#COVID-19 · homophobia · Mental Health Stigma Suicide · Nursing

Ten Things I’ve Learned as a Mental Health Provider During COVID-19

  1. People can only handle stress for just so long. When I explain chronic anxiety and depression to patients I often use the analogy of a teapot. When you are walking around filled up with stress/anxiety/trauma/depression for years eventually you do not have room for normal every day stressors. This leads to epic breakdowns over seemingly innocuous things. Did you ever cry when you couldn’t open a jar of sauce? Or start screaming when you can’t find your keys? We all have a boiling over point. February 2021, about eleven months in, seemed to be most peoples boiling point. In the Northeast we had a lot of snowstorms which I think compounded things for many of us. My practice received upwards of ten-fifteen calls a day just from new referrals, not counting our five hundred plus current patients who also all started to melt. These calls were desperate. Crying into voicemails. There were suicides in our communities. There were drug overdoses and relapses. February 2021 honestly was one of my hardest months as a mental health provider.
  2. Women bear the brunt of childcare and homeschooling responsibilities. This is a gross generalization. Please note I know that there are many wonderful Fathers and husbands who have supported their families during the pandemic in every way imaginable. But in my own practice I have seen my female clients taking responsibility for the organizing of homeschooling. They have described screaming matches with their partners about who has to sacrifice work time. I’ve had women clients leave their full time jobs, drop to part-time, and/or change positions in order to accommodate their children suddenly being home full or part time. I have seen women making sacrifices and publicly smiling but privately falling apart with grief, anger, and sadness.
  3. Minorities are under more minority stress. From the LGBTQ community to POC to children to the elderly. All vulnerable populations have been made more vulnerable. The death rates of COVID-19 are disproportionately higher in the African American communities. https://www.cdc.gov/coronavirus/2019-ncov/community/health-equity/racial-ethnic-disparities/disparities-deaths.html Does a nice job of objectively presenting this evidence. The LGBTQ individuals who have lost jobs and been forced to move back in with homophobic and transphobic families are real. LGBTQ children, teenagers, and college aged individuals who have to live with homophobic and transphobic families is real. Suicide risk is high in this population already. The social isolation and inability to be “out” due to COVID-19 has added to these already significant issues for minorities. I literally have had telehealth sessions with a client crouched in a dark closet (and the irony of them being in a closet is not lost on us) in order to obtain privacy in order to cry in despair at not being able to be “out” and to have to experience homophobia and/or transphobia in every day life with their family. These sessions are gut-wrenching.
  4. Postpartum Moms and Dads have stress you can’t understand. I’ve often said the most unsolicited advice I ever received was during my pregnancy and in the first year of my twin boy’s lives. People who have been parents or not have opinions and stories and think everyone should hear them. Being postpartum regularly is hard. Being post partum during a pandemic when so little is known about the impact on newborn health is terrifying. Newborns can’t wear masks. Babies in daycares crawl and touch each other’s boogers. Parents have delayed putting their children in daycare because there is no true protection against exposure for infants. They are told that they are right, wrong, stupid, smart, and everything in between by people around them. I have never treated as many postpartum women as I have in the last year. SO much of it is providing reassurance that they are doing everything right. That there is no one right decision. That they know their baby and their lives best and they have to make the best decision for themselves. I offer validation and objectivity and I have seen them cry when I’ve told them they are doing everything right. Because no one has validated them since they gave birth. Unless you sit with people who have newborns day in and day out and see the agonizing choices they have to make; you don’t understand. And you shouldn’t be offering anything except validation and support.
  5. People NEED people. I’ve also said before I’m not a hugger. But the first time my friend and I hung out after we were both vaccinated and she asked if she could give me a hug and I enthusiastically consented. We weren’t big huggers before COVID-19 but after a year of isolation we unashamedly and laughingly embraced. One of the most poignant sessions in the last year, that has consistently stuck with me, was a young adult who lived alone and who did a Zoom with her family for Thanksgiving. Through tears she said, “I had to do a Zoom with my family. I just. want. to. hug. them.” Her breath hitched with each word and the tears turned to sobs and we sat for several minutes with her sobbing and me watching; neither of us speaking. I held back tears of my own as I wanted to reach through the screen and pat her shoulder and tell her it would all be okay. I heard so many of these stories but her vulnerable and raw pain in that moment touched my core. I had clients tell me their parents cried during their Zoom Christmas’ and they couldn’t stand to see their Mom cry. I sat with them through that pain. I offered nothing but space and understanding to feel pain. I have never known with such certainty after the holiday season of 2020 that we need physical touch to survive. We need our families. We need connection. Of all the long term sequelae that COVID caused, the isolation and desolation of being alone is by far the worst.
