Surfing the seemingly endless tide of negative stories and comments that fill social media and news feeds now has a name: doom scrolling.

Many have felt varying degrees of despair and anxiety it creates, but the pandemic has made everyone acutely aware of how COVID-19 is impacting mental and emotional health. As the pandemic continues, counties have also seen a significant increase in demand for mental health services.

While essential workers and those in high-risk groups for the virus are more likely to suffer adverse mental health conditions, substance abuse and suicidal ideations are up across all demographics. A Center for Disease Control survey in June found that “the prevalence of symptoms of anxiety disorder was approximately three times those reported in 2019 (25.5% versus 8.1%), and prevalence of depressive disorder was approximately four times that of 2019 (24.3% versus 6.5%).”

WSAC had the opportunity to discuss the rising need for mental health services with Whatcom County Health Department Human Services Manager, Anne Deacon. She explained that some areas where counties are seeing the impact directly are with treatment courts, jail operations, and crisis services.

Counties facilitating treatment courts have had to revamp operations to meet social distancing guidance. Several treatment court participants have abided by the “Stay Home, Stay Healthy” order, meaning they haven’t been seeking out help when they may need it most. As a result, they may have fallen out of compliance and could potentially lose their job due to court orders.

County jails have decreased their census where possible. Those who must be incarcerated typically have more severe and acute behavioral health symptoms, requiring expensive medications to help them stabilize and jail staff capable of managing challenging behaviors. Health officials are now seeing the effects of postponing mental health treatments on a broader level.

According to Deacon:

“The demand is not decreasing; the acuity of the symptoms is increasing. The majority of the 911 calls have had a behavioral health component, and that is pretty significant. I think in part, it’s related to COVID because people can’t get the services when they need it. They weren’t getting help early on, so they’re much worse when they finally seek help.” 

Deacon’s observations are in line with national trends. The CDC found that 40% of over 5,000 people surveyed reported an adverse mental or behavioral health condition, including symptoms of anxiety or depression (30.9%), substance abuse (13.3%), and suicidal thoughts (10.7%).

There has always been more demand than the capacity for mental health services, and the recent increases are straining systems further. In Washington State, the health crisis came at a time of transition for the North Sound Region. The five counties in the region formed the North Sound Behavioral Health Administrative Services Organization (ASO), which primarily administers publicly funded behavioral health crisis services. With Integrated Managed Care (IMC), five MCOs now administer the Medicaid behavioral health services.

The counties now have to work with six entities to try to build and sustain effective systems of care, whereas, before IMC, there was just one entity, the Behavioral Health Organization. Four of the five MCOs are for-profit organizations, which changes the dynamics of any potential, yet necessary, collaboration. The competitive nature of this structure challenges the ability of counties to collaborate on building and improving systems. These challenges are works in process and impact jail re-entry services, law enforcement responses, triage and detox facilities, and the crisis system generally. Coupled with the challenge of the pandemic, counties must find ways to influence this new system, created by the state’s Health Care Authority, so that it best serves constituents.

Deacon summarized the situation, saying:

“Now you have seven entities instead of two trying to create and sustain systems, each with their own rules and funding structures. So, it’s new enough where there are many glitches, and we hadn’t gotten to fix them before COVID hit. It just became a morass because no collaborative system existed where a thoughtful and comprehensive response could be generated. People are falling through the cracks, and that’s a serious concern.”

As with most public and non-profit organizations, budgets have been unexpectedly slashed for 2021. Whatcom County’s Behavioral Health sales tax operates on a $5 million budget, which has been reduced by 20%. The services being reduced “are the glue for the systems that hold them together,” said Deacon. “Behavioral health was notoriously underfunded, and it’s going to get a lot worse. We don’t have near enough clinicians, and almost 20% of our population [in Whatcom County] is on Medicaid.”

It’s not all bad news, though. With limitations on meeting in person, telehealth has grown by leaps and bounds, group treatments have adapted to online meetings, and some insurance companies have begun to give out free cell phones to allow individuals access to treatment critical to their recovery.

As Washington State and the rest of the country continue to adapt to the “new normal,” Dr. Betty Pfefferbaum encourages:

“Mental health and emergency management communities work together to identify, develop, and disseminate evidence-based resources related to disaster mental health, mental health triage and referral, needs of special populations, and death notification and bereavement care. Risk-communication efforts should anticipate the complexities of emerging issues such as prevention directives, vaccine availability and acceptability, and needed evidence-based interventions relevant to pandemics and should address a range of psychosocial concerns.” 

On a community level, leaders can encourage residents to hold strong, watch for ways to help others, and not be afraid to seek assistance before an issue becomes acute. Just because we cannot be together does not mean we cannot reach out. Listen and help where possible, but remember, whatever you do, don’t read the comments!

If you or someone you know is in need of mental health resources, please visit the National Alliance on Mental Illness.