Troy Chamber President, Tara Tomcsik-Husak interviews Lori Kanat Edelson LMSW LMFT from Birmingham Maple Clinic.

 

TARA: Since March, during the Stay at Home Orders, many of us have spent most of our time in our homes trying to balance the outside world.  We protected ourselves from the virus but decreased our social interactions and increased our isolation.   How has this affected our mental health?

LORI: The verdict has been split.

There are many people who describe the stay-at-home order as “an opportunity to live my best life.” For those, spending much more time at home, limiting social obligations, and avoiding public events and activities, has afforded them the time to focus on their families, themselves, their homes, and their priorities. They have found a way to feel safe at home and have appreciated slowing down and minimizing their activities.  For very young children, being at home with their parents has been an extremely positive experience and they are thriving under these circumstances. For these people, re-entry into the world when things get safer, will be more difficult and generate more anxiety.

Those who feel best at home may feel increased anxiety around people who may not be as conscientious as they are, worry about going to new places and in general, their anxiety will increase as they are required to interact more with outsiders.

There are many others who have experienced the stay-at-home order as the most upsetting, anxiety-producing event in their lives. They feel restricted, isolated, cut off from the world, and alone.  Previously, they relied on their engagement with the world outside of their homes for their excitement and purpose and their anxiety has been escalating throughout the past several months.  There are adolescents and older teens who feel trapped at a time when they were hoping to explore their independence and emancipation from home. Young children who miss friends and schoolmates and are becoming symptomatic as the months pass and there are no concrete answers to their questions about when this will end.  For these people, the stay-at-home order has become more difficult with each passing month.

For them, re-engaging with the world brings enormous relief and they describe feeling “more like themselves” once they are able to leave their homes and spend time with others.

In all cases, anxiety and stress has been escalating and will continue to until we feel safe again.  Some feel more anxious out of their homes while others feel more anxious being confined.  Anxiety can feed on itself and therefore, can get worse, which is why it is so important to do things to specifically reduce and manage its effects.

TARA: Obviously, this has changed the way we work.  How has your clinic adapted to the needs of its patients since this crisis?

LORI: I remember driving to work on a Tuesday morning, it was March 10, and I received a call from my son in Washington DC.  He told me I had to close the clinic that day…and I was speechless.  It seemed an absolutely impossible task; how could I send 48 people home and cease treating thousands of patients in a day or two?  Still, my son was emphatic; explaining that we had no choice.  It is a 20 minute drive from my house to work, and by the time I arrived at the office, I knew he was right.  We completely closed the clinic four days later.

It took us three days to shift from in-person treatment to video-conferencing to continue treating our patients without interruption.  It was overwhelming for all of us; none of us had used telehealth before, but we had no choice and we adapted quickly. Our administrative staff, under the direction of our Office Manager and Senior Biller, worked round the clock from that week forward, and we made it work.

My priority was to do the best we could to continue to provide therapy services to our patients with the least interruption possible.  The last thing I wanted, was to leave our, close to 4,000 patients, hanging out there without the stabilizing continuation of their therapy sessions when the world was closing in on all of us

As things changed daily, I kept the staff updated and created new procedures and protocols as new information became available.  We were deemed an “essential business” by the Governor, so we were able to go into the office if we wanted to, and we were certainly able to continue working remotely.  The therapists with young children have had the most difficulty adjusting; they had difficulty finding space in their homes and quiet time away from their kids to see their patients.  This continues to be a problem, but they’re working on it.

TARA: We know that the Birmingham Maple Clinic is devoted to helping their patients through this difficult time.  With mental health concerns being on the rise, have you seen an influx of new patients?

LORI: Surprisingly, when the country first identified the presence of coronavirus, and businesses began shutting down and families were locking down, our usual influx of new patients slowed down significantly.  I think people were in a state of shock and panic; focused on making sure their families were safe, that they had provisions to survive a lockdown, and holding their breath to make sure they remained employed and could put food on the table.  I believe initiating treatment, and for some, just continuing their treatment, during those first weeks felt too overwhelming; ‘what if I lose my job,’ ‘…afraid to spend any extra money right now,’ ‘too many other priorities to attend to first.’

