The coronavirus crisis is testing the limits of the health care system, the global economy and many facets of American business, media and culture. As this social upheaval filters into family life, it can be traumatic for older adults, children and people with mental-health issues.
Social isolation, the disruption of daily routines, stress over a job, or lack thereof: these can affect anyone. And indeed they have affected everyone.
To help during these times, UC San Francisco psychologist Elissa Epel, PhD, worked with colleagues across the UCSF Department of Psychiatry to create a webpage of mental-health resources. Rather than just listing resources or bullet points, it offers advice from deep experts in the range of mental health issues, from managing children with challenges, to managing more serious issues, now all at home.
The site is divided into six sections, some with a focus on family issues, like helping to support anxious children, and others focusing on a broad array of self-care for management of one’s own internal state during a pandemic, like mindfulness.
Matthew State, MD, chair of the Department of Psychiatry, organized his department’s efforts early. “I have been in touch with the leadership of psychiatry departments from across the U.S. and in several countries. We are all trying to help each other navigate and ameliorate the mental health burden on our health care force and universities. The hidden long-term toll of trauma exposure, without support or treatment, cannot be underestimated.”
Apps for Mental Health
Many wellness companies have responded to the crisis with free and reduced-fee access to their products. Yoga studios and cycling gyms stream classes on video for the house-bound. There’s also a whole constellation of apps for meditation, relaxation, anxiety and insomnia. Some of the digital health applications that were only available through employers are now accessible.
UCSF researchers have studied various digital health applications and thrilled they are now available. A new UC study, led by Aric Prather, PhD, found that a mindfulness app called Headspace “used daily for just 10 minutes, reduced stress in a meaningful way, and the benefits lasted for two months after stopping use.”
Jennifer Felder, PhD, and colleagues found that Sleepio reduced insomnia and improved mood in pregnant women.
As people are practicing physical distancing, apps that can be used within the confines of our homes give us an instant infrastructure for well-being, daily pings and short audios, that we can rest upon, reminding us to pause, breathe fully, and become more grounded, letting our nervous system relax a bit. The alternative is not good, Epel said. Given the slow unfolding of this crisis, if we do not step up our self-care – to do these things within a day not just at the bookends – we will quickly become depleted, risking burnout and other mental health consequences.
Coping with Anxiety
Anxiety is an understandable reaction to the ways in which the COVID-19 pandemic has upended daily life, Epel said. While anxiety helps us as a society bond together and cope, we need to be able to manage it so as not to be overwhelmed.
Staying safe and healthy is a large part of anxiety management. That includes getting enough sleep, maintaining physical activity, washing hands, eating well, and creating a decent work-from-home space, Epel said.
Another important remedy for anxiety is social ties. Epel noted that what we call “social distancing” really means physical distancing. Social distancing does not mean social isolation. A social life mediated by phone calls, emails, or video chats remains essential for reducing stress and feelings of isolation. With that in mind, practice kindness to others, and yourself.
Research has shown that limiting media exposure is an essential part of coping strategy. “Overexposure to media is a serious problem to mental health,” Epel said. “Things are still changing quickly, but we can check the news once or twice a day and still be well informed. We need to stop the compulsive checking.”
For Epel, mindfulness is an important focus of the site because we already spend so much of our time toggling among tasks. “Mindful attention, with kindness, is one of our most important tools right now to stay sane, to quell churning anxiety, to keep us from time traveling to a worst case scenario.”
Epel views the pandemic as part of resilience training for us as a community. Mindfulness training leads to a deeper understanding of the uncertainty and fragility of life. “We cannot control external events, but we can learn to control our attention and down-regulate our stress responses,” she said.
During this pandemic, many people have tried mindfulness training for the first time. That may turn out to be especially helpful when we face our next challenge, one of the many possible disasters stemming from global warming, like wildfires.
In addition to apps, the site lists daily meditations and talks offering contemplative wisdom, from UCSF’s daily noon mindfulness meditation, led by Spiritual Care, to live daily meetings on the East Coast.
Resources for Mental-Health Issues
Stress can exacerbate existing mental-health issues, and the resources people normally turn to may be unavailable due to closures.
The stress of distancing and isolation in homes is leading to predict-able exacerbation of problems, such as more domestic violence, and more substance abuse.
It’s important for people to know where to go for help, says Andreea Seritan, MD, a geriatric psychiatrist and one of the site’s authors.
“In general, for people with pre-existing mental health conditions, this is a more challenging time. Many clinicians offer video check-ins, and pharmacies can deliver medicines.”
