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By Real World Health Care Editorial Staff  |  Mar 3, 2021

A Pandemic of Uncertainty: Mental Health Challenges in the Era of COVID

For over a year, the world has lived under the dark cloud of the COVID-19 pandemic, a global, population-wide traumatizing event that has impacted people in a variety of ways – physically, financially and emotionally.

According to Maddy Reinert, Senior Director of Population Health, Mental Health America (MHA), the pandemic has had “disastrous” effects on mental health and has led to a mental health crisis that will extend long after everyone is vaccinated and the virus is no longer a threat.

Maddy Reinert

Maddy Reinert, Mental Health America

She pointed to several COVID-related factors contributing to stress, anxiety, depression and other mental health conditions: “Fear of contracting the disease or a loved one contracting the disease is very real, as are uncertainties around how to keep ourselves and our loved ones safe,” she said. “Add to that the fact that our entire physical and social environment, and the ‘normal’ ways in which we interact with that environment, have changed. Those changes come with grief for what our world once was.”

According to Reinert, people are experiencing anxiety and uncertainty about immediate concerns like losing their jobs, homes, and ability to access food and medical care. They also may feel a sense of shame if they contract the virus, especially if they have been following public health guidance. These issues are compounded when normal avenues for assistance are more difficult to find due to stay-at-home orders and shutdowns.

Dr. Debra Kissen

Dr. Debra Kissen

“Uncertainty has come in waves,” added Debra Kissen, PhD, MHSA, CEO of Light on Anxiety CBT Treatment Centers and co-chair of the Public Education committee of the Anxiety and Depression Association of America. “It started with questions like how long will the pandemic go on? How am I going to work from home? Is my children’s education going to suffer? Then it moved to questions like Should I get tested? Is it ok for me to get a vaccine before someone else who may be more deserving?”

Screening for Mental Health Distress

At MHA, Reinert is responsible for collecting, analyzing and interpreting data from the organization’s free, confidential and clinically validated mental health screening tools. She shared results of MHA’s screening data for the period of April-December 2020, noting that loneliness was the most-often reported contributing factor to mental distress during that time – even more than the virus itself.

“Humans are social animals who make connections with others,” Reinert said. “Now that school, work and other gatherings have gone virtual or have been cancelled, we can no longer be in close proximity with others, which can make us feel like we’re lacking those connections.”

Just over 70 percent of those who screened at risk for moderate to severe anxiety or depression said they experienced loneliness, a figure that jumped to 78 percent among children ages 11-17. Children 11-17 also screened at higher rates for moderate to severe symptoms of depression and anxiety in general, and more frequent suicidal ideation, than other age groups.

“We typically think of children as being resilient, but they are showing more negative effects than other age groups,” she said. “Most teens and children have not experienced this level of consistent trauma and they may not have the perspective and foresight that adults do in terms of knowing that things will get better eventually.”

Health Care Workers Face Significant Mental Health Burden

According to Reinert, health care workers also are particularly vulnerable to mental health issues arising from the pandemic. “They are exposed to the virus every day, their workloads have drastically increased, and they’re not getting a break,” she said. “There’s a tremendous amount of emotional exhaustion associated with witnessing daily suffering among patients and their families.”

MHA used its online mental health screening site to survey more than a thousand health care workers over a four-month period last year and found:

  • 93 percent reported experiencing stress.
  • 86 percent reported experiencing anxiety.
  • 77 percent reported experiencing frustration.
  • 76 percent reported experiencing exhaustion and burnout.
  • 70 percent reported trouble sleeping.
  • 63 percent reported experiencing work-related dread.

“Of particular concern, the survey found that 39 percent of health care workers and 45 percent of nurses felt they weren’t receiving adequate social support,” Reinert said. “We must remember, even when the pandemic goes away, the mental health impacts of what health care workers have experienced will remain for quite a while.”

Validating and Addressing Mental Health Concerns

Reinert stressed the importance of addressing mental health concerns before they rise to the level of crisis or become a chronic condition. Immediate support for a mental health crisis is available from the National Suicide Prevention Lifeline, a 24/7, free and confidential support program, by calling 1-800-273-8255. Immediate support also is available from Crisis Text Line, by texting MHA to 741741 to be connected to a trained Crisis Counselor 24/7.

