STATEN ISLAND, N.Y. -- While many health-care workers around the globe are focused on treating coronavirus (COVID-19) patients during the ongoing pandemic, others are preparing for a new health crisis on the horizon, one centered around mental health.
Earlier this month, the United Nations released a new report, “COVID-19 and the Need for Action on Mental Health," highlighting ways in which the pandemic has been, and will continue to, negatively impact citizens’ mental health.
The report notes that feelings of depression and anxiety have increased in areas most severely impacted by the pandemic, with a combination of fear, isolation and financial insecurity often contributing to the deteriorated mental state.
“People’s distress is understandable given the impact of the pandemic on people’s lives. During the COVID-19 emergency, people are afraid of infection, dying, and losing family members. At the same time, vast numbers of people have lost or are at risk of losing their livelihoods, have been socially isolated and separated from loved ones, and, in some countries, have experienced stay-at-home orders implemented in drastic ways,” according to the report.
Certain populations -- such as first responders, health-care workers, the elderly and children -- are increasingly vulnerable to the detrimental mental health effects of the pandemic due to heightened stress levels at work and physical isolation from friends and family.
With the mental health issues onset by the pandemic expected to last long after the virus is gone, the report emphasized the need to not only provide widespread, emergency support in the near-term, but to invest in long-term mental health initiatives and enact policies that provide care to all those in need.
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“An ongoing, longstanding issue is that mental health — across health, social, education and other sectors — has been heavily underfunded. Countries spend on average only 2% of their health budgets on mental health. Given the increased long-term needs caused by the pandemic, this is the time to address inequity and organize affordable community-based services that are effective and protective of people’s human rights as part of any national COVID-19 recovery plan,” according to the report.
The Staten Island Advance spoke with the borough’s leading mental health experts to discuss how the pandemic has impacted Staten Islanders, and where those who are struggling can seek help.
HEARING FROM PATIENTS MORE
With the coronavirus pandemic placing a great deal of unforeseen stress on Staten Islanders, the borough’s mental health-care providers say they have seen an increased volume of calls from those seeking help.
“We are getting a real surge in the number of people reaching out and looking for referrals and support and it’s certainly a sign of the times,” said Pete Shiffman, a nurse and president of the National Alliance on Mental Illness (NAMI) NYC Staten Island.
Dr. Joel Idowu, chief of Psychiatry at Richmond University Medical Center (RUMC), said: “We put out a public hotline that people can call if they are experiencing anxiety about the pandemic and we got a lot of calls, especially in the beginning."
While the number of people reaching out for help has increased, it has become more difficult, in some cases, to connect these people with the appropriate resources due to the pandemic.
“What we’ve found with the pandemic is that it’s really complicated the process of getting help for a loved one because finding a therapist or psychiatrist that is accepting new patients right now is very difficult, and then there’s the issue of health insurance that compounds it,” Shiffman said.
FEAR OF CONTRACTING AND SPREADING
A major factor contributing to declining mental health is people’s fear not only of contracting coronavirus themselves, but also the fear of spreading it to loved ones who may be at an increased risk of death should they get sick.
“There’s a direct impact if someone has become ill or a family member has become ill that may involve feelings of fear, grief and the associated stressors of having to take care of one’s health or having to take care of a loved one’s health,” said Dr. Timothy Sullivan, chair of the Department of Psychiatry and Behavioral Sciences, Northwell Health, Staten Island University Hospital (SIUH).
Shiffman said: “The anxiety or phobia of becoming sick, there are people who have had this long before the pandemic and this has certainly exacerbated that. Not to mention fear for younger people of infecting their elderly relatives. These are all anxiety-producing things.”
EFFECTS OF ISOLATION
Being forced into isolation due to strict stay-at-home orders has also negatively impacted the mental health of many.
“The fact that people are restricted to their homes and don’t have the freedom to go out can cause cabin fever,” said Idowu. “People might then start experiencing anxiety, depression and difficulty interacting with those within their household as they lose connection to the outside world.”
Isolation can be particularly hard on the elderly, many of whom are separated from their family, whether they live alone or within a nursing facility.
“Knowing that many of my patients can not receive visitors is such a hardship. Having people involved in your life is one of the key components, so this has really made things difficult," Shiffman said. “And we know that as the city begins to reopen, people who are considered vulnerable, like the elderly, will still be in this lockdown state for quite sometime.”
Sullivan said: “We’re seeing an increase in reported symptoms of distress from elderly patients who don’t have the benefit of being in contact with loved ones. It’s really stressful to not be able to get a hug from your family members.”
In some cases, the detrimental effects of isolation can become so severe that Sullivan has advised some of his elderly patients to go out and spend time with their family, so long as they are able to do so in a safe and healthy environment.
“We have to try to have whatever contact we can with older family members as they continue to isolate. I have patients who I have urged to go to a park with their family where they can maintain safe distance because just seeing them in the flesh is helpful as long as people can do it safely. It’s certainly an improvement over just talking to people on the phone or over the internet,” he said.
DISRUPTED DAILY ROUTINES
The disruption of daily routines due to the pandemic is also wearing on some, with shifting schedules making many feel unproductive and potentially driving them into a deep depression.