  6. Never underestimate the power of pets. I don’t have to explain much about this. If you have animals then you know what I am referencing. The isolation of this past year has made people get new pets and appreciate the ones they have. Pets are some of my clients purpose in getting out of bed every morning. They have truly saved lives this past year just by existing and offering unconditional love. To all our four legged friends, you have my true admiration and thanks.
  7. People who treated their mental illness before COVID faired better. One of my clients who was extremely ill a few years ago, but has since stabilized, greeted me smiling at our six month check in. She was doing great, and felt validated in her own experience of mental illness. “People know now how it feels to live with anxiety. I can now explain to people mental illness and they get it. Because their anxieties about COVID are exactly how I felt about everything all the time.” She wasn’t my only client who had severe mental illness in the past and stabilized with medication and therapy who have done excellent during the pandemic. They had coping skills, we knew what medications work for them, and they were connected to providers. My takeaway from them is to deal with your mental illness before you boil over.
  8. After people boil over Desperation sets in. I think it’s hard for some one to truly understand desperation until they have experienced it. Desperation is finding cuts on your childs arms or legs and bringing them to a hospital and being told they are not sick enough to be admitted and to connect to outpatient care, then calling forty providers and being told no one is accepting patients. Desperation is watching your loved one suffer and struggle and slip away and not be able to find them help. The mental health system’s flaws are fully exposed now. There are not enough providers. The providers that are in practice are un-paneling from insurance because insurers have made the last year so much worse than it needed to be for small practice owners. I have been screamed at on the phone more times than ever in my career when I call to tell people I am full or not accepting their insurance or not taking pediatric referrals. I have been threatened. I have been told through tears that they are desperate. I have been begged and pleaded with. I have been offered twice my normal rate just to fit some one in. I had to not return every phone call because I became fearful of what would be said to me when I told them I was not accepting patients. I had to hold my own boundaries and not take new patients in reaction to other people’s desperation. Because I was becoming burned out. I grew as a clinician and a business owner in the last year in more ways than I ever imagined. I also heard and saw desperation in ways I never imagined I would.
  9. I will always accept Medicaid. So many of my clients have been on and off Medicaid and commercial plans this year. Medicaid’s rates of reimbursement in my state are disgustingly low. But I will always have it as a plan I accept because my patients who lost commercial plans this year with job loss needed to have continuity with their mental health provider. I do not want my practice to be fully medicaid as that’s not sustainable revenue wise for a small practice. However, it will always make up a stream of our revenue because it has to be an option when clients lose jobs.
  10. Everyone has it bad. In the past year I’ve heard why the people in their 50’s and 60’s have it the worst. I have also heard why kids in high school, college, in their twenties, single people, married people, parents and non-parents all have it the worst. Every one thinks their lot is the worst. Young people are missing out on proms, college admission is being delayed in some cases, parents are overly burdened with childcare duties, single people are the most isolated, etc. I’m just throwing this out here; it’s been a shit year for everyone. There have been highs and lows for all ages all social statuses and in every way imaginable everyone has undergone stress, loss, and an understanding that things will never be like before. There is a before and there is a now and there will be an after but life will never be the same.

Through this past year of COVID-19 I have lived history. I am a front lines provider during a global pandemic. I have been through more personally and professionally than I could have imagined. My biggest and best takeaway from this past year though is to be grateful. I am grateful for my children. I am grateful for our health. I am grateful that I have been able to see my mom and sister, sister-in-law and niece, throughout the last year. I have known loss. I have grieved. I have cried. I have hoped.

About a month ago, I went to the office. I saw a long term therapy client for the first time in person for several months. He sat down, and I sat down. We both removed our masks. And we smiled. We were both vaccinated. The window was open. We sat eight feet apart. And then we had a therapy session in person without masks. It was possibly the most beautiful moment of the last twelve months.

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