Josephine Peterson: COVID fatigue has set in across Washington. Collective mental health eroding, data shows

Oct. 7--Feeling down? You aren't the only one.

Health care professionals have seen an increase in hospitalizations, substance abuse and overall collective fatigue as the coronavirus pandemic continues.

A Washington Department of HealthSept. 21 report said about 1.6 million residents have reported experiencing symptoms of anxiety on most days, and about 850,000 reported experiencing symptoms of depression on most days.

MultiCare and CHI Franciscan, two of the largest health systems in Pierce County, have seen increases in access to care.

In the last two months, MultiCare has seen a 20 percent increase of people with behavioral health issues visiting the emergency room or being involuntary committed, said Tim Holmes, president of MultiCare's Behavioral Health Network.

Wellfound Behavioral Health Hospital's medical director, Dr. Brian Neal, works with CHI Franciscan hospitals. He said there has been an uptick in a behavioral and mental health admissions related to COVID-19.

In a Tacoma-Pierce County Health Department Board of Health meeting on Sept. 23, staff discussed the visible malaise en masse.

Mary Bridge Children's Hospital data shows a substantial increase in mental health-related visits from July to August. The Tacoma hospital saw emergency department visits for behavioral health increase from 97 in July to 304 in August.

The Tacoma-Pierce County Health Department's health promotion coordinator, Elizabeth Allen, told the board at the last meeting in September there is a collective fatigue. Everyone's life has changed through work schedules, home life, child care and social lives, but we don't know when "normal" will return.

"We don't have a timeline. We can't pinpoint exactly what day COVID will stop impacting our lives. Because of this, it really creates quite a lot of stress and anxiety," she said. "What we're seeing is emotional burnout due to the length of this pandemic. "

Who is accessing care?

MultiCare's Holmes said there are varying degrees of stress for everyone.

"It's not kind of a one size fits all," he said. "Each one of us is experiencing some level of loss."

The pandemic has more people turning to mental health specialists for help.

Neal said most of the increased behavioral and mental health admissions related to COVID-19 stem from two groups: patients with chronic mental illness and those recently unemployed.

Prior to the pandemic, many patients with chronic mental illness had already been socially isolated.

Without in-person support groups and therapy due to COVID-19 precautions, Neal said, they can have little to no human contact for days to weeks.

"We are supporting these patients who are now coming to us with increased instances of anxiety, depression and related symptoms," he said.

Virtual care has made access to care easier for some people but more difficult for others, Holmes said.

Some enjoy chatting with a psychiatrist from their home.

Others with Medicaid who have serious mental illness have not done as well. A lot of services aren't funded through Medicaid, Holmes said, and virtual care isn't enough to provide the help they need.

Reaching patients who are experiencing homelessness and paying for room and board aren't necessarily covered by Medicaid, MultiCare spokesperson Marce Edwards explained.

"While we are able to bill for the services provided within that residential setting, we are not able to bill for the costs of the facility or the food," Edwards said.

Unfunded services make it difficult to connect patients to ongoing care.

"We are seeing a number of individuals in that seriously mentally ill grouping that are showing up in our emergency departments that are translating to involuntary commitments," Holmes said.

Rather than total virtual care, those who are seriously mentally ill do better with outreach and some additional virtual support mixed in, Holmes said.

Nearly 1.4 million Washingtonians have applied for unemployment benefits since March 8. Neal said Wellfound has been working with patients whose employment status was affected by COVID-19. In these cases, the pandemic has taken away their ability to go to work and have structure. Wellfound has seen a 25 percent uptick in admissions since March.

They are feeling bored and uncertain about what to do with their time, Neal said.

"Financial stresses, depression and arguments at home lead many patients to seek care who may not have needed it prior to COVID-19," he said.

Age divide

The state Department of Health'sSept. 21 report suggests younger generations are struggling emotionally more than folks 50 and older.

