Mental health issues are not new, of course, but the COVID-19 pandemic has placed extra strains on the ability to cope with family, health, work and financial challenges.
In 2019, prior to the pandemic, 21 percent of American adults had a mental illness, according to the Substance Abuse and Mental Health Services Administration. By November 2020, as COVID swept through the United States, 43 percent of Americans reported anxiety or depressive symptoms; the number declined to 30 percent in May 2021.
These data are based on a Household Pulse Survey conducted by the U.S. Census Bureau to assess conditions during the pandemic. According to the World Health Organization, the prevalence of anxiety and depression increased 25 percent worldwide as a result of COVID-19.
Michigan’s experience reflects these trends — local physicians, therapists and social service administrators report a significant increase in mental health problems.
“There has been a tsunami of mental health and behavioral problems. COVID triggered more anxiety and depression because of problems people couldn’t control,” said John Blanchard, M.D., CEO of Troy, Mich.-based SALTA Direct Primary Care.
Uriel Stephens, director of family services at Easter Seals of Michigan, reports that the agency has experienced a 25 percent increase in requests for mental health services during the past two years. She says that COVID has been the top factor for mental health problems among young people, including a higher-than-usual incidence of suicidal thoughts.
Stephens adds that existing patients felt more anxiety during the “intense COVID period” due to concerns about unemployment and financial issues. As a result, their staff has devoted attention to care management — connecting people with resources in addition to counseling.
COVID’s Uncertainty Leads to Widespread Anxiety
Therapists report that some patients are experiencing intensified symptoms and that their new patient base is growing.
“There is a significant increase in people reaching out for therapy,” says Andrea Rawat, PhD., a clinical psychologist with Nexxus Behavioral Health in Troy, Mich. She attributes this to job instability and families being home together constantly. “Our families aren’t set up for that. There has been an increase in anxiety, a lot of uncertainty,” she says.
Rawat notes that being housebound, often in homes with open floor plans, leads families to spend a lot of time together in close proximity.
“There is no place for people to take mental health breaks,” Rawat said. “They’re working in bathrooms or closets and sitting in cars for therapy.”
COVID-related anxiety stems from multiple concerns, including infection with the virus at work or school and subsequent transmission to a family member. There is uncertainty about jobs and income as well as safety on the job. For employers, changing government and public health regulations were a constant unknown, along with continuing difficulties obtaining supplies and retaining workers.More recently, inflation has led to increased financial strains.
Young people in particular suffered from the pandemic lockdown — losing opportunities to socialize and play outside. Stephens says that the lockdown meant that children were not able to socialize and build a bond with adults.
Being home-schooled reduced their ability to cope and, as a result, there has been more “acting out,” with some children being suspended from day care, she explains. During COVID, parents’ special concerns about their children’s welfare add to their overall stress.
Mental Health Resources Include Self-Help Training and Counseling
Organizations of all kinds — from schools to small businesses and large employers with multiple locations — have recognized the need to seek help. Some already had Employee Assistance Programs, insurance plans, special health benefits and other programs to reduce stress and provide mental health services to those needing specialized treatment.
Stress reduction measures can include flexible work schedules, onsite exercise opportunities and in-house counseling. LaFleur Marketing, which has 40 employees based in Grand Rapids, offered flexible schedules before COVID, allowing employees to work remotely at their discretion, as long as work requirements were fulfilled.
According to Jane Newton, operations manager, most of the firm’s clients aren’t local, so their operations have always been virtual, although some employees choose to work at their downtown office.
The company has many employees who are parents and appreciate that being physically present in the office isn’t required. Newton says that the company believes that “what’s best for you personally and for the company are not mutually exclusive.”
During the pandemic Chip LaFleur, the company’s president and CEO, paid for a trainer to provide online workouts for employees, as well as an in-office yoga instructor. Special efforts were made to include employees working remotely through virtual happy hours and team building.
