The second pandemic, mental illness, could come roaring at us as the COVID-19 virus spreads
April 1, 2020
By: Pam Zubeck
‘I’M SUPER STRESSED RIGHT NOW. Everything’s stressful.” That was a text message from a friend that lit up my phone on March 22. The COVID-19 virus was invading the country, and Colorado already reported nearly 600 positive cases and six deaths.
Things would get worse in the days to come.
But already people were grasping for ways to anchor their psyches in a time when everything is out of whack. Many fled their offices to work from home. Schools were dismissed. Events canceled. Restaurants closed except for carry-out orders.
Hordes of shoppers made nonsensical runs on toilet paper, and, more troubling, guns and ammo.
Where is this going? Will I lose my job? How will I pay the bills? Will someone try to steal my food? Will I die?
These questions suddenly existed within the realm of possibility, and they landed on a mental health infrastructure that had to pivot to find ways to respond when “social distancing” discouraged in-person meetings or leaving home at all.
With greater numbers of people asking for help, providers shifted the paradigm in delivering counseling. Many went digital.
Transitioning most outreach to technological avenues, mental health professionals advise people in the crazy world of the coronavirus to avoid being glued to TV news throughout the day, which can aggravate stress. Focusing on the unknown and sharply digressing from a normal routine can also cause anxiety to build.
Instead, stay moored by keeping in touch with friends and family, they say. Adhere to a normal schedule as much as possible. Relieve stress by reading, watching movies, walking, gardening, cooking, volunteering when it makes sense, and even adopting shelter animals.
While AspenPointe, the region’s chief mental health provider, refuses to disclose whether calls for help have escalated as the virus takes root, others report a noticeable difference from the norm.
“The tone and tenor of the calls have definitely changed,” says Lori Jarvis-Steinwert, executive director of the National Alliance on Mental Illness (NAMI), Colorado Springs. “The isolation is real for people. There’s something about the sense of, ‘I really don’t have the option to connect with people.’ They don’t have that face-to-face connection they rely on to stay healthy.”
And Mental Health Colorado reports that after an initial post on its website explaining how to avoid anxiety due to COVID-19, it saw a 25 percent increase in website visitors.
AMONG THE MOST DESPERATE AND TRAGIC reactions to depression and mental illness is suicide.
Glenn Sullivan, a professor of psychology at the Virginia Military Institute, noted in a Psychology Today post on March 22 that increased gun ownership could drive a rise in suicide rates. But a more predictive factor could be the vast increase in unemployment claims as the coronavirus escalates.
Between March 15 and 20, some 180,000 people tried to file unemployment claims in Colorado, which crashed the system and represented a 25-fold increase over the previous week, according to media reports.
As the economy grinds to a halt, Sullivan says, some economists predict unemployment will rival that of the Great Depression when one in four Americans were out of work.
In the pre-Depression years, the national suicide rate was 12.1 percent per 100,000 people, but after the 1929 stock market crash, it surged by 50 percent to 18.1 per 100,000. As the Depression deepened, suicides stayed high at 15.4 per 100,000 and dropped only with the advent of World War II.
“Unemployment is a well-established risk factor for suicide,” Sullivan writes. “In fact, 1 in 3 people who die by suicide are unemployed at the time of their deaths. For every one-point increase in the unemployment rate, the suicide rate tends to increase .78 points.”
If the suicide rate increases as it did after the 1929 stock market plunge, the U.S. could see more than 54,000 deaths by suicide in 2021, he says.
The Dow Jones average’s 30 percent plunge as the virus triggered mass layoffs and business closings might have set the stage for a repeat of a vaulting suicide rate.
Will the March 25 adoption by Congress of a historic $2 trillion stimulus package change things? The bill will fuel businesses and place billions of dollars in the hands of the unemployed and guarantee jobs for others.
It also contains money for domestic violence shelters and hotlines, and earmarks $425 million for mental health and substance abuse disorders related to the pandemic, The New York Times reported.
But what impact the new funding will have on the economy and specific programs is impossible to predict.
