She has thought about killing herself. Not once or twice, but often.
She has gone through periods of such severe anxiety and depression that all she could manage to do was spend the day curled up in bed.
Ashlee Shull has seen the bottom of addiction and the destruction of alcoholism and anger. She has racked up DUIs, police citations and defied anyone who tried to help.
She has long fought demons, but she was beginning to take control. Shull had committed to therapy, to recovery and to a support network that was pulling her away from the brink.
She enrolled in college, got a job at a bank and settled down to looking after her apartment and her two Huskies. Recovery wasn’t easy, but she was fighting the fight.
Then coronavirus hit.
Overnight, Shull found herself in the most dangerous situation: she was isolated and cut off from the world, and suddenly, she was unable to meet face-to-face with her therapist.
“Throwing a pandemic in the mix of what already seems to be self-destruction, may just be the final straw to a world of ultimate chaos,” said Shull, who is 28 and lives in Newport.
She was far from alone.
The coronavirus pandemic has exacted a toll on public health and the mental well-being of millions of people. Studies have tracked reports of unprecedented levels of stress, anxiety and grief in legions of people, even individuals who do not typically struggle with such issues.
For people who were already dealing with behavioral health issues, though, the pandemic posed a particularly dangerous threat to health and lives.
Shull is among the legions of people across Pennsylvania and the country that have had to navigate mental health concerns amid a crisis that not only exacerbated emotional symptoms, but hampered access to the level of care they were accustomed to or, indeed, needed.
“Everything was on standstill,” Shull said. “It wasn’t just about not being able to go out to restaurants, and people saying, ‘I can’t go to concerts.’ It was people not being able to see their therapist. Everybody around the world is so worried about how they are going to come back from this financially, and worried about going out, but few worry about how it’s affected people with mental health problems.”
More demand for services
Approximately 40 percent of the American population has over the past year reported that mental and behavioral health concerns have interfered with everyday life, said Dr. Erika Saunders, chair of the Department of Psychiatry and Behavioral Health at Penn State Health Milton S. Hershey Medical Center. She cites data from federal public health officials, including the Centers for Disease Control.
The rate is four times higher than the general prevalence prior to the pandemic.
“With the pandemic by necessity we and the rest of the world changed just about everything we do in how we live day to day and that has heightened anxiety across the board for everyone,” Saunders said.
“We’ve seen a huge increase in the overall levels of depression, anxiety, worry, and for completely understandable reasons. We changed how we interact with family, how we interact with people outside the home. There’s been universal change in workplace and educational settings, and of course, we know people who have gotten sick or passed away. It’s been a stressor on the entire population.”
In the past year, the demand for behavioral and mental health treatments in the commonwealth have increased significantly, particularly among certain population groups, including children and adolescents.
Similarly, the pandemic has ushered an uptick in demand for services for serious mental illness, conditions such as persistent depression, bipolar disorder, schizophrenia, but equally for the more run-of-the-mill mental health needs such as stress and anxiety, particularly among the young.
“Some children are thriving in a virtual environment, others are not,” Saunders said. “People who live alone, many times we think of the elderly, but it’s not restricted to them. Regardless of your age, if you live alone and have been observing the recommended distance requirements, that’s been very, very difficult.”
The pandemic has hit the recovering community particularly hard, and that’s not just people in early recovery. Individuals who have been in recovery five or more years are reporting relapses, according to Jennifer Smith, secretary of the Department of Drug and Alcohol Programs.
The department’s support and referral line – designated to assist people with any crisis – is getting between 310 to 350 calls a week. Early data point to an additional sobering fact: Fatal overdoses are up for 2020.
That number hovers around 4,700, outpacing 2019 by several hundreds.
“We expect that number to go up even more,” Smith said.
Tele-therapy isn’t for everyone
An immediate response to the pandemic was the pivot by the medical community to telehealth services. State mandates, insurance companies and public health programs such as Medicare and Medicaid got on board early in the pandemic to facilitate access to telehealth for millions of commonwealth residents.
“Unlike many other medical treatments where there was a huge dip and people were not able to receive care, mental health services went on,” Saunders said. “We didn’t see a drop in the number of people seeking services, in fact, we saw an increase.”
But not everyone adjusted well to therapy via videoconferencing.
Shull, for instance, found that something was missing. Video sessions with her therapist were coming up short in providing the therapy and guidance she needed.
