Counties step up mental health services

Three months into the COVID-19 pandemic, more than two million U.S. residents have seen the virus take root in their lungs, but a much larger share have felt it affect their minds.

As the tolls of physical distancing and economic uncertainty, along with anxiety resulting from the many unknowns of the novel coronavirus, add up to emotional stress and turmoil, effective mental health services have proven crucial to keeping residents functioning while they wait out a return to a somewhat familiar life.

Nearly one-third of Americans have been reporting signs of anxiety or depression since the pandemic began, according to the Household Pulse Survey by the National Center for Health Statistics and the Census Bureau. A poll by the Kaiser Family Health Foundation found that 45 percent of adults across the country say that worry and stress related to the pandemic are hurting their mental health.

Long-term, research by the Robert Graham Center for Policy Studies in Family Medicine and Primary Care and the Well Being Trust found that as many as 75,000 more people will die from drug or alcohol misuse and suicide throughout the decade if policymakers ignore the collateral damage from the pandemic as it affects Americans’ emotional well-being.

But as counties grapple with how best to provide mental health services, they are uncovering new challenges and also new adaptations that could pay off down the road.

Many counties report taking greater advantage of telehealth in assessing patients in distress, in addition to replacing in-person meetings with clients. They save time for both client and practitioner and limit exposure to the novel coronavirus.

“It’s magic,” said Sevet Johnson, behavioral health director for Ventura County, Calif., whose staff has rarely had enough personal protective equipment to safely enter hospitals where they would be at risk of contracting the virus. “We need to see their faces, have some interaction, see how they’re responding. But now we can see their faces, see their delays, their confusion, track their eye movement. That’s the kind of thing you would be able to do in person, and you get a good feel for what’s going on with them.”

In addition to avoiding a drop-off in efficacy, Johnson said the efficiency presented by telehealth, which wasn’t really on her department’s menu before the crisis, has been productive.

“We can assess three people in three hospitals over the course of six hours,” she said. “Usually we have to drive back and forth and that takes most of the time. We might have been able to do 1.5 a day beforehand.”

She also reports that administrative work has been more efficient with the adoption of telework.

“We’re finding benefits in the midst of all of this chaos,” she said.

How long the chaos lasts, however, will change the way counties are able to respond. After six weeks of physical distancing restrictions and stay-at-home orders in Madison County, Ill. Mental Health Board Director Deborah Humphrey saw everyday residents getting closer to a breaking point. While their calls for service hadn’t increased dramatically, anecdotes from community service practitioners have helped Humphrey monitor the county’s pulse.

“There are a lot of distressed people, they’re dealing with food scarcity, economic insecurity,” she said. “The longer this goes on, the worse it’s going to get. People are living on the edge right now, not knowing how long this is going to go on, ‘Am I going to be laid off? Are my hours going to be reduced?’ And parents are finding themselves suddenly becoming educators.”

In Clark County, Wash., Crisis Services Manager Kara Wade said her team received a lot of calls in late February and early March for people paranoid about exposure to COVID-19, a number that tapered off as March went on and residents stayed home.

“There was a steady stream of concern in their comments,” she said. “I expect we will hear from more people when we start opening back up.”

Her staff mainly evaluates patients in person, while maintaining physical distancing.

“If someone is already paranoid, to have to talk to someone in a little box, to not know where they’re coming from, that is unsettling. It’s better to provide the services in person.”

Concerns mount

Though Humphrey prides herself on maintaining healthy habits, she admits feeling social isolation wearing on her, and she can’t blame others for feeling the same way.

“I feel like I practice good self-care,” she said. “I get up, I take my shower, I get dressed like I’m going to the office, I’m doing the things I would if I were going to work. I take the boys (her husband and twin 11-year-old sons) on walks, we’re eating well, but I still feel that isolation from our friends even though you can do virtual with them. It’s just not the same.”

In addition to the cumulative stress from prolonged physical distancing, Humphrey sees emotional challenges coming when the county’s economy restarts.

“To me, when I’m in a crisis, I tend to maintain through that,” she said, “Afterword, when I get through it and reflect on what I went through, that’s when it hits me. I think a lot of people are going to see a need for help right about when they expect things to get better.”