For those who respond to calls from people experiencing domestic violence, the virus could open the flood gates for cases, according to a March 24 report in the Colorado Independent. “I’m very concerned that we will end up with a lot more individual survivors and survivors with children who will become homeless,” Amy Miller, executive director of Violence Free Colorado, a coalition of providers, told the online newspaper. “I am worried that homicides will increase. Physical violence will probably escalate and what does that mean also for a health care system already pushed beyond capacity by people affected by COVID-19?”
Anne Markley, executive director of TESSA, which responds to domestic violence reports and helps victims, tells the Indy so far the number of calls for help hasn’t spiked.
But she fears the uncertainty of the virus and its financial impact could cause more incidents of domestic violence. “We are very prepared to eventually see an uptick in the numbers, largely because we’re asked to be more isolated,” she says. That means forcing some women to be at home with an abuser under pressure from possible job loss and with children home from school, which compounds stress in daily life.
She emphasized that TESSA, while not accepting walk-ins, maintains all of its services, from counseling to housing, through 24/7 advocates.
All of that is why mental health providers want people to understand how to break the cycle of anxiety.
AS THERAPIST LORI GOTTLIEB WROTE IN the Atlantic, “unchecked rumination” about the future health of yourself or your loved ones can cause people to “futurize and catastrophize,” which creates a cycle of worry.
She and others warn against clinging to news reports around the clock, which is “bloating our minds with unhealthy ‘foods’ that will make us feel sick.”
Lindsay Gries, AspenPointe’s director of psychology, agrees and recommends limiting time spent watching the news. “Watch twice a day, and change your focus to a calming activity,” she says.
A 2014 report from the U.S. Substance Abuse and Mental Health Services Administration backs up those warnings.
“You will want to stay up to date on news of the outbreak, particularly if you have loved ones in places where many people have gotten sick,” researchers advised. “But make sure to take time away from the news to focus on things in your life that are going well and that you can control.”
Feeling in control, Gries says, can guard against spiraling moods.
“Those who engage in mindfulness, it lets them feel more in control, more able to connect with loved ones,” Gries says. “Those who do more typical daily activities tend to do better in times of high stress.”
If a person can recognize that they’re stressed or depressed, they should take note of what’s causing those feelings. “The key is knowing how different stimuli affect you individually,” she says. “Structure your daily routine as much as possible, doing things that make us feel in control.”
Social distancing, however, can inhibit one’s ability to detect how friends or family members are coping, due to a lack of face-to-face meetings.
In that case, Gries suggests reaching out in other ways, via phone, text and video.
Those displaying signs of mental stress become more irritable, short with others and show a change in behavior, she says.
“People who are struggling might not think of reaching out to people,” she says. “They might rely on people in their lives to reach out and check in.”
Vincent Atchity, president and CEO of Mental Health Colorado, says text messages are good but “there’s no substitute for the human voice.” He also suggests the old fashioned letter placed in the U.S. mail.
“It ought to be part of everybody’s routine to build in time for communications,” he says. “Reach out to people we’re concerned about who are isolated. It’s on us to do that.
“We always see that amazing rescue footage from earthquakes where rescue workers are digging down to find the folks buried beneath rubble,” he adds. “We should dig in and find people who are buried in isolation.”
Atchity, reached by phone in his backyard, says staying home doesn’t have to translate to a dearth of contact with others.
“I’m standing outside talking to you,” he says. “I can see neighbors over there. They’re no threat to me over there. If you were working on the other side of the garden, we’re working in the garden together. We can keep each other 6 feet away. Structure your day, even if it’s a bunch of stuff that’s made up. These are strategies people living in space stations and people crossing the prairies figured out for themselves. Stay busy, think local, what can be affected by your own hands? These are good remedies for anxious obsessive concern about large global stories.”
IF THE MENTAL IMPACT OF ISOLATION OR a pandemic taking place around us seems elusive, consider this:
• A study by the University of Calgary and Alberta Health Services in Canada reports that those who are isolated experience higher rates of depression and anxiety than those who are not, based on a review of academic articles published on the topic before March 2019. “All studies except one showed negative impact of isolation precautions on anxiety,” it found.
