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2020 has been an extraordinary year in so many ways, but its effect on our mental health has been tangible. Social isolation, grief, loss of income, working from home, and school disruption, among other things, have triggered mental health conditions or exacerbated existing ones. Studies in the United States alone have shown depression and anxiety rates increasing to over 30%. At the same time, Covid-19 itself has known neurologic and mental health complications, including anxiety, insomnia, and depression. There is also new data suggesting those with substance use disorders and psychiatric disorders are at a higher risk for worsened outcomes from the disease.
Yet, despite all of these compounding reasons for an increase in need right now, a new study by the World Health Organization(WHO) showed that in 93% of countries worldwide, the pandemic has halted or disrupted mental health services. And, though mental health appears to be prioritized and is mentioned in 89% of the national Covid-19 response plans of the countries surveyed, only 17% of these countries actually have provided additional funding for it. In other words, while mental health services are needed at a higher demand, funding remains inadequate. In fact, mental health only receives less than 1% of the health focused international aid.
With so many barriers to care and so little financial investment by policymakers, it can be hard to know much about mental health at all. In honor of World Mental Health Day, these are the 8 things mental health experts want you to know right now.
It Is Normal To Feel Bad Right Now
While there is no typical response to a global pandemic, feeling like you are struggling right now is not just common, it is expected. Dr. Samantha Meltzer-Brody, Assad Meymandi Distinguished Professor and Chair, Department of Psychiatry at the University of North Carolina at Chapel Hill, explained that many people feel like their sense of stability has changed and that their lives look quite different right now. As a result, she said they can “feel like they are walking on shifting sands and feel highly unsettled, anxious, or depressed.” Uncertainty about the future and a person’s inability to shape it, Dr. John M. Constantino, Professor of Psychiatry and Pediatrics at Washington University in St. Louis and Psychiatrist-In-Chief at St. Louis Children’s Hospital noted, can also cause symptoms like depression, helplessness, hopelessness, and meaninglessness at a higher frequency and intensity than usual.
Dr. Kaz J. Nelson, Associate Professor and Vice Chair for Education in the Department of Psychiatry & Behavioral Sciences at the University of Minnesota Medical School, said that to her right now, “if you feel bad, you’re paying attention.” She explained that our bodies and brains are wired to respond to threats and when they are activated, our brain’s ability to concentrate, plan, calculate, or even be empathetic for others, decreases. When these threats occur for a long time, our body shuts down to conserve energy, which can show up like exhaustion or fatigue. She added, “If you feel this way, this means your body is doing what it’s been wired to do to survive. It does not mean you are ‘broken’ or ‘poorly wired’.”
These feelings might also be something we are surviving for a long time. Dr. Drew Ramsey, Assistant Clinical Professor of Psychiatry at Columbia University, stated that while we need to cope with the depression and anxiety we are experiencing right now, we also need to be prepared for winter, which is going to be hard. He illustrated it as the following: “It’s like my mental health already did a triathlon, but actually the finish line is next June.” It is, quite simply, exhausting on top of existing exhaustion. But, right now, even that is normal.
It’s OK Not To Be OK
According to Dr. Jennifer M. Gómez, Assistant Professor in the Department of Psychology and Merrill Palmer Skillman Institute for Child & Family Development (MPSI) at Wayne State University, having good mental health does not mean you are happy all of the time. She pointed out that a wide range of emotions from sadness to anger to grief are “integral parts to being alive.” Listing many triggers in our environment including Covid-19 and police violence, Dr. Gómez noted that reacting happily after experiencing any of those things directly or indirectly would be abnormal. She added, “If you’re struggling, there’s nothing inherently wrong with you.”
Dr. Riana Elyse Anderson, Assistant Professor at the University of Michigan, agreed and emphasized, “When people say “it’s okay not to be okay”, I want you to really hear that.” She explained that there is no precedent for navigating this high level of stress from different sources at the same time and our bodies were not built for sustaining it. In other words, she said, “Would you know how to get to point B if you didn’t have your GPS?” Dr. Kevin M. Simon, Fellow in Child & Adolescent Psychiatry and Addiction Medicine at Boston Children’s Hospital/Harvard Medical School added that a critical part to dealing with stress and being mentally well, is actually being intentional about finding safe spaces to express emotions. This can include, for example, a therapist or trusted friends.