Johnson said Ventura County has seen about half as many suicides among residents compared to the same four months of 2019, but she also expects mental distress to pick back up when residents get a full view of the economic upheaval.

“We haven’t seen a huge surge yet, but we’re more worried about later,” she said.

Humphrey lives three blocks away from her 87-year-old mother, and while her family can interact with their matriarch from her porch, it isn’t the same, she said.

That sense of social isolation is a feeling Oakland County, Mich. Commissioner Katherine Nelson anticipates many of her county’s residents are feeling as a result of physical distancing measures, and successfully pitched the Social Connectedness Task Force to the County Board. “We are an aging county, and senior isolation is the perfect breeding ground for loneliness,” she said, noting that seniors there often lose many “snowbird friends” in the winter. “What can we do in light of living in a time where we have to practice physical distancing?”

Nelson said some seniors have reported struggling with the purpose of each day while isolated.

“We know that digital solutions aren’t the only solutions,” she said. “They don’t have access to family members, and they’re frustrated with not knowing how to use technology. Everyone is talking about these great digital platforms, but if they don’t know how to use FaceTime, and their relatives can’t come over to teach them, what use is it to them?”

The task force will identify solutions to reduce social isolation and loneliness among the county’s senior population.

Although some older residents have been resistant to adopting videoconferencing, Johnson said it has helped bring in participants in Ventura County’s DUI treatment program, many of whom face transportation barriers to reach meetings.

“We’ve seen a significant increase in participation that we haven’t seen in years,” she said. “If they can just sign into Zoom and participate in their classes to get their licenses back, people are eager and they are showing up in unprecedented numbers.”

“I think staff are adapting well and our clients are too,” she said. “We’re finding while it’s different and it’s not something we really planned for, given the current stay-at-home orders and we can’t see most of our clients face-to-face like we routinely would, we found some great efficiencies and we found some great processes that we really would love to be able to use in the future.”

Humphrey continues worrying about the future, not just for the idled workers and the heads of households. With summer approaching and school closures continuing, she is concerned for the social development of children who haven’t seen their friends in months.

“We probably won’t have summer camps and we probably won’t have sports leagues, but there has to be a way the parks departments can do some program while practicing social distancing,” she said, “In my own children, I can see their energy level is off the charts. Part of that is from not having gym and running around, but I see it as a lot of nervous energy; that’s how children manifest stress.”

Like Johnson, Humphrey does see a positive for her field coming out of the pandemic.

“Mental health practitioners have been trying to raise consciousness forever, and now it’s hitting everybody’s doorstep,” she said. “Our county chairman said the Board is looking at things differently, mental health is one of the top five issues for the county. I never thought we’d see the day with that kind of support from that level. This is negative, but it’s given us an opportunity to get out there and talk about mental health and engage the public right now while we can.”

Mental health during COVID-19: What some counties are seeing and doing

• Coconino County, Ariz. Community Services will begin offering financial coaching classes via Zoom to help individuals prepare for a financial crisis.
• Arapahoe County, Colo. has added a support line staffed by bilingual behavioral health experts.
• The DeKalb County, Ga. community services board/pharmacy services has arranged for same-day delivery of medication refills to the homes for all clients using telehealth access.
• Though Solano County, Calif. adult wellness centers are now closed, the agency set up “buddy calls” so local residents can provide peer support to one another. Agency staff are also calling them to check in and are delivering food.
• The San Diego County, Calif. suicide prevention and stigma reduction campaign began media messaging that directly addresses behavioral health impacts of COVID-19, including impacts of prolonged isolation.
• Cook County, Ill. created multidisciplinary behavioral health tactical teams that include psychiatrists, mental health Advanced Practice RNs, MAT (medication-assisted treatment) certified medical providers, psychologists and LCSWs to provide telehealth services to individuals experiencing homelessness and residing in shelters.
• Palm Beach County, Fla. implemented a strategy to ensure food distribution and services to seniors and other populations in partnership with community-based partners, faith-based community and local municipalities.
• Charlotte County, Fla. added a free hotline staffed with two therapists, dedicated toward those who are not currently in treatment, but are seeing an exacerbation of stressors like job loss or illness.