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We are all working to maintain our peace of mind during this tricky time. Stay-at-home orders and a continuous stream of news and social media focused on the coronavirus pandemic is a form of stress most of us have never encountered.
But for people who were already struggling with a serious mental health issue, being cooped up represents not only a loss of livelihood and connection. With diagnoses such as depression or bipolar disorder, anxiety, panic or PTSD, obsessive-compulsive disorders, substance dependence, schizophrenia or psychosis, coping with the pandemic also carries a high risk for symptoms getting worse, deterioration of mental or emotional state, or full-blown relapse.
Gazing into the vast expanses of unstructured time and isolation leaves people to free-range ruminate, at the mercy of their own rattling train of thought. Without those external checks and balances, or just plain distractions, an increasingly narrowed perspective can develop. The world feels further away, while fears both new and old can become louder. As recovery-oriented author Anne Lamott says, “My mind is a neighborhood I try not to go into alone.”
At the same time, being in constant proximity to family members or roommates can be even more difficult than being alone. People performing the juggling act of mental health maintenance have learned to carefully manage the frequency and duration of interactions with others. Losing the option to take personal space can disrupt what is sometimes a delicate balance.
Access to uninterrupted screen time increases the pressure even more. News updates and social media feeds serve up frequent “threat cues”—that is, pictures, words, facial expressions and vocal tones that convey to your conscious and unconscious mind that you are in danger. Exposing ourselves to a steady stream of these cues keeps us all in fight/flight/freeze mode, but they are even more likely to capture the attention of people who are anxious or depressed (1,2). Adding these triggers to the mental whirlwind can result in sharp increases in negative thought patterns, emotions, and behaviors towards self and others.
People who are in recovery or remission from mental health disorders are also at risk, since they may have carefully constructed an ecosystem in their lives to keep them balanced. They may lose visits with friends, 12-step meetings or support groups, seeing a therapist, time with their spiritual community, going to the gym, being in nature, and even the security and structure of their jobs. For those in recovery, staying “sane” is often less a matter of comfort and more a matter of survival.
So what can people facing mental health issues do, and how can friends and loved ones help?
1. If you or someone else is a danger to themselves or others, call 911 or go to the emergency room. If you are not sure, call the toll-free National Suicide Prevention Lifeline at 1-800-273-TALK (8255), which is confidential and available to anyone, 24/7. Under normal circumstances, suicide is the second leading cause of death in people ages 10-34. This is far and away higher than the risk of becoming seriously ill or dying from coronavirus. Do not hesitate to get help for a mental health crisis due to coronavirus risk.
2. If you are taking medication, be sure that you have enough and that you take it as prescribed. Request a refill well before you run out — many insurance companies have been instructed to waive requirements and limits on ordering prescriptions. Find out where you will go to pick up refills, as your usual pharmacy or clinic may be temporarily closed. If you have trouble with cost or access, talk to your prescriber or pharmacist about options available to you.
3. If you have a therapist, try to continue your treatment by phone or online. If you need treatment, visit SAMHSA’s National Helpline, or call 1-800-662-HELP (4357) for a local referral to low- or no-cost services, or text the National Alliance on Mental Illness (NAMI) crisis line 24/7 by texting NAMI to 741741. There are several online psychotherapy providers such as BetterHelp or TalkSpace, or you might try 7 Cups: a free online volunteer “listening” service that says it is the “world’s largest emotional support system.” A virtual “visit” to a therapist can feel awkward at first, but that professional perspective is often vital in spotting increased symptoms and getting new ideas that don’t come from more casual sources.
4. Join a free support group online. A multitude of 12-step and other free community-based programs meet online—and not only for people recovering from alcohol or substance dependence, but also for people who overspend using credit, gamble too much, are quitting smoking, have a loved one with a substance use disorder, grew up in alcoholic or dysfunctional families, and many more. These groups offer not only support for quitting unhealthy behaviors, but also for coping with daily life. You don’t have to be currently in crisis to benefit from them. At a time when a lot of people are at a loss for how to help others, support groups are also an unconventional way to contribute to your community. Your experience may be exactly what someone else needs to hear.
5. Move your body. Even a little is great. You can take a walk to the mailbox, around the block, do a few sit-ups or pushups, dance to your favorite song or playlist, move while washing dishes or folding laundry, or do a quick online gentle stretching or brief exercise routine. Even a tiny amount of movement can make a huge difference to your mental state, and when you can do more—even better. Regular exercise has been shown to be equivalent to antidepressants in treating depression and appears to change the body’s chemistry in some of the same ways. The tricky part is doing it when you feel down. Start small, and give yourself a huge pat on the back when you do even a little.
6. Take about an hour each day to read things that are helpful to your mental state, to talk to a therapist, sponsor, or good listener, to journal, or to use a free online guided meditation app that has specific recordings for mental health issues. Much like with exercise, if these are not part of your regular routine, you can start small with just a few minutes or a single chapter.
7. Bring things into your life that give you happiness, meaning, gratitude, and joy. These may seem superficial, but in fact, they are antidotes to stress. Whether spiritual practices, inspirational movies, awe-inspiring photography, crafts, hot baths, or something as simple as getting flowers or lighting a candle – these things can help maintain your emotional balance, and prevent resorting to less healthy coping behaviors. If you feel too depressed or anxious to do any of these things, start by making a list of 20 things that might bring you moments of clarity, peace or joy, and then committing to doing just one of them.
I recommend doing these things even if you are not currently symptomatic. Don’t wait until you feel off-balance, or in crisis. It’s like adding to your mental health bank—and just as important as stocking up on other basics in your life. Maybe more, especially now.
