Fear, isolation, depression

WASHINGTON — At Provident Behavioral Health in St. Louis, people who called the helpline at the beginning of the pandemic were fearful, even panicked. "Nearly everyone expressed fear. Fear of catching the virus, fear of the future, fear of the unknown and fear of not knowing how to cope with their feelings," said Jessica Vance, who manages the Disaster Distress Helpline at Provident. Now people's calls and texts, which have leveled off in the past couple of weeks, are more about their isolation and depression. Nationwide, mental health call and text centers, the first lines of defense for many people feeling jittery during a crisis, offer an early picture of how Americans are coping with the coronavirus pandemic. Many crisis centers are reporting 30 percent to 40 percent increases in the number of people seeking help. The helpline at Provident is experiencing a tenfold increase compared with this time last year, when no national disaster was occurring. So far, the nation's most heavily used helpline, the National Suicide Prevention Lifeline, has not seen a spike in call volume. But mental health experts predict an avalanche of mental health needs as the pandemic progresses. Ultimately, the psychological impact of the pandemic will harm far more people than the virus itself. And the widespread emotional trauma it's evoking will be long lasting, experts say. Already, more than 4 in 10 Americans say that stress related to the pandemic has had a negative impact on their mental health, according to an April poll by the Kaiser Family Foundation. "There's no doubt that the coronavirus pandemic will be the most psychologically toxic disaster in anyone's lifetime," said George Everly, who teaches disaster mental health and human resilience at the Johns Hopkins Bloomberg School of Public Health. "This pandemic is a disaster of uncertainty," he explained, "and the greater the uncertainty surrounding a disaster, the greater the psychological casualties." Based on Americans' reactions to previous disasters, the emotional phases people can be expected to go through are predictable, Everly said. "But how many weeks or months those phases will last, I can't tell you." United For now, starting the third month of the crisis, a sense of shared experience and a felt need to stay strong and fight a common enemy may be keeping many people from emotional collapse and suicide. But as time wears on, more extreme psychological effects of the pandemic's widespread trauma can be expected to surface, said Jerry Reed, senior vice president at the Education Development Center and member of the National Action Alliance for Suicide Prevention. "When the pandemic wanes and most Americans return to work and school, disillusionment, depression and despair will likely arise for some people," Reed said. "That's when we could see an increase in suicides. "But that's only if we fail to prepare. We know that suicide is preventable," he said. "Let's take advantage of the time we have now and try to get ahead of the curve rather than waiting." More than 47,000 people in the United States died by suicide in 2017, making it the 10th-leading cause of death, according to the Centers for Disease Control and Prevention. The same year, 1.4 million adults attempted suicide and 10.6 million reported seriously considering suicide, according to the Substance Abuse and Mental Health Services Administration. The suicide rate in the United States has risen 30 percent since 2000, with the highest prevalence among middle-aged white men. At the same time, deaths from drug overdoses and alcohol abuse have risen sharply, resulting in a decrease in American life expectancy for three consecutive years. This rise in what are called deaths of despair, social scientists say, is caused by worsening economic conditions and social isolation in much of the nation over the past two decades. Despair Last week, a mental health advocacy nonprofit released an analysis predicting that the massive job losses resulting from the economic shutdown during the pandemic, compounded by increased social isolation, could lead to an even sharper increase in deaths of despair. The coronavirus pandemic, which has killed about 79,000 Americans, could lead to another 75,000 deaths from alcohol and drug misuse and suicide, the analysis projected. National disasters in the past have resulted in higher suicide rates in the months and years after the initial crisis. But it's too soon to know whether this pandemic already is causing more suicides. National data on the cause of deaths is collected by the CDC from state death certificates and lags two years behind. Mental health advocates say that despite Congress approving trillions in emergency COVID-19-related funding, it has not allocated enough to shore up the nation's failing mental health system. Last month, the federal Substance Abuse and Mental Health Services Administration sent states a total of $110 million for "crisis intervention services, mental and substance use disorder treatment, and other related recovery supports" for Americans affected by the pandemic. Even before the pandemic, there was a shortage of mental health providers and limited access to residential care, leaving many Americans, especially rural residents, without access to needed care. According to the National Council for Behavioral Health and the American Academy of Addiction Medicine, an additional $38.5 billion is needed to keep community behavioral health centers operating when the pandemic subsides. After shuttering during the pandemic and furloughing staff, many such centers won't have the money to reopen, much less provide additional capacity for the anticipated surge in demand. On top of that, the National Alliance on Mental Illness (NAMI) and a dozen other mental health advocacy organizations called for $10 billion to support national mental health and suicide crisis lines and other crisis response centers. Misery, company Roughly 11.2 million Americans, including many who are homeless or in prisons, live with serious mental illness. They are the most vulnerable to the psychological effects of the pandemic, said Dawn Brown, who runs a crisis call line for NAMI. But during this pandemic, she said, even people who have never experienced a mental disorder are beginning to feel many of the same symptoms as people with serious mental illness. Some callers are saying they're having panic attacks, some report short emotional fuses, and others say they're unable to get out of bed in the morning. "The good news is we know how to treat those symptoms," Brown said. People who may have been able to manage their depression through exercise, or keep their anxiety in check with meditation, are finding that's no longer enough, she said. Some who call the NAMI Helpline are referred to online or telephonic therapy services, which are readily available and often free. Others may need medication as well, she said. When you call the NAMI helpline, counselors first listen to your story and validate what you're going through. Then they recommend resources to help you manage your symptoms. Brown said people who need urgent help managing their feelings should call NAMI's helpline, the National Suicide Prevention Lifeline or other local and national crisis centers. The trained professionals who answer those lines can refer callers to local mental health services and other valuable resources. For those who just need to vent, dozens of so-called warmlines are available in most states, where peer support specialists who have experienced mental illness are available to talk. Text lines also are available for people who prefer to communicate that way, or are seeking greater privacy while quarantined with roommates and family members. The helpline at Provident includes a text service (text TalkWithUs to 66746). That service received nearly 30,000 texts last month, compared with fewer than 2,000 in the same period last year. Crisis Text Line (text HOME to 741741), used primarily by young people in emotional distress, conducted more than 180,000 text conversations last month, up 30 percent from last year.. Other services are reporting similar spikes. At Crisis Text Line, texters have expressed three waves of concerns since the crisis began, according to the center's communications director, Ashley Womble. "In the beginning it was full-on anxiety about catching the virus," she said. In early March, the key words were "asthma" and "cough." Later, texters started expressing fears about their loved ones catching the virus. The trending words then were "grandma" and "grandpa." Next came financial worries, with trending words "quarantine" and "laid off." Now, Womble said, "People are telling us they feel isolated, anxious and depressed because there's nothing they can do, and they don't know when this will end."