Everyone’s Anxious. Therapists Are Slammed. Here’s How Mental Health Care Is Keeping Up.
In a time when we’re experiencing a collective amount of anxiety, the field of mental health is changing
The coronavirus pandemic has changed so much about the way we live, from how we socialize with one another to the way we work. More invisibly but no less impactful, the virus has also changed the level of anxiety many of us are experiencing on a daily basis. “Anecdotally, we know that most people are reporting — whether they’re in treatment or not — elevated levels of stress and anxiety,” says Lynn Bufka, PhD, senior director of practice research and policy at the American Psychological Association (APA). This anxiety is almost unprecedented in its universality — nearly every single person worldwide is currently experiencing some kind of coronavirus-related impact on their mental health.
To cope, many of us will (and should) seek mental health support or services. Of course, finding a new therapist is no easy task, pandemic or no. In much of the United States, there are not enough therapists. Even in areas like major cities where therapists are easier to come by, they often don’t take insurance, making it difficult to find affordable, accessible mental health care even under normal circumstances. Now, a digital relationship with a therapist isn’t just your best bet, it may be your only one.
A recent article in the scientific journal Telemedicine and E-Health argued that telehealth services will be crucial in reducing the mental health burden of Covid-19, and organizations that currently offer digitized mental health services are already seeing spikes in users. Talkspace, an online and mobile therapy platform, reports their user volume has gone up 25% in just the last month, including a 30% increase in use of coronavirus-related terms in text exchanges with providers since March 5. Crisis Text Line, a confidential text messaging service for individuals in crisis, reports that 80% of their texters are now mentioning anxiety versus 30% pre-pandemic. And their user base — which before the pandemic was primarily teens aged 14–17 — has seen an 11% jump in texters 18–34 years old.
It’s helpful that services like Talkspace and Crisis Text Line already have the digital infrastructure required to handle this new influx in an era where therapists are suddenly, almost exclusively trying to see patients from home. After all, Bufka notes, not all therapists are used to providing telehealth, so you may have to brace for some speed bumps as more traditional providers get ramped up. “They’ve got a pretty steep learning curve to master the technology and how to make it work,” she says. “It’s a transition period.”
Therapists are also facing difficulties finding time and space to provide therapy. Clinicians who can’t safely travel to their offices need to find private spaces to take patients, and if they have children at home, it’s challenging to make appointments work. Sasha Taskier, a licensed marriage and family therapist in Chicago, struggled at first to see all her clients in the limited window of her two-year-old daughter’s naptime and after she’s asleep for the night, though she’s now negotiated clearer work hours with her partner and found a babysitter who is helping her block time. One therapist who asked not to be named (as her clients don’t all know this) has been taking her sessions in her car to protect their privacy from her school-age children. “I’m seeing all kinds of really creative, flexible ways of making things work,” Bufka says. “Briefer sessions. Generating white noise on their phone and putting it outside their door.”
Everyone is being more flexible. The Department of Health and Human Services (DHHS) has issued a Covid-19 alert about telehealth, amending that providers using apps like FaceTime and Google Meet are considered “good faith” HIPAA compliant. HIPAA, the Health Insurance Portability and Accountability Act of 1996, requires health providers — both mental and physical — to protect the privacy and security of your health information, which is much easier to do in a controlled setting like a doctor’s office. Now that doctors and therapists may be using third-party apps like Apple’s FaceTime, they’re not able to ensure that the interactions are 100% secure and private. But in this national emergency, the DHHS has said it’s good enough.
Meanwhile, the APA is working on building out a section of its site devoted to answering Covid-19 related FAQs for practitioners, including questions about providing teletherapy. “We’re determining things like whether having an infant in your arms while you’re providing therapy is okay or not. They’re not overhearing anything, but it could be hard to focus. But if your patient is in extreme distress and you’re not going to see them any other way, those are trade-offs and considerations that clinicians are having to make constantly,” says Bufka.
This anxiety is almost unprecedented in its universality — nearly every single person worldwide is currently experiencing some kind of corona-related impact on their mental health.