Prioritize Self Care, Find What Works
Though challenging with so many competing needs, it is critical to focus on yourself whenever you can. Dr. Pooja Lakshmin, Clinical Assistant Professor in the Department of Psychiatry & Behavioral Sciences at George Washington University School of Medicine explained, “If the pandemic has taught us anything, it’s that mental health is not “extra”. Mental health is health.” She added that women, in particular, often think self care is selfish, but that is not true. Instead, Dr. Lakshmin feels, “Your mental health is the foundation upon which the whole house is built. Never apologize for taking time and energy for yourself.”
Self care right now, however, might look really different than it usually does. Joey Lusvardi, a psychiatric physician assistant, pointed out that during Covid-19 you might not be able to do all of the things you normally enjoy doing, or due to precautions you might not find them as relaxing. It is still important, however, to find ways to unwind. He advised using this time to find new hobbies or interests and highlighted that self care can also include less “sexy” things like setting a routine, keeping your home clean, and showering.
Dr. Meltzer-Brody suggested that to protect our mental health we should “prioritize doing things that give us a sense of stability or grounding—in whatever small ways we can.” She noted that this can occur by focusing on tasks that feel nurturing or restorative to us, like connecting with friends and family or getting outside and enjoying nature. Dr. Jack Turban, Fellow in Child and Adolescent Psychiatry at Stanford University School of Medicine, highlighted that with “social distancing” for Covid-19 came social withdrawal that actually worsened depression. Instead, he prefers the term “physical distancing” and often reminds patients to keep social connection just in safe ways (e.g. through zoom or outside walking with masks).
Boundaries Are Not Just Acceptable, They Are Necessary
Protecting our mental health and focusing on self care, according to Dr. Meltzer Brody, should also include becoming aware of the triggers that make us feel worse (like social media or the news) and finding ways to limit them or swap them out with the things that are more nourishing or calming. This includes saying no to requests we don’t want to do as they come, even if it is difficult, and taking breaks and time off when we can. Dr. Nicole Washington, Chief Medical Officer of Elocin Psychiatric Services emphasized, “If you have leave at work, take it. If you need a break from the news and social media, take it. These rests are what is needed to recharge and to promote mental wellness.”
Boundaries between work and home are also essential to preserving our mental health, especially now with working from home. Dr. Washington noted that many of her patients now live at work due to the blurred boundaries of the two worlds and work late into the evenings. She explained that this is not sustainable and will lead to burnout. To help, she advises working in a space that is not your living space and avoiding it during non work times. If that is not possible, she said to try to “box up” your “office” at the end of the day so that “returning to it isn’t easy.” She added, “Some days I actually walk outside at the end of my workday for a few minutes almost as a symbol of leaving work and returning home. Sounds silly but [it] really helps.”
Be Nicer To Yourself…And Others
Many of the experts interviewed said that it is important right now to understand that you are not going to be as productive as you were and that is OK. Jessica Dyer LCSW, Director of WashU Cares at Washington University in St. Louis explained, “Your best is not attainable under these circumstances…Right now is about learning to ride the waves of up and down and be compassionate with ourselves in a high stress time.” Dr. Washington added that since it can cause mental distress or self doubt to expect the same level of productivity, it can be helpful to adjust your goals to something more realistic and “in step with the world we are trying to function in right now.” Then, when you accomplish something, you can celebrate, which we all need right now.
Dr. Sherrita A. Strong, Director of Inclusion and Assistant Professor in the Department of Psychiatry at UNMC has noticed that with our altered abilities right now, we also need more self-compassion and compassion towards our coworkers, friends, and family. She explained, “As we become more and more stressed, there is a tendency to have less empathy for ourselves and others…Remember to give grace to each other and to ourselves and recognize that we are all just doing the best that we can.”
You Are Not Alone, Reach Out To Others
If you feel scared or sad or anxious, sharing those feelings with others can help. Dr. Chase T.M. Anderson, Fellow in Child and Adolescent Psychiatry at UCSF highlighted that it is important for people, particularly those who identify as minoritized, to know that they are not alone and reaching out can help. He said he would want to tell them, “You are seen. You are loved. You matter…Keep your head high.”
Yet, many worry about asking for help at all because of stigma and shame. Abhisek Chandan Khandai, Assistant Professor of Psychiatry at the University of Illinois-Chicago, feels that there is no shame in struggling with your mental health, but, instead, “there’s shame in shaming those who struggle.” Dr. Anne Glowinski, Professor of Psychiatry and Associate Chief of the Division of Child and Adolescent Psychiatry at Washington University in St Louis, added that she believes that asking for help is a strength. She truly hopes people open up to others and get the help they need.
