The pandemic’s surging toll on mental health

Attending to our mental well-being was a struggle during better times. Now we really need more support.

man with mask wipes his eyes

Milton I., 50, a resident living with schizophrenia at The Robert Meineker House, wipes his eyes as he speaks about the loneliness caused by social distancing in an empty common area, Wednesday, May 6, 2020, in the Brooklyn borough of New York. Even before the pandemic, access to mental health services in the U.S. could be difficult, including for people with insurance. Now experts fear COVID-19 will make the situation worse. (AP Photo/John Minchillo)

The COVID-19 pandemic — and the economic downturn that came with it — has impacted mental health for many people in our communities. These circumstances have also created new barriers for some who were already suffering, as in-person care appointments were paused, providers scrambled to adopt telehealth visits and many individuals lost their jobs (along with employer-provided health coverage).  

People working on the front lines as behavioral health clinicians are diligently providing care for those who need it now, while also preparing for the pandemic’s potential long-term impacts.

Unfortunately, even in the best of times, mental health needs have been historically underserved in our state and local communities. According to the Washington State Department of Health, approximately 650,000 Washingtonians were receiving treatment for behavioral health needs before the COVID-19 outbreak. However, approximately 700,000 more had mental health concerns but were not receiving services.

This describes our state’s behavioral health care deficit before the coronavirus. The pandemic has challenged and upended the physical health, work, social connections, personal routines and simple comforts that many of us rely on for sustaining our well-being. 

People who struggled with mental health and substance abuse disorders before may find their symptoms exacerbated by the disruption in care, social isolation and economic difficulties. Those who may not have struggled with mental health concerns prior to COVID-19 may discover a new onset of symptoms that surface during this time of unprecedented stress.

The Substance Abuse and Mental Health Services Administration offers a “Phases of Disaster” framework that shows how people tend to respond physically and emotionally under stress from natural and human-caused disasters.

After the initial impact of the disaster, there is a heroic phase, followed by a honeymoon phase, then a steep drop into disillusionment, until finally a prolonged reconstruction phase.

In my estimate, as a community we are likely embarking upon the “disillusionment” phase, which can last up to one year. This excerpt from the Substance Abuse and Mental Health Administration’s description of the disillusionment phase may resonate: “As optimism turns to discouragement and stress continues to take a toll, negative reactions, such as physical exhaustion or substance use, may begin to surface. The increasing gap between need and assistance leads to feelings of abandonment. Especially as the larger community returns to business as usual, there may be an increased demand for services, as individuals and communities become ready to accept support.”

The state Department of Health has examined Washington’s population data in the context of known cycles of psychological disaster response and shared its dire expectation:  Between 2 million and 3 million Washington residents could experience behavioral health symptoms consistent with acute stress, anxiety or increasing depression over the next three to six months. A second pandemic wave would dramatically change this forecast.

Our already-stretched behavioral health resources will be severely challenged as our community recovers from the pandemic. In addition, the death of George Floyd, social unrest and persistent systemic racial injustice continue to perpetuate trauma. It is critical that services are available and further expanded as our country confronts these dual public health crises. 

This is a difficult time for everyone, and many people experience the disaster response cycle with discomfort, but it is important to know this is a normal response.

Resilience can be practiced and learned and, in the next several months, we can look to our social connections, support groups, organizations and other resources for reinforcement. It’s essential for each of us to work toward enhancing our coping skills, which include: connecting with our community in creative ways (videoconferencing meetings or virtual game nights, for example); eating well and drinking plenty of water; getting enough sleep and physical exercise; practicing meditation or deep breathing; and avoiding mind-altering substances, which can exasperate symptoms. In addition, focusing on healthy thinking strategies is crucial. It is important to acknowledge the uncertainty we are facing while also combating the feelings of uncertainty by recognizing what is still in our control. Implementing a practice of gratitude has also been scientifically proven to boost resilience. An easy way to start is to end each day by naming three things you are grateful for. (The state coronavirus response website offers resources for enhancing your own and your family’s mental and emotional well-being.)

To everyone who is struggling now, I encourage you to seek help sooner rather than later. More now than ever, it is critical that we eliminate the stigma and barriers to mental health care. If you are experiencing anxiety, depression or other mental health and substance use concerns because of COVID-19 implications in your life or otherwise, know that you are not alone and your symptoms are treatable. Don't delay care because of fear of catching COVID-19 at the hospital; we have protocols in place to protect you, or we can provide virtual visits at your convenience. Your mental health can’t wait.

About the Authors & Contributors

Laura Knapp

Laura Knapp

Laura Knapp serves as director of Behavioral Health Northwest Service Area, Providence Regional Medical Center Everett.