“Structure to me is one of the key things that has been really damaged by this pandemic, people’s sense of structured days,” Shiffman said. “Without that people’s sleep patterns are disrupted, and the scariest thing is when people are home all day and there’s nothing to do but think and think and think.”
“Scheduling activities, however small they may seem, is key because we need to maintain that structure,” he added.
Sullivan echoed Shiffman’s sentiment, noting that the return to a regularly scheduled routine can be incredibly beneficial for one’s mental health.
“Healthy routines tend to get disrupted during times like this, which is part of what’s hard about this pandemic," Sullivan said. “It’s funny, I had some co-workers, administrative folks, who were working from home for awhile and when they came back to work recently they said, ‘You know, it’s nice to actually have my routine back,' and that’s something that affects everybody who had a routine and had to give it up.”
SUBSTANCE ABUSE
Although the borough’s hospitals have not seen a large uptick in substance abuse admissions, mental health experts tend to agree that the increased levels of stress and anxiety brought on by the coronavirus have driven many to abuse substances as an unhealthy coping mechanism.
“Surprisingly, we haven’t seen a large increase in people coming in for substance abuse,” said Idowu. “That being said, we know that people are using alcohol and other substances as a coping mechanism in the home.”
Sullivan said: “We worry that there are people who are using substances in greater amounts, but they have not yet presented. For example, our admissions for detox from alcohol are relatively low compared to our averages."
“I don’t think all of a sudden everybody got sober and stopped drinking. In fact, if you look at liquor store sales I think people are drinking a fair amount. At some point that’s going to rear its head as big problem,” he continued.
Sullivan went on to explain that while alcohol-related admissions are down, there has been a slight uptick in admissions at methadone clinics, potentially due to the disrupted supply of illicit street drugs.
“We do know our methadone clinics are seeing a slight uptick in people seeking help for opiate use,” Sullivan said. “That’s probably, partly, because the supply of opiates is a little less dependable than the liquor stores are.”
EFFECT ON CHILDREN
Children, some of whom are too young to fully grasp the implications of the pandemic, are particularly susceptible to declining mental states due to lack of socialization, increased academic stress as a result of remote learning, disrupted routines and increased conflict within the home.
Some children, particularly those without siblings within their age range, are at increased odds of developing mental health issues, which can manifest in the form of behavioral outbursts.
“I think a lot depends on the number of siblings in the household and their relative ages,” said Christopher Keane, a family nurse practitioner (FNP) who serves as assistant vice president of Outpatient Behavioral Health at RUMC.
“There’s a lot of sibling bonding going on, which works as a positive, but then -- depending on the number of children and separation in age groups -- it can lead to incredible isolation on the other side," he continued.
Miriam Prat-Jerez, a licensed mental health counselor (LMHC) who runs RUMC’s largest children’s mental health clinic, explained the various issues Staten Island children and families have been experiencing throughout the coronavirus crisis.
“We are seeing a lot of trauma reactions and grief, and an increase in anxiety and that sometimes in children manifests in behavioral disturbances -- which increases conflict at home,” Prat-Jerez said.
The disruption of daily routines can be even more impactful on children than adults, particularly those who can’t fully grasp why their world has changed so suddenly.
“The disruption in the routine and the unpredictable environment is definitely going to trigger children, especially if they’re too young to fully comprehend what’s happening,” Prat-Jerez said.
Remote learning, which has taken the place of in-class instruction during the pandemic, has also placed a burden on both children and parents struggling to adjust to the new routine, some of whom can not afford enough supplies for the whole family.
“The academic instruction at home causes a lot of stress on the parents and the children. Even things like not having enough laptops at home or having to listen to your sibling’s Zoom class from across the table. Those things over time contribute to stress,” said Prat-Jerez.
This time of year can be particularly tense for many children anyway, according to Keane, with high levels of academic stress brought on by impending final grades and the possibility of summer school.
“This time of year is always delicate, because this is when the grades come in, when graduation either does or doesn’t happen, so it’s a high-anxiety time of year for the youngsters,” Keane said.
EFFECT ON FRONTLINE WORKERS
Those operating on the frontline of the pandemic, specifically health-care workers and first responders, are at increased risk of developing mental health issues, in some cases as serious as Post-Traumatic Stress Disorder (PTSD), as a result of facing the crisis head on.
“I think that for first responder and health-care workers, especially those on the real forefront of this, they’re witnessing things that they’ve never seen before and that has a psychological effect on them,” said Idowu.
For health-care workers, the fear of contracting the virus at work and bringing it home to their loved ones can be a major stress on the whole family.
“If you’re a health-care worker, you’re family doesn’t see you the same way anymore. They’re worried about what you might be coming home with, which can breed a whole new anxiety within the family,” said Keane.
Additionally, some health-care workers across the country have been forced to make the near-impossible decision of which patients to place on ventilators and which to stop treating, an unbearable choice that can result in “moral injury,” where health-care workers are left wrestling with whether or not they made the right call.
Others experience moments so devastating that the situations feel unjust, causing a great deal of conflict within the worker’s mind.
