THE SILENT MENTAL HEALH CRISIS OF COVID-19 and what to do about it

By: Dr. Dee Gaines

The almost silent but most impactful aspect of the coronavirus pandemic is the great mental health toll it has taken on people who suffer from various mental health disorders, and others who never before experienced clinically significant symptoms.

During the first weeks of the COVID-19 pandemic, it was almost expected that individuals who suffer from clinical anxiety will face exacerbation of their symptoms. 

The umbrella of anxiety disorders includes a host of conditions whose roots lay in fears and worries. Obsessive compulsive disorder, panic disorder, post traumatic stress disorder, phobias, and illness-somatic disorders include fears of the unknown, fears of diseases, of dirt, of danger, and other factors. The presence of a novel virus that can cause severe physical symptoms and even death with no known cure is a tragic “perfect storm” of factors to destabilize people who suffer from anxiety and maximize their symptoms. Additionally, the drastic disruption of daily schedule, which otherwise keeps individuals healthy, destabilized individuals and their families. Not being able to go to work, to school, to sport classes, social events, the outdoors, and to see friends has taken away the activities that reduce stress and anxiety in normal times. 

While about 20% of the population suffers from clinical anxiety, about 20% of the population also suffers from clinical depression. As with anxiety, we combat depression with socialization, exercise, socialization, and hobbies, in addition to pharmacological and psychological management.  

As businesses began to shut down and the unknown grew larger, people who are susceptible to depression suffered a dive in depressive symptoms, a loss of motivation, and even suicidality. Concerns about getting sick, about death, and losing a job, business, retirement, and the inability to pay bills all became significant stressors for which many could not find relief and solutions. 

Life is such that many individuals have an ongoing family conflict: married couples, couples in the midst of divorce, couples who are in the midst in infidelities, and financial problems. Couples and families who already suffer from internal conflicts prior to the pandemic now have to spend more time together, facing their ever bigger shortcomings and dysfunctions - resentful spouses, frustrated teens, and tired parents.

Teenagers, who are biologically wired to hyper-focus on socialization, self- judgement, self-doubt, and seek social confirmation are now missing the in-person experience and find themselves connected to their smart phones around the clock. Younger children, who have limited words and insight to their growing angst, have difficulty understanding what is happening to themselves, their parents, and society at large. The disconnect from schools deprives them from growing in the countless developmental areas in which they are meant to make progress, such as sensorial, social, and academic. Children with special needs thrive when their system of care and routine are in place, including targeted programs, one-on-one support, various therapies, and socialization. Management of symptoms in isolation becomes challenging of the children and their parents. 

The lack of structure for children has become a great emotional and functional burden to both parents and their children. Parents struggle to fill in gaps on multiple fronts: educational goals, activities, socialization, and even exercise, which many parents are not skilled to do, while trying to make a living and maintaining household care. This causes everyone’s anxieties and frustrations to meet head-on. Different family members may have their own “moments” of emotional breakdown, fatigue, or panic. 

Physical, sexual, and emotional abuse are unfortunately all too common in our society. Due to the Stay Home order and the fear from the virus, the abused are forced to spend more time with their abusers and have no outlet to which they can escape, no change of environment or an outside person to be comforted by. The physical and mental health damage is immeasurable. 

As we age, some of us have a partner we whom we share a life. However, reality is such that as early as in our 50’s, we may find ourselves alone. A loss of a spouse, a divorce, and simply the inability to find a suitable partner results in many people who live alone. Aging individuals, some away from their families and riddled in fear from the virus, experience loneliness, desperation, difficulty caring for their own needs, and are at the highest risk for neglect or exploitation. Individuals diagnosed with dementia may struggle to have visits by caretakers. Their basic needs such as food, house care, and getting medical care may be compromised as well and due to dementia they may be unable to reach out for help.

Medical procedures have been delayed and paused due to the pandemic. As a result, patients awaiting critical clinic care, cancer treatments, surgeries, and ongoing management of chronic conditions, experience anxiety,depression, hopelessness and despair, as they worry their survival depends on a ticking clock. Patients undergoing medical treatments during the pandemic do so without the physical presence and support of their loved ones due to safety restrictions and have to rely instead on their own grit and the care of their nurses. 

Loneliness and long-term isolation are documented to have serious mental health implications, such as thought disruptions, negative self-talk, depression, panic, rage, and increase in thoughts of self-harm or harm to others. 

For people who live in small apartments in congested areas, the toll of isolation is more profound, and they do not have enough physical space to experience privacy and mental relief. In some states, as many as 20% to 35% of the state population live in apartments. 

Overall, fear-driven behaviors may take place, such as hostility, aggression, but also withdrawal and lack of motivation. It is therefore important for friends and family members to look out for each other for signs of distress and seek immediate professional help. 

Humans thrive when certain lifestyle changes are in placed combat pandemic-related mental health crises. Some of those changes are listed below: 

1. Supportive Communication. Listening, talking, and listening some more. Every person and child may have moments of frustration, concerns, and those are best processed together in a supportive manner. 
2. Practice Forgiveness. Everyone’s stress levels are high. Mistakes can be made and wrong things can be said. This is the time to understand and forgive. 
3. Management of Expectations. Current circumstances limit our abilities to achieve goals we normally would expect to achieve. Managing our expectations for ourselves, for our children and spouses, and for our work is critical to avoid conflict and find peace with what we can achieve. 
4. Reduction of Unnecessary Stress. When things become complicated, it is good to hunker down and avoid unnecessary stress. One should consider tabling projects that can wait, complex expenses, and major commitments. 
5. Safety and Security. Anxiety is often linked to fear of safety and security. Take the necessary steps to make your family feel safe and secure. Take the time to discuss what it would take to make everyone feel this way. 
6. Predictability and Consistency. Create a daily and weekly schedule that strives for consistency. Daily and weekly order that includes various areas of life, such as work, study, regular meals, and leisure time helps in reducing the unknowns and provides activities to look forward to. 
7. Exercise and Fresh Air. Exercise increases our endorphins, which reduces our stress, improves our mood, and strengthens our immune system. Breathing fresh air and looking at greenery also has a similar positive impact. Make it a part of each day with activities such as taking short walks, dancing, and exercising to online videos.
8. Creativity. Any form of art provides relaxation and wellbeing, such as painting, creative writing, cooking, and playing a musical instrument.
9. Active Socialization. Find daily opportunities to face-time, make a call, take a social-distancing walk with a friend, and call extended family. Take the time to reach out to lonely or older loved ones who really appreciate it. 
10. Ongoing Contact with Mental Health Providers. Whether you have a standing clinical diagnosis, or you notice that your mental health is declining, reach out to mental health professionals to get the support that you need. 
11. Use of Experts. A big factor that is causing anxiety these days is major decisions. Consider getting expert advice in finance, retirement, child care, and martial/family discord to feel greater control over the course of your life and reduce the unknowns.
12. Do Good Deeds. Sometimes the best healing is healing someone else. Any person has something they can do or give to another. Use your kindness to bring love to the world. 
13. Schedule Weekly Fun Time. All work and no fun makes Jack a dull boy. Yes, we have many reason to worry all day, but our worries won’t fix them. When we have something fun to look forward to, we can be energized to deal with the difficult aspects of our week. 
14. Practice Spirituality. Connection with our faith, our spiritual mentors, and our sense of purpose can revitalize us. Find opportunities to connect with what provides you with meaning. 

Stay healthy and and safe. This too, shall pass. 

Dr. Dee