Dr. Madhukar Trivedi, director of the Center for Depression Research and Clinical Care at UT Southwestern Medical Center, says the world is experiencing two disasters at the same time: COVID-19 and the mental health crisis it has created.
In a time when people feel anxious about their own health, their job security and the well-being of loved ones, public health experts are asking them to physically remove themselves from their support networks.
“What I’m really worried about is that while we are focusing on the medical crisis, which we need to and should, there is a longer term mental health crisis that is unfolding.”
Trivedi shared tips for coping with what he called a “very scary time” during a July 23 conference call with The News’ science reporter Anna Kuchment. The event was part of the DMN Download series of calls that keep the public informed about issues that affect the local community.
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Here are some highlights from the conversation. The following remarks have been edited and condensed for clarity.
Which groups of people are most vulnerable?
The first are people who have had trouble with depression, anxiety, alcohol use and drug use in the past or are currently experiencing it, Trivedi said.
“Often they get isolated and they don’t realize that care and services are available.”
The second and larger group includes those who have struggled with depression or anxiety and substance abuse in the past but were able to function.
“They had figured out a way to get social connectedness and support structures around them so they were able to function and talk out their problems with friends, neighbors, relatives, etc. That has come to be missing for a lot of people, and so they are experiencing significant symptoms of anxiety, depression, stress, and also alcohol use. We are also noticing higher rates of domestic violence as a result.”
The third group is people who are still struggling to figure out how best to navigate the COVID-19 crisis.
“They are the group that might benefit from more information, more support.”
Know that help is available.
One of the upsides to the pandemic, Trivedi said, is that insurance companies have recognized the need for mental health care, and virtual care has become more widely available.
“Virtual care delivered by Skype or FaceTime is accepted now both on the part of patients, it is accepted on the part of the health systems and, thankfully, reimbursement for their services by their insurance or by Medicare has become routine. This may actually outlive the virus crisis, and people in the future, I can imagine, will often be engaged in virtual visits when possible, so that they don’t have to waste their time driving to and from a home to a clinic.”
UT Southwestern, Dallas County and the city of Dallas all have mental health resources available on their websites.
Sleep well and turn off the news.
“Most of us have to recognize that we may have to live in this new normal for some time,” Trivedi said.
Figure out a way to have a balanced sleep/wake cycle so you’re not staying up late and sleeping too late into the day, Trivedi suggested. Include physical activity during the day to engage with the outside world. Monitor your consumption of the news.
“Decide which two or three sources of information you are willing to trust, but modulate them so that you’re not constantly looking at the news all the time.”
“Finally, social distancing does not have to mean social isolation. Find a way to schedule calls, have conversations with friends, families, call your grandmother, call your grandkids, call your siblings, and make an appointment so that you are doing those kinds of things regularly. One of the major risks for people who experienced symptoms of depression, anxiety is the real social isolation. One of the symptoms of the disease is trying to draw from society. So you should proactively program yourself so that it happens and you’re not isolated.”
Check on your teen.
“Teens and children obviously thrive on the social interactions they get at school, at playgrounds, at pool parties, etc.,” Trivedi said.
Parents should figure out a way to program interaction time for children, even if it’s not physical.
Parents should also not be afraid to ask their children and teens if they are having problems with stress, anxiety or depression.
“Remember, asking never introduces that thought in the person’s mind. Most often, if a teen is experiencing these things and the parent asks, they feel relieved; they feel like they’re being heard.”
Orchestrating interactions with friends and family will help draw out teens and children who may be reluctant to share feelings with their parents. The conversations will help them understand that others are experiencing the same things they are.
Supporting seniors
“I think seniors are having the hardest time, because their capacity to even go out for a walk is hampered, and they’re not getting visitors,” Trivedi said.
It’s important for seniors to connect with family and friends on a regular basis by phone or through safe, socially distanced get-togethers. Friends of seniors should look for depression warning signs, including a drop-off in communication or excessive sleep.
Trivedi also recommended reaching out to businesses and organizations — such as places of worship, book stores, the YMCA — that seniors used to be connected with to see if they offer remote or virtual programming.
Beware of channeling anxiety to small children.
After a reader asked how to help a 4-year-old who was acting out, Trivedi suggested maintaining a routine, including regular bedtimes and regular socially distant or virtual playdates, and reassuring small children that their parents are there to protect them. Conversations are best held while playing together, so it’s not just a lecture, he added.
“One additional thing is, remember that at that age they pick up on the mother or the father’s anxiety. So, try to be careful about how much of this anxiety you’re expressing in front of them.”
Memorialize loved ones virtually.
“We have several patients who have experienced despair: Somebody loses a loved one, but they cannot physically even attend the memorial service or, even if they do, it is very brief and there isn’t the normal, interactive, grieving process that happens,” Trivedi said.
He recommends holding a virtual memorial service in place of an in-person one.
“Have a conversation about the person who passed away, celebrate their lives and do it in concert with all the other loved ones in a similar environment.”
Acknowledge your sense of loss.
A caller asked if Trivedi had strategies to deal with the “mild sadness and grief due to the losses and changes in life because of the pandemic.”
“I have had a lot of people express this,” he said. “You are now living a different, new, normal life, at least temporarily. The kinds of social interactions you were experiencing — you would run into somebody at work and start having a conversation, you would find something amusing and go two doors down to your office mate and share that — those kinds of things are not easy now. And, therefore, that is the kind of loss that the caller is alluding to. And that is an important type of loss and grief that we should be at least mindful of and aware of so that you understand that this is what you’re experiencing.”
Trivedi recommended recreating these same kinds of situations by calling those people that you would have regularly interacted with.
“That relationship is not lost, but I think this is something that is now beginning to wear on people, and this is why I think people are beginning to itch to go back out, because I think those kinds of intangible social realities we all used to live are less and less common [in our new normal].”
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