The pandemic changed how mental health is discussed and treated
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Health providers discuss the COVID-19 pandemic’s substantial impact on mental health.
Over the last 15 months, caregivers, patients and everyday people have endured unprecedented conditions. The events of this period were taxing mentally as well as physically, with anxiety over contracting or spreading COVID-19, uncertainty about transmission methods, loss of work, and social isolation contributing to declining mental health during 2020. These factors worsened preexisting mental health problems for some, while others experienced them anew.
In fact, a recent report from the Kaiser Family Foundation (KFF) noted that in the U.S., four in 10 adults reported symptoms of a depressive disorder or anxiety during the pandemic: an increase from one in 10 adults reporting the same symptoms in early-to-mid 2019. The KFF also reported that incidents of depression in children ages 3-17 grew from 4% to 7% and those experiencing anxiety grew from 8% to 13%.
“Certain populations, age groups, and jobs were disproportionately impacted,” said Arpan Waghray, MD, chief medical officer at Providence Behavioral Medicine. Those most at-risk included young adults (ages 18-24), frontline and essential workers, and people of color.
As a result, healthcare organizations like Providence quickly pivoted to provide different support and care models. Telehealth, which existed before the pandemic, grew significantly during the crisis when providers realized how beneficial it was for many populations. Providence began offering same-day access to a behavioral health concierge program, with therapists trained in all modalities of care, including access to a telehealth chaplain.
"Behavioral health lends itself naturally to telehealth,” Waghray said. Some are even better served this way, like parents with childcare issues, people with social anxiety disorder, and those with transportation difficulties.
The Providence substance abuse programs received more self-referrals for treatment during the pandemic as well, said Danilynn Benavente, an education and outreach specialist with the Providence St. Peter Hospital Chemical Dependency Center in Lacey, Washington.
“We can’t dismiss that COVID influenced first-time use or increased substance use,” she said. “Many people reported that the impact of COVID increased their triggers for using.”
Youth and young adults
The youth population experienced more symptoms of depression and anxiety than years prior, leading to increased pharmaceutical treatments. For the 10-14 age range, prescriptions for these symptoms were twice as high as they were before the pandemic.
“We noticed a greater need, mostly through pediatricians,” Waghray said.
More than half of young adults (56%) experienced depressive disorder and/or anxiety as well, according to the KFF report. And 26% of young adults expressed suicidal thoughts, more than double the 11% rate of all adults.
The struggles were often due to isolation. Because young people were not able to spend time with friends in and outside of school, clinicians needed to suggest new ways for youth to creatively keep their minds occupied.
Sharing the Work 2 Be Well website was one way to help kids and their parents. The youth-led site provides mental health education and advocacy programs, along with a clinically-vetted curriculum for schools and youth groups, said Robin Henderson PsyD, chief executive of behavioral health for Providence Oregon, and the organization’s chief clinical officer. The site shares information on understanding the science of mental health, how to recognize when friends or kids are in distress, and how to have conversations with teens about mental health.
In addition to the Work 2 Be Well site, Providence shared self-help tools through the Credible Mind website, which shares appropriate resources based on self-reported responses to issues like stress.
“Not all kids coming back from college want to talk to a therapist. They want self-help but are overwhelmed and underserved by a Google search,” said Waghray, who added that some prefer learning from a podcast or app.
During the pandemic and after, parents should pay attention if their child stops talking with them, advised Henderson.
“It’s a warning that they have something inside and they don’t know how to share it. They may need more help than parents can provide,” she said.
Prior to the pandemic, Providence began adding behavioral health staff to primary care and specialty clinics in Oregon. In 60 of the 110 clinics across Oregon, behavioral health clinicians are embedded.
Substance abuse and dependency
The young adult population was more likely to report substance abuse compared to all adults, with 25% of young adults reporting it, compared to 13% for all adults, per the KFF report. Additionally, 13% of adults reported that stress from COVID-19 led to new or increased substance use, according to a Centers for Disease Control (CDC) report from June 2020.
Providence St. Peter Hospital Chemical Dependency Center pivoted to phone or video visits and support groups, which was difficult for some patients to adjust to, while others found the virtual setting optimal, according to Benavente. The staff emphasized emotional wellness, validating what the patients were going through.
“Early on we focused on gauging how people were doing at that moment with processing, problem solving, and crisis interventions,” she said. “We focused on the here and now rather than continuing with our curriculum.”
Changing the focus allowed providers to meet patients’ immediate needs and review or adapt to techniques they already learned. That included suggesting exercise routines to do at home for patients who relied on working out, or identifying social alternatives for those missing in-person gatherings.
Focusing on the self
While transitioning to virtual mental healthcare visits, Providence’s behavioral health and primary care clinicians provided patients with ways to focus on their wellbeing.
“The biggest thing to focus on is what you need to do to take care of you,” said Henderson, who suggests simple techniques include engaging in breathing exercises, or even pausing what you’re doing for a few minutes, which can help lower your heart rate.
Henderson also recommends that people make their own self-care kits, incorporating photos, sounds, playlists, smells and tactile objects. Even having a soft blanket nearby and drinking a cup of tea when you need a break can make a difference.
“We forget the importance of that type of self-care,” she said.
One of the pandemic’s silver linings is that it changed the way people talk about mental health. Mental health is now considered essential, said Henderson.
“People are realizing that mental health is a factor in their overall health. I don’t think we can put that back in the box,” she said. People are using routine language to talk about self-care, dealing with anxiety and depression, and processing trauma.
While a pandemic is something people will hopefully not experience again, Waghray agreed that as a society, it normalized help-seeking behavior. Having gone through the pandemic as a community, people learned to show up for one another, turn to each other, and practice more gratitude and mindfulness overall.
To learn more about how Providence addresses and prioritizes the mental health of its patients, visit providence.org.