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COVID Stressing the Nation’s Stress Therapy System

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Jan. 8, 2021 -- Lucy McBride, MD, is a primary care doctor in Washington, DC, who makes time during appointments to address her patients’ physical and mental health in tandem. Never in her 20-year career, she says, has she seen the need for mental health support as great as it is now.

“COVID-19 has basically poured lighter fluid on a preexisting fire,” she says. “We already had diseases of despair at very high levels in terms of addiction, depression, trauma, anxiety, isolation, loneliness, and more. The pandemic has only heightened preexisting mental health challenges. And many people are being forced to reckon with their mental health for the first time."

Kati Duncan, PsyD, a licensed clinical psychologist in Chesapeake, VA, is seeing the same. “I’ve been in practice for 15 years and have never seen it like this,” she says. “The need for therapy has increased, but the number of therapists has not. We all have waitlists, are working more days and longer hours, and taking tougher cases.

Duncan says she can’t take on any more patients, and many of her colleagues are also booked solid. “In fact, I recently tried to get somebody help who was in crisis, and I really had to pull some strings to make it happen,” she says.

There’s no question the nation’s mental health system is stressed and strained amid the increased need that COVID-19 continues to create. And that help is also harder to find -- not only because of the availability of mental health professionals, but also because money is tight for many, counseling often isn’t covered by insurance, and many simply can’t afford it.

So what should you do if you or someone you love is in need of support? Here are some ideas.

The Effect of COVID Trauma on Our Mental Health

Doctors say that first, it’s important to understand the toll COVID-19 is taking on our collective mental health. McBride says we’re seeing the effects of widespread trauma on society. “Trauma is the reaction to feeling unsafe. We’re wired for safety, and with an invisible, ubiquitous, and potentially lethal virus in circulation, we simply don't feel safe. As a result, people are struggling with fear, vulnerability, worry, depression, and often adopt behaviors to numb those uncomfortable feelings.”

The DC-based doctor says the trauma is only worsened when you or someone you know or love actually gets COVID-19, as her husband did in November. “The anxiety of having it in your home is intense. You have no idea if your loved one will experience minor symptoms, end up in the hospital, or die. You also worry about who else you might have infected without knowing it. The ripple effects are huge."

With more than 21 million cases confirmed in the United States, these fears are widespread.

Having this level of fear, vulnerability and uncertainty hang over our heads for months takes a toll that has vast amounts of people needing professional mental health support. But that help can be hard to find for a variety of reasons.

“That's one of the hardest things about seeking mental health care. When we need it, we're often emotionally and mentally overwhelmed and unable to find it,” says Lynn Bufka, PhD, senior director of practice transformation and quality at the American Psychological Association, and a licensed clinical psychologist who sees patients in Maryland.

“Add to that, right now, the sources of support we normally rely on like friends and family are likely socially distant because of the pandemic and may also be equally overwhelmed, stressed, struggling, and unable to help like they typically do. Our capacity to cope is stretched pretty thin right now.”

There are often financial barriers, too. Mental health services often aren’t covered by insurance, and getting help is generally pricey. A session of therapy costs $65 to $250 in the U.S., but most people pay between $100 and $200 per session.

Mental health professionals in the U.S. are also stretched quite thin now. “We have our members telling us that they are busier now than they have been and that they have more referrals than they know what to do with,” Bufka says. “People are seeking help everywhere. There are waitlists, and it’s very hard to keep up with the demand right now.”

There were shortages of mental health professionals before the pandemic. Data shows there were 30 psychologists and 15 psychiatrists per every 100,000 people in the U.S., and in some places, that radio dropped to just one professional for every 30,000 people. (That’s compared to nearly 280 doctors in general per 100,000 people in the United States). Data from Mental Health America also shows almost a quarter (22.3%) of all adults with a mental illness say they aren’t able to get the treatment they need. That number has stayed steady since 2011.

Bufka says there’s no doubt the search for mental health help is complicated by the fact that providers aren’t always where the need is. “We know that there are many more mental health providers on the coasts than in the middle of the country; and in the South, there are fewer than say in other parts of the country. But that doesn't mean the need is less in those parts of the country,” she says.

