Mental health and coping in the time of COVID

“I hear you.”

Often it helps just to know you are not alone in struggling through a tough time, wrestling with difficult emotions. Living through the first pandemic of most of our lifetimes has more people than ever experiencing depression, anxiety or other mental illnesses, says Milwaukee County’s Medical Director of Crisis Services Dr. Tony Thrasher.

“Some of the things we talk about may be very emotional, they can be very personal,” he says. “You may in some of these scenarios, see yourself or a friend or a loved one or a family member, or somebody that you have worked with before in the past.” 

Thrasher, a psychiatrist specializing in emergency and crisis medicine, describes what people are going through in this pandemic using the Kubler Ross stages of grief: denial, anger, bargaining, depression and acceptance. It’s not always these five, he adds, and not always in this order. But very often the process of grieving does involve a majority of them. 

“When I approached the pandemic, I approached this from a perspective of grief,” says Thrasher. “We are grieving for a life we once lived. And that can mean from things that we were used to, such as going out to a restaurant after work and talking with friends, or it could mean missing out on hosting a 40 to 50 person Thanksgiving that we really look forward to every year.”

While some people are still in denial that there is a pandemic, Thrasher says most individuals he works with “are now somewhere in those fourth and fifth components, a depression kind of knowing that the pandemic is here and how it’s affecting us and heading towards an acceptance of how we can approach this. … That doesn’t mean the other stages vanish. But it does mean it gives us a more healthy, adaptive way of coping.”

Thrasher, speaking to the Milwaukee Rotary Club on Nov. 24, quoted from the American Journal of Public Health’s Oct. 2020 issue, which read, “The social isolation, financial hardship and fear associated with this pandemic could present a perfect storm for public mental health in the US.” 

Thrasher would edit the word “could,” saying straight up that the pandemic has created a perfect storm. To wit, Centers for Disease Control and Prevention (CDC) data shows that mental health symptoms and COVID cases are tied so closely together that a state that had twice as many COVID diagnoses also had twice as many mental health issues. 

“The two subcategories of mental illness that have shown the greatest rise since the pandemic have been anxiety disorders, and depressive disorders,” Thrasher adds. “There are many other disorders which we treat which are being complicated by the pandemic, but we aren’t necessarily seeing an increase in, say, schizophrenia disorder or obsessive compulsive disorder.”

There is a higher rate of positive COVID-19 tests among people diagnosed with mental illness, he says, and worse outcomes for people with mental illness who are hospitalized with coronavirus. There is no explanation yet, Thrasher says, for why coronavirus outcomes are more adverse for those with mental illnesses.

And then things exploded

At the Wisconsin branch of the National Alliance on Mental Illness (NAMI Wisconsin), when the pandemic hit in March, Executive Director Mary Kay Battaglia braced herself, waiting for her phone to explode with calls. She was worried because her group offers support groups, family classes and peer groups among other meetings supporting people who have mental illnesses and their families. But she needed to send her staff of seven to work from home.

“The irony was, it was just dead quiet here,” says Battaglia. “My phone was not ringing at all and I think everybody was in kind of a state of shock wondering what was going on. And then about a month into the pandemic I think people were just not able to handle it anymore and that’s when we started getting a lot of calls — and not only from people that were previously diagnosed with mental illness, but lots and lots of new people.”

According to the CDC, by June of this year 40% of adults in the United States were struggling with their mental health or substance abuse or both. Thrasher, who as a doctor worked a 14-hour day himself leading up to his Rotary talk, points out that many healthcare workers, feeling overwhelmed, burnt out and helpless are experiencing mental health struggles. They get little time off and are forced into making choices about providing care that they don’t want to make.

For healthcare workers and the general public, these feelings are adding to what’s being called the indirect death toll from the pandemic.

The World Health Organization warned in September that the pandemic “may exacerbate suicide risk factors,” and urged people to speak out and connect, as well as learn to identify warning signs to prevent suicide and domestic abuse. 

Battaglia attributes the rise in new clients not only to increased isolation during the pandemic — or the tremendous burden placed on healthcare and other frontline workers — but additionally to stress that arises from losing a job, and often tied to that, losing health insurance. FInancial burdens and capacity limits can mean people who are symptomatic may not seek healthcare immediately. She has experienced that first hand, losing her brother to a heart attack that occurred shortly after he came down with COVID symptoms.

Recent studies have shown, she says, a 30 – 40% increase in people diagnosed with anxiety. She, too, urges people to seek help, not waiting for things to reach a crisis — although she says that the stigma associated with mental illness often keeps people from doing so. But, she adds, that means “the recovery is so much longer and so much harder.”

