Sky

The Masked Crossroads: Having COVID-19 While Having Mental Illness

Author: Parnika Celly

As we end the first full year of the lockdowns associated with the coronavirus pandemic, it is a good time for reflection and planning for the future. Since early in the COVID-19 pandemic, people have talked about mental health. There was a brief push to reframe social distancing as “physical distancing” to emphasize the importance of keeping connected with loved ones safely. There were articles written about effective leadership through crisis and how to combat the impact of screen fatigue on the motivation of remote workers. Losses of people, expectations, control, and life as we knew it were grieved by people from all walks of life. The general exhaustion of the pandemic is so widespread that search results on information related to the virus or pandemic on Google include a section on coping that includes CDC recommendations such as taking time to breathe, taking breaks from overwhelming media, and connecting with mental health professionals.

The actions that sites like Google and entities like the CDC have taken in recognition of and in response to the toll of pandemic-related stress are essential. Many professionals have described the pandemic as being a “collective traumatic” experience because the pandemic has overwhelmed our ability to cope with all the distress it has brought. This pandemic will have long-lasting effects on all aspects of our lives, including mental health. Suicide rates are up. Burnout is on the rise. An avalanche of financial burdens are pushing people to the brink of their tolerance. Recognizing the impact that this pandemic is having on people’s mental health is absolutely critical.

 

Yet…

 

Last fall, I contracted the coronavirus in the course of providing in-person services. While I was fortunate to have had a mild case of the virus, the worst effects I felt both during and after the time I was sick were on my mental health. I had spent a lot of time consuming information about the virus, partly out of interest and partly because I work as a contact tracer and want to make sure I understand the virus as much as possible. However, for me, being a person with a mental illness and having the virus really highlighted an important point about the discussions we have been having about mental health: they are all geared towards the average person without a mental illness. There was little mention in the literature then about experiencing both mental illness and the coronavirus, even though over 47 million adults have a mental illness in the United States and the intersection of mental illness as well as having coronavirus brings additional challenges.

 

Consider:

Panic attacks can often include shortness of breath (“Is it anxiety or is it a symptom of COVID?”)

 

Depression can be significantly worsened by isolation and often includes either being unable to sleep or feeling like sleeping all the time. (“Is it depression or fatigue from COVID?”). Depression-related hopelessness can be validated by the immense uncertainty in the world.

 

Chronic stress, anxiety, and exposures to trauma can weaken the immune system and cause numerous health issues, including some of the issues that increase risk for COVID-19.

Some forms of obsessive compulsive disorder include fears of contamination, which could be validated and worsened by the pandemic.

 

People with illness anxiety disorders now have a disorder to think about that has really random and highly variable symptoms.

 

Interruptions to structure in daily life can be harmful for people with bipolar and mood disorders, as well as people with eating disorders.

 

A whole body of internet memes regularly describes the constant use of alcohol as a coping mechanism, which reflects the reality of an increase of substance use among young adults during the pandemic.

 

People with schizophrenia who contract COVID-19 are more likely to die from the illness. This is also true for people who have been diagnosed with any mental illness recently (i.e. within the past year).

 

Some of the symptoms that can develop while infected and some of the long-term effects of COVID-19 are psychiatric, including depression, anxiety, PTSD, brain fog, and dementia. These can occur even in people who did not have mental health issues before getting the virus.

 

These are just a few examples.

 

I remember waking up in the middle of the night while I had the virus, struggling to breathe. I couldn’t figure out if I couldn’t breathe because of COVID or because of a panic attack. Or both. Should I go to the E.R.?? Why aren’t  my oxygen levels or heart rate being picked up by my phone??What if my symptoms suddenly worsen out of nowhere?? What if I do go to get help but my family takes me and gets exposed in the process???

 

According to Google, I could stop, breathe, connect with others, seek help from a professional. But I remember laying in the bitterest depths of depression, anxiety, and loneliness during my isolation period. I remember the moments when I wanted desperately to connect with others or seek help but the fatigue was so overwhelming that I lacked even the ounce of energy to make a phone call. In those moments, the skills and tools I cultivated in my past experiences in therapy as well as in my current clinical social work training were what kept me going. These carried me through the days I had the virus and have been helping me through the long-term depression and anxiety that having the virus has been causing me to face for months afterward.

But what if I hadn’t gone to therapy?

It is no secret that there is great stigma against going to therapy, both in mainstream American culture and in many South Asian cultures.  I would be lying if I said I never let the stigma impact me.  When I finally did go to therapy, it was because I knew my goal was to be a therapist, I knew I should get help, and I did not want to be a hypocrite.  It was one of the rare occasions where being a bit egotistical was surprisingly beneficial.  My own vanity left me feeling ashamed at the knowledge that I was not practicing what I preached and pushed me to go to therapy to look better in my own eyes, but it ultimately led to growth, change, new perspectives, and greater strength.  Of course, this was a very specific situation that motivated me to finally go to therapy, and most people would not share this experience.  Since seeking mental health services is so stigmatized and discouraged in our community, I can’t help but constantly think:

But what about the people who have coronavirus and a mental illness who haven’t gone to therapy?

