Each new day brings more concern over the COVID-19 pandemic than the one before it, and the impact of the virus is seemingly inescapable. The physical effects of coronavirus ravage the respiratory systems of those who contract it, but there is another, more stealthy side effect to living in a world where people live with the threat of a global pandemic.
The looming threat of coronavirus is irrevocably intertwined with exacerbation of mental health disorders, only adding to Idaho’s existing mental health crisis. Mental Health America ranks Idaho 49th in terms of overall mental health nationally, according to a comprehensive analysis of multiple factors, and the Gem State also has the lowest ratio of psychiatrists to residents. Nonprofits, the court systems, shelters and crisis hotline services are all too aware of how mental health is connected with physical health.
“Unfortunately, Idaho has a high suicide rate in comparision to other states. We have the fifth-highest suicide rate in the nation. Suicide has been a problem in Idaho for far too long, and now that Idahoans are living in a pandemic, it is causing more strain on people,” said Idaho Suicide Prevention Hotline Director Lee Flinn.
Indeed, data from Idaho Health and Welfare shows Idaho’s average suicide rate to be consistantly higher than the national average, which speaks to the state of mental health in Idaho. Add this to an international public health crisis and a frail economy, and that’s a recipe for mental health services and resources in Idaho being inundated with people needing more help than ever.
Isolation can increase the number of people who face crisis situations. Idaho Suicide Prevention Hotline (208-398-4357) provides crisis intervention, emotional support, and resource referrals to callers and help-seekers via its text hotline and online chat portal. Though ISPH reports that the volume of calls between April and June showed no increase from the same time the previous year, there has been an uptick in callers in July 2020.
The nature of the calls that ISPH receives has shifted dramatically, as well.This is consistent with data collected from previous international pandemics including SARS, MERS, Ebola and the HIV crisis. A study published in association with five medical research universities in America found that there can often be a substantial lag between the physical and psychological repercussions of living in a deadly pandemic.
“Callers are reporting more stressors related to joblessness, more concerns around self-reported anxiety, more issues surrounding interpersonal conflicts, and more reports of isolation and loneliness. Those are all experiences that Idahoans have felt before the pandemic—it is just made worse during this pandemic,” Flinn said.
Between April and June 2020, 19% of the contacts that ISPH received expressed explicit concerns surrounding COVID-19, 62% of which were classified as relating to anxiety. This can be compared to 21% of calls from the same time period in 2019 being in relation to anxiety.
The pandemic affected the staffing at ISPH, but not its operations, when the 70 active volunteer phone respondents were asked to stay home due to the dangers that COVID-19 posed. The small number of paid staff were left to answer phone calls and cover all shifts. June was the volunteers’ first time back, but there are fewer people in the call room than ever before to ensure adherence to new social distancing rules. Despite this, Flinn said ISPH made arrangements so its volunteers could work remotely.
“This is something that we have talked about before, but when the pandemic came around, it became clear that it was something that we needed to innovate on quickly,” Flinn said. “We are finding it a really good option for some, and it allows us to be fully staffed. It allows our highly skilled volunteers to continue to help their fellow community members.”
Both physical and emotional abuse are closely linked with the mental well-being of both abusers and victims. The Women’s and Children’s Alliance works closely with affected people in the Treasure Valley and, while its services were crucial before the pandemic, those who needed services and support are reaching out more than ever.
WCA operates a domestic violence hotline (208-343-7025), and runs a secure emergency and transitional shelter program in confidential locations around the Treasure Valley. WCA reports a 93% increase in calls related to domestic violence in the first quarter of 2020 as compared to the first quarter in 2019.
“Data from around the world shows that anytime there is an national disaster, which leads to an increase in stress, the financial hardships, there is definitely an increase in domestic abuse and violence,” said WCA Executive Director Beatrice Black.
Black told Boise Weekly that there were 194% more calls relating to domestic abuse in April 2020 compared to the number of calls in April 2019. WCA went from receiving 102 calls from the same period last year to fielding over 300 calls in April 2020. Additionally, the nonprofit engaged in nine emergency intakes into its domestic violence shelter in the last 12 weeks, where last year it averaged one per quarter. This dramatic increase is reflective of situations relating to isolation and quarantine.
“It is harder to physically get away from someone if you are being isolated with them, which may be why we are getting more phone calls and not necessarily more people coming to see us downtown,” Black said. “[Quarantine] really plays into the hands of the abusers who want to control the abuse victim anyways, and if you add to that potentially one or both of them are not able to go to work, so they are away from other avenues of being able to interact with people outside of their homes.”
