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Amid COVID-19, Anxiety And Depression Risks Grow

Courtesy The Charlotte Ledger
Charlottean Andrea Mikels (shown here in the bonus room where she has virtual therapy appointments) writes about her journey with depression in her blog, Messy Mountains. She wants others going through mental health struggles to know they're not alone.

Andrea Mikels was already struggling with depression, but when the COVID-19 pandemic hit this spring, it couldn’t have come at a worse time.

The winter had brought a ruptured disc and unrelenting back pain and a fresh bout of deep sadness. But she’d found a new therapist, and as spring arrived, she was finally improving.

Then: quarantine.

Mikels, a South Charlotte mom of three active school-aged kids who relishes her gym workouts, tennis teams and evenings out with friends, was suddenly at home with a blank calendar and a feeling of despair.

“It’s been brutal, because the way that my brain works, I thrive on a reason to get out of bed and go somewhere,” said Mikels, who chronicles her journey with depression in a blog, Messy Mountains. “No distractions, just so much time to think and overthink and dwell, is not good.”

Entering a crisis: The COVID-19 pandemic has made us acutely aware of our physical health, but public health officials say we’re entering another crisis that’s getting largely overlooked: a mental health crisis.

For many like Mikels who are already battling mental health issues, the isolation, stress, schedule disruption and economic fallout of the pandemic has only made their struggles harder.

And mental health experts warn that a new wave of people with mental health disorders is on its way, brought on by the stress of COVID-19.

Mental-health related visits to emergency rooms were down by at least 50% during the first month of the pandemic, mirroring the decline in overall ER visits, said Dr. James Rachal, a psychiatrist with Atrium Health. But the low numbers don’t mean fewer people need help — it’s that they’re staying away from hospitals out of a fear of contracting the virus, he said.

Other metrics portend trouble down the road, Rachal said:

  • Alcohol and gun sales are high. Mecklenburg liquor sales surged 29% in March, and nationwide, 2.9 million applied for FBI gun background checks in April.
  • Unemployment is way up, with 1 million people filing claims in North Carolina, or 20% of the state’s workforce, according to the state’s Division of Employment Security.

“Psychiatric disorders that are related to COVID-19 could crop up a year down the road,” Rachal said. “There’s going to be economic consequences that we haven’t seen yet. Relationships that, while they may be held together right now, may fall apart and lead to increased stress for people. Substance abuse disorders are just getting started.”
The onset of the pandemic was so sudden and so all-encompassing that it distracted many from their troubles, Rachal said. “The concern is that once the crisis passes … we’re going to see all the people who weren’t taking care of their medical conditions or psychiatric conditions because they were afraid to go in, we’re going to see a rebound.”

Isolation and ‘entrapment’: We humans are social creatures, and we’re missing the mental and physical health benefits from coffee shop chats, workday lunch dates and gym workouts with friends.

“Social support as coping is one of the best protective things we have. It’s one of the best stress buffers and one of the best ways to cope with poor mental health. I think a lot of us are losing our traditional sense of that support,” said Robert Cramer, associate professor and Irwin Belk Distinguished Scholar in Health Research at UNC Charlotte.

“That can put us at risk for mental health concerns like anxiety and depression, and can make some of us look for other ways to cope — ways that may or may not be healthy,” he said.

Social isolation can play into a concept called entrapment, Cramer said, “What kinds of things make you feel trapped? Losing a job. Financial stress. Things you can’t escape. … We know from recent research that entrapment in particular is a risk factor for suicidal thinking.”

(The National Suicide Prevention Lifeline’s call volume has stayed steady so far through the pandemic, a spokeswoman told The Ledger. But calls to its Disaster Distress Helpline, which provides help to those experiencing emotional distress related to a disaster, rose 338% in March.)

The rise in telehealth: For mental health practitioners, the switch to video or phone appointments has been a game-changer. No-show rates for Atrium’s behavioral health patients dropped sharply after the switch to virtual or phone appointments, Rachal said.

Meghan Rawlings, a Charlotte child and family therapist, said her clients have embraced the virtual visits. Couples counseling is harder via virtual sessions, Rawlings said, but young people especially have embraced the switch.

“You have to have privacy, and a sacred space carved out — an area where you can have the conversations you need to have freely,” Rawlings said.

Mikels said she hesitated to do virtual therapy at first, but after three weeks without a session, she decided to give it a try. Now, she schedules her appointments for between her husband’s work calls, goes up to his office in a third floor bonus room, and prays no one will overhear or walk in.

Virtual visits have proven critical for one Charlotte mental health facility that had to close its doors and send patients home when the pandemic struck.

HopeWay, a non-profit residential and outpatient mental health treatment center in South Charlotte, was forced to discharge its 60 patients and shut its doors in March out of fear of spreading COVID-19.

Most patients were able to go home and continue their treatment through virtual therapy. Three went to the hospital because they needed more intensive care, said Dr. Alyson R. Kuroski-Mazzei, HopeWay’s CEO and chief medical officer.

HopeWay will start reopening this week, and Kuroski-Mazzei says she expects both local and national mental health providers to see a wave in the coming weeks and months of people who need treatment because of COVID-19 related trauma and stress.

Ways to cope: For Mikels, daily life is still a struggle, but she’s found ways to cope.

She works to distract herself by tackling lists of home improvement projects. Recently, she blogged about why people shouldn’t be critical of those shopping for non-essential items during a pandemic.

“You may look at this person in Target getting peel-and-stick wallpaper, and judge them, but that could be saving that alcoholic from taking a drink,” she said. “You don’t know what somebody’s ‘why’ is for what they’re doing.”

She’s passionate about making sure others who share her struggle know they’re not alone.

“Depression is painfully lonely and exhausting, even when we aren’t facing quarantine during a pandemic. I want others to know that they are not alone in their daily struggles with mental health,” Mikels said.

“Depression doesn’t discriminate. But everyday we wake up and face our struggles, we are brave, we are strong, and we all need to remember to check in on each other.”

Tips for staying mentally healthy: Rachal, the Atrium doctor, offers these guidlines:

  • Stay on a regular schedule, especially for sleep and meals
  • Eat well-balanced meals, and try to limit carb intake, which can make you feel sluggish and lead to weight gain
  • Maintain a regular exercise schedule, and get outside as much as possible
  • Keep doing the activities you enjoy most, whether it’s reading, sewing or crafting
  • Stay away from alcohol and drugs. With nowhere to go every night, it’s easy to fall into a pattern of regular drinking, but that could lead to trouble down the road.

Need help? Here are some local and national resources:

  • The National Suicide Prevention Lifeline is a 24-hour resource: 1-800-273-TALK (1-800-273-8255)
  • HopeWay can serve as both a treatment center or offer referrals: 1-844-HOPEWAY
  • Atrium Health has a 24-hour crisis intervention help line: 704-444-2400

Cristina Bolling is managing editor of The Ledger: cristina@cltledger.com

This post first appeared in the Charlotte Ledger Business Newsletter. It is reprinted with permission.