A representative from Priority Health — the company’s health insurer — was brought in to discuss mental health benefits. Newton says that LaFleur’s efforts have paid off with high rates of employee retention and expansion, despite COVID.
Employee Assistance Programs (EAP) have provided a way for employers to assist workers for many years. They offer a range of services to help with family, health, financial and job-related problems at no charge to workers.
CARE of Southeast Michigan provides EAP services to municipalities, schools, nonprofit organizations and smaller businesses. CEO Susan Styf says that the company has experienced an increase in its client base, as well as increased usage of EAP services by their clients’ employees.
“There is no screening to see an EAP counselor. Six sessions are provided per issue — such as how to manage frustration with a boss or family problems,” Styf said. Services are provided by their own counselors and through an independent network of social workers and counselors with master’s degrees, as well as psychologists.
CARE also provides work-site training for stress reduction, coping with interpersonal conflict, and diversity, equity and inclusion. The firm counsels human resources staff members who have been challenged by COVID.
“HR professionals are burnt out,” Styf said. “Companies have had to navigate this for a while.” That meant developing new policies, as employees worked from home and now coping with those who don’t want to return to the office.
“Employees are anxious about returning. Some are caring for an elderly relative. They ask ‘why can’t I continue to work from home? I’ve been able to do it for a year,’” says Styf. The Family Medical Leave Act and Disabilities Act are guidelines for determining whether an employee meets the threshold for not returning to the office, she says. “We need to be legal, fair and engaging.”
More Therapists Are Needed
Even when an individual has insurance or the financial means to seek therapy, it may not be easy to find a counselor. Several local therapists describe a significant lack of trained professionals even before COVID. Styf says that the pandemic increased the demand from new patients. Most appointments were transferred to a virtual format, which not all therapists or clients liked. “For some, it became overwhelming. Some clinics closed,” she says.
As a result, waiting lists for therapy are not uncommon. Gretchen Moran Marsh, PhD, a psychologist in Franklin, says that the average wait time for a child therapist is 50 days.
Some employers are providing resources for their workers to help themselves by reducing stress and increasing resiliency. SALTA Primary Care provides health benefits beyond regular health insurance to clients including municipalities, companies and unions. Blanchard believes that mental health care is an integral part of overall health. All of their providers are trained to coach patients in behavioral techniques to reduce stress and learn how to cope with life’s challenges. Those who need more intense services are eligible for eight individual counseling sessions. In addition, SALTA provides group classes for clients.
Marsh points out that more than half of individuals with mental health problems don’t receive treatment. This is often due to a lack of insurance, financial resources or the stigma that counseling has for some people. While an individual is comfortable going to a cardiologist for cardiac care, seeing a therapist for mental health may be embarrassing, she says. Marsh notes that some individuals turn to online apps to help them with stress and other mental health issues, but these rarely offer clinical evidence of effectiveness.
Fortunately, employers recognize that mental health issues can cause communications problems and absenteeism, among other issues.
“Employees know that their workers need services. They need a multi-modal approach. There has been a culture shift to bring in mental health experts,” Marsh said.
She has turned to speaking engagements to expand her ability to help people build resilience. Marsh recommends self-help techniques that have been clinically validated. These include SELF — getting appropriate sleep, exercise, leisure and food; practicing gratitude; and learning strategies to cope when things go wrong.
According to Marsh, children have experienced an increase in depression and anxiety due to COVID and some are having trouble returning to school and the regular world. Some school systems have expanded mental health services. Stephens says that CARE has staff co-located in 11 school districts in Oakland County. CARE’s mental health providers also offer professional development to school staff and have assisted the Oxford Schools after the shooting at Oxford High School.
While COVID exacerbated the need for mental health services, experts don’t anticipate a less stressful environment short-term. “There is so much going on in the country. This is the new normal,” says Dr. Rawat.
While mental health is more widely recognized today as a serious issue, there is still some stigma surrounding it, as well as insufficient financial and clinical resources for prevention and treatment. Those organizations that proactively help their students, members and employees are likely to benefit from a healthier, more productive environment.