“When you’re working closely with someone whose dying and can’t see their family -- even though you know the reason why that’s so, and that nothing can be done about that -- as you’re holding up the cellphone so they can say good-bye as someone is about to be put on the ventilator, there’s a natural feeling in us that things shouldn’t be this way," Sullivan explained.
“That kind of situation creates tremendous stress in our mind because things don’t mesh. There’s a strong feeling that it shouldn’t be like this,” he continued.
For first responders, such as EMS workers, Keane said that the sheer volume of calls during the height of the pandemic likely contributed to increased levels of stress and anxiety that were exacerbated by the inability to stop and process.
“Generally speaking, they get what is called a secondary traumatic stress response because of ongoing trauma and having to look at very bad situations every day,” said Keane.
“It’s almost like someone told you the house next door is on fire. And then they said the house across the street is on fire. And then as soon as you thought you had control of that, by the way, the house behind you is on fire. Having a never-ending cycle like that for a solid 60-day peak, without having time to process what’s happening, is incredibly challenging,” he added.
The painful experiences of these health-care workers and first responders make them increasingly vulnerable to developing PTSD, as many did in the aftermath of the terrorist attacks on 9/11.
“They often have to view or be present for situations in which they have very little control, and that’s certainly the case when you see a lot of people dying, especially people you wouldn’t expect to die. I think some of the toughest stuff people have had to face was seeing otherwise healthy, young adults coming in, ending up on ventilators and ultimately passing away. That stuff’s not supposed to happen,” said Sullivan.
EFFECT OF UNEMPLOYMENT, FINANCIAL INSECURITY
As unemployment continues to soar across the country, the accompanying financial insecurity can cause increased levels of stress and anxiety, in some cases resulting in substance abuse and domestic disputes.
“If you lose your job, and then there’s the fear of how do I meet my financial obligations to my family, you can’t pay your bills, you don’t know when you’re going to be able to get another job, those worries and anxieties can then lead to mental health issues,” said Idowu.
“It can lead to people abusing substances and can create interpersonal relationship problems within households. Couples start to argue more which, in some cases, resulting in physical altercations,” he continued.
For some, the inability to provide for one’s family can lead a person into a deep, depressive state that causes him or her to further isolate.
“People become very depressed and reclusive. I’m fearful there will be a surge in substance and alcohol abuse, not to mention people losing their home and not knowing how to care for their families. That’s a tremendous anxiety-provoking experience for anybody, and for some it’s crippling,” said Shiffman.
FIRST TIME HANDLING MENTAL HEALTH ISSUES
While people dealing with existing mental illnesses have seen their problems exacerbated in recent months, many others who have never dealt with such issues are now experiencing them for the first time.
“The people who have existing mental health issues, the pandemic is increasing their symptoms in some ways because of the fear and anxiety of either getting the virus,” said Idowu. “But we also know that periods like this will lead to new sets of people developing mental health issues, either during the pandemic or after it happens."
While both groups will experience similar symptoms, those who have existing mental health issues may actually be better positioned to handle the situation than those experiencing them for the first time.
“People who already have a history have the benefit, hopefully, of being connected to care providers who will be checking on them. They have an increased tendency to develop severe symptoms because of that history, but at least they’re seeing their providers and responding to our efforts to reach out to them,” Sullivan said.
“If it’s someone who has never had a history of psychiatric issues, we want to really educate them, because it may be hard for that person to ask for help or know that they need help,” he continued.
Unfortunately, the pandemic has made it more difficult for some with existing issues to receive regular care.
“Some are being disconnected from their treatment services, which increases the likelihood that they will start to not function well within the community,” Idowu said.
“Some clinics are not open, so patients have not been able to see their care providers because of that. Those who have been doing it over the phone or virtually are realizing that it’s not the same as sitting down face-to-face with your doctor or therapist,” he added.
HOW TO GET HELP
If you or a loved one are struggling with mental health issues, there are numerous resources available to you on Staten Island.
NYC Well offers free, confidential mental health support for all New York City residents. To receive free counseling, New Yorkers can text “WELL” to 65173, call 1-888-NYC-WELL, or visit the program’s website to chat online.
RUMC has also set up its own 24-hour mental health hotline that can be reached at (718) 818-6300.
In addition to free mental health counseling, NYC Well offers a list of free mental health apps to help during the coronavirus pandemic and can connect you with behavioral health and substance abuse services in your area.
Both SIUH and RUMC also offer robust mental health and substance abuse programs for Staten Islanders seeking assistance.
“People can call our clinic. They can call for an appointment or even just for a screening,” said Sullivan. “We’ll talk to you and do a screening and see if you need to come in for an evaluation. Then we’ll set that up and, if need be, we can do it remotely for people who may be apprehensive about coming in.”
Idowu said: “We have several services and programs that provide mental health services to different age groups and categories depending on what the patient’s needs are, from patients as young as 2 years old to those as old as you can think of."
Visit the SIUH website to get in touch with a mental healthcare provider within their network.
Visit the RUMC website to get in touch with a mental healthcare provider within their network.
Additional local support programs are available through the NAMI NYC Staten Island website.