Where to Look for Mental Health Help

It’s a complex situation, and experts say there are no easy answers. If somebody is having suicidal thoughts or is in crisis, certainly go to an emergency room, call 911, or talk to your health care provider to get immediate help. For those not at that crisis point, but still feeling distressed and overwhelmed, Bufka admits that accessing care becomes far more challenging amid such demand. “That’s where the options for help become harder to find. You’re not going to be pushed to the top of the list to get into care because you're not an imminent threat to yourself or others. But how long does a person continue struggling and struggling and struggling?”

The pandemic is highlighting a variety of ways to access support. Telehealth is one, and Bufka says research does show that it works well. “I think it's important to make sure people know that telehealth, receiving mental health care via video conferencing and actually over the phone, has been demonstrated to be as effective as in the office, face-to-face with somebody,” she says.

Other places you can look for support:

  • Your primary care doctor: If you have one, start with them. They are likely to know good resources in your community.
  • State psychological associations: Bufka says checking in with these organizations may help you get leads on resources near you.
  • College counseling centers: These can be great resources for college students.
  • Work-based wellness and emotional support tools: Investigate whether your job offers these resources.
  • Some universities are affiliated with training clinics for graduate programs.
  • Some parts of the country have sliding-scale, low-fee clinics or free counseling programs.
  • The National Alliance on Mental Illness has a free hotline that can be accessed Monday-Friday to help people get information, resources, and referrals.
  • The Trevor Project has a 24/7 crisis hotline for LGBTQ youth.
  • The United Way has a free and confidential service to help connect people with resources in their communities.
  • The Substance Abuse and Mental Health Services Administration (SAMHSA) has a 24/7, 365-day-a-year National Helpline that is free, confidential, and offers treatment referral and information to individuals and families dealing with mental and/or substance use disorders.
  • The Alcoholics Anonymous (AA) 12-step recovery program is a free treatment program available across the country for people dealing with alcohol abuse and addiction, and meetings are now available virtually on digital platforms during the pandemic.

Digital resources: Mental health apps offer support through cognitive behavioral therapy, self-care exercises, meditation, and more, including Happify, Headspace, Calm, MoodKit, MindShift, Bloom CBT Therapy and Self Care App, and others. The Anxiety and Depression Association of America reviews some of them and posts the results on its website.

Many people are turning to text therapy, too. The services have been around since before the pandemic through companies like BetterHelp, Talkspace, and others. They allow patients to send audio, photos, video, or texts to therapists. Some offer live video sessions and telehealth options.

Amy Cirbus, PhD, is a licensed mental health counselor in New York City and a licensed professional counselor in New Jersey. She saw patients face-to-face for 10 years before becoming the director of clinical content at Talkspace, an online therapy platform with thousands of providers. She now sees clients in her private practice and on the Talkspace platform and says demand is definitely up during the pandemic.

“We’ve seen an overall increase in demand for services, specifically with clients who are seeking therapy for the first time, and these numbers continue to climb,” she says. “Likewise, we're seeing people who have previously felt they've overcome mental health hurdles feel they need to return to therapy, but are unable to get to there for a number of different reasons.”

Cirbus says that therapy through digital platforms is different from traditional methods and that it’s important to set clear expectations at the start. But she says this format can be incredibly useful for many.

Bufka says that data isn’t as clear or robust when it comes to text therapy. There have been some studies showing patients connect well with their therapists via text, but the studies are very small. The American Psychological Association has tips on its website if you are considering online therapy.

McBride, the primary care doctor, says virtual therapy is only as good as the relationship with your therapist, but it can be very helpful -- and provide a lifeline -- for many.

“Ultimately, you need a safe, nonjudgmental space to work on mental health issues,” she says. “If that starts with your doctor, great. And if you can find that through online or virtual therapy, that is a step in the right direction.”

Other Ways to Focus on Your Mental Health

Experts stress that in an ideal world, you should have a therapist if you need one, and they urge people to keep looking for one, even if it’s hard. But they also stress there is much we can do -- with or without a therapist -- to manage increased stress with small life changes and mental mind shifts.

“For the person who's lost their job or facing eviction, this will feel out of touch with their world,” Bufka stresses. “But for those who are feeling stressed and overwhelmed but still have some stability, there is an opportunity to reframe what's going on.”  

Start with an evaluation of 24 hours of your life, and look at small tweaks you can make to help your mental and emotional health.

