When Gov. Tom Wolf issued a stay-at-home order for Philadelphia area residents on March 23, Julie Peticca braced herself for a deluge of calls to the Montgomery County suicide prevention hotline. Peticca, the director of crisis intervention at Montgomery County Emergency Service Inc., knew that isolation could exacerbate mental health issues, especially for people with depression and anxiety.
The first two weeks were quieter than she expected. But then the calls flooded in. On one day in March, Peticca said her team received 25 calls—more than double the center's daily average.
"People dealt with not having access to their usual coping mechanisms OK for the first few weeks, but now we're settling into a longer situation," Peticca said. "We're seeing the impact of the loss of human touch."
Other suicide hotlines across the country are experiencing similar patterns. A Los Angeles mental health clinic reported 1,800 COVID-19 related calls in March, compared to just 20 in February. Montana's Department of Public Health and Human Services said they've seen calls double since March 13.
On April 1, Pennsylvania created a toll-free 24-hour support line for people struggling with anxiety from the pandemic. The line has taken more than 2,000 calls since its launch.
"Now the calls seem to be shifting from pragmatic information to discussions about mental health. People are struggling with isolation and feeling depressed," said Kristen Houser, the deputy secretary for the Office of Mental Health and Substance Abuse Services. "We fully expect behavioral health needs to increase as the situation goes on."
While social distancing is critical to slowing the spread of COVID-19, experts have cautioned that it can greatly strain mental health. Previous research has shown that large-scale disasters lead to increases in depression, post-traumatic stress disorder (PTSD), substance use disorder, and other mental and behavioral disorders. In an article published in JAMA Psychiatry on Monday, researchers warned that numbers of death by suicide in the United States and coronavirus could create "a perfect storm" for increased risk.
In Philadelphia, calls to suicide hotlines have increased only about 10% in the last few weeks, said Omoiye Kinney, the communications director at the Department of Behavioral Health and Intellectual disAbility Services (DBHIDS), which oversees two hotlines—one national and one local. But she said that many of the calls are related to COVID-19.
"People are calling because of things that are causing them anxiety and stress, like losing their jobs, social isolation and domestic situations," Kinney said. "We can't anticipate whether the number of calls will go up or down—that depends on the progression of the pandemic—but the reasons have shifted."
In Delaware County, there has been a 20% to 30% increase in calls to the suicide prevention hotline, said Kevin Caputo, chair of psychiatry at Crozer-Keystone Health System, which operates the hotline. Many of the calls are "very specific to fear over COVID-19," he said. People are afraid of contamination, losing their jobs, and their loved ones getting sick.
"We've seen a number of voluntary admissions of people to the crisis center," he said. "There was an increase in visits by about 20% when this health crisis hit."
After the stay-at-home order was issued, Caputo said, the crisis center saw a decrease of inpatients as phone volume ticked up.
Because many coping strategies, such as hanging out with friends or visiting the gym, have been altered, mental health symptoms will likely get worse, he said. For example, mild depressive symptoms that can be treated with therapy can turn into clinical depression, which requires medication. And while nearly everyone is worried right now, those feelings of apprehension can manifest into severe anxiety disorders for some.
Even after the quarantine is lifted, Caputo expects to see mental health symptoms that emerged during the pandemic for years to come. But reaching out for help now can mitigate some of the damage, he said.
"With any medical issue, the sooner you deal with it, the better the prognosis," Caputo said. "In psychiatry, untreated illness can take on a life of its own. The earlier you catch something, the easier it will be to treat."
Colleen Reichmann, a Philadelphia psychologist, said loneliness and hopelessness, which many people are experiencing right now, are two main risk factors for suicide. Many psychologists and therapists are offering sessions for free or extremely reduced rates because they're so concerned about this, she said.
"There's a constant fear that's simmering in the background, about the economic toll this is going to take, how long social distancing is going to go on," she said. "That's really detrimental to mental health."
Reichmann said mental health experts are particularly concerned about people who live alone or have preexisting mental health issues, such as anxiety disorders or eating disorders. But she's hopeful that conversations surrounding mental health will "allow us to get ahead of things and hopefully stop the escalation."
"Open conversations about how people are feeling during the pandemic are really important," she said. "If there's no opportunity to hear about other people's experiences, to hear someone say, "Me, too," about the things you're struggling with, it can really exacerbate things. That's the kind of antidote to the feelings that can contribute to being suicidal."
If you or someone you know is thinking of suicide, call the National Suicide Prevention Lifeline at 1-800-273-8255 or text TALK to the Crisis Text Line at 741741.
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