Over the past several weeks, probably because we have become used to the status quo and the immediate panic has subsided, the influx of new patients has resumed and people are calling requesting treatment for increasing anxiety and depression, overwhelming fears and frustration, grieving losses and recurring memories of trauma, and struggling with their ability to manage what is out of their control. We are now at the point where we cannot possibly accommodate all of the calls requesting treatment.  If I cannot refer the incoming caller to the therapist on our staff that is the best fit for the situation because they are fully booked and unable to take new patients, I am referring them to an outside therapist who might also be a good fit – and I really don’t know whether that therapist has availability either.

TARA: What tips do you have for managing our mental health at home?

LORI: Everyone needs some time alone, away from the family; to unwind, breathe fresh air, refocus and enjoy some peace and quiet. Make sure to carve some time out for yourself and that everyone in the family has that same opportunity, if not every day, at least a few times each week.

Some find exercise especially helpful for de-stressing, some like to write or talk or paint, but everyone must find what works for them and make sure to build it into their weekly schedules at least a few times each week.  Living together as we are now, is more intense and can quickly become a pressure-cooker, so we need to focus on the benefits of spending more time with our family while remaining conscious of the importance of having some time alone to unwind.

Be sensitive to each other and recognize that each of us may need different things to manage our anxiety and stress.  To feel safe and balanced, some may prefer quiet and more time alone, while others want to be surrounded by others and communicate freely and frequently. Everyone is working to adapt to a new world, yet we each still adapt and cope in different ways.  Family members, especially those who are living together now, need to be patient with each other and try to respectfully accommodate each other’s needs and differences.

It helps when family members work together to complete household chores so that no one person feels over-burdened with most of the responsibilities; including meal preparation, housekeeping, home maintenance, and more. Families may choose to take turns making dinner, grocery shopping, cleaning, babysitting, and managing other specific tasks so that others may get some time off.

Remember that despite the burdens that the pandemic has created for families, there are ‘gifts’ that have also surfaced; spending more time together, getting to know each other in more intimate ways, sharing family activities and learning more about each other and ourselves, are some of the silver-linings of these unprecedented times.

TARA: I know how stressful it was for us to close our office and find new ways to serve our members during this pandemic.  Personally, I was overwhelmed with stress and hopelessness in trying to find solutions for our members.  With that being said, I feel like we have all experienced a heightened level of anxiety and stress.  What are the main causes for feeling this way?

LORI: Anxiety is intense fear and worry that takes over and becomes unbearable.  There are often physical symptoms that include trouble breathing, rapid heart rate, intense sweating, shaking, and other uncomfortable physiological symptoms.

A common precipitant and agitator for anxiety is feeling out of control.  The impact of this pandemic has left most people feeling that there is very little they can control. If a person has an underlying propensity for anxiety, the stressors from the coronavirus pandemic may be too much to manage and anxiety can quickly escalate and overwhelm.  With stressors as intense as this pandemic, a person can quickly feel anxious even without underlying or predisposing factors.  Additionally, fears about the future can become preoccupying and further stoke the fires of anxiety.

TARA: So how do we minimize these feelings? Do you have any tips or lifestyle changes one can make for those to help minimize the stress and anxiety?

LORI:

  • Stay well nourished, drink plenty of water and get enough sleep. When your body is nourished, it is much easier to cope with additional stress.
  • Use relaxation techniques, guided imagery, yoga, and deep breathing exercises daily to maintain calm.
  • Do not try to plan too far out. Thinking ahead and trying to get your head around ‘what might happen’ creates more anxiety.  Focus on the day at hand and the moment at hand and learn to develop awareness and appreciation for the present and all that gives you pleasure.
  • Take a day off to re-balance your hectic life.
  • Slow down.  The fast-paced lifestyle you may have lived prior to COVID is too overwhelming and virtually impossible these days.  Slow down and enjoy the new pace.
  • Get out of bed every day and get dressed.  Plan to spend 30-60 minutes as many days as possible to devote to something that gives you pleasure.
  • Talk, share your feelings with someone you trust.  Talking about our fears helps reduce them to manageable levels.
  • Physical exercise actually helps lower stress and depression.  If you already have an exercise routine, you may want to try increasing it slightly. If you have not exercised regularly, taking walks several times each week will help you better manage anxiety and depression.
  • Limiting exposure to upsetting media and disturbing news platforms.  If you are continually bombarded by frightening, upsetting information, it can overload you and significantly increase anxiety and stress. Instead, mix it up with music, quiet time and positive, pleasant movies and programs.
  • Deep breathing helps slow down your pulse and reduce anxiety and stress levels. Use deep breathing techniques when you feel anxious, and practice a few times each day to prevent intensification of stress and anxiety.
  • Consider therapy if none of the above provides enough relief.