“I do this with myself,” she says. “Have I been sitting all day? OK, I need to get up and go on a walk. Have I been eating cookies and Doritos and Diet Coke all day? I know I’ll feel better if I have a salad too. I try to do a little self-assessment and then correct what I can.”

Focus on just one thing at a time rather than trying to make many changes to your life at once, she says. No one thing in isolation will solve your problems, but it could be the first step to giving you more control over your day and perhaps a little space in your life to slow down and not feel overwhelmed. That could be going for a short walk each day, eating dinner as a family, or having a dance party when the school day ends.

Bufka suggests talking with friends or loved ones about becoming someone you check in with daily to stay on track with your goals. She also says if you find yourself spiraling into anxious thoughts about all that you can’t control with the virus, you can zero in on what is in your control. “I can control whether I wear a mask when I go out in public, whether I call my mom and talk to her every week just to check in, or have long conversations with my best friend who lives 700 miles away when we're both walking our dogs,” Bufka says.

Intentionally searching for the good in your day -- even if it’s small things like no longer having to commute, deal with traffic, spend money on tolls, etc. -- can also help shift you toward a more positive mindset she says.

McBride offers suggestions to people in a newsletter she started during the pandemic that now has more than 8,000 subscribers. She writes often about the intersection of physical and mental health during the pandemic and what people can do to manage all they are feeling or struggling with. Some of her recommendations include:

  • Prioritize sleep. Get 7 to 8 hours every night. “That is the glue that keeps our mood, stress levels, and concentration under control,” McBride says.
  • Make sure you move each day. It doesn’t have to be a gym or anything fancy -- just move every day, even if it’s just a walk around the block or making sure you aren’t sitting all day inside your home.
  • Get outside daily. People are staying in their homes so much more during quarantine, but McBride says breathing in fresh air and being in nature go a long way in quieting stress hormones.
  • Make time to do nothing. We’re all so busy these days that McBride stresses the importance of building moments into your day that allow you to create time and space between your thoughts and actions so you aren’t reacting to one stressor after another all day long.
  • Focus on good nutrition. Eat healthy foods, and avoid skipping meals, which only promotes binge eating later. Aim for a balanced diet that includes proteins, carbs, and fruits and vegetables.
  • Make time for mindfulness, whether it’s meditating with a free app, doing some yoga through a video on YouTube, journaling at the beginning or end of the day, or just stopping throughout the day for some deep breaths. Build calm moments into your day.
  • Connect however you can. Talk with a trusted friend or religious leader, do a video chat with friends, wave to neighbors, and talk from a safe, socially distant spot -- interact however it’s safely possible. “We do need social connections to be healthier mentally, and sometimes when we’re struggling, we tend to withdraw when really we need to connect with others more than anything,” McBride says.

She says she urges her patients to have hope because, she says, as hard as this pandemic has been, there are hopeful signs on the horizon.

She recently got the first dose of a COVID vaccine and says she was amazed at the mental load that lifted for her. She shared this in her newsletter and is talking about it with patients to make sure people realize there is a light at the end of the tunnel.

“Now that we have a little bit of hope, it can make it feel a bit easier to get through the day,” McBride says. “It feels like help is on the way.”

WebMD Health News

Sources

Amy Cirbus, PhD, Talkspace, New York City.

Lucy McBride, MD, Foxhall Internists, Washington, DC.

LucyMcBride.com.

Lynn Bufka, PhD, American Psychological Association, Washington, DC.

American Psychological Association.

Death Studies: “Internet-based cognitive-behavioral therapy for complicated grief: a randomized controlled trial.”

Psychiatric Services: “Outcomes of 98,609 U.S. Department of Veterans Affairs patients enrolled in telemental health services, 2006-2010.”

Alcoholics Anonymous: “Physically Distanced but Digitally Connected: The Alcoholics Anonymous Message Carries On Amid Coronavirus (COVID-19).”

Anxiety and Depression Association of America: “ADAA-Reviewed Mental Health Apps.”

American Psychological Association. “What You Need to Know Before Choosing Online Therapy.”

Goodtherapy.org: “Is There a Shortage of Mental Health Professionals in America?” “How Much Does Therapy Cost?”

Mental Health America: “Adults With AMI Reporting Unmet Need 2020.”

National Alliance on Mental Illness: “NAMI HelpLine.”

Substance Abuse and Mental Health Services Administration.

Talkspace.com.

The Trevor Project

UnitedWay.org.

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