We’re counting the hours to that first drink of the day; going for an extra scoop rice or bowl of ice cream (maybe both); binge-watching, whatever; staring at our phones or email instead of working out or calling a friend. We’ve got less money, more stress and aren’t really sure how we feel.
Some mental health experts in Hawai‘i compare the pandemic to a magnifying glass: It’s amplifying existing problems and sharpening the focus on fractures in relationships at home, at work and across our community.
“If there was something there, then it scratched away the surface,” says mental health advocate Kathleen Rhoads Merriam, who has worked in the mental health field for 36 years.
And that’s taken a toll. A Hawai‘i Health Department survey found 82% of residents reported that they experienced a mental health condition during the latter half of 2020, with more than half—52%—saying their symptoms began during the pandemic.
“We’re all being affected by the pandemic,” declared Amy Curtis, administrator of the DOH’s adult mental health division.
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Answering the Calls
Mental health professionals felt the pressure building as the sustained stress of the pandemic burned through people’s reserves. More of us shut ourselves in our homes to avoid potentially unsafe activities. As 2020 wore on, calls to the state’s crisis hotline—Hawai‘i Cares—spiked to the highest volume in seven years with 16,158 calls in September alone.
Samaritan Counseling Center Executive Director Rachelle Chang also watched demand skyrocket. Since 1989, the center has provided counseling to individuals, families and couples, regardless of their ability to pay. In recent months, all nine counselors worked at capacity to try to keep up.
The center locates its offices at churches and temples to keep costs down and uses money saved in rent to subsidize care. Last year, those subsidies soared 89%—from $36,000 to $66,000—as more patients lost their jobs and couldn’t afford to pay. Chang says being based in the community also allows them to reach more people who “don’t have to drive halfway across the island into town to get counseling.” And once they came, many stayed. Chang saw more patients returning for treatment rather than leaving after a few sessions devoted to one issue or event. “Not surprising, we’re kind of all stuck at home with conflicts with work or spouse or significant other,” she says.
As executive director of the National Alliance on Mental Illness Hawai‘i, Kumi Macdonald provides education, awareness and advocacy all aimed at supporting those affected by mental health issues. She believes the pandemic also unearthed some underlying issues that people brushed aside earlier. “Once you’re stuck at home or the social connections are disrupted, then it escalates,” she says.
Macdonald is among the professionals urging people to be aware of how they’re feeling and to check in and talk with others. Experts we spoke with worry about skyrocketing liquor sales, patients relapsing into substance use after years in recovery, an increasing demand for street drugs reflected in higher prices. Macdonald also sees lots of folks leaning harder on alcohol: “I’m thinking, wow, that person is drinking a lot more these days.”
The state mental health survey for 2020 reveals the range of conditions: 68% of adults experienced anxiety, 61% reported loneliness, 57% felt depressed and 33% suffered a panic attack. And even that daunting assessment of our collective mental health likely underestimates the current state of our community, experts say. The extremely stressful time also is reshaping how we relate to one another, encouraging open discussion of issues and prompting acceptance of innovative ways to provide help over the telephone, computer and through webinars.
Samaritan Counseling adjusted swiftly. But diving deep into telehealth created another problem when payments from insurance companies fell short. Chang says one insurance company that had paid $85 per session dropped to $45 for visits by phone or computer. “They just cut it in half,” she says. “We wanted to make up that difference with our counselors.”
“You’re doing your best every day and every day your best looks different and sometimes your best is not what you want it to be but that is what it is.”
— Mestisa Gass
State lawmakers are working to ease the financial strain. They gave initial approval to measures this year that would classify telephone calls as telehealth so those visits would be covered by insurance. In a committee report, longtime patient advocate Sen. Rosalyn Baker wrote that those calls prove “absolutely critical for maintaining connection and care for those who do not have access to smartphones, devices or computers with webcams.” Baker, who represents South and West Maui, says phone follow-ups help remove barriers to care for elderly and high-risk patients.
Early this spring, Chang was working to hire another counselor and was encouraged by legislative efforts to help reimburse therapists for their work. While the pandemic has strained our community, she agrees that there are reasons to be hopeful. “In a way it’s been good for mental health, maybe not in the first month or so, but as it’s continued and people are more OK about reaching out.”
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Young and Anxious
Adults are not the only ones feeling the strain. Claudia Crist is CEO of Sutter Health Kāhi Mōhala, the 88-bed West O‘ahu medical center that specializes in mental illness health care. She worries about the spike in patients needing help and the severity of those needs, especially among adolescents.
