In the March-October period of 2020, the mean ER visitation rate for disaster-associated mental health conditions was 2,540.4 per 100,000 visits. This rate was higher than in 2019, when an average of 2,152.3 ER visits out of every 100,000 involved mental health. The same figure for suicide attempts was 314.2 in 2020 and 250.1 in 2019. Researchers also found an increase in ER visitation rates for all drug and opioid overdoses, intimate partner violence, and child abuse and neglect. Rates of ER visits for mental health conditions, suicide attempts, drug and opioid overdoses, and intimate partner violence peaked between April 3 and May 11. However, rates for suspected child abuse and neglect peaked later into the pandemic, between May 24 and 30. Researchers looked at rates instead of numbers because there were fewer visits to the emergency department in 2020 overall. Despite this drop in total visits, between April 11 and October 10 the number of drug-related ER visits each week remained 1% to 45% higher than the numbers for the same weeks in 2019. Sabrina Romanoff, PsyD, a clinical psychologist, saw these mental health trends firsthand at the start of the pandemic while working in the psychiatric emergency room at Harvard’s Cambridge Health Alliance. “Many international Harvard and MIT students presented with health-related concerns that were compounded by anxieties about losing housing coupled with experiences of discrimination and xenophobia,” she says. “This is not a unique phenomenon for emergency departments, which in many ways, serve as an analog to represent local issues existing in the community,” Romanoff adds. “It is a breathing, living, representation of current challenges faced by members of the population. While it provides a pulse for conflicts experienced by those with perhaps the most complex cases and presentations, it also speaks to and embodies challenges experienced by those who do not make it into our department.”
How the Pandemic Negatively Influences Mental Health
The pandemic’s mental health strain is at the heart of many of the conditions for which people are turning to the emergency department. You would be hard-pressed to find someone not negatively affected by the pandemic, and for many people, that extends to the state of their mental health. “People have experienced multiple losses, from deaths to missing important milestones to fractured relationships due to disagreements or just distance,” says Aimee Daramus, PsyD, a licensed clinical psychologist. “Most of us have never lived through anything like this before, so our entire sense of reality has shifted, and we’ve had to live with the surreal idea that the wrong trip to the grocery store could put us on a ventilator," Daramus says. People with pre-existing mental health conditions are finding their coping mechanisms taken away and symptoms exacerbated. Others are exhibiting symptoms for the first time and given limited support, if any. “Individuals without prior psychiatric concerns are presenting to my clinic with new-onset anxiety and depressive symptoms in the context of psychosocial stressors related to the pandemic,” says Leela R. Magavi, MD, an adult, adolescent, and child psychiatrist and regional medical director for Community Psychiatry, California’s largest outpatient mental health organization. In a June 2020 study of U.S. adults from the Centers for Disease Control and Prevention (CDC), 40.9% of participants reported having at least one mental or behavioral health condition, and 13.3% reported starting to or increasing their use of substances as a method of coping with the pandemic. “Individuals of all backgrounds and ages are suffering, and now more than ever, we need to come together to advocate for mental health parity in all domains,” says Magavi. “Mental illness is faceless and can affect anyone and everyone.”
Steps You Can Take for Your Mental Health
While the pandemic has limited access to some coping mechanisms, there are many options to pursue in care of your mental health without exposing yourself or people around you to COVID-19.
Find a Therapist or Start a Support Group
Working with a therapist you trust can help you manage mental health issues, but long wait times and session costs may bar you from seeing one. Online therapy may be one solution, or you could turn to a support group. Forming a healthy, safe space to speak with others can provide an opportunity to work through your feelings. “There’s no rule against you starting your own informal online support group with a few other people and some ground rules about communication,” says Daramus.
Be Aware of How You Spend Your Time
If you’ve fallen into a routine that bores or depresses you, it can feel harder to shake with limited options for activities. However, ignoring it can emphasize the negative feelings you’re experiencing and perpetuate that mood. Be aware of how you’re spending your time and the thoughts festering inside your head. “Taking breaks from reading about COVID-19 or watching the news, and instead spending time exercising and practicing mindfulness techniques, could help individuals decrease ruminative thinking,” says Magavi.
Engage with People in Safe Ways
Fortunately, there are countless ways to interact with loved ones that don’t require being in the same room. “Utilize technology to get as close to face-to-face interaction as you can,” says Romanoff. “We are social creatures. We need to connect to others to survive. Research has found in-person communication to improve mood and reduce depression." Romanoff adds to plan an activity that involves others, like running in a park or walking somewhere you’ll see other people. Whether or not you have someone specific to make plans with, being around others can help your mood and overall well-being.
Celebrate Good Things
As the pandemic brings pain into so many people’s lives, you may feel guilty celebrating anything good happening. While it’s important to be sensitive to other people’s feelings and experiences, burying anything positive in your life may negatively impact you. “When something good happens to you, share it with the people who care about you,” says Romanoff. “This is a two-way street. Oftentimes the best way to reduce loneliness is to hear about the experiences of others.”
Contact a Mental Health Hotline
Are you struggling with your mental health and unsure who to talk to or what steps to take? A mental health hotline can provide you with free, anonymous assistance. Below are a few mental health hotline options to reach out to.
National Alliance on Mental Illness (NAMI) HelpLine, open Monday to Friday 10 am to 6 pm EST at 1-800-950-NAMI (6264) Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline, open 24/7 in English and Spanish at 1-800-662-HELP (4357) National Suicide Prevention Lifeline, open 24/7 at 1-800-273-TALK (8255) Crisis Text Line, open 24/7 by texting “HOME” to 741741
When to Visit an Emergency Department
If you or someone you know struggles with mental health conditions, there are clear signs that an emergency department visit is warranted. “If you feel like harming or killing yourself, if you’re unable to care for yourself due to mental health problems, if you or someone else is manic, hallucinating, or violent, the emergency room can be the right move,” says Daramus. Alternatively, you can enter an intensive outpatient or partial hospitalization program. However, an emergency department can provide immediate relief and protection. The information in this article is current as of the date listed, which means newer information may be available when you read this. For the most recent updates on COVID-19, visit our coronavirus news page. “I see a lot of people who think that they’re the only one who feels like they’re falling apart, but that’s not true,” says Daramus. “So many people are barely hanging on. There’s nothing wrong with feeling wrecked when terrible things are happening. That’s a natural response to a bad situation.” Reaching out to loved ones and getting help are the first steps towards improved mental health.
