When the nationwide stay-at-home orders began in mid-March, for some, it seemed to provide a little respite from life. As the coronavirus has rapidly spread, however, our “vacation” has turned into what seems like a never-ending sentence to life at home. Tiger King feels like years away, and one can only binge-watch so many shows before even Netflix grows boring. As time goes on, the present feels ever more confining and the future daunting. The pandemic, and more specifically quarantine, has had a unique impact on those who struggle with mental illness.
While quarantine has a lasting effect on people with diagnosed mental health conditions, it is also bringing about a new wave of depression, anxiety, and substance abuse disorders for people who have no prior history of mental illness. A federal emergency hotline providing emergency counseling for people in emotional distress reported a 1,000 percent increase in calls from last April to this April. Feelings of isolation and loneliness from quarantine are having a serious effect on the general population’s mental health. Moreover, mental illness among frontline healthcare workers, in particular, is rising, as they are constantly reminded of the pandemic’s intensity.
The pandemic has completely changed the landscape of mental health care, one of the key components to battling mental illness. Perhaps one of the hardest parts of quarantine has been losing in-person visits with my mental health professionals. In their stead, telehealth therapy appointments are one of the only ways I have made it through quarantine. Previously, telehealth mental health services faced issues with HIPAA, given concerns over privacy and security of services over the internet. During the COVID-19 outbreak, however, the Office of Civil Rights gave healthcare providers the OK to deliver telehealth practices over secure networks such as FaceTime, Zoom, and Skype. The Centers for Medicare and Medicaid also passed a waiver to include mental health in telehealth services covered by federal insurance. Many private companies have followed suit, extending reimbursement policies to include telehealth therapy services.
This has had tremendous effects on the reach of therapy across the United States. With telehealth, patients now have much greater access to the country’s network of therapists and psychiatrists. By allowing greater insurance coverage for telehealth services, the financial barrier to mental health services is lowered greatly. Telehealth services also allow people to participate in therapy from the comfort of their home. This makes appointment times more flexible and easier to attend by removing the commuting times to appointments. Additionally, telehealth removes some of the stigma of having to visit a therapist in person, where you may find yourself making shifting eye contact with someone in the waiting room. Online appointments provide comfort and privacy in ways unattainable in physical space.
Similar to telehealth appointments, the use of e-therapy apps and websites like Talkspace and Betterhelp are on the rise. E-therapy apps offer a cheaper alternative to face-to-face therapy and focus heavily on “text therapy.” Instead of meeting or videoconferencing with a therapist, users are connected to a therapist and form a relationship primarily over text. Like telehealth, these apps provide a range of benefits that one does not see in traditional therapy—easy, constant access and privacy. Texting a therapist can help remove the stigma of seeing a therapist at all. There are, however, many concerns regarding e-therapy. Despite using licensed therapists, very little research has been done regarding the effectiveness of text-therapy, which concerns some users. There are also questions regarding the privacy of conversations on the app. In terms of privacy and effectiveness, telehealth provides a more secure platform for online mental health treatment, as opposed to these new e-therapy apps. We must acknowledge, however, that there are also downsides to telehealth. States have different licenses, which can limit a provider’s ability to access patients across state lines. There are also concerns surrounding the appropriate platform to conduct telehealth appointments on, for fear of the patients privacy and data safety.
Despite the benefits and comforts of teletherapy, most of these waivers are temporary, having been put in place to fill a void during quarantine. As time rolls by, the periods for these waivers are expiring, and it is unclear if they will be extended, either throughout the continuing pandemic or permanently.
Telehealth is an overwhelming upgrade to the population who previously could not access these services. The extension of these health services now becomes even more important, as data proves that a spike in mental illness is already occurring, and an even larger one may follow the pandemic. Past pandemics and economic recessions demonstrate a pattern of precedence for a wake of mental illness following major crisis: following the 2007 recession, suicide rates increased by more than one percent for every one percent increase in unemployment. If the telehealth waivers are not extended, this new portion of the population that has been able to access mental health care will once again be left with very limited options.
This is especially true because therapy is not the end all-be all solution for mental health disorders. One of the pinnacle mechanisms for dealing with a mental illness is creating a daily routine, which quarantine has largely disrupted. Without structure during the day, it is easy to stay up all night, wake up late, and spend endless hours on your phone or computer mindlessly scrolling and watching, disrupting natural sleep cycles and serving as a buffer from engaging in enriching activities. When a daily routine is ripped out from under a person, it is very difficult to do anything else but think. Routines are so important for those dealing with anxiety, depression, bipolar disorder, and substance abuse issues—they help people structure their time in productive ways, allowing them to actively work to combat the anxious and depressed feelings that creep in during unstructured time.
As dire as this may seem, there are ways in which we can add a little routine in our lives during quarantine. Setting a regular sleep schedule ensures both a proper amount of sleep as well as a better time structure to the day. Carving out 30 minutes to read a book every day can engage the mind more actively than brainlessly watching TV. Dedicating evenings to learning a new craft is another constructive and fun activity that one must actively take part in. I, for example, have been teaching myself to sew.
The point is you have to start somewhere, and even the smallest additions of structure help. For me, this has taken the form of using exercise not only as a way to build my routine, but also as an outlet for the extra anxiety and stress that quarantine and the uncertainty of COVID-19 has caused me. In another article written for The Voice, Rose Dallimore talks about how her practice of mindfulness has helped her find a little peace during these scary times. In a New York Times article, two writers discuss how it can be as simple as changing your mindset from “I am being forced to do this,” to “I am choosing to do this for the safety of my community.”
Beyond a need for telehealth waiver extensions and routine creation, the mental health crisis that accompanies the COVID-19 pandemic is being greatly ignored. Only two percent of the $2 trillion relief package was dedicated to substance abuse and mental health services. In the 2021 city budget, the D.C. Council cut $4 million proposed to be spent on mental health services, which already face a dire shortage in funding. If we do not begin to address these problems in mental health, the fallout may ravage the country for years to come.