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Anxiety, depression tripled, substance abuse up 15% in NC

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It’s clear the coronavirus has taken a tremendous toll on the physical health of North Carolinians.

But experts say its impact on mental health has been significant, too.

Statewide data shows symptoms of depression and anxiety have tripled amid the pandemic, according to Victor Armstrong, executive director of the Division of Mental Health, Developmental Disabilities and Substance Abuse Services. North Carolina also has seen a 15% increase in emergency room visits for substance use and binge drinking.

Officials say the rise in mental health issues is affecting historically marginalized populations and younger people, in particular.

It comes as the population grapples with uncertainty, isolation and loss. Social determinants of health, which play a role in mental well-being, also have been affected by the pandemic, with many in unstable housing situations or out of work.

“I think some of those folks are probably experiencing this kind of anxiety and stress for the first time,” Terri Harris, president of the Western Carolina affiliate of the National Alliance on Mental Illness, told the Citizen Times. … “People are having to play additional roles that they don’t usually play, like being a teacher for homeschooling and those sorts of things. Some people feel out of their element.”

Harris said many of the coping mechanisms that people typically rely on — like spending time with loved ones, going to the gym or participating in group yoga — are less accessible due to health concerns, which compounds the problem.

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The state is working to make resources more accessible, raise awareness and combat stigma surrounding these issues. Meanwhile, mental health professionals are encouraging people to prioritize self care through nutrition, exercise, getting enough sleep and maintaining social connections where they can.

They also urge people to reach out for professional help when they need it.

Isolation and lack of support

North Carolina as a whole — and Buncombe County specifically — started seeing an increase in suicide rates and overdoses last month, according to Rhonda Cox, chief population health officer with Vaya Health, which manages mental health, substance use disorder and developmental disability services in the 22 westernmost counties of North Carolina for those with Medicaid or who are uninsured or underinsured.

“It’s not unusual to see suicide rates increase in the spring and the summer, but this is above what we would normally expect to see,” Cox said. … “We’re seeing increased rise in substance use … and methamphetamine is starting to also be used more heavily.”

Cox said national psychological and psychiatric groups expected to see an increase in mental health symptoms and substance use in response to the pandemic due to “the cumulative impact of isolation.”

“You’ve got quarantine measures; you’ve got people who are having decreased access to their faith community, their social supports; there’s all the stress and anxiety and economic loss that is getting layered,” she said. … “I think everyone’s feeling some level of stress related to this, but when you take individuals that are already wrestling with a mental health need or someone who is struggling in recovery from substance use, it makes it even more difficult to retain that stability.”

‘Existential threat’ and instability

Paul Fugelsang, executive director for the Asheville-based nonprofit Open Path Psychotherapy Collective, said he thinks “each and every person on this planet has been affected in some way” by COVID-19.

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Open Path operates nationally, connecting those in need to mental health professionals who offer therapy sessions — both in-person and online — at reduced rates. Early in the pandemic, Fugelsang said the number of individuals seeking the organization’s services dropped as the country adapted to the pandemic. 

But in mid-April, he said numbers “started to skyrocket” and have climbed steadily since then. Pre-pandemic, Open Path’s monthly record for new client connections was 1,400 — a number they hit in January. In July, they connected 2,400 new clients.

“I think that, as a collective, our rates of anxiety and maybe depression have all risen, and I think that that’s not only due to the pandemic and the existential threat of what’s happening, but I also believe it’s due to poor leadership and everything that’s gone on in this country since the start,” said Fugelsang.

Fugelsang said he thinks people generally take solace in the idea that they have strong leaders “guiding the ship,” but that there is a sense among some that that’s not happening right now, which he said likely has increased levels of anxiety. 

Positive byproducts of the pandemic

There may also have been a few positive byproducts of the pandemic that have contributed to higher numbers of people seeking mental health care.

Harris said the state office and various affiliates of NAMI — a grassroots organization that serves Americans with mental illness and their families through educational programs and support groups — have noticed an uptick in participation. The organization’s hotline also has seen an increase, though Harris did not have specific numbers.

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On top of heightened stress and instability, Harris said she thinks the anonymity of virtual platforms has been partially responsible for a rise in involvement because it provides a more comfortable space for individuals who would not otherwise seek the help of a support group. The virtual option is also more accessible to those with transportation issues.

After the pandemic, she said NAMI intends to continue offering online options.

Fugelsang also thinks the recent popularity of articles related to the pandemic that emphasize the importance of mental health and de-stigmatize the practice of therapy has played a role in people’s willingness to seek outside help.

“I think because of the pandemic, it’s become more socially acceptable than ever before,” he said.

How to manage anxiety, depression

Dr. Mandy Cohen, secretary of North Carolina Department of Health and Human Services said in a July 30 briefing that the state is “coming out of the gate at a disadvantage in terms of increasing access to … mental health services” because it is one of 13 states that has not expanded Medicaid.

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But the CARES Act and other federal funding have supported some additional services, and state officials are continuing work on that front.

Armstrong said that, beyond funding, it’s important to highlight “ways to manage the stressors brought about by this pandemic and provide individuals with access to early intervention.”

With that in mind, state officials developed two mental health hotlines and are promoting the the acronym “SCOOP” to help people remember ways to manage stress. Armstrong explained those letters stand for the following:

  • S – Stay connected to family and friends.
  • C – Compassion for yourself and others.
  • O – Observe your use of substances.
  • O – It’s OK to ask for help.
  • P – Physical activity to improve mood.

Cox promoted the SCOOP guidance as well. She added that people should stay connected to “their support communities” in whatever way they can and “check in with loved ones.”

Fugelsang cited the importance of tending to nutrition, sleep, exercise and social connections in order to stay balanced.

Cox, Fugelsang and Harris all recommend taking advantage of opportunities for therapy and support.

“Ask for help, look to see what’s available, don’t try to just sort of go it alone,” said Harris.

Hotlines and resources

  • Hope4NC crisis line: 1-855-587-3463. Available 24/7, this statewide hotline connects callers to mental health support resources and offers immediate crisis counseling services for those affected by the coronavirus crisis.
  • Hope4healers hotline: 919-226-2002. Available 24/7, this statewide hotline provides mental health and resiliency support for health care professionals, emergency medical specialists, first responders, other staff who work in health care settings and their families.
  • Vaya Health Call Center: 1-877-849-6127. Available 24/7 this WNC center provides information on local treatment services and a behavioral health crisis line. More info can be found at www.vayahealth.com.
  • NAMI’s NC Hotline: 1-800-451-9682. Available Monday-Friday, 8:30 a.m.-5 p.m., this hotline offers information, referrals and support. Please note, this is not a crisis line. Find out more about NAMI WNC at www.namiwnc.org.
  • Open Path Psychotherapy Collective: 1-800-268-2833. Available Monday-Friday, 9 a.m.-5 p.m., this line offers more info and resources. Find out more about Open Path at www.openpathcollective.org/city/asheville.
  • National Suicide Prevention Lifeline: 1-800-273-8255. Available 24/7.

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Mackenzie Wicker covers growth, development and healthcare for the Asheville Citizen Times. You can reach her at [email protected] or follow her on Twitter @MackWick.

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