Mental health effects expected to long outlast COVID-19

May 24--As society begins to reopen from the coronavirus pandemic, mental health experts warn the mental health effects of the pandemic and shutdown may far outlive the virus.

An April 24 report published by the Kaiser Family Foundation found 56% of American adults have experienced at least one negative impact on their mental health as a result of the pandemic, "such as problems with sleeping or eating, increased alcohol use or worsening chronic conditions."

For those who have experienced income loss, that percentage goes up to 65%, and is 64% for frontline health care workers and their families.

The CDC also warns long-lasting effects of any disease outbreak can include excessive fear, changes in sleep and dietary habits, increased substance abuse and worsening of mental and chronic health conditions.

Many effects

Shawna Perryman, community education manager at St. Mary's Resilience Behavioral Health, said quarantine and isolation during the pandemic "has impacted so many people in different ways."

"Some people have lost their jobs, others have kept their jobs but are fearful of getting the virus, or are fearful of being asymptomatic and giving it to someone else," Perryman said.

Perryman said those fears and anxieties have been made worse because everyone's routine, and the sense of stability that comes with it, "has been shaken and turned upside down."

Tasha Billingslea, Resilience program director, said the mental health effects of the pandemic may not be seen for quite some time.

"This is an unprecedented event that will affect people's mental health in ways that haven't happened in a long time," Billingslea said. "I think there's a lot of uncertainty for people, a lot of fears of what the future looks like, because it is an unprecedented event.

"There isn't the ability to look down the road and see what's going to happen," she said. "The outcome is uncertain how this will affect their lives, financially and in regard to their health."

Billingslea said that sense of uncertainty, persisting for weeks or months at a time, can affect anxiety levels and overall mental health.

"I don't even think we fully understand the impact yet that it is going to take on people," Billingslea said.

Trauma can affect anyone

You don't have to have a prior mental health condition in order for the pandemic to cause mental health symptoms, such as anxiety or depression, Billingslea said.

"Depending on the person or the situation, there could be potential trauma related to COVID," she said, "and when there's trauma sometimes you see after-effects of trauma such as depression, PTSD and anxiety."

And, she said, for those who've already been suffering with mental health issues, "trauma or even isolation is going to exacerbate that condition, most likely."

When the pandemic first hit, Billingslea said Resilience and many other inpatient mental health treatment centers actually saw a decrease in admissions.

"Initially we did see a decrease in our patient census, due to people just not coming to the hospitals due to their fears," Billingslea said.

But, as shelter in place restrictions have eased, she said Resilience has seen "a great increase in our behavioral health unit" of admissions with "fairly high acuity."

"I think it's because people have been without that help, or they had a perceived sense they could not receive help," Billingslea said. "We are seeing a surge, and it is across the state."

Adolescents at risk

While Resilience, which treats adults, is seeing a surge, Integris Bass Behavioral Health at Meadowlake, which serves patients ages 5 to 17, has seen a steady flow of admissions, consistent with pre-pandemic levels.

Steve Atwood, director of clinical services at Meadowlake, said youth admitted there have not shown any "out of the ordinary response to COVID-19."

But, he added, for most children who need inpatient mental health treatment, the pandemic is not their first exposure to trauma.

"You have to keep in mind," Atwood said, "the kids we deal with have long histories of trauma and mental illness they're struggling with."

He said the pandemic and social isolation have a greater potential for negative effects among adolescents than among younger children.

"It would not be uncommon if you were in a community that had a total lockdown for there to be some effects on adolescents, because they are not able to interact with their social network as they did before the pandemic," Atwood said. "That could be a stressor for adolescents."

New approaches to treatment

While the pandemic is likely causing long-lasting mental health effects in the community, it may also be changing the way mental health treatment will be provided.

Because of social distancing guidelines, mental health providers have been relying on video conferencing for family visits to those in inpatient care, and providers also have increased the use of tele-medicine resources to see patients, said Miranda Barney, nurse manager at Resilience.

Barney said that can have both positive and negative effects. Patients who are leery of tele-medicine may not keep follow-up appointments, but tele-health also increases the availability of mental health treatment, she said.

"I can see how it is beneficial," she said, "as long as the physician is very involved in it as well."

But, she said, tele-medicine has its limits.

"If they really need inpatient care, they need to be in here," Barney said, "rather than being outpatient or using tele-health."

Who is more at-risk?

The CDC reports stress can affect anyone, but some people may respond more strongly to stress during a crisis. These include:

--Older people and people with chronic diseases;

--Children and teens;

--Front-line medical staff and first responders;

--People with pre-existing mental health conditions or substance use.

Coping with stress

The CDC also offers tips for people to cope with the stress of the pandemic:

--Take breaks from news of the pandemic;

--Take deep breaths, stretch or meditate;

--Eat healthy, well-balanced meals;

--Exercise regularly;

--Get plenty of sleep;

--Avoid alcohol and drugs;

--Make time to unwind and engage in activities you enjoy;

--Talk with people you trust about your concerns and how you are feeling.

The National Alliance on Mental Illness offers more tips on living with the mental health effects of the pandemic at https://www.nami.org/covid-19-guide.

Good habits to carry forward

Despite the negative mental health effects of the COVID-19 crisis, Billingslea said there also are positives she hopes will continue after the pandemic.

"Families are spending more time together, eating dinner together, having more quality time and doing fun things together they would not have done if it weren't for this," Billingslea said. "I think people are reprioritizing their values and their activities and what's important to them, and people may not go back to the busy kind of life we had, and that can have a negative impact on families."

Where to go for help

If someone is in need of inpatient mental health treatment, they can be referred by their physician, go to the emergency room, or contact Resilience Behavioral Health directly at 580-233-CARE (2273), or for children and teens, contact Meadowlake at (580) 234-2220.

Information on outpatient and tele-health services through Northwest Center for Behavioral Health is available at (580) 234-3791.

Oklahomans also can call 211 to be connected with mental health resources, and those who need to talk can all 24-hour hotlines at (800) 273-TALK (8255) or (800) SUICIDE (784-2433).

If someone is at immediate risk for harming themselves or someone else, call 911.

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