These factors put children at a higher risk of becoming victims of domestic abuse, often leading to psychological disorders including anxiety, depression and PTSD down the line. Black said that there have been more severe cases of child abuse since the pandemic arrived, leading to an increase in hospitalizations, in part because isolation means there are fewer chances for child care providers and teachers to advocate for children.
As schools prepare to open their doors for the first times since March 15, children will be under the supervision of teachers who are able to keep an eye on the kids who would otherwise have no one to look out for them. Boise School District social workers have had limited interaction with families and children, leaving them with little idea of how the students are doing.
The school district hopes that it will be able to reinforce its connection with students in September, but in the meantime, it offers several resources for families and children. The Boise Public Schools Foundation runs Student Aid Fund for Emergencies (SAFE) hotline (208-472-2233), which helps support the basic needs that families in Boise.
A group that is often left out of the national conversation surrounding both mental health and COVID-19 is people going through state and federal court systems. Hon. Judge Steven Hippler has been a District Judge for the 4th Judicial District Court with chambers in Ada County since 2013. Hippler also presides over the Ada County Mental Health Court program.
Mental health court works to “reduce recidivism of some severely and persistent mentally ill offenders in the criminal justice system,” and has funding for 40 slots. Hippler told Boise Weekly that the pandemic has affected the ways in which participants in their program are able to receive care despite some needing it more than ever. Treatment and assessment has become conducted remotely in order to protect the participants and the staff members.
“There are some things in the program that are really dependent on the relations that I, as the judge, am able to have with each individual participant so that they are able to get to a point where they trust that I am going to respond fairly and appropriately with how they are doing,” Hippler said. “That is harder to assess when you are only seeing them via Zoom.”
Participants in mental health court rely on a combination of services that include weekly visits with a probation officer, individual and group therapy sessions, and weekly court appearances. Darcy Dickinson, coordinator for the Ada County Mental Health Court program, said when courts hit the pause button in order to regroup, so did the mental health court proceedings.
Dickinson was hired on March 26, the day after the stay home order was announced, but she noticed how hard telehealth has been on participants. She said there was a brief period of time when individuals stopped receiving treatment while the mental health court made sure that it could provide the best possible care, but that things are going relatively well now.
“I will say that telehealth has been hard on our participants. They really need and thrive on those in-person interactions, so that has been hard,” Dickinson said. “We have really ramped up the communication with our participants because we can’t physically see them. We try to reach out to them on a daily basis via email or send them a text message.”
Hippler agrees with Dickinson’s sentiment, but said that he realizes the lack of ability for some of the participants to engage with technology effectively. He also said that many of the program’s participants have co-occurring disorders, substance abuse disorders compounded with a multitude of other mental health issues.
“Many of them, as a result of a long history of substance abuse, or due to lack of attention to their health, or as a result of their means and resources to understand how to live a healthy lifestyle, have an underlying physical condition that puts them at high risk for an adverse outcome if they were to get COVID,” Hippler said.
Both Hippler and Dickinson said that there are concerns surrounding the environment that many of their participants are in. They are often living in group homes with 18-20 other people, and there is almost always somebody in the home being quarantined because they were exposed to the virus. In turn, everyone else living in the house must go into isolation, which limits their access to mental health court services.
There are a few successes that have come from the trials of the pandemic. Dickinson said that because of the need to frequently check up on participants, people have gotten to know her much quicker than would have happened otherwise for a new coordinator. Mental health court as a whole has seen the potential of long-term changes to its program.
“We can greatly expand our ability to provide services to people even when they are serving jail sanctions. We may put someone in jail to complete one of the in-custody jail classes that can last 30-60 days if they were struggling or if they were having behavior issues,” Hippler said. “In the past when this would happen, they were basically cut off from their treatment and therapy and classes, but now with the ability to do telehealth, we are better equipped for a continuum of care when they are in custody.”
The long-term implications of a national health care crisis on the collective mental state of Idahoans are yet to be seen, but there are a multitude of resources in the Treasure Valley available for people struggling with mental health concerns, each with its own passion and dedication.
“We are here for everyone. A person does not need to feel suicidal to call the hotline,” Flinn said. “People experience crises for a variety of reasons and we really want to be a resource to individuals before they feel more in crisis.”