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Tanzina Vega: Nearly six months into the global pandemic, COVID-19 is taking a toll on our mental health.

Julia Wright: Hi, this is Julia Wright calling from New Concord, Ohio. I'm a chaplain and previously I prided myself on having excellent coping abilities and even leads my students on grounding and centering practices. Through this pandemic, I have struggled with being able to focus on anything for 15 to 20 minutes. I feel restless and sad and on edge all the time. I keep telling my students that this is the time to give yourself a break to just look at yourself and love yourself and not be too harsh, but I look at the changes in my life, my social life, my body, my mental health, and I can't help but be horrified.

I'm wrestling with returning to work this week and putting on work clothes today made me cry.

Bernadette: My name is Bernadette Martin. I'm calling from Portland, Oregon. My mental health during this pandemic, it has been a lot. It's definitely taken a giant downturn. I actually gave birth a week before the pandemic was declared a pandemic. We've been home with the newborn ever since. They are now five months old and thriving, and loving all this extra parenting and home time, but it is a lot. I do have postpartum depression, and it's definitely exacerbating the issue. I luckily have a lot of support from my partner, and my roommates, all of which are also dealing with their own mental health issues right now.

Honestly, I think I'm probably really lucky all things considered, but some days are really hard and I'm trying to set a really good mental health example for my baby. Hope everyone else is doing okay.

Tanzina: Bernadette, as a new mom myself, I hear you. Thank you so much for sharing your stories. You can keep telling us how the pandemic is affecting your mental health by calling us at 877-8-MY-TAKE. In June, more than 36% of US adults reported symptoms of anxiety or depression and that's an increase of roughly 25% from the same time last year. That date is according to the Kaiser Family Foundation. Even former First Lady Michelle Obama said she's experiencing low-grade depression because of the state of the country today.

Bottom line we're dealing with a lot right now economic insecurity a global pandemic that forces us to stay apart, political infighting and the ongoing fight for racial justice are just some of the stressors we're facing right now. Listeners, you're not alone. I'm Tanzina Vega and the state of our mental health is where we start today on The Takeaway.

Sandhya Raman is a healthcare reporter with CQ Roll Call. Welcome to the show Sandhya.

Sandhya Raman: Hi, thanks for having me.

Tanzina: Dr. Suzan Song is the director of the division of child, adolescent, and family psychiatry at the George Washington University Medical Center. Thanks for being with us, Dr. Song.

Dr. Suzan Song: Thank you.

Tanzina: Dr. Song, what are been some of the most notable changes in our mental health or in the mental health of patients that you've been seeing during the pandemic?

Dr. Suzan: It's been quite variable and it changes over time. With the start of the pandemic, I was actually very surprised. I think myself and my other psychiatry colleagues, we were really worried about those who had pre-existing anxiety because of course we thought they would worsen and yet people with anxiety were my bright stars actually. They are used to seeing threats and being concerned and feeling fear ruminating about bad things about to happen.

Many have learned, therefore ways of coping so they can label their feeling as anxiety. They are now at the beginning of a pandemic, they're going to teaching other people like, "This is what you're feeling you're feeling anxiety, this is what you can do, here are some breathing techniques, here's some relaxation behaviors you can do." They're really validating, feeling more at ease because now the reality of worry was true. They can sit back and let other people carry the anxiety for them. Now, four, five, six months in it's a very different story.

I think almost all of my patients every single session, are talking about what your callers actually just spoke about, low motivation, difficulty focusing, low energy, irritability, and just a general ennuilike a boredom with life. They have things we can do, but there's really no reason for doing them.

Tanzina: Would you describe that as low-grade depression, is that on the depression spectrum, Dr. Song?

Dr. Suzan: It is, and it's hard when an entire community were experiencing a collective depression almost. Now people with a depressive disorder where it actually affects their functioning, they also have negative self-appraisal. They often think negatively about themselves. Like, why did I say that? I look bad, I am bad. I'll never be anything. The problem is now they have the space and the time at home without other distractions or social input to immerse in this negative self-dialogue.

Tanzina: Sandhya, you've reported recently on some of the concerns that the pandemic has raised around suicide in this country briefly, what were your findings there?

Sandhya: Right now, we in the past year or so, we have been on an upward trend where even in 2019, we were at like a 20 year high of suicide death rates. Right now in certain parts of the country, it little pockets throughout the country, there have been some spikes in suicide deaths, but it's hard to tell because the national data from places like the Centers for Disease Control and Prevention and from all the different medical examiners' offices, won't be available for a little while.

A lot of experts are worried that it might spike because of all the different stress factors that you've mentioned. Things like the economic situation, the health situation, the races, and lack of social interactions and being able to go to religious services. There's just so many different factors that could increase the suicide death rate.

