The COVID-19 pandemic, which has taken lives and jobs and stressed families, has made existing serious mental health and substance use problems worse, say mental health experts in Michigan.
Data on suicides, substance use overdoses and deaths, psychiatric hospital admissions, domestic abuse and outpatient behavioral health visits for serious mental health issues is limited since March, when coronavirus began to spread in Michigan.
But those on the front lines of the field say they believe serious mental health issues have increased dramatically as some people have despaired, lost hope and isolation has set in because of mandatory lockdowns to prevent the virus spread and social distancing precautions followed.
John Greden, M.D., founder and director of the University of Michigan Comprehensive Depression Center, said the impact of the steadily mounting numbers of COVID-19 deaths and positive case counts, unemployment, political disagreements and the inability to freely socialize creates stress and anxiety that plays out in many ways.
"We have a collision of things underway. The combination is toxic. Some people have preexisting depression, bipolar and anxiety conditions. They are intensified because of the pandemic, job loss, social isolation and sleep disturbances," said Greden, a psychiatrist in Ann Arbor.
"If there are brain changes, which is something nobody seems to acknowledge, that intensifies anxiety and depression. There are all these social consequences of staying at home and keeping safe distances from people when they have job and financial worries. We won't know fully until this is over."
Joy Wolfe Ensor, a clinical psychologist and president of the Michigan Psychological Association, said she fears Michigan's fragile resources for behavioral health support will be overwhelmed once the pandemic eases and people feel more comfortable seeking services.
"Whatever else is going on in the background, whether it is stress, or depression, or anxiety, or learning disability, or family conflict, or the political conflict, we all are just experiencing this through the lens of the impossible. It's seemingly neverending stress. We are depleted, and we don't have the reserves," Ensor said.
"That's why everybody's feeling more miserable than before. And that's why it's gonna take a toll on our physical and mental health for years into the future because the body holds that memory of stress."
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Analyzing the Great Depression of the 1930s and even the Great Recession of 2008-2009, suicide rates tend to drop during the early days when everyone appears to be suffering equally and then rise dramatically during the eventual recovery, said Jonathan Singer, president of the American Association of Suicidology.
"One of the hypotheses is that in the winter months, there is a shared sense of it's gloomy out, it's dark, it's terrible. Everybody feels a little bit down," said Singer, who also is associate professor of social studies at Loyola University in Chicago. "But when the weather starts getting better, everybody's like, thank God, it's sunny out, I can go out, we can hang out outside, I feel so much better."
On the other hand, Singer said, the people who are suffering depression and had suicidal thoughts before feel the same.
"It's the folks that don't start feeling better, that have thought about killing themselves who are the ones at increased risk because their sense of suffering is greater. They're no longer in the same boat with everybody else. Suddenly, it's not about the weather's crappy. It's not about this thing that we're sharing together," Singer said. "Some folks realize their boats are full of holes and they're sinking."
(If you or someone you know is feeling suicidal, the National Suicide Prevention Lifeline is available 24 hours a day at 1-800-273-8255.)
Nationally, Singer said suicides have averaged about 50,000 per year for the past three years. In Michigan, suicides have been steadily increasing since 2007. During the three-year period from 2016−2018, an average of 1,441 Michigan residents died by suicide, according to the Michigan Violent Death Reporting System.
Earlier this year, Gov. Gretchen Whitmer launched the Michigan Suicide Prevention Commission to analyze suicide rates and come up with policy recommendations on how to reduce suicide deaths. The 30-member commission is expected to complete a report by the end of the year.
"We have been seeing an increase the past few years and now we have coronavirus," Greden said. "It started out looking at the issue broadly, but we have been talking a lot about COVID-19 and all those people who have lost jobs, those forced to say at home and in isolation, and the frontline health care and essential workers who are dealing the stress and anxiety."
Nearly 60 percent of 2,300 physicians said in a recent survey they are feeling symptoms of burnout since the COVID-19 pandemic began, according to the Physicians Foundation. Two years ago, 45 percent of physicians said the same thing in a similar survey by the foundation.
Debra Pinals, M.D., medical director of behavioral health and forensic programs with the state Department of Health and Human Services, said national data from the Centers for Disease Control and Prevention in an August report shows increases in people reporting anxiety, substance use and thoughts of suicide.
The CDC said a nearly 60 percent jump in suicides by young Americans since 2007 has experts alarmed. From 2007 to 2018, suicides among children and young people aged 10 to 24 rose from about 7 per 100,000 in 2007 to nearly 11 per 100,000 in 2018.
While it's too soon for the state to know whether suicide rates are increasing in Michigan this year, the rising numbers of opioid overdoses sometimes can indicate rising suicide numbers, Pinals said.
"We are hearing anecdotal concerns and seeing (an increase in) people use our resources for wellness," Pinals said. "(There is) fear of infection for themselves, for their loved ones. When there is anxiety and depression, some people turn to substance use."
Greden said some overdoses are passive suicides. He said it is likely that 50 percent of opioid overdoses are suicides or attempted suicides.
"Forty thousand people are dying each year because of opioids. It is very much part of whole story (with COVID-19) with people turning to opioids and drinking," Greden said.