Keeping Families Strong
With schools closed and many parents working from home, families suddenly find themselves in close quarters, spending much more time together.
“Families with children at home have a lot more demands,” said Epel. For children, maintaining a routine is essential. Also important? That adults and caregivers carve out quiet time for themselves.
Isolation can bring out all sorts of conflict in families. In the event of an outburst, one of the best solutions is simple, said Seritan: “Just walk away.” Try to have an agreement about key words that mean time out, that mean you go to that room and I will go to this room.
For children with ADHD or autism-spectrum disorder, setting expectations and supporting routines are more important than ever, but also can be harder to maintain.
Underlying all of this is the reminder to “turn up the compassion.”
Now that the Bay Area has appeared to somewhat flatten the curve, “we can finally breath more easily. We can turn our attention to helping other hospitals in hotspot areas. We are now working on short videos to deliver critical material to front line providers,” said Epel. “Preventing burnout and acute stress disorders is an urgent goal.”
Wellness for Older Adults & Caregivers
Older adults have a heightened risk of infection from COVID-19. While isolation may be essential for physical health, it can affect mental health, causing depression when inside the home and anxiety when outside.
To help stay healthy and active while physically distanced from others, Seritan said to apply the same rules as for everyone else: maintain routine, stay socially connected and get exercise. Yoga and meditation are also great activities.
Above all, Seritan emphasized the value of creativity and staying cognitively active.
“Your calendar is empty. This is the time to start new projects,” she said, noting that gardening is a good example.
Seritan also has encouraged patients to learn how to use video chat.
“They need to learn this in order to stay connected, but also it serves another purpose: Learning a new skill is good for the brain.”
Resources for Low-Income & Other Groups
It is becoming clear that the COVID-19 outbreak is causing widespread disruption that will go on for many weeks and months, including the loss of jobs across the nation. Low-income groups are the most affected by this, and their financial strain will become more extreme in the coming months.
Financial and other uncertainties, including food insecurity, create severe anxiety. To that end, UCSF mental health experts gathered resources for insurance, internet service, free meals, loan re-lief and immigration questions.
“As mental health clinicians and researchers, we wanted to do the best we can to bring valuable information that is easy to use and helpful for anyone in this time of crisis,” Epel said. “There is so much advice and information flying around that even browsing for what you need online can be taxing. Here in one place – promote well-being, prevent worsening of conditions we struggle with, breathe into the realistic helpful anxiety, find ease in the moments we can.”
For Our Frontline Workers
In addition to how to live well with our day turned inside out, it’s important to reach front line workers, people running our hospitals and keeping our refrigerators full. They have the challenge of long challenging hours, witnessing tremendous suffering, and risking COVID exposure and, for many, their worst fear, exposing their families to COVID.
The department, with the help of the UCSF Alumni Association, has reached out to health care providers across the nation to provide a weekly webinar on emotional first-aid skills and other ways to ease the burden of serving at this time. It will turn toward issues of moral distress from both what they are witnessing, and the risk many take on without the resources they need, and ways to reduce anxiety in the moment.
UCSF Psychiatry is also building out a large program to support our front-line health care providers and our entire workforce, called the UCSF Employee Coping and Resiliency Program, under the leadership of Maga Jackson-Triche, MD, MSHS, vice president of Adult Behavioral Health for UCSF Health and the vice chair for Adult Psychiatry in the UCSF Department of Psychiatry.
“COVID-19 is having, and will continue to have, a profound mental health impact worldwide and upon on our entire UCSF community,” said Christina Mangurian, MD, MAS, professor of Psychiatry, Epidemiology and Biostatistics and Vice Chair for Diversity and Health Equity in the UCSF Department of Psychiatry. “The UCSF Employee Coping and Resiliency program will offer screening and delivering individual treatment. We will also collect data to track our effectiveness so we can continually refine our approaches and best meet the needs of the UCSF community.”
Margo Pumar, MD, associate professor of Psychiatry and Associate Medical Director for Integrated and Collaborative Care at UCSF Health, said that it’s helpful to think about ‘the phases of disaster.’
“We are just at the beginning of this pandemic. For the time being, this is the ‘new normal,’” Pumar said. “Our routines have been disrupted, and so it key to consider how we can restructure our lives to ensure not just physical but mental health and wellness. Improving our resilience during this time is not optional, it is a must. Humans across time have endured many hardships and flourished. We can do this.”