Tanzina: Dr. Song, we mentioned there's so many things that people are dealing with. Is it the culmination and the layering of all of these issues on top of one another, that's adding to our collective Malays or is there one specific thing that is most to blame for the recent uptick in what we're seeing as far as anxiety, depression, and other issues?

Dr. Suzan: I think it's definitely multifactorial. It's overlaid with, our preexisting mental health care or access to resources and support. I want to emphasize the impact of truly our social inequalities and how that impacts mental health. When we talk about suicide, often, a precursor to that is feeling isolated. When we have physical distancing restrictions, that doesn't necessarily mean social isolation and yet right now we have such a wide spectrum of precaution behavior.

You might have patients who feel even more isolated from family and friends now because they don't share the same precaution behaviors or maybe adults who are compliant with masking and distancing, and yet their older parents or their loved ones or their spouses at home they differ in this. Now there's this feeling of what's wrong with me? Am I overreacting an underlying worry about their lives in danger? People are scared to walk by someone and now we view everybody as a threat, and that is a huge stress to our system.

People are grieving. We experienced collectively grief, the loss of life, jobs, security, relationships, former ways of living. All of this will also losing our normal outlets for coping. We don't have our workouts or vacations, things to look forward to or office talk, social outings.

Tanzina: Zoom meetings just to be honest they just don't seem to cut it which is how a lot of us are staying connected, whether that's through Zoom or FaceTime or texting. Sandhya, has the federal government noticing what's happening here issued any resources for mental health care for people who are dealing with this right now. I recall at the very beginning of the pandemic here in New York, Governor Cuomo, for example, asked for thousands of mental health professionals to come to the state to help with the increase in calls to hotlines. What is the federal government done to switch some of our mental health concerns nationally?

Sandhya: It's two-prong, there are things that have been done already, and there are things that are in the process of being done. Right now federal government has made it a lot easier that if you want telehealth for any of the mental health services or substance use services that you have, it's a lot easier to get that paid for by your insurance. Whether it's through government insurance or private insurance, it's just simplified a lot during the pandemic. That's definitely a helpful thing for people that are seeking treatment either for the first time or if they've gone many times.

Then on the other side, there are a few things that the government has been doing in the previous bills that have been there to help with COVID relief. There's been money appropriated to go to some of the behavioral health providers to help them. get through it because they have not been having as many people come in person. They've been experiencing some of the troubles that a lot of different businesses and providers have had.

In the house, the Energy and Commerce Committee has marked up a bunch of different mental health bills that could see for action and become law. Four of them related to suicide, but some of them were more broadly related to things like getting mental health covered under Telehealth, under Medicare even after the pandemic is over. All these bills are pretty bipartisan, so they're likely to be brought up at some point.

Then even yesterday, a bipartisan group of 58 members of Congress wrote a letter to leadership to just prioritize mental health, substance use treatment, in the effort whatever the next big packages that comes out that there's agreement on. A lot of different things are happening.

Tanzina: Dr. Song, to that point, we knew before the pandemic about a year ago, the data in the United States around suicide was grim. I'm wondering, not just specific to suicide, but more broadly, how can people assess whether or not they're dealing with a short term stress? Whether it's about wearing masks or what have you, or something more severe that might require treatment?

Dr. Suzan: It's a great question. I think we always have to think about how pervasive our symptoms are, and the severity of them. We all feel bad, one day here, one day there. Maybe in the morning, we feel better throughout the day, but if they're persistent, severe symptoms, where we just really can't focus and we really have periods where that negative self-appraisal just takes over and we feel hopeless, frankly, in existential despair and not just persistent. That's time to think it's really important to seek mental health care, now is the time right now. Because there's no need to suffer in silence alone when there are so many people right now.

Almost one-third of Americans right now are experiencing symptoms of depression and anxiety. Now is the time to come forward and to ask for help.

Tanzina: To know that they are not alone.

Dr. Suzan: That's right.

Tanzina: We on the show, I asked our listeners a couple of weeks ago to talk about how they're coping by creating moments of joy. Joy is something that's very immediate. I think what we're talking about now is hope. Are you noticing hopelessness among people? Is that what's driving the sense of depression and darkness right now? Is it that people are lacking hope? If so, how do we get better at finding that hope?

Dr. Suzan: Such a great point. It is extremely hard to find hope. The reason, I think is also multi-layered. We think about in the short-term, versus the long-term effects of this stress. In the short-term, sometimes it's easier to have hope than in the longer term. It's like a house on fire. In the short-term, there's lots of damage done, the house is on fire, but you don't really see the after-effects until the fire dies down, and you have the space and time to look at the remains, see the damage. Then you can start to build that hope for the future because the crisis is over. You have the space and capacity to actually have hope.