• In 2012, the National Biodefense Science Board’s Disaster Mental Health Subcommittee recommended that government officials proscribe messages to the public that anticipate issues with high psychosocial impact, such as perceived scarcity of resources, varied implementation of federal guidance across state and local jurisdictions, and perceived fairness and equity. The subcommittee also noted the need for public education about how people’s mental health and behavior might be affected by crises and where they can seek help.
• Researchers from the Johns Hopkins Bloomberg School of Public Health reported in 2009 on mental health consequences of a pandemic, noting “psychological contagion” and fear, paranoia and anger “may drive behaviors that can include evacuation panic, resistance to public health measures, overburdening of hospitals and clinicians, blaming of the government, and abandoning responsibilities to families and jobs.”
Jarvis-Steinwert with NAMI of Colorado Springs, which relies on volunteers to help people manage crises, says signals of mental breakdown include changes in behaviors, extreme withdrawal, non-communication, anger, aggression, hostility and obsessive behaviors.
NAMI switched its group sessions to online meetings the week of March 22, she says, and has asked participants to evaluate how they’re working. It’s too early to arrive at concrete conclusions about that, she says. “We’re figuring it out as we go,” she says. But she adds she’s heard from the mental health provider community that capacity exists to increase numbers served through tele-health practices.
An AspenPointe spokesperson also noted that the agency is “embracing” tele-health delivery of mental health services and could expand availability of help.
So far, NAMI is seeing the numbers of people seeking help rise, which is understandable given the circumstances. “If you’re isolated, as some of us are, and you count on work life for a lot of social connection, when you leave that, it’s challenging for all of us, no matter how emotionally healthy we consider ourselves,” JarvisSteinwert says.
That’s why she strongly recommends people focus on their own needs — what she calls “the basics of self-care,” which are “stay hydrated, eat nutritiously, try to get some sleep, try to get some exercise.”
“I think this whole self-help thing is really important — for people to make it a priority to get the help they need,” she says. “You may not have ever had signs of any kind of behavioral health issue — although 20 percent of our population is struggling with a mental health challenge to begin with,” she says. “Have the courage to reach out and get the help you need, especially people not accustomed to feeling that way.”
ATCHITY, WITH MENTAL HEALTH COLORADO, says it’s too soon to measure the COVID-19 pandemic’s impact on Coloradans’ mental issues.
“It’s a little soon for any formal data,” he says. But he notes “an unusual volume” of responses to his agency’s daily email blast messages that provide tips for managing mental health wellness.
“We don’t normally get a lot of people writing back to us,” he says. “We’ve had a tremendous response rate, encouraging us to keep it coming.” Noting the state’s lack of mental health resources, Atchity predicts the pandemic’s toll could further tax that system. “We’re going to go from bad to worse if there’s an increase in demand for care,” he says.
Jarvis-Steinwert agrees the long-term impact of the pandemic on the general public’s mental health can’t be predicted, but she’s encouraged by the coping mechanisms she’s observed.
One person she knows who jogs daily with a friend has continued to do that remotely by hooking up headsets to have a phone connection while they’re running.
“They’re still catching up with each other while they run, rather than running side by side,” she says.
While on a walk on March 24, she rounded a corner to see a large group of people gathered on someone’s front lawn, all distanced 6 to 8 feet apart and enjoying one another’s company.
“There’s some good things that can come out of this,” she says. “We’re all going to exhibit symptoms and signs of post traumatic stress disorder, whether insomnia, lack of control of emotions. We have to know that’s going to happen and understand it and be accepting of it and get the help we need.”
Atchity, like others, recommends finding activities to divert attention from feelings of loneliness or idleness. But one activity he recommends doesn’t require any equipment or other participants.
“It’s an old thing, but one of the fundamental long-time mental health calls to action — count our blessings,” he says. “You’ve never had control of the future. There’s no morning in your life you were absolutely sure you’d make it to the end of the day. Instead of letting all those things worry and incapacitate you, stay focused and count your blessings.”