Briefly, it seemed like the coronavirus pandemic had turned a corner.
“People were starting to feel a little bit optimistic this summer,” says Ariel Shumaker, an Asheville therapist in private practice, about COVID-19. “And now, it’s not feeling optimistic.”
Fatigue, sadness, anxiety, rage, fear, exhaustion — these are the emotions area behavioral health professionals report their clients are experiencing instead as the pandemic continues. As Shumaker puts it, “There’s a prevailing sense of existential doom that a lot of folks have right now.”
According to an April report by the nonprofit Kaiser Family Foundation, 1 in 4 U.S. adults said worry or stress related to the coronavirus has had a major impact on their mental health. That proportion rose to nearly 1 in 3 for women, Black adults and adults ages 18-29.
Behavioral health professionals are fielding influxes in interest. Shumaker says her client waiting list is much longer now than it was prior to 2020 through no effort of her own. “I’m getting constant referrals and I’m not networking or marketing at all,” she says. “It’s just a lot of people trying to access support.”
Taylor Walker, a therapist in private practice in Asheville and counselor at Warren Wilson College, says she has received roughly twice as many calls from prospective clients than usual. “I’m getting text messages randomly and I’m doing a lot of 15-minute check-ins with people because the anxiety and the panic is revved up right now, and has been for several months,” Taylor says. “To be honest, I’m not quite sure it died down.”
Fifteen-minute check-ins between sessions are a courtesy provided by most therapists. “I would like to note, none of them are just 15 minutes,” Taylor emphasizes. “They usually turn into 30 minutes.”
And the licensed clinicians who answer the free Vaya Health 24/7 Access to Care Line “are spending a longer time on the phone and dealing with more difficult situations,” says Christine Elliott, the organization’s member services care coordinator. Vaya manages public funding for mental health and substance use services in 22 Western North Carolina counties.
The volume of calls to the care line has been consistent through 2021, following an initial dip in spring and summer 2020. Now, those calling have more severe problems, Ellliot says. The hotline has more frequently been contacting 911 to send help for the caller immediately, as opposed to dispatching its mobile crisis team within a period of hours.
“Whereas before they might have been on the phone for 20 to 30 minutes, sometimes 40 minutes, [now] it’s hour-ong conversations,” Elliott says. “Unless it’s an absolute emergency, when they have to send the police out right away.”
Even outside of a global pandemic, anxiety disorders and depression disorders affect millions of Americans. And almost everyone experiences situational anxiety or depression at some point, such as when starting a new job or after a breakup. At the moment, the long-term repercussions of pandemic-related mental health struggles aren’t fully known.
One clear effect of the pandemic is heightened anxiety among people with the condition. But many people developed anxiety for the first time during this period as well, says Walker.
Her student clients at Warren Wilson, Walker continues, feel frustrated with measures suggested by the school to “strictly adhere to their COVID ‘bubble.’” Socializing has been particularly difficult for freshmen trying to meet people, she says. And Walker’s clients in private practice, many of whom are parents, fear for their children’s safety.
The licensed clinical social workers Xpress spoke with are not able to prescribe medication, but Walker reports that she’s making more referrals to prescribers for her patients. Shumaker adds she has more clients now who are taking the antidepressant and anti-anxiety medications called selective serotonin reuptake inhibitors.
Among people of color, trauma caused by the pandemic happened concurrently with trauma caused by high-profile incidents of racial injustice, including the police murder of George Floyd.
While trauma from racism is always ambient, Shumaker, who is white, recalls that her BIPOC clients reported “a sense of hopelessness” during the summer of 2020 in particular. And Taylor says more people sought her support at that time: “I got a lot more calls from Black and brown people who wanted to see a Black counselor,” she recalls.
Few therapists of color other than her and Elizabeth McCorvey, who practices both privately and at UNC Asheville, serve WNC, Taylor says. She made a lot of referrals to Black counselors in Charlotte, Raleigh and Durham who could see patients over telehealth. (McCorvey recommends A Therapist Like Me, a local online directory that allows clients to search for therapists by race, ethnicity, sexuality, gender, neurotype and other categories, for people seeking certain characteristics in their mental health provider.)
Financial insecurity underpins much of the mental health problems people are experiencing right now. Elliott from Vaya Health says many callers to the crisis hotline face housing issues or unemployment and feel hopeless and angry as a result.
People in professions where working from home is impossible, such as hospitality and retail, are particularly struggling, therapists say. Some lost their jobs or had their hours cut back earlier in the pandemic. That previous financial hardship is putting pressure on people to work in situations where they don’t feel entirely safe.
“It’s a choice right now between opening yourself up to possibly getting COVID — and if you’re Black or brown having twice the risk of being hospitalized or dying — or paying the rent or putting food on your table,” says McCorvey. “And that’s an impossible choice.”
The ongoing politicization of vaccines and masks is also compounding stress, McCorvey continues. “It’s not just that people are exhausted from doing their best to stay healthy and safe. They’re also exhausted from feeling frustrated at having different political beliefs from friends, relatives, teachers and faculty,” she says.
Substance abuse and relapses
Anecdotally, behavioral health providers say that substance use has increased during the pandemic. Data from the N.C. Department of Health and Human Services confirms that emergency room visits due to medication or drug overdoses are up as well, increasing 22% from 12,163 in 2019 to 14,826 in 2020. (State data tracks with national trends: Overdose deaths from opioids and other drugs rose by about 30% from 2019 to 2020, according to data from the Kaiser Family Foundation.) In July, Buncombe County Emergency Services reported 6 to 8 deaths monthly from probable overdoses.
Some people do not have access to their usual coping skills due to pandemic-related closures or cancellations. As a result, McCorvey says she has seen some substance use increase. “I would say people are using substances as more of a coping skill now,” she says, as opposed to recreation.
Recovery has also been hard. “A lot of my clients have relapsed,” says Walker, explaining that both drugs and alcohol are issues. “People are struggling in their relationships with parents, their romantic relationships and friendships, and a lot of folks are feeling really isolated.”
“This has been a horrific year and a half of relapse for everyone,” she continues.