If that house continues to burn for four to six months, and it's hard to see when that will end, then it's really hard to have that hope because you don't know. We have that uncertainty of what the future is going to be. When will this crisis be over? What makes it worse is, for example, we have firefighters who are arriving to that house, in the metaphor it'll be like masks or distancing, and they're actually being turned away from helping that fire. Or let's say the fire is your house and people are walking by, but they're ignoring it and pretending it's not on fire.

It's those things that make hope very, very difficult. The trauma and the stress and the difficulty in having hope, the hopelessness right now, is not just the actual virus, it's not the actual fire. It's all of the stress, the inconsistency in response, the lack of uniform guidance, the variability and messaging about what's safe for the virus itself, the devaluing of some people's lives. All of that is extremely traumatic in this catapulting of helplessness, fear, and despair.

Tanzina: Before the pandemic, there were lots of conversations about resilience. I often find those conversations or that topic, it really depends on who's receiving the message. I think about as you were mentioning earlier, there are people who have suffered anxiety and depression and almost were prepared for this moment in a different way. Then there are folks who hadn't and this was a new place for them mentally. When we talk about resilience women, people of color, poor people have had to be resilient, and are probably examples of resilience or unfettered resilience in many ways because they've had no choice.

How do we create resilience in this moment for Americans? Because I just don't know what else to say at this point. I think a lot of people feel that way. They don't know what else to say, what else to do, what to do. Like you said, all of our coping mechanisms that we used to have including gathering and community have been taken it away.

Dr. Suzan: Resilience is a dynamic process. It's not a static trait that we either are resilient or we're not, but it's a process, which means it can be learned. It's also time and context-dependent. I could be resilient in the past, but right now, I'm not feeling resilience at all. Or it's context-dependent. I might be able to build on my resiliency in the work situation. If my boss gets upset with me, I can find ways to overcome that, but the same day, if something happens within my family, I crumble. I really let that get to me and it's hard for me to be resilient.

For people to know that resiliency is a process, and just because you're not feeling resilient right now does not mean one doesn't have the capacity to be resilient. You mentioned some extremely good points around the structural inequalities and the impact that it has. I think you're right, we are forcing people to be resilient, but tolerating is not the same as being resilient. In order to help people be resilient, I think the thing we most need to do is to change the structures and the social systems that are forcing people to be resilient. Meaning, we change our policies to better reflect our society where we actually value children and families.

We know right now, one of the hardest hits groups right now mental health-wise, there's a study from University of Southern California, is mothers. Mothers right now with children, women with children, are really struggling with the burden of working full-time trying to manage childcare. Also typically being the caregivers in their family for their other loved ones. These are some of the social policies that we need to really address to help people become more resilient.

Tanzina: Dr. Suzan Song is the director of the division of child, adolescent & family psychology at the George Washington University Medical Center. Sandhya Raman is healthcare reporter with CQ Roll Call. Thanks to you both.

Sandhya: Thank you.

Dr. Suzan: Thank you so much.

Tanzina: If you or someone you know is in need of mental health treatments, the number for the Substance Abuse and Mental Health Services Administration's national hotline is 1-800-662-4357. This is The Takeaway.

Casey: Hi, this is Casey Kraus calling from Fanwood, New Jersey. The isolation of this pandemic is surely affecting me but not nearly as much as it's affecting my six-year-old daughter. She's become prone to emotional outbursts and has a bit of anxiety about hand washing, even if we're just at home all day. I'm watching her closely and we'll be seeking a therapist if that behavior gets worse.

June: The pandemic has caused me to be extremely sad, and then I get angry, then I'm okay. I get extremely angry at our so-called president for not protecting our nation, and protecting all of its people no matter what their affiliation is, and posting consistent lies on any platform that he can get. This is scary. This is dangerous. Yes, it does impact me. My name is June, and I'm from Corning, New York.

Jennifer: Hi, this is Jennifer from Utah. Yes, my sleep has suffered and worry is constantly occupying my mind. I've had to limit my listening to or looking at the news. I used to listen and look at it every day, but now I only do it every few days or sometimes not at all. That has seemed to help a lot. I also try to refrain from arguing with others about our differences of opinion on what the country should do. As I've realized it only causes me more anxiety and that I really can only control my own action.

Judith: This is Judith Pawson from South Bend, Indiana. I'm socially distancing and after five months, it's very hard. I'm sole caregiver for my 87-year-old husband who has dementia. I text, I do Zoom religious services, I go outdoors. I am somewhat depressed. I'm also COVID-19 long hauler. The burdens and isolation and current events all way down my spirit even though I feel I'm doing the right thing ethically. I'm grateful my situation is difficult but bearable. Riding my horses a few times a week as I can is my secret weapon for maintaining my sanity.

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