The Longevity Project, Part 3: Mental health impacts of pandemic are multifaceted
For Steamboat Pilot & Today
Local mental health care providers are seeing a higher patient load than ever. And nationally, research shows an increase in anxiety, depression, burnout, sadness and substance use since the beginning of the COVID-19 pandemic.
“It is impacting our mental health,” said Lilia Luna, behavioral health director for Northwest Colorado Health. And the national trends “align with what we are seeing in Northwest Colorado.”
“It’s been a year unlike any other,” said Justin Ross, a licensed clinical psychologist and director of UCHealth’s workplace well-being program. “Very few people have gotten through it unscathed.”
There have been across-the-board increases in anxiety, depression, trauma, stress and sleeping and eating disorders, Luna said.
Dr. Thida Thant, a psychiatrist at UCHealth University of Colorado Hospital, reported “skyrocketing” rates of people reporting anxiety, depression and sleep issues, as well as people starting new medications.
Of course, the pandemic and changes it wrought have disparate impacts on different populations — young, old, minorities and those already among the most vulnerable.
But some kind of impact is being felt universally, and some people are equipped with better coping strategies and resilience than others.
“This just trickles into every little part of life,” said Gina Toothaker, the Steamboat Springs and Walden outpatient program director for Mind Springs Health.
“At the heart of anxiety is the perception of threat,” Ross said. “Anxiety always contains threats to things we care about.”
And threats to stability abound — including jobs, school, income, housing, routines, social connection and health.
And “at the heart of depression is almost always a sense of loss,” Ross said. “There’s so much loss that has piled up in the last year.”
As kids headed back to school, Toothaker said the first week was full of chaos for many students and their families, with “all kinds of stuff bubbling up.”
Ross talked about “disenfranchised grief” — a kind of grief that typically goes unacknowledged or unvalidated by social norms.
People have experienced different kinds of loss throughout the pandemic, Ross said, with grieving processes similar to the loss of a loved one.
The cancellation of “key events,” like concerts, athletic events or other social gatherings, can be very painful, but people aren’t necessarily identifying those as painful losses, Ross said. There’s not just sadness but a layer of guilt preventing people from being able to express the sadness of the loss.
“We put a lot of meaning into those things.” They are a part of our identity and our connection to the community, he continued. “They bring people together, which is at the heart of well-being.”
While so many people have experienced fear, anxiety, sadness and grief due to the pandemic, others have discovered the opportunity for deep introspection, which has prompted positive life changes.
Some people have welcomed a chance to slow down and focus on what is most important. Others have used isolation and extra free time to explore new passions and hobbies.
Earlier in the pandemic, Toothaker saw families who cherished the additional time together.
“The forced togetherness has really helped some relationships and helped some feel more connected,” Toothaker said.
Thant described it as a “weird silver lining.”
“Facing death or disabilities puts things into perspective,” Thant said. “Important life reflections got sped up.”
The increase in people seeking care may also be a positive movement in the reduction of stigma around mental health.
It may not be that the pandemic created all new mental health issues but pushed people to address existing ones.
“We have had a lot of new people who have not done counseling before,” said Minds in Motion owner Angela Melzer, a licensed clinical social worker who specializes in neuro-based therapy and mindfulness. “I don’t think more people in the community are falling apart. What I’m hearing from people who haven’t been in before is, ‘I needed to do this for a long time, and this was the last straw.’”
Melzer reported many of her patients are now working through tough issues very successfully.
“More people are willing to take accountability for their mental health,” she said.
What: The Longevity Project Live Event
The Longevity Project is an annual campaign to help educate readers about what it takes to live a long, fulfilling life in the Yampa Valley. This year’s project will focus on the critical and relevant topic of mental health. Join us Sept. 22, for presentations from keynote speaker Kevin Hines and Megan Francone, suicide prevention coordinator of REPS (Reaching Everyone Preventing Suicide) in Moffat County.
When: 6-8 p.m. Sept. 22
Where: Colorado Mountain College Steamboat Springs, 1275 Crawford Ave.