Within sessions, therapists are facing new kinds of questions, even from pre-existing patients, as the virus becomes the sole focus of sessions. “Pretty much everyone who is in therapy, this is what they’re talking about,” Bufka says. It’s changed the tone of sessions for many. “I’m seeing such fascinating dynamics right now,” Taskier says. “For single people, it’s a lot of feelings of social isolation and feeling disconnected. For parents, it’s very much about staying sane, managing childcare, and balancing the load with their partners.” The close quarters we’re all in put additional strain on relationships. “Couples have already been more critical and short with one another. I also see couples whose levels of anxiety are vastly different, so they’re having trouble taking care of one another,” Taskier says. “A lot of people are making more assumptions about their partners — they think that because they are around each other more, their partner should know their needs, and they are getting hurt, disappointed, frustrated when that doesn’t happen. I’m working with a lot of my couples to start explicitly naming their triggers, their needs, and how their partner can support them in times of distress.”
All this constant corona-talk is taking a toll on clinicians, too. “There’s a collective sense that the rug has been pulled out from under us,” says Amy Cirbus, PhD, director of clinical content at Talkspace. Everybody is trying to find their footing, and that includes the pros. Almost all the experts I spoke with likened this time to the period right after 9/11, where the nationwide anxiety bled from patient to provider and back again. “As a clinician, part of what you’re trying to do is to help people assess whether their anxiety is appropriate in response to the stressor,” Bufka says. “But we don’t really have a roadmap here. What is an appropriate level of concern and preparation, and what is beyond the pale? We know under non-coronavirus circumstances, the person who’s washing their hands for an hour a day after every time they touch a surface, that’s beyond the pale. It probably is now, too. But it does raise the question: What’s reasonable behavior?”
The good news: If you’re looking for help working through these kinds of issues, there are plenty of resources out there. Talkspace opened a free therapist-led Facebook support group and a Covid-19 channel on their Instagram for coronavirus-specific questions. Crisis Text Line reports that 89% of texters mentioning coronavirus find their conversations helpful — two points higher than their normal score. Still, some individuals who find themselves seeking mental health support (perhaps for the first time), feel wary of digital platforms. “We’re hearing that some people feel ‘if I can’t see a face, I don’t want that,’” Bufka says. “But the data shows that technology-based services can be just as effective.” So if you’re looking for more continuous one-on-one support, don’t be nervous. “It can be overwhelming and scary to reach out even in ‘normal times,’” Cirbus says. “When you reach out to any telebehavioral health platform, take it at your own pace. Be honest and say, ‘This is my first time. I’m not really sure what to talk about. I’m not really sure how this is supposed to go.’ The therapist is going to be gently guiding you through,” she says.
If you’re working, it’s worth seeing what resources your employer has available. “Reach out to your EAPs [employee assistance programs] and other health providers,” suggests Doreen Marshall, PhD, a psychologist and the vice president of programs at the American Foundation for Suicide Prevention. EAPs often offer no-cost sessions. “All organizations that provide health services are thinking about this right now and knowing they need to up their service level.” If you already have a therapist, but they’re not yet using telehealth systems, have a conversation with them about your options. “We don’t want care to be disrupted for our patients if they still want to be receiving it and have a demonstrated need,” Bufka says. “So even if you’re not going to be meeting on a weekly basis, they might be able to try to help you find some online tools to work with — maybe even something simple like a confidential email with tips and strategies,” she says.
If you’re looking for a therapist, perhaps for the first time, or on your own, start by searching for therapists who specialize in what you’re struggling with, like anxiety. (Psychology Today has a large database, and you can filter by therapists who offer online services.) Marshall advises trying to find one locally even though you’ll be primarily communicating over the phone right now. “That way, there might be a way to pick up your sessions in person when this is over, and you won’t have to start over with someone new,” she says. If you have financial concerns, always ask upfront about pricing and whether they take insurance — some providers may offer a sliding scale of their fee if you are in financial hardship. “And while finding a therapist would be wonderful in many situations, if that’s not going to be doable, start thinking about how you can get some social support from other sources,” Bufka says. The most important thing if you’re struggling is to find someone. “Reach out to your primary care provider, to your local social services agency, to a hotline,” she says. “Anything to try to get that connection.”
The coronavirus outbreak is rapidly evolving. For updates, check the U.S. Centers for Disease Control and Prevention as well as your local health department. If you’re feeling emotionally overwhelmed, reach out to the Crisis Text Line.