Because stigma can delay people reaching out for help, as a friend or family member, it is important that you reach out to someone you feel is struggling and not wait for them to reach out to you. Dr. Khandai explained, “When someone’s drowning, you don’t ask them to swim to you- you throw them a life preserver.” Dr. Turban pointed out that specifically for LGBTQ youth, a population his research focuses on, being home has worsened their mental health and they could benefit from a phone call for support as a check in. He stated, “Hearing even a single affirming accepting voice can have a positive impact on [their] mental health.”
Get Professional Help If You Need It
It is common for people to wait to deal with their mental health until a crisis, putting off getting professional help due to stigma, lack of time, or even believing their symptoms could go away. However, Dr. Lisa Merlo, licensed psychologist and Director of Wellness Programs at UF College of Medicine, noted that it is important to instead reach out early because treatment can often then be faster, more effective, and less expensive. It also prevents unnecessary suffering from your condition. In other words, she added, “the point at which you FIRST think, ‘I wonder if I should get some help’ is the best time to reach out.”
A similar sentiment was echoed by Dr. Christine Moutier, Chief Medical Officer of the American Foundation for Suicide Prevention who said we should not wait until we are in crisis to “get serious about mental health.” She explained that many people do not realize the many ways that mental health permeates their lives including their relationships, their productivity at work, and their physical health including their sleep, energy, sexual functioning, and even pain/inflammatory conditions. She added, “Since mental health affects more than just our thoughts, feelings, and mood, we can actually have much more influence over our life if we start finding ways to make mental health a priority.” Similarly, Dr. Carol Bernstein, Professor and Vice Chair for Faculty Development and Wellbeing at Montefiore Medical Center/Albert Einstein College of Medicine, emphasized that it is important to not treat mental health like the “neglected stepchild of healthcare” and instead to always “make sure to take care of your emotional needs as well as your physical needs.”
This means, however, that you understand how to get help, which the experts acknowledged was a challenging part of care seeking. Dr. John Krystal, McNeil Professor and Chair of Psychiatry at the Yale School of Medicine, noted that there are different levels of care and ways to get help depending on the severity of your symptoms. He explained that feeling “out of sorts” or not getting along with your family or colleagues might be a sign that you are under stress and should get help. However, there are so many different ways to destress including sleep, exercise, meditation, and counseling and Dr. Krystal emphasized that it is important to determine which method works best for you. If, however, you have more serious symptoms like no pleasure in your life or hopelessness, you may be depressed and along with exercise and counseling, Dr. Krystal felt at that point, it is possible that medication might then be helpful. Ultimately, treatments do work, and according to Dr. Merlo, “you won’t know how much better you can feel until you take advantage of mental healthcare resources available to you.”
Mental Health Is Health
Finally, many of those interviewed discussed the importance of valuing and prioritizing mental health so that the system could be changed and barriers to care could be decreased. Dr. Rona Hu, Clinical Professor of Psychiatry and Associate Dean of Academic Affairs at Stanford University School of Medicine, explained that “a system that ignores or discriminates against mental healthcare is a system that ignores who we are as human beings. There is no health without mental health.” Dr. Gail Saltz, Clinical Associate Professor of Psychiatry at The New York Presbyterian Hospital Weill Cornell School of Medicine added that stigma and lack of access prevent many with mental illness from getting the treatment they need to decrease their suffering. As such, she emphasized that “attention and access to mental health care needs greater prioritization in this country.”
In this advocacy, it is important to work to make physical health and mental health equivalent and recognize that there are continued disparities in who has access to good mental health care, according to Dr. Joan Cook, Clinical psychologist and Associate Professor at the Yale School of Medicine. To make effective services available to everyone will also include advocating to make sure mental health and substance use are covered by insurance the same equivalent as physical health. Dr. Cook noted, “This is a tall and urgent, but doable order.” Dr. Michael McClurkin, psychiatry resident at the Yale School of Medicine echoed these sentiments and stated that while 2020 has been a unique and hard year, one thing that has not changed is how critical mental health access and delivery is, particularly for our most vulnerable populations. He explained, “As healthcare for millions remains in peril amidst an escalating COVID-19 public health crisis, we must continue to sound the alarm for increased awareness, advocacy, and investment in mental health worldwide.”
Ultimately, on this World Mental Health Day, listen to the experts and consider making mental health, at least your own, a priority, too.