TARA: Many people are trying to navigate working from home, while parenting children in virtual schools.  Are there any key things that a parent should keep an eye on when it deals with their children and family members’ mental health?

LORI: This is probably one of the most challenging scenarios, and it is a common story in families with young children.  Working parents with young children who either need to be home-schooled or babysat, are experiencing a much higher than usual level of tension and chaos that feels as if it will never end.  Parents are overwhelmed, unable to fully focus on their jobs or on their children’s needs, while their younger children need parental supervision and care all day long, and older children struggle to manage virtual schooling, isolation and boredom.

If children are unable to attend to virtual schooling on their own; if they need an adult by their side to manage the technical glitches and to assure that they stay on task, that must be a priority for the student to succeed during the pandemic.  If the parents are both working and unable to alternate their schedules to be available for support during the educational hours, then consider bringing in a relative or outside adult to be available for help and additional guidance during schooling hours.

If children are left to fend for themselves to get through their virtual schooling without adult support, they may struggle along and fail to benefit from the educational opportunity of virtual learning.  They may become frustrated, angry, act out and refuse to participate if they are overwhelmed and cannot stay on track by themselves. Students may feel like they are failing at virtual schooling and may be reluctant to share these feelings with their parents.  If an adult is present for help and support, this is far less likely to occur.

When families are confined to the same space for extended periods of time, it becomes more difficult to manager anger and irritation.  Parents are yelling more, abuse rates are rising and substance abuse is likely to increase. While some intensification of symptoms under these unusual circumstances is normal, when changes are persistent and intensify over time, further attention is recommended.

Warning signs that mental health problems are intensifying may include:

Physiological Symptoms
Stomach aches, headaches, excessive complaints of pain, appetite changes, sleep problems, significant changes in energy level

Cognitive Symptoms
Self-critical thoughts, feeling hopeless or worthless, increasing negativity, noticeable changes in concentration and focus

Behavioral Symptoms
Repetitive rituals, nail biting, stuttering, acting out behaviors, excessive crying or tantrums, isolating more, regressing to earlier developmental levels

Emotional Symptoms
Appearing more anxious or depressed, suicidal ideation or comments, easily upset and extreme emotional reactivity, angrier and more irritable than usual

Seek professional help if symptoms persist for several weeks and you are unable to manage the symptoms on your own.  It is always best to have a professional evaluation than to sweep important symptoms aside, presuming they will pass on their own.

TARA: What should a person do if they are suffering from mental health concerns?  Who should they reach out to?

LORI: Most mental health professionals are now available to provide services virtually; by phone or videoconference.  While this may not be the ideal method of service delivery, it is certainly better than not receiving any treatment, and studies are beginning to show that the benefits of virtual therapy are measurable and impressive.

Still, there are some who do not feel comfortable receiving therapy services virtually and prefer in-person therapy.  For those people, there are some providers who are practicing in the office, but sitting in a closed office with another person for prolonged periods of time comes with risks. Mental health therapy has been deemed an Essential Service since the first day of the shut down, and families must also understand the critical importance of maintaining and managing mental health problems in a crisis like the pandemic, as well as during all other times.

Community mental health agencies, private clinics and individual providers are all currently able to provide mental health treatment, especially while insurance companies are willing to reimburse for services at the same rates as in-person therapy services. There are serious risks of provider shortages if the insurance companies return to pre-COVID reimbursement rates, which may prevent many mental health professionals from continuing to provide virtual therapy services. Pre-COVID reimbursement rates were so low, that most mental health specialists were unable to afford to participate. It is important that virtual treatment remains an affordable option for patients and therapists to protect the health of patients and therapists going forward.

TARA: If anyone wanted more information from you, what would be the best way to reach you?

LORI: For more information, anyone can contact the Birmingham Maple Clinic at 248-646-6659, and ask for Lori Edelson or email ledelson@birminghammaple.com

TARA: Thank you Lori for sharing your insight with the Troy Chamber members.  We are excited that you will also be one of our subject expert panelists for our Covid-19 and your Mental Health: Virtual Event, that we will be hosting on September 1st at 9AM.  To learn more about this event and to register CLICK HERE.