“Zoom just doesn’t do anything for me compared to one-on-one,” Shull said. “For me to see a therapist over Zoom, I‘m not getting any connection. I‘m one of those people who isolates myself as it is because of depression. It changed everything up. For someone like me to have a schedule and accessibility was really important.”
Studies have shown that telemedicine sessions with a therapist – and for the appropriate services – can be as effective scientifically and medically as in-person sessions, Saunders noted. Moreover, telemed sessions have increased accessibility for some populations, in particular, for new mothers and parents.
“Each of us has our own preference,” Saunders said. “Some people will find in-person sessions more helpful for them.”
At least in Pennsylvania, much of the data available continues to be anecdotal. That’s because given the lag of up to six to nine months for reporting, much of what is known reflects what was going on last year; and with regards to the pandemic, that meant lockdown and a drop in services.
Anecdotal reports from the field, though, suggest that demand for services continues on an upward trajectory.
“When people feel disconnected, when they experience loss, when they feel helpless and especially feel hopeless, you can expect an intensity of the behavioral health needs to increase,” said Kristen Houser, deputy secretary of the Office of Mental Health and Substance Abuse Services in the Pennsylvania Department of Human Services.
More people in crisis
The substance abuse hotline, which saw a dip in calls last year at around this time, these days at times peaks to 400 calls a week.
That’s almost 400 people per week asking for resources or access to treatment services. Of those 400 calls a week, half result in direct referral to treatment providers, Smith said.
“We are seeing the negative effect in terms of increased fatal overdoses, but also the positive effect in terms of availability and accessibility in access to treatment resources through the hotline,” Smith said.
Smith is concerned that people are reaching out only when things have escalated.
Collectively, as a society, indeed a global community, the pandemic continues to impact public and mental health .
Saunders, the chair of the Department of Psychiatry and Behavioral Health at Penn State Health Milton S. Hershey Medical Center, said it is going to take an equally collective effort to lift everyone up and out of the emotional morass of the pandemic.
“Collectively as society and across the world this has been a huge trauma affecting us at multiple levels,” she said. “This will have long term effects for our society and I think we will see that in terms of lingering effects on mental health as well as every other area that has been touched by the pandemic.”
The coronavirus pandemic is fast being labeled a mass trauma event, one that has affected the entire social system, much like world wars, but our response to it remains far from uniform.
Despite a wealth of online tools and new workplace and educational settings, some people are able to be resilient and tap into new-found strength, while others struggle.
“We are going to be feeling this for a long time,” Saunders said.
Experts urge everyone to modulate stress, and that includes limiting social media or consumption of the news; finding ways to relax, meditate, and prayer and spiritual practices.
“Never underestimate the profound impact of general health promoting activities,” Saunders said. “Eating a variety of whole nutritious foods, getting exercise, getting outdoors even if it seems like little exercise, daily movement and good sleep. Keeping up with general health needs is extremely important.”
The past year forced many people to curtail their social interaction, but that may ultimately be crucial to dealing with stress, anxiety and isolation.
“We are social beings,” Saunders said. “We are a year into the pandemic and for many people that has meant that a lack of social interaction has become a habit. Reversing that habit and rediscovering reinforcing nature of social interactions in a safe way is very important.”
Houser stresses that help and treatment are available.
“It’s very normal for people to say I’m having a bad time but I know others are having a worst time,” Houser said. “Reach out for help anyway. Let others, let somebody else help you make that assessment. People often feel alone and don’t realize many others are going through the same thing they are and that help is available.”
Ashlee Shull still struggles, but she is feeling better these days. She is committed to therapy and also to helping out. She volunteers with a number of programs to help people dealing with substance abuse and mental health issues.
Speaking out and sharing her story, she said, is just one of the ways she is walking her path to recovery.
“Each of us need the help and support of others to maintain a healthy life,” Shull said. “We need to feel like we belong and help others to feel the same. We need to know that people are not just in our corner but that there are people fighting the same battle we are fighting. We need to do more than talk about these issues. It’s time to recognize and respond to these issues and to not allow COVID-19 to be prioritized as more important than connection.”
How to get help
Need treatment? Call the Get Help Now Hotline at 1-800-662-4357 to speak with a professional.
If you or someone you know is experiencing a mental health crisis, please reach out for help.
Crisis Text Line: Get 24/7 help from the Crisis Text Line.Text PA to 741741 to start the conversation.
Suicide Prevention Lifeline: If you or someone you care about is experiencing thoughts of suicide, please call the Lifeline at 800-273-8255.
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