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COVID-19 Crisis Takes A Toll On Americans' Mental Health


Tens of millions of Americans are diagnosed every year with mental health problems - anxiety, depression, substance abuse. Even for people who haven't been diagnosed with anything, this is a really anxious time. And the things that we use to cope, like therapy and group meetings, aren't possible because of social distancing. NPR's Yuki Noguchi has been looking into this. Good morning, Yuki.

YUKI NOGUCHI, BYLINE: Good morning, Noel.

KING: So, broadly, what has this pandemic meant for mental illness in this country?

NOGUCHI: You know, experts can't really say yet because many people are still suffering behind closed doors still. But they have studied disasters and wars, and they say typically a third of those living through trauma see some kind of mental health aftereffect like depression or anxiety. And there are lots of different kinds of trauma playing out right now. You know, millions are out of work. Relationships are strained. Some are grieving deaths alone. Some are using drugs or alcohol to cope. And you've heard this idea of flattening the curve with the virus. That's, you know, slowing the infection rate so hospitals can care for those who are infected. Well, Roy Perlis, a Harvard psychiatrist, says he expects a different kind of surge.

ROY PERLIS: The first curve was the pandemic itself. But I'm concerned that the second curve that we need to flatten is the consequences of the pandemic in terms of the psychiatric fallout, which I think could be substantial.

NOGUCHI: And he says we'll be contending with that fallout for years.

KING: What could that look like?

NOGUCHI: You know, the common thread I've heard across a lot of stories is that life in pandemic is just full of triggers, stresses that stir up past traumas and past problem behaviors. So, for example, I talked to one local woman. She's in early recovery from addiction and didn't want us to use her name. She's a teacher and isn't working obviously. And in the past, she says that kind of social isolation triggered heavy drinking.

UNIDENTIFIED PERSON: I could just sit for the whole evening and nobody would notice that I was gone just drinking.

NOGUCHI: You know, she's still sober today. She says that's because she fills her otherwise empty days with virtual AA meetings and talking to her therapist by Zoom.

UNIDENTIFIED PERSON: There's tons of people in recovery right now who, because of their circumstances, they might not have Internet access. They might not even have a home. They don't have the same access to these meetings that I do. And, you know, I worry for them or I think of them a lot.

KING: Yeah. She's making a really good point there. So what are some ways that people can get help if they don't have Internet access or if they're homeless?

NOGUCHI: You know, calls to crisis hotlines have gone up. That's one major, you know, help for people in crisis. And the fear is you'll see a new crop of people without a prior mental health diagnosis fall into a kind of panic, you know, desperation or hopelessness and that those feelings could turn into a lethal impulse. I talked to this woman Dese'Rae Stage, a suicide attempt survivor and advocate and she says suicide doesn't just affect the mentally ill.

DESE'RAE STAGE: So many people are unemployed. They don't know how they're going to pay their bills. They don't know how they're going to pay their rent. The weight of that is crushing. And the weight of that can make you want to die.

NOGUCHI: So she's urging people to take precautions to protect themselves from doing something rash.

STAGE: I have friends who struggle with suicidal thoughts but who are generally pretty solid who are saying, you know, like, I've had to put my guns away. I never have to put my guns away, but my guns are in a safe right now.

NOGUCHI: Crisis hotlines are obviously a critical resource, Noel. Normally, they refer the most acute cases to hospital emergency rooms. Well, they're reluctant to do that right now because of the pandemic. So they're having to spend more time with each caller to keep them safe. Another way people are accessing help is through teletherapy - you know, remote therapy - if they have the means and can find a provider. But there are challenges. I spoke with psychiatrist Philip Muskin who's quarantined at home in New York City but continues to see his patients the only way he can - over the phone.

PHILIP MUSKIN: I've been a psychiatrist for more than 40 years. I have never FaceTimed a patient in my entire career. And I usually shake patients' hands, put my hand on the patient's arm or shoulder and try to be reassuring. Well, I'm not doing that, and that's weird to me. So it's a whole new very unpleasant world.

NOGUCHI: Muskin normally works at Columbia University Medical Center in New York. The psychiatric wards there have converted to beds for COVID-19 patients.

MUSKIN: That means we have no place to send patients who need admission.

NOGUCHI: Last month, Muskin, who is 72, started feeling sick and remains home. Meanwhile, he says patients are suffering. Those hospitalized with COVID-19 are terrified and lonely. Their families can't sit with them and hold their hand. Overworked doctors and nurses have little time to offer comfort. In the most agonizing situations, families of the sickest face the death of a loved one without a goodbye. Muskin says the hospital is now using donated old iPads to seal in Ziploc bags so counselors can connect with those people, too.

MUSKIN: To reach out to families, give them updates or talk to them about their stress because people aren't allowed visitors.

ELINORE MCCANCE-KATZ: I don't think we've seen anything quite like this, at least not in my lifetime.

NOGUCHI: Elinore McCance-Katz is assistant secretary at the Department of Health and Human Services. Normally, privacy rules limit doctors' ability to provide care over the phone or online. There are also concerns about the security of those connections. Nevertheless, restrictions were lifted out of concern for those facing anxiety, depression and addiction.

MCCANCE-KATZ: We want people to be aware of the flexibilities that are in place now that will allow them to get care and treatment.

NOGUCHI: Whether they work in hospitals or private practice, physicians are adopting telemedicine. Services like Eden Health are booming. Eden normally provides both in-person and online care and has seen a 61% increase in patient calls through its app in recent weeks. Rachelle Scott is medical director of psychiatry at Eden Health.

RACHELLE SCOTT: This is what's really driving our health care system right now, the ability to provide telehealth.

NOGUCHI: Scott says at a time of social distancing, patients say they feel lonely. They crave human connection. A webcam is not a perfect substitute. Scott can only see what's on the small screen.

SCOTT: So is somebody fidgety, right? Are they moving their hands? Are they sweaty - like, if I shook their hand and I felt a sweaty palm.

NOGUCHI: But she says there are also many advantages of remote therapy. It's easier and immediate and, of course, at the moment, there are no alternatives. Muskin, the New York psychiatrist, says he aches for the patients and hospital staff he left behind who are still fighting.

MUSKIN: It never occurred to me that colleagues would die.

NOGUCHI: Yet some still have. He says he feels desperate to help.

MUSKIN: I feel guilty. I spend a lot of these days crying because I feel very guilty. And so I'm trying to do as much as I can.

NOGUCHI: You know, Noel, I should add that when the epidemic ends, experts like Muskin expect a surge of both in existing cases and new people in crisis. And if you're listening and you or someone you know is in crisis, there is help. The National Suicide Prevention Lifeline is staffing up, and you can reach them at 1-800-273-8255. Transcript provided by NPR, Copyright NPR.

Yuki Noguchi is a correspondent on the Science Desk based out of NPR's headquarters in Washington, D.C. She started covering consumer health in the midst of the pandemic, reporting on everything from vaccination and racial inequities in access to health, to cancer care, obesity and mental health.
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