“It is crucial for people and their loved ones to validate feelings of stress, anxiety and depression,” Reinert said. “These are all normal reactions. Let yourself feel what you’re feeling and treat yourself with compassion. Don’t be afraid to ask for help or to talk to the people in your life about what you’re feeling. You may be surprised to learn they share your feelings.”

If a friend or loved one seems to be showing symptoms of mental distress, Dr. Kissen said it is important to be available for them in a non-judgmental manner.

“It’s natural for people to want to solve a loved one’s problem, but that often can have the opposite effect,” she said. “Instead of saying ‘you don’t seem well, and I think you need therapy,’ just listen to and validate what they’re saying, and try to relate in a genuine way.”

Validating feelings of stress or anxiety is especially important for those who had a pre-existing mental health condition, because worsening stress can exacerbate existing symptoms. Moreover, pandemic restrictions and a lack of daily structure can make it difficult for people to maintain coping strategies like exercising, visiting with loved ones and maintaining treatment regimens.

“In some ways, people with existing mental health conditions are doing quite well, because they already understand what it’s like to be afraid and to push themselves forward when they’re struggling,” said Dr. Kissen. “It’s like they’ve been training for this marathon we know as the COVID pandemic and have already learned the lessons and coping skills they need to exhibit.”

According to MHA’s Reinert, the increased acceptance and use of tele-mental health services has helped improve access to mental health treatment at a time when in-person therapies were placed on hold – a trend she hopes will continue after the pandemic ends.

“The good news is that more people are striving to get mental health services,” said Dr. Kissen. “The not-so-good news is that some mental health services providers have struggled to meet the increased demand. That’s one of the reasons our practice has continued to offer in-person appointments, using proper social distancing inside and even moving outside to walk and talk. For some clients, getting out of their home and interacting with another human being is beneficial. The important thing as a therapist is to be as accessible and creative as possible to meet our clients’ needs.”

Mental Health Resources

MHA and ADAA offer COVID-specific online resources for those seeking mental health information.

ADAA’s Coronavirus Corner includes helpful tips and resources to manage anxiety. A series of free videos covers COVID-related topics as diverse as managing COVID fatigue, racial inequities, and how to cope with worries and fears about finances during the pandemic. The site also provides links to resources on tele-mental health for both therapists and the general public.

“ADAA has done an outstanding job of presenting free, high-quality resources from top mental health experts as well as professional education and training resources for therapists,” said Dr. Kissen. “As clinicians, we tend to get down in the trenches with our clients, so it’s nice to have ADAA as a professional home of sorts.”

MHA’s COVID-19 site provides information from trusted sources on topics such as wellness and coping skills and caregiving and parenting, as well as targeted information to help vulnerable populations, including those with existing mental health concerns, frontline workers and Black, indigenous, and persons of color (VIPOC) and LGBTQ communities. It also provides access to a variety of mental health screening tools that give people a quick snapshot of their mental health, after which they are immediately directed to information, resources and tools to help them understand and improve their mental health.

“These screening tools are useful for early identification and intervention,” Reinert said. “We’re also using the de-identified data we collect to further our population health initiatives and advocate for more mental health resources on a federal level as well as support and inform services for our national network of 200 local affiliates. It has become the largest data set of mental health help-seeking individuals and the only real-time data set to monitor mental health throughout the U.S. during the pandemic.”

Reinert concluded with a message of hope: “The COVID-19 pandemic will not last forever. It’s OK to be in mourning for your old life and the people and things that have been lost. But try to keep looking forward. Don’t give up on new possibilities. Even if life can’t be the same again, it can be good again.”

A Message from our Sponsor

To help meet the mental health needs of frontline health care workers during the COVID-19 pandemic, the HealthWell Foundation has launched a new fund to provide copayment assistance for behavioral health treatments. Through the COVID-19 Frontline Health Care Workers Behavioral Health Fund, HealthWell will provide up to $2,000 in financial assistance for a 12-month grant period to eligible health care workers who have annual household incomes up to 500 percent of the federal poverty level.

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