The COVID-19 pandemic represents not just a medical crisis, but a mental health crisis for millions of Americans. Threats to mental health and how to overcome them during long periods of isolation was the subject of the May 21 edition of Virtual Face to Face with Dr. Bruce Jarrell. Joining University of Maryland, Baltimore (UMB) Interim President Bruce E. Jarrell, MD, FACS, to lend her expertise was Michelle Pearce, PhD, clinical psychologist and associate professor in the University of Maryland Graduate School.

First, there are the overt causes of stress and anxiety: fear of becoming sick or even dying, loss of a job and financial security, isolation caused by stay-at-home orders, and family relationships frayed by dramatic changes in routine.

But every day there are also a hundred little things missing from our lives that add up to a tremendous sense of loss: neighborhood barbecues and yoga classes, after-school meetups and strolls through the shopping mall, the good feeling that comes from holding a door or offering a seat on the bus. Even a friendly smile at the grocery store, now covered by a face mask.

The consequences may be fights with family, overeating, a loss of sleep. But for many Americans, it’s much worse. In a recent Kaiser Family Foundation survey, 19 percent of respondents said the current crisis has had a “major impact” on their mental health. One California study predicts an additional 75,000 “deaths of despair” in the U.S. due to suicide, increased alcohol consumption, and relapse into drug addiction – all tied to COVID-19.

Four groups may be especially at risk: 

• Children, who have less well-developed coping strategies and are now largely separated from the mental health resources provided at school; 
• People with existing mental health issues;  
• Residents of long-term health care facilities who suffer visitation restrictions; 
• Health care workers, who are overworked and witness to unending trauma.
  

Jarrell kicked off the program by acknowledging what was obvious to everyone watching on their computer’s Webex platform. “As you can all see I’m still at home, just like last week and the week before. I think I’m pushing two months working at home. I’ve learned how to cope with it. I get my work done, but that computer still stares at me every morning when I get up and every night when I go home ... go to bed, actually, because I’m already home. So, it’s been an interesting experience but we’re all coping with it,” he said.

Pearce, whose clinical practice has continued unabated via an online portal, has also been offering her guidance to a wider audience as well. In March, she published “Psychologist’s 10 Tips for Staying Emotionally Healthy During a Pandemic” in the online magazine, Medium. Among them: Take breaks, set limits, and count your blessings.

“Let me first just begin by normalizing what we’re all feeling,” she began. “Feeling things like anxiety and irritability and loss are very common. We’re experiencing a lot of uncertainty right now. There’s been a lot of change very quickly. A lot of loss. Some of you who are tuning in today have experienced a tremendous amount of loss.”

Questions from the audience confirmed that those feelings are shared widely, and not just as a result of COVID-19 itself, but also of the changes in home and work life.

“What practices do you suggest to avoid cognitive overload and resulting mental distress as a result of increased computer-based work?” asked UMB Writing Center Director Isabell May, PhD. 

“Working from home can suddenly become like working all the time,” Pearce acknowledged. “Now you’re working as soon as you get up in the morning. You’re working at night. You’re working on weekends. And it can become a kind of expectation that we’re supposed to do that because, well, your boss is sending you email on the weekend or your colleague is still working at night. I think it’s really important to step back and say what are the hours I would normally work? How do I need to be flexible given my family situation? But still setting those firm limits."

For many, just admitting the need for help can be very stress-inducing. “I worry that so many folks that are struggling with depression, or other forms of mental stress, are worried that if they speak up, they will be seen as weak or unable to continue working. What could you, or anyone, say to someone with these worries?” asked Lois Warner in the Office of Philanthropy.

“This still upsets me, this stigma we have in our society about mental health,” Pearce said. “I think it starts with us as individuals. Dr. Jarrell, I’m just so appreciative that you have us addressing this along with all of the other important issues. Because it gives a forum and it starts to give us a language and a permission to talk about these things.”

“What do you suggest for someone who has a loved one who has anxiety, but is in denial about getting help?” asked an anonymous audience member.

“You can’t force someone to get help who doesn’t want to get help,” Pearce allowed. “I find the best thing in those situations is to be compassionate. As soon as you get into that judgmental, critical, blaming place, the person shuts down. And the more open you can be and the more compassionate, the more likely they are to come around and maybe come out of that place of denial.”

Among the causes of anxiety shared by the audience was concern over job security and the threat of budget cuts at the University. “Many staff members have a lot of anxiety right now about the possibility of salary reductions, furloughs, budget cuts, layoffs, etc., which ultimately affects our mental health due to the unknown financial troubles that we may be going through in the future. How is it best to cope with that anxiety?” asked another anonymous audience member.

To this question Pearce offered an important coping strategy. “One of the things I tell my clients and I tell myself, too, is that if you’re going to suffer from something, suffer from it one time. So, I tell my patients if they’re afraid of flying, that the plane is going to go down, I say to them, you’re allowed to worry about it one time. When the plane is going down, you’re allowed to freak out as much as you want, but until then you just add to your suffering,” she said. “The way our brains work is that, if we imagine something, the same parts of our brain light up as if we’re actually going through that experience. So, if you keep worrying about something you literally have to experience it every time you worry about it.”

Jarrell quickly set straight any notion that UMB’s financial situation is in any way analogous to a plane crash. “This plane isn’t going down. We’re still flying and we’re flying high. You talk about adversity and how different institutions react to it and this institution has reacted remarkably well to these adversities,” he said. “Nobody can make you promises right now. All I can say to you is the last thing that we want to cut into is furloughs and salaries and jobs, etc. So, we’ve got lots of different things we intend to execute in terms of actions to save money before we get into that because I consider that to be such an important part of the university. Like Michelle says, you can worry about it when it happens, but quit worrying about right now because this plane isn’t going down.”