A couple of weeks ago, Americans were trucking along the busy highway of life, mindful of stock market and other signposts along the way but more or less keeping their loads balanced. Then the new coronavirus slammed on the brakes, causing a multi-vehicle pileup that commingled their stuff — their jobs, their kids’ schools, every aspect of their lives — in a big mess on the freeway.
Mental health professionals who are front-line responders in the spill are already seeing a spike in demand for their services as millions of Americans face the prospect they could be cooped up in their homes for weeks.
“We have to change how we’re navigating life,” psychotherapist Danica Delgado told Patch in a telephone conversation from her home office in West Hartford, Connecticut. “We were all living our lives, the moving parts were working, and now we don’t have the control to continue to make those things happen.”
The sudden loss of control over simple things is an adjustment for everyone, whether they were seeing a therapist or not, says Mary Ann Starkes, a psychiatric nurse practitioner from Hamden, Connecticut.
“It’s the unknown,” she says. “You can’t see it, you don’t know how to fight it, and what you hear every time you turn on the news is that it’s getting worse, but we don’t know what the worst is.”
States fell like dominoes last week as governors and mayors announced shelter-in-place orders or asked residents of their states and cities to leave their homes only for essential business, such as going to the grocery store or filling a prescription at the pharmacy.
The U.S. Centers for Disease Control and Prevention has tips for people to manage increased stress surrounding the new coronavirus, including:
Therapist Couches Move Online
Mental health experts have changed the way they treat their patients. They prefer face-to-face, in-person sessions; for now, though, that’s not possible in most parts of the country.
Delgado and Starkes are among a growing number of counselors, psychologists and psychiatrists who are taking their practices online — in effect, dealing with a disruption in their own lives as they help people navigate depression, anxiety, panic and other mental health issues that can be exacerbated by prolonged isolation.
“This isn’t a profession that can hang out at home and not work,” Delgado says. “We need to be present and available.”
Various models show hospital readiness for COVID-19 patients, but no such model exists for how the emotional toll of the global pandemic could burden mental health systems.
And though the United States is yet to see the full effect of the virus’s spread, Delgado says the longer the crisis drags on, the more demand she expects to see for her services among people who previously never sought mental health counseling.
“People in the general population who were not struggling with mental health stuff before this happened are now facing the fear of the unknown — something new that feels like a bigger fear than other things that have been around for a while,” she says. “This unpredictability is something we’re all swimming in.”
It’s not just that Americans can’t go about their lives in the same way they did just weeks ago. They’re isolated from friends and extended family members and don’t have their normal social outlets. Everything that was normal in their lives has been upended.
Little Things Can Mount Up
Delgado says isolation can fuel worry about the possibility of losing a job and the ability to pay rent or a mortgage, whether their 401(k) plans will recover, the overall economic health of the country and other financial stressors.
“It’s really broad-based,” Delgado says of the range of emotions shut-in Americans may feel. “It could be distrust, or a sense of anger or frustration with people who aren’t going with the program — the toilet paper hoarders and the people with N95 respirators who are keeping them for themselves instead of giving them to health care workers.”
In other words, little things can add up.
“I anticipate more people will be dealing with anxiety,” Delgado says. “We might see higher rates of depression and anxiety, and increased trauma symptoms in those people who have had trauma related to their physical health or a loss.”
Particularly vulnerable are patients who live alone and are battling severe depression or anxiety, Starkes says, noting that she has increased the dosage on some of her patients’ prescription drugs more times in the last two weeks than ever before in her career. Starkes is in her 70s.
No one knows how long the coronavirus pandemic — so categorized by the World Health Organization because of its global scope — will sideline life in the United States.
Locks snapped shut on nonessential businesses across America week, and bleak statistics about the spread of COVID-19, the illness caused by the virus, greeted Americans at the start of this week.
Dr. Jerome Adams, the U.S. surgeon general, drove home that point in a dire warning Monday, telling NBC News: “I want America to understand — this week, it’s going to get bad.”
The number of dead in the United States has increased daily, sometimes dramatically in a single day, according to Johns Hopkins University. A week ago the number of deaths was 70. By Tuesday, the death toll was approaching 600.
It may seem counterintuitive, but the greatest risk isn’t so much for patients with severe symptoms who become more anxious or depressed by the uncertainties surrounding the coronavirus, Starkes says.
“If somebody is very acute, it’s easier to treat,” she says. “It’s those subacute people who fall between the cracks. There are always some on the bell curve who do very well, some who do terrible and some people in the middle.”
Psychological Effects of Quarantine
There isn’t a lot of research on the psychological effects of quarantines, whether voluntary or ordered, but a study of patients quarantined in the 2003 SARS outbreak showed they exhibited increased symptoms of anxiety and depression and feelings of fear, abandonment, loneliness and stigmatization.
The study, published in the British Journal of Psychology in 2004, helped inform the protocol when 15 passengers who had been stuck for weeks on the Diamond Princess cruise ship were put under medical isolation last month at the University of Nebraska Medical Center at the Nebraska Biocontainment Unit and National Quarantine Center housed there.
One emotion the passengers shared in common was loss of control, according to a news release from the American Psychological Association.
One-on-one counseling sessions were made available at patients’ request or if they were flagged by a health care worker. But the medical staff also conducted virtual “town hall” meetings to focus on wellness and resilience, the importance of staying busy, mindfulness and relaxation exercise, the importance of social support, and ways to manage their stress.
The UNMC team couldn’t do that while caring for patients during the Ebola outbreak in 2014; each patient came to the hospital alone.
“For the first time, we have enough people to build a community,” David Cates, a clinical psychologist and behavioral health consultant at the biocontainment unit and quarantine center, says in an American Psychological Association news release. “We launched these daily meetings to capitalize on that.”
Those meetings helped the UNMC team better understand what extended isolation felt like for those patients when they weren’t able to tap into coping strategies, such as social support, spiritual or religious practices, or outdoor exercise. Those feelings, along with missing work or other obligations, can trigger a powerful sense of losing control, so Cates designed the daily meetings to talk about those things.
‘Do Something Lovely’
Starkes and Delgado focus on the same in their online counseling with patients. Remote access isn’t ideal. Therapists rely on visual cues in their sessions, and some of those may not be as noticeable in internet settings.
But the clues are often there, Starkes says.
“Because I do Facetime, I can see if someone’s still in their PJs at the end of the day,” she says. “We all need structure. It’s a way to mimic life as it used to be as much as possible.
“I get up, brush my teeth, take a shower and get fully dressed, and the reason is for my own mental health — a sense I’m doing something. It’s too easy to slip into losing your whole self and a sense of what you’re doing and when you’re doing. That can lead to depression for everybody.”
Starkes says she works with her patients to “focus on what’s right in front of them, rather than getting sucked into this idea that it’s forever.”
“Make sure you feel like you’re being productive and useful,” she says. “Do something you care about. Do something for yourself that is lovely.”