All of these problems are more difficult to address due to a lack of sufficient mental health and other medical providers. “It is hard as an organization that’s encouraging people to seek out help early when there’s not enough helpers out there. It’s a very frustrating formula right now for all of us.” 

Another troubling trend looking into future years is that people who have tested positive for the coronavirus are reporting a 30% increase in neurological symptoms after recovery from the coronavirus.

Governor urges reaching out

The state Department of Health Services (DHS) is swamped dealing with COVID-19 testing, falling far behind in contact tracing and begging for compliance with public health orders, such as wearing a mask and avoiding large gatherings, that are being knocked down by Republican lawsuits. 

Yet DHS began talking about mental health issues early on in the pandemic, establishing outreach and a website dedicated to the topic it branded ‘Resilient Wisconsin.’ The site addresses toxic stress and trauma and says both are “a risk factor for — and a painful consequence of — some of Wisconsin’s most complex public health challenges, from mental health disorders and harmful substance use to child abuse and suicide. They’re all connected.”

At a recent media briefing, Gov. Tony Evers once again brought up how challenging the year has been for mental and emotional wellbeing.

“First, remember to make time for self care whether that’s taking time to relax, doing something for someone else, trying something new or getting some fresh air,” Evers advised. “Second, check in on your people, whether that’s talking on the phone or connecting over Zoom. It’s a great time to reach out and connect with somebody you haven’t heard from.”

“Finally, know that it’s OK not to be OK. And you are not alone,” he added. “I care about you and the people around you do also. No matter your age or situation there are resources available. … It’s OK to ask for help. In fact, it’s more than OK. It can make a real difference for you and for your loved ones. We’ll get through this together.”

DHS Secretary-designee Andrea Palm suggested paying particular attention to the mental health of seniors. “One of the hardest parts of this pandemic is the loneliness and isolation that some people have faced [particularly] in nursing homes. Maybe [even worse] in that category, because they are so vulnerable to severe illness and death. And it has been a long nine months.” 

She suggests being creative with technology and reaching out or sending care packages. “We need to be very conscious about not leaving them alone … bring a surprise to their day or to their weekend.”

The conversation is louder

It’s not all bad news. For years, Battaglia has wanted to see Wisconsin more fully utilize telehealth, with insurers covering such visits as it does office visits. The pandemic has made that possible — and proven it can be effective.

“This is something I fantasized about, years ago, and never envisioned that this would happen,” she says. “The positive is they are providing support groups online throughout our community and many [participants] are reporting that they like it. And even if COVID goes away, they much prefer not having to get in the car and drive somewhere and go into a building — you know that’s stressful for a lot of people, that exposure and vulnerability for some people who have social phobia or it’s just anxiety provoking, or for someone who is depressed and does not want to leave their house. That alternative to be able to do that online is just, it’s amazing.”

She has also watched volunteers at NAMI local affiliates throughout the state getting trained on how to provide support groups online, even ones that are not tech savvy. But they are willing to do it to adjust and help during this crisis. 

“I just can’t tell you how proud and excited I am that this has come out of [the pandemic] and we will now, from this point forward, never think that we can’t provide it. And a lot of people just like telemedicine. This can be a real positive thing that comes out of this coronavirus.” 

The online groups provide a social connection as well, because being in coffee shops or the gym or at a job may be needed to protect one’s mental health. Battaglia notes that others, whose mental health causes them to isolate even pre-pandemic, are responding to this crisis saying, “Welcome to my world. I don’t know what everyone is so stressed about. I do this all the time.”

Perhaps the greatest upside to current circumstances, in Battaglia’s view, is that mental health is being discussed more openly and more often.

“I do think the conversation is louder,” says Battaglia referring to open talk about mental health, particularly in the workplace. A number of major Wisconsin employers have invited her to speak to their administrators or employees, showing a new willingness to aid workers experiencing anxiety, depression or other mental-health issues. 

“Twenty years ago, an employer would never even admit that there’s stress and anxiety in their employees,” she says. “I think people as individuals and companies are acknowledging that the mental health of their employees is really important and makes a difference in the production.”

She concurs, citing an estimate that mental health issues cost companies around $200 billion a year, up to 10 times more than an illness like the flu. “I have always emphasized that a compassionate company is going to have a wise investment if they think about their employees’ mental health,” Battaglia says, “and right now so many employers, like all of us, are trying to figure out what to do.”