More info: Visit SteamboatPilot.com/longevity
Ross said he’d like to see the pandemic cause a “rebranding” of mental health.
“We are all human beings, and we all struggle with similar things,” he said. “We need to be vulnerable sharing what our concerns are so we can support each other in meaningful ways.”
He’d rather call mental health issues “deeply human conditions.”
Melzer said she notices the Generation X and younger generations talking more about mental health, including children.
COVID-19 stressors continue
But as COVID-19 cases continue to spike, and hospitals in many parts of the country, including Colorado, find their resources strained, there appears to be no end in sight for the pandemic, and the related stressors continue to evolve.
A year ago, there was more fear and uncertainty about when a vaccine would be available and when things would open back up, Toothaker said.
“One thing I realize now — a year and a half into it — is that COVID has become a chronic stressor, and it’s going to continue,” she said. “It’s not going to disappear completely, and we eventually need to learn to live with this.”
Getting back to routines and re-establishing social connections is resolving some issues, Toothaker said, but some people have new or worsening mental health issues because of the pandemic that she believes will persist over time.
Routines play a big role in mental health, according to Toothaker.
“They keep people moving forward,” she said. “When you are so depressed or exhausted, you can’t focus — you have that routine to fall back on.”
The rise of telehealth
Another significant silver lining of the pandemic is the explosion — and deregulation — of telehealth, which “has opened up a whole other avenue for people to get the support they need,” Toothaker said.
“People are accessing care that never would have before,” Thant said.
They are able to more easily fit care into their daily schedules, and care is more accessible for people in rural areas or without transportation.
“I’m so incredibly grateful this has opened up virtual care,” Luna said.
And Luna hopes some of the legislative red tape that was removed during COVID-19 can stay gone.
There are some downsides, Thant acknowledged, such as for people without access to technology or for those not accustomed to technology.
And for some, in-person therapy just works better. But “by and large,” she said, the expansion of virtual therapy is a big step forward in mental health care.
While the Yampa Valley has more access to resources than some communities, there are ancillary impacts and stressors unique to every community.
In Routt County, for example, numerous industries and small businesses are experiencing crisis-level worker shortages.
Compounded by a lack of affordable housing, life for many who might have otherwise thrived in the community and contributed greatly is increasingly unsustainable.
The lack of workers, influx of people fleeing the pandemic into the mountains and skyrocketing rental and real estate costs may very well change the demographics and culture of the valley for the long term.
And there will be an inevitable loss in terms of the services once provided by those who either are forced out or want to fill vital roles but can’t move here, including those employed in the mental health care field.
“There is a huge behavioral health worker shortage nationwide,” Toothaker said. “And we are really feeling the impact of it in Colorado. We can’t hire professionals in our clinic because people are moving away because they can’t afford to live here.”
Luna also reported a staff shortage at Northwest Colorado Health. If there was a shortage of mental health care staff before the pandemic, it has only been exacerbated.
Because of the shortage across so many industries, many people are feeling the load of having to do the job of two or three people — adding to burnout.
And in terms of the impact on people who do not have stable employment, food, housing, child care or transportation, it’s reached crisis levels.
“It’s not just a health crisis,” Toothaker said. “It’s a multitude of aspects of crises. I think it could continue even intergenerationally — having impacts on families and kids that may affect them for years to come.”
The great divide
“Polarization is one of the biggest stressors people are experiencing,” Luna said.
There was a climate of intense political division prior to the pandemic, Toothaker noted, and along with other social struggles brought to the forefront, “it all compiled together in a perfect storm of polarization.”
“It’s not just the pandemic,” said Vincent Atchity, executive director of Mental Health Colorado. “It’s everything else that’s going on that complicates it. One of the challenging things I feel about the pandemic is how it’s really laying bare the incomprehensible levels of divisiveness in communities. We just can’t get on the same page as humans who want to have health and well-being.”