Because data on mental health conditions, including suicides, drug overdoses and domestic abuse, takes time to gather and confirm, experts must rely on historical patterns and anecdotal evidence.But a snapshot of available statistics from MDHHS on opioid overdoses illustrates part of the problems facing society, health care providers and state and local governments.
- Emergency medical services response for probable opioid overdoses increased 33 percent from April to May from 1,030 to 1,374. Increased for all age groups except those 65 years and older.
- EMS responses for opioid overdoses from April through June 2020 were 26 percent higher than the same period in 2019, increasing from 2,994 to 3,756 during those periods.
- Hospital emergency department visits for opioid overdose increased 42 percent from 439 to 625 from April to May.
- Black residents have higher opioid overdose rates than whites. The average monthly overdose rate for Blacks was 219.8 per 100,000 residents compared to 123.4 among whites.
Jennifer Peltzer-Jones, R.N., assistant medical director of emergency behavioral services with Henry Ford Health System, said the number of people coming to the emergency department with a mental health crisis has increased over the last several months.
"An interesting anecdotal observation is that the patient population now presenting in mental health crisis seem to consist more of those who have never sought help in an ED before as opposed to people we have worked with in the past," Peltzer-Jones said in an email.
Peltzer-Jones said there has been "alarming increase in people with intellectual and developmental disabilities presenting to EDs during the pandemic." She said people with these conditions have suffered the most due to the physical distancing needed for safety.
"I have not seen as much attention to this vulnerable population, which is contributing to their increased ED use," she said. "Families and home providers need more support. This is a population that is struggling right now."
Carol Zuniga, executive director of Livonia-based Hegira Health Inc., said the high number of ER visits for overdoses makes sense because, while the acuity level of patients served by the agency's crisis center has increased dramatically, the overall number of people seeking outpatient services is lower than normal years.
"Substance use is worse. It brings us backwards in the opioid fight," Zuniga said. "Access to services and availability has been impacted as people are choosing not to get into treatment because of social distancing concerns and fears of contracting COVID-19."
Zuniga said more people are unemployed and are "just hiding it more at home. We are encouraging them to come in for treatment. We know they are having problems because ERs are getting more critical care with serious cases."
On the other hand, smaller mental health agencies are having financial problems, difficulty finding staff and have had to turn away patients, Zuniga said.
"I don't know of anyone closing in Wayne County, though smaller agencies are talking about not being able to make payroll and larger agencies are absorbing significant loss," Zuniga said.
A survey published Sept. 9 by the National Council for Behavioral Health, which represents about 3,000 mental health and addiction treatment providers, found that 54 percent of organizations have closed programs and 65 percent have had to turn away patients. As a result, nearly half have decreased work hours for staff, and over a quarter had to lay off employees.
With the pandemic exacerbating many of the risk factors of addiction — isolation, economic distress, lack of routine — the need for treatment services has gone up significantly, with 50 percent of substance abuse treatment providers reporting a growth in request of their services, according to the survey.
Travis Atkinson, a crisis systems Consultant with TBD Solutions in Kentwood, said a survey on the behavioral health crisis in Michigan showed an increase in mental health problems this year. The 2020 COVID-19 Impact Survey was funded by the Michigan Health Foundation.
"There has been a significant increase in call volume in the suicide prevention hot lines, we found in the survey, but a decrease in crisis services," Atkinson said. "People are so fearful of going out of the house because of COVID."
Atkinson said another trend the survey found is an increase in people accessing the mental health system for the first time.
"If a person lost a job, lost a loved one to COVID, they are experiencing new stressors in their life, and it creates a challenge if they never used services before," he said.
The survey also found people seeking mental health services have increased levels of anxiety, anger, hopelessness, paranoia and other secondary health issues.
"Homelessness has increased due to a lack of shelter space. Our survey has shown a 50 percent increase in the number of persons requiring continuing stay," Atkinson said. "This is due to a greater acuity when they present for services and the lack of resources."
Older adults also say they're more lonely than ever and have little contact with friends or family, according to a poll released in September from the University of Michigan.
Some 56 percent of respondents over the age of 50 reported in June 2020 that they sometimes or often felt isolated from others — more than twice the 27 percent who felt that way in a similar poll in 2018. The National Poll on Healthy Aging survey was conducted along with AARP and Michigan Medicine.
John Piette, a researcher in the UM School of Public Health, said many seniors who are isolated and not interacting with other people have feelings of depression.
"Thirty-four percent of older adults felt a lack of companionship. That is up 10 percent from the 2018 survey. It reflects the mental health statistics that showed 84 percent (of seniors) had symptoms of depression, which bears out the isolation and loss of connections," Piette said.
Piette said some people become depressed because they are unable to follow their normal routines. "They can't exercise because the gym was closed. They can't connect with the community because they closed the churches," he said.
Ensor, who said her clients range in age from 12 to 75, said one common theme is parenting stress because of having to juggle work, education and everything else.
"If you are in a two-parent family, and especially if you're a single parent and you're trying to work remotely, you're trying to manage your kids' education, which is being delivered remotely. It's just impossible to do it all, do it all well, and do it all without enormous stress," she said.
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