The frequency of depression symptoms decreases as age increases. Nearly one in four 18-29 year olds have reported feeling down, depressed or hopeless most days, compared to less than one in six adults aged 50 and older, the report said.

Prior to the pandemic, Holmes said he believes Generation Z and millennials have lived in more pressurized environments than older generations. The global health crisis has increased the depression and anxiety for them.

"This environment around social media and constant exposure is around the clock," he said. "You layer this on top, and in some ways, it's not surprising that kids and adolescents would be having a kind of a greater challenge, because it's a kind of additive to what they are going through."

On a whole, older generations have lived through more difficult periods of life than younger ones, Holmes said.

"They've also had time to be through different things and develop and grow, and they're in a different place maturity wise," he said.

Substance abuse

Liquor and marijuana sales have increased throughout the pandemic.

State taxes collected from the sales of spirits have soared. The Department of Revenue reports consumer spirit sales from April to June brought in $94,341,000 in taxes. Last year, that same time period saw $68,454,000 in spirit taxes.

The Washington state Liquor and Cannabis Board also reports a surge in marijuana use. This August, the board collected $50,262,806 in tax, a 41 percent increase from last August's $35,617,301.

Hospitals have seen decreased admissions for substance abuse, the state report said. Holmes agreed that there have been fewer outpatient clinic admissions.

"During this pandemic time, people are being much more selective about where they go to physically," he said. "So a lot of people are waiting, and I think getting worse without help."

Substance misuse will continue to be problematic, Holmes said, as people develop coping techniques that sometimes include drugs or alcohol.

Holmes describes coping during the pandemic to be like the grief process.

At the beginning in March, many people were in denial and shock. Over the summer, some began to bargain, saying while we can't go to restaurants, at least we can order out. Holmes believes those who are doing best have reached the acceptance stage.

"Once you get to that level of acceptance, in gaining that perspective, it can help you to begin to focus on what you do have, or what you're learning from the situation," he said.

Suicides are down

The state health department reports suicidal ideation has dropped by 12 percent and suicide attempts by 19 percent compared to last year.

There are fewer suicides to date in 2020 than previous years, according to the Pierce County Medical Examiner's Office. This year, the office reported 98 suicides by the end of August. By that time in 2019, there were 118 deaths ruled a suicide and 124 in 2018.

The New York Times reported in May that it likely will be some time before scientists are able to determine how the pandemic affected the nation's rate of suicide.

Suicide attempts and completions sometimes spike among people starting to see improvement with medication and treatment, Holmes said. Those improvements might not be happening as much now with COVID-19 keeping people from treatment, he said.

"It's not always when people are in full-on depression," Holmes said. "I don't know that to be what's at play, but I do think it's something we have to watch as we come out of the pandemic."

Tips from health care experts

The health care professionals mentioned that a daily routine is important throughout the pandemic to keep a consistent structure.

Here are a few other self-care tips:

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If you aren't working, create a schedule that includes addressing things you need to do like pay bills, clean and search for a job. Be sure to schedule regular recreational activities as well, preferably daily.

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Go outside daily

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Exercise regularly

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Be social -- within the guidelines of Public Health officials/agencies. Visit, or virtually visit friends and family, if those are positive relationships for you. Conversely, if you're confined with the same person or people, plan some alone time.

Neal said everyone shouldn't wait to be mentally ready to follow these tips.

"Just do them, and as you do, a better mood will follow," he said.

Allen recommends people who are struggling create their own self-care plan and set boundaries. A self-care plan includes figuring out your triggers, things that bring comfort and bring back a routine.

For health care workers and first responders, Allen said it's important to recognize compassion fatigue training. Those working from home need to set boundaries, because working 60-hour weeks is not ideal.

"You need to take care of yourself and you need to acknowledge that it's stressful for all," Allen said.

Some are concerned for the coming months. Between the holiday season, an ongoing pandemic and shorter, darker days, there could be a further uptick in behavioral health challenges, Allen said.

"So those are all very, very concerning points to be made with our current state of behavioral health," she told the board in September.

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