September 23, 2020

Hope During COVID-19

What To Do, Where To Turn During Crisis

COVID-19By G. Richard Smith, M.D.

The news about the COVID-19 pandemic, to no one’s surprise, is not very hopeful.

The effects of the coronavirus are going to be felt here in Arkansas and the rest of the country much longer than anyone expected. The best expectations are for some kind of consummation around mid-2021, but that’s only an educated guess.

The pandemic causes stress, no matter where you live, no matter who you are. And while stress makes everything more difficult, it’s especially harmful for vulnerable people and those in tense situations where strong emotions are at play. Unfortunately, as stress levels have increased, our limited outlets to relieve stress have changed or diminished.

None of this is news to anyone remotely aware of the state of mental illness in our state. One in five Arkansans currently have a mental illness or substance abuse problem or the history of one. Virtually every family has such an individual, some may have more than one.

Families cannot safely get the space they need to decrease the intensity of these strong emotions. For anyone who has lived with a loved one with a mental illness or substance abuse, you know what I mean. When you add the fear associated with the disease, especially for those suffering from a chronic illness and the elderly, to the disagreements about how to behave – masks or no masks, restaurants or no restaurants, birthday parties, school, kids at home – you get a recipe for problems and sometimes big problems with stress that can complicate mental illness and substance use.

A recent study found that the prevalence of mild to severe depression has tripled in the U.S. during the pandemic, from 9 percent to 28 percent of the population during COVID-19.  As one would predict, this is especially so for people with lower social resources, lower economic resources, and greater exposure to stressors such as job loss.  Another survey found that 65 percent of Americans thought that COVID-19 was causing significant stress in their lives and complicating much of what they do. Loneliness is also on the rise due to social distancing and limitations on public gatherings. About 45 percent of people of all ages report significant loneliness.

BoxNow take into consideration our nursing homes and assisted living facilities. Not only are these people extremely vulnerable to COVID-19, but the very way that they are protected is by isolation. Many of these folks have limited coping abilities due to brain dysfunction or physical illness. The isolation and loneliness is only making it worse for them.

So what can we expect the next few months to be like? Normally easy-going people will likely be more irritable and cranky on numerous occasions. People who are normally hard to deal with may often become harder to deal with and disruptive. This will happen in your offices and at home. And those who have a mental illness may well relapse or have their stable conditions such as anxiety or depression worsen. Suicide rates are beginning to rise and will likely continue to increase.

People who have more serious mental illness such as schizophrenia or bipolar disorder may relapse or have even more difficulty coping with life. This is especially worrisome for law enforcement officials, who can expect to receive more crisis intervention calls.

Liquor sales have increased partly due to bar closures, but also because people are relying more on alcohol to cope with difficult emotions, stress or even boredom. While alcohol can work as a short-term strategy, it usually has emotional, social, and physical long-term costs. As a result, we are likely to see increases in DWIs, alcohol poisoning cases, and alcohol-related accidents. People may also be more likely to seek out treatment and support through sources like Alcoholics Anonymous.

Prescription drug use is on the rise as are opioid and other drug overdoses. Our state’s drug czar reports that naloxone (opioid overdose treatment) usage is on the rise. The state’s illegal drug business is booming as people attempt to cope. And if you have a medical marijuana dispensary in your community, I predict that the parking lot will be full and more people will be buying their full quota of the drug as often as they can. We are seeing medical marijuana cause as many or more problems in our clinics and hospitals than the street drug except that it is less likely to be cut with toxic substances. Remember, just because it is legal does not mean it is good for people and it can cause problems.

Hope

Given the bleak news above, what can/should we do?  I suggest we lean into HOPE.  Hope is a science that can be developed and nurtured and can change your life and the world (“Hope Rising,” Gwinn and Hellman, 2019).  They define hope as an interaction between Willpower (Agency) and Waypower (Pathways) leading to Desirable Goals. In other words, if we can conceptualize a better state of being and have the tenacity to stick to a plan to move in that direction, we have hope.

While each of us will have our own hope(s) for these difficult times, the following are worth considering. Please start with Dr. Sacha McBain’s suggestions. Her material is evidenced-based, and reliably works for each of us, our families, our co-workers, our employees, and the public. Let’s use the practice of these new strategies and skills acquired during this time to sustain each other during the pandemic and beyond.

Be kind to yourself, give yourself a little more time, and be forgiving of yourself.  Under stress, we lose more things, forget more things, and function more poorly than usual.  Find every opportunity to laugh at yourself and be gentle with yourself.

Be kind to people. This goes a long way toward helping people cope. Encourage the people around you to pause and breathe deeply, be present in the moment and out of the past and the future.  There is significant research to support these approaches as healthy, helpful, and hopeful.

Finally, encourage people to get the mental health and substance abuse treatment they need.  There are real-world obstacles to getting treatment during the pandemic; however, where there is agency (willpower) and pathways (waypower), the goal can be achieved.

One of these goals, born during the pandemic, that will outlast COVID-19 is AR-Connect, PRI’s new 24/7 tele-video service where anyone can get the mental health and substance abuse treatment they need whenever they need it.

G. Richard Smith, M.D., is the chairman of the UAMS Department of Psychiatry and the director of the Psychiatric Research Institute.