What do you do when you are in crisis with no supportive tools to help you cope and you are unable to seek out emergency help? I think about this all the time and have no good answer about how to handle this right now, but I do feel that the pandemic has brought forth an important opportunity to rethink and reshape mental health care more broadly.

A mental health crisis has been brewing for years, and this pandemic has created the perfect storm for it to explode. From frontline workers who are navigating a level of human suffering unlike ever before to young children in lockdown who are missing developmental milestones from their lack of social interaction and everyone in between, mental health ramifications will only grow to impact virtually every person in some capacity. I believe that, in an ideal world, every person would spend some time in therapy until we can get to a point where our society’s structures support mental health for every person and teach skills to promote healthy social and emotional development for future generations. In order for that to happen, seeking mental health care needs to be de-stigmatized and treated as normal and essential as getting an annual physical.

I would love to tell you, dear reader, that you too should seek out mental health care in your life and encourage your family. After all, the traumatic experience of the pandemic has been and will continue to affect you and your loved ones. So, being proactive about taking care of yourself can both benefit you and help reduce stigma.  Mental Health America even found that more people who identify as “Asian” have been seeking out services than ever before! Unfortunately, however, receiving services is not feasible for most people.

The reality of American society is that our healthcare systems fail to meet the needs of the people. Insurance is one major barrier for many people, with over 511,000 American adults with mental illness lacking insurance and 901,000 children whose parents’ private insurance would not cover mental health services. While ratios of mental health professionals to clients vary greatly by state, the lack of available professionals remains another major issue that prevents people from accessing mental health services. The cumulative effect of these barriers to access is that thousands of adults and children in the US are unable to seek out mental health care. 

 

Within the South Asian community, many people who are seeking services are understandably looking for professionals that look like them, speak their language, and understand their cultural context. At the same time, our largely immigrant communities still often prioritize certain high-earning and prestigious professions as career paths over others. De-stigmatizing mental health and mental illness must also include accepting and encouraging members of our South Asian community to join professions that deal with mental health care. This includes clinicians that can understand and meet the needs of the community, researchers who can become a voice for the community in spaces where South Asians are hardly mentioned, and advocates and policymakers who are motivated to work to bring about positive change. Reforming the healthcare system and the education systems that produce its workforce are crucial advocacy endeavors for South Asians to be involved in, from having important conversations with other community members about issues related to mental health to advocating directly to policymakers.

Mental health care systems have had these issues for years, and South Asian communities have been talking about de-stigmatizing mental health more and more, so why is this an important conversation to have right now? The mental health crisis is burgeoning to impact more people now than ever before as the world deals with the immense challenges and stresses that have come from the pandemic. Although it is problematic that more attention has not been given to the unique experiences that the pandemic and actually having the virus have on people with mental illness, the widespread discussion of mental health is an important opportunity for major policy change.  A lot of messaging early in the pandemic compared our modern-day crises to the Great Depression. Well, the Great Depression was the first time that the US passed a major piece of social welfare legislation (social security), and it happened because economic hardship was suddenly seen as an issue that impacted everyone.  If mental health issues are now being seen as issues that impact everyone, the stage is set for a major change in mental health care policies.

Pandemics and crises are not going away, and the long-term impacts of these traumatic experiences on our mental, physical, and societal health can be disastrous. Taking advantage of the opportunity that this moment presents by creating a cultural and political shift in both our South Asian community and in American society, more broadly, is an important way that we can advocate for ourselves and others to create a better future.

 

COVID-19 and Mental Health Resources:

https://psychhub.com/initiatives/covid-19/

https://www.newpaltz.edu/media/idmh/covid-19/IDMH%20COVID19%20Continuing%20Stress%20Tip%20Sheet.pdf 

https://mhanational.org/covid19 

https://www.nctsn.org/what-is-child-trauma/trauma-types/disasters/pandemic-resources 

https://www.apa.org/topics/covid-19/domestic-violence-child-abuse

https://www.apa.org/monitor/2020/06/covid-grieving-life 

https://www.apa.org/topics/covid-19/local-mental-health 

https://www.apa.org/monitor/2020/06/covid-reaching-public 

 

Policy Positions to Learn About:

https://www.apaservices.org/advocacy/news/isolation-loneliness-covid-19?_ga=2.202777169.1162613058.1615186768-881110198.1615186768 

https://www.apaservices.org/practice/reimbursement/health-codes/comprehensive-telehealth-coverage?_ga=2.232736095.1162613058.1615186768-881110198.1615186768 

https://www.nami.org/Press-Media/Press-Releases/2021/NAMI-Statement-on-House-Passage-of-COVID-19-Relief-Bill 

https://www.apaservices.org/advocacy/news/supporting-students-covid-19?_ga=2.220147033.1162613058.1615186768-881110198.1615186768 

https://www.apaservices.org/advocacy/news/testimony-behavioral-health-access?_ga=2.220147033.1162613058.1615186768-881110198.1615186768 

https://www.apa.org/topics/covid-19/vulnerable-populations