental illness, has seen a rise in calls to its hotline.

With time, as the full societal impacts of the pandemic are felt, these trends may continue. As one mother said this week, “you do whatever it takes to get through the storm, and then you fall apart afterward.” Healthcare workers are one group that may be particularly vulnerable to post-traumatic stress as a result of COVID-19.

Who is Most at Risk?

• People experiencing economic instability, particularly the undocumented. Calls to 2-1-1 about basic needs have risen significantly. During recessions, economic insecurity correlates with an increase in mental illness, including suicide risk. These impacts may be yet to come.  
  
• People living in unsafe situations. Domestic violence programs report up to a 10% increase in calls. Child abuse is going underreported since teachers have less access to students.
  
• People unable to access their usual social-emotional supports. Isolation can exacerbate mental health and substance use disorders. People who are depressed may not have the wherewithal to ask for help. Substance use programs are seeing relapses among some people in long-term recovery.
  
• Teens and young adults, already an at-risk population, now faced with distance learning, missed job opportunities, and fears about their future, including the return to school. Young people often lack good social and coping skills, since adolescence is a time when those skills develop. 
  
• Healthcare workers and first responders, who have been unable to help severely ill patients, who fear for their own and their families’ safety, and who have watched people die alone.

Support is Available

Social support is a protective factor that helps counteract these struggles. We can all play a role in helping others by checking in and providing a listening ear. If you are concerned about someone, reach out!

For those in need, help is accessible from a phone or tablet. There are 24/7 hotlines to call in crisis; warmlines just to talk; online meetings offered daily by groups like Advocacy Unlimited; and a variety of phone and online support groups, including NAMI, DBSA, CCAR, 12 step groups, SMART Recovery, Refuge Recovery, and The CARES Group. For healthcare workers and first responders, Magellan Health offers a free national hotline: 800-327-7451.

Individual and group therapy are available online or by phone. At first, some clients were reluctant to participate in virtual therapy or support groups, but most adapted quickly. Now, therapists have full caseloads and agencies are hiring to meet new need.

If You Are Struggling

• Touch base with family and friends each day and tell them how you’re feeling
  
• Create a daily routine
  
• Get outdoors for a mood boost
  
• Limit your consumption of news about COVID
  
• Exercise daily—a proven antidepressant!
  
• Take advantage of free hotlines, warmlines, and online supports. Visit: TheHubCT.org/covid
  
• Use mindfulness apps like Calm,  Headspace or 10% Happier
  
• Seek professional help. Visit: TheHubCT.org/treatment for resources

What’s Next

While COVID-19 may not feel like a trauma for everyone individually, the experience is a “collective trauma” likely to affect society as a whole. Consider air travel before and after the 9/11 attacks. Collective trauma can alter systems, policies and behaviors.

The behavioral health world has already undergone regulatory and technological change in response to COVID. There should be no looking back. Teletherapy has improved access by removing barriers such as travel and child care, reducing no-shows, and allowing more frequent brief check-ins. Forward-looking provider agencies are already redeploying staff virtually to fill gaps in the community and are considering converting offices to address basic needs. Agencies are creating hybrids of in-person and virtual meetings to best address client needs. To sustain these gains, insurance policies will need to reimburse virtual visits on a par with in-person visits, and the expanded service on state phones should be continued.

Our social behaviors may also change. Will we become afraid of gathering in groups? Will we touch and hug less? Will we miss how people are feeling under their masks? Or will we continue our outpouring of support to neighbors, donations to food pantries, appreciation for healthcare workers and teachers? Our communities have united to develop new celebrations of birthdays, graduations, and funerals. Our hospitals have implemented peer support programs. Our senior centers have created online programs to keep seniors connected. Our prevention educators are using webinars and social media to reach broader audiences.

What we’ve gained during the quarantine is better connectedness with friends, more caring interactions, gratitude for the little things, and an opportunity to refocus. Let’s protect those qualities as we go forth from the quarantine.

Margaret Watt
Co-Director,
The Hub: Behavioral Health Action Organization for Southwestern CT
mwatt@thehubct.org

Margaret served as the Executive Director of the Southwest Regional Mental Health Board for the last 6 years of its existence, winning the Policy Leadership Award from the Keep The Promise Coalition in 2017. In 2019 SWRMHB was merged into the new Regional Behavioral Health Action Organization known as The Hub, under the auspices of RYASAP. Prior to her work in mental health, Margaret had 12 years of experience in public health, working as a global health consultant specializing in program monitoring, system development and training. She also worked as an educator for 8 years, including 3 years as a bilingual teacher. Margaret is a QPR suicide prevention trainer. She has an MPH from UNC/Chapel Hill, an MA in Education from Columbia University, and a BA in Hispanic Studies from Harvard. She is fluent in Spanish and French.

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