We’re still in a pandemic and people are dying and I got sick and my grandma died and I lost my job and I started hating my kids and I ran out of toilet paper and I never see my friends and I can’t hug my mom and the hospitals were at capacity and this all has gone on for months.
A year into the COVID-19 pandemic, the “what ifs” having come true, therapists hear story after story of collective trauma, of grief, of loss, all through a computer or phone screen. A year into the pandemic, they’re navigating a still-unprecedented time, one that was worse than they could have imagined.
There was also the killing of George Floyd by Minneapolis police and the protests that followed, unhealthy air from massive wildfires, the presidential election and the siege on the U.S. Capitol. And as the nation goes through a second March in a pandemic, feelings of grief and hopelessness are heightened over a year that’s been lost, and so are the feelings of anxiety over what a post-pandemic world might look like.
The country will need to grapple with mental health concerns that won’t disappear just because people are vaccinated, therapists say.
Countless surveys and studies have looked at rates of depression and anxiety that emerged or were exacerbated over the past year, and specific issues affecting populations that have been hit hardest, like young adolescents struggling over Zoom school or octogenarians isolated at home or in nursing-home rooms.
Among the findings: Forty percent of Americans reported anxiety or depressive disorder during the pandemic, which is four times more than pre-pandemic, according to the Kaiser Family Foundation, and higher rates of women, Black and Hispanic Americans and essential workers reported the same symptoms. A national hotline in 2020 received 176,645 more calls asking for referrals for mental or substance abuse disorders than in 2019, an increase of 27%. A Gallup poll found that more Americans rated their mental health worse in 2020 than any year in the past 20.
The National Alliance on Mental Illness (NAMI) reported a 70% increase in phone calls and other messages compared with 2019, and NAMI Seattle’s call volume increased by about 50% in the summer and fall, according to program manager Katie Mahoney. NAMI Seattle has also seen specific upticks in calls and requests from parents of youth and young adults whose families are struggling with mental health challenges.
“Trying to pretend that we as a society are going to come out of this unscathed is setting us up for some ‘shoulds’ that will be harmful,” said Katherine Walter, owner of Catalyst Counseling, a Woodinville-based (before everyone moved to working from home) practice with 10 clinicians. “We will be marked, but let’s see how we can be the healthiest we can be as this plays out.”
Multiple times per day, she reminds clients that we haven’t reached the “post” in post-traumatic stress. We’re still in the trauma.
Within the emotional response to a disaster cycle — a way experts track behavioral health experiences following a major event — Washington remains in the disillusionment phase.
This phase is characterized by trouble with cognitive function (also known as “pandemic brain fog”), depression and anxiety symptoms, fatigue and burnout, according to the Washington State Department of Health’s Behavioral Health Strike Team. Disillusionment began in the fall, around the four- to six-week period heading into the presidential election, dark evenings because of daylight saving time, and a new wave of COVID-19 cases and deaths, said Kira Mauseth, psychology senior instructor at Seattle University and co-lead of the state’s Strike Team.
The anniversary of when cases started rising and the economy shut down can conjure several types of reactions, according to the Strike Team. One is despair or hopelessness about the past year, as well as apathy or anger about the restrictions still in place.
“The length of the containment is beyond what most of us thought it was going to be,” said Jane Simoni, a University of Washington psychology department professor and director of clinical training. “No one was thinking we would close society for 12 months. With the anniversary, it’s the fatigue of it, we can’t believe it’s really 12 months. It’s astounding to acknowledge it’s been this long.”
Another area of concern surrounding an anniversary is significant grief and loss. This is most pronounced among people who have lost loved ones or been connected to deaths, but can impact anyone.
“That uncomfortable distress you have? That’s grief, for the loss you have, for the year we didn’t have,” Simoni said.
Telehealth and a ‘tsunami of need’
Walter was in the middle of an evening session with a client when she had to pause because her 6-year-old son had been playing in another part of the house with his father and, as 6-year-olds do, had crashed and burned into a bathroom door and started bleeding. Sometimes Jaya Ramesh’s dog barks during her appointments. Michael Archer switches rooms in his house every week, to give himself a change of scenery.
When mental health switched to a telehealth model instead of the stereotypical therapist’s couch, there were questions about whether speaking through video would prove beneficial or a less-than-ideal alternative. With months of experience, therapists largely say telehealth worked better than they thought, and some plan to continue even when in-person sessions resume.
Doing sessions from their own homes exposes them as people in ways a therapist’s room doesn’t, said Jaya Ramesh, who works with individuals and couples.
“I’ve talked to some therapist friends about our own humanity showing up,” Ramesh said. “In a therapist’s room it’s sanitized, but now it’s ‘oh, you have a dog that barks.’ My clients know I sit in my laundry room, and that the light hits in a funky way. They get to see me in a human way, which is very healing.”
It’s still difficult, Ramesh said, to pick up nonverbal cues, especially with couples, through a video call. She has to be “on,” much more than an in-person session, or else she might miss something subtle, like someone turning their body away slightly. Before her sessions begin, she tells clients she is going to be asking more explicit questions, because she can’t see half their body on the screen.
“It’s become more directive,” she said. “I’m going to be asking, ‘What is going on with you right now, can you communicate that to your partner?’”
Ramesh has seen an increase in requests from couples, which many mental-health professionals attribute to pandemic-related stressors like work, child care or elder care, and being in close contact, surfacing underlying tensions in the relationships.
Therapists describe a “tsunami of need” that’s stretched them to their own limits amid worries that people who needed help before need even more help now, and those who need help now aren’t getting it. At one point at Eastside Psychological Associates, which has between 50 and 60 providers, everyone was full, according to Archer, who is a provider at EPA and is also the director of clinical training at Fairfax Behavioral Health.
“Being filled to capacity and having to meet the higher mental health needs is one thing, but the secondary impact of not being able to provide help, for people whose job it is to provide help, was a great negative impact than I think many people anticipated,” Archer said. “A huge frustration that led to the burnout of ‘we have all these people coming in, and we don’t have resources for them.’”
That led to EPA getting creative with how it provided additional resources. The practice started a remote provider program, where therapists from different parts of the state would do telehealth services. It’s also created therapy groups conducted through Zoom; one is specifically for people who have lost someone from COVID-19, another is for those struggling with anxiety because of the pandemic.
Moving from disillusionment
Another challenge prevalent throughout the year: Being reminded of and seeing the impacts of pandemic is seemingly unavoidable.
“In therapy, if a goal is to reduce anxiety, but the stressor that is causing the anxiety is inescapable, that creates a bind,” said therapist Nathaniel Amos. “You can’t just say, ‘Do some yoga and you’ll be fine.’ That’s disconnected from reality.”
Amos focuses on validating his clients — yes, you’re anxious, because it’s still an anxious time.
Based on her expertise with disaster responses, Mauseth believes that by the time we reach late spring to early summer, a lot of people will feel better than they do today, as they move from disillusionment to the reconstruction phase, when there’s coming to terms with what occurred and a move to a new stage of normalcy.
“What I have learned is that resilience is the most powerful thing and it’s amazing how strong humans can be,” she said. “It’s been amazing to see.”