The lack of consistency and the confusion around pandemic-related policies only adds to the general distress, Atchity said.
“There’s so much disagreement on how to deal with the pandemic,” Thant echoed. “We are seeing more anger and frustration, and it continues to rise as it goes on longer and longer.”
And the longer it goes on, the harder it is for people to feel hopeful, better before getting worse again, Thant said.
The conflict — especially when it involves close friends and family — can cause frustration, anger and the fracturing of social support systems.
“A lot of mental health can stem from feelings of safety and knowing yourself and the people around you — knowing truth, right from wrong and beliefs in how we walk through the world,” Thant said. “The pandemic tore a lot of that way.”
When to seek help
Feeling anxious and situationally depressed has become the norm for many. Being nervous about being around crowds of people is now commonplace, and many feel they are sinking under the weight of compounding stressors.
So at what point should someone seek professional help?
According to Luna, it’s when “it impacts your ability to have relationships. Or succeed at your job or other domains. Or impacts your ability to function.”
While not everyone may benefit from counseling, for some — even those not at a crisis point — therapy can “increase one’s awareness about what emotional health is — and increase one’s ability to have a sense of agency and the ability to navigate challenges,” Luna said.
“There’s normal anxiety we should all have right now,” Toothaker acknowledged. “But if it becomes debilitating and impacts your ability to do everyday things, then it is time to seek help.”
The problem of burnout
“I think the pandemic has taken a huge toll on health care workers,” Thant said. “They are a group trying to hold everything up despite what is happening around them.”
For people who have stayed working and on the front lines throughout the pandemic, Toothaker described a perseverance that now may be waning.
“Now people are going through a more intense phase and dealing with the whole weight of what they’ve gone through,” she said. “I am seeing some PTSD (post-traumatic stress disorder) and real severe burnout.”
According to Ross, the mental health impact on health care workers has never been greater.
“There are alarming rates of anxiety, depression and burnout,” Ross said. “There are also a significant number of people considering leaving the industry.”
Molly Lotz, a licensed clinical social worker and crisis support counselor at UCHealth Yampa Valley Medical Center in Steamboat Springs, also pointed to “moral injury.”
Lots defines that as “when your gut, or your moral code and compass, is in direct conflict with the work you are being directed to do.”
People who work in health care tend to start with a compulsion to help, Lotz said. But with the new set of circumstances brought on by COVID-19, there are times when workers “are not able to provide the care we think is moral and ethically obliged to provide.”
And it can look a lot like burnout, she said, with people not wanting to go to work.
“‘I didn’t go into this line of work to do this’ is the quote most associated with moral injury,” Lotz said.
Uncertainties around the pandemic remain, but there are bright spots.
The pandemic has promoted more frequent and open conversations around mental health, every health care professional interviewed for this story agreed.
Asked for advice for enduring not just the pandemic but a world seemingly overflowing with chaos, division and disaster, the professionals offered some advice.
Do a self-evaluation, Luna advises.
Ask yourself, “What gives you meaning in your life? Is that aligned with what you are doing? What promotes positive emotion in life? What does your social support look like at present? Where are there disparities and how do you cope with that?”
As the pandemic persists, Toothasker said it is going to require having a “flexible, open mindset.”
“Try to give yourself some grace,” Thant advised. “Cut yourself some slack.”
Atchity also advises “scaling down” and limiting the scope of what you worry about.
Lotz advises people to pay attention to how they are feeling.
“Right now, it’s OK to say you are not thriving,” Lotz said. “That’s part of the process.”
Lotz also encourages people to pay attention to their bodies and any physical ailments that might signal mental health distress.
Melzer advises paying attention to what you are doing with free time, especially when it is scarce. There’s a difference between “zoning out” or “checking out” and relaxing, she said. Zoning out isn’t necessarily restorative, she said, and achieving that restoration is a big part of combatting burnout.
And Achity suggests people be kind to each other.
“Do what you need to get through the day and find some joy,” he said.
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As the new year gets underway, many people work to refocus their health.