The Centers for Disease Control and Prevention reported that while overall visits to U.S. emergency rooms declined from January to mid-October of 2020, mental health-related visits for children and teens rose by 24% among children, ages 5-11, and 31% for ages 12-17. And while the number of suicides in the U.S. remained around 47,000, more people have been considering it, even before the pandemic. In 2019, the CDC reported 12 million American adults seriously thought about suicide, 3.5 million planned a suicide attempt and 1.4 million attempted suicide. Even more alarming is the increase in each of those categories among all ages. While suicide is the 10th leading cause of death in the U.S. overall, it rises to the second-leading cause of death for people ages 10 to 34. The trend in youth suicide has increased a startling 56% from 1999 to 2016, compared to 30% for other age groups.
“It’s really discouraging to see the trend in youth suicide,” Crist says. One vital way families can help is to talk about mental health challenges like any other chronic illness to remove the stigma. She suggests that parents educate themselves about mental health and make it a routine part of everyday family conversation so children feel safe to speak up. “Maybe parents will talk about how they’re struggling with something and they sought help and it’s a normal thing and how they’re getting help,” Crist says.
Click on Clint Oka’s LinkedIn social media profile and you see a smiling young man who launched his career after earning a degree in finance from UH Mānoa. Only his last position as a peer specialist for Mental Health Kōkua hints at his decade of struggle with schizoaffective disorder. “My life was turned upside down right when I was coming of age with college and career. I experienced delusions, voices, paranoia,” he says. After working through anger, sadness and denial, he found the road to recovery.
Accepting both his diagnosis and that it meant he needed to remain on medication to stay well proved difficult. This past year brought more challenges. He’d been working as a peer counselor helping others come to terms with their illnesses when the pandemic cut funding for the program, he says. He still struggles with finding the balance between being open about his illness and fearing it will hold him back from a job or relationship.
Oka, 34, grew up in Kāne‘ohe and lives with his parents whom he credits, along with support groups from NAMI Hawai‘i and The Queen’s Medical Center, for helping him move forward and share his story. Now, he’s also embracing stress-relieving techniques, meditation and yoga. He’s teaching breathing techniques through his Instagram @breathnique and looking into part-time work. “Quiet time helps me put things into perspective and focus less on comparing and expectations and think about what good things I already have in my life,” he says.
SEE ALSO: As Places Continue to Reopen in Hawai‘i and We Can Do More Things, Why Are We Feeling Even More Anxious?
Learning to Cope
Connecting with others, simply talking—and listening—can make the difference for all of us. And if there is an upside to the sustained trauma we’re all experiencing at the same time, it may be that it’s made mental health a part of everyday conversation. Merriam and other experts are encouraged that it’s in the news and on our minds, even if it took a crisis to get here. “Maybe people are becoming better listeners and better problem solvers,” Merriam says. She sees people finding help through peer support, whether through Alcoholics Anonymous, or a Monday game night with family and friends scattered across the country.
“I’m hopeful that I see people going, ‘Have you tried meditation? Oh, I love deep breathing,’” says Mestisa Gass, program director of Mental Health America of Hawai‘i. “I see them sharing their favorite skills and how they’ve gotten through it. And that’s not a conversation that we used to have.”
After decades of being in recovery from depression and anxiety herself, Macdonald brings warm, informed empathy to her role. She nudges folks toward community support from NAMI and other organizations. “It’s not just taking a class but you really get to meet people, you get to make friends with other family members, you get to make friends with other people going through the journey with you,” she says.
As for those who are considering seeking guidance from a therapist for the first time, Macdonald assures people that therapy now goes well beyond old movie stereotypes. “You don’t just sit there on a couch and have to tell your whole life story,” she says. The nonprofit runs structured eight-week courses that provide specific coping tools, as well as family support groups, crisis intervention teams and workshops. It also hosts an annual fundraising walk, which builds awareness. “There’s so many more creative and awesome options, there’s so many other ways to do therapy and feel better.”
Crist also encourages people to talk about their mental health during routine doctor visits, as part of “our total emotional, psychological and social well-being,” she says, adding that changing the perception starts when people see how mental health “affects how we think, feel and act, and how we handle stress, how we relate to others, and the choices we make.”
And getting back to basics might be what helps us most in 2021, Gass says: “Are you drinking enough water? How’s your sleep? Are you exercising? If those things aren’t where they need to be, that’s where you put your focus.
“Coping skills are what you do to calm your nervous system. You can use deep breathing here, you can do mindfulness, you can do yoga, intense exercise.” Happily for ocean lovers, Gass says swimming brings several benefits: “muscle relaxation, it paces your breathing and it burns off the anxious energy.”
While 2020 sometimes felt like a seesaw between anxiety and lockdown bright spots, Gass says this year has brought burnout as we find that what lifted our spirits a few months ago isn’t working now. “You’re doing your best every day and every day your best looks different and sometimes your best is not what you want it to be but that is what it is,” Gass says. “Be patient with yourself. Be kind to yourself and just focus on the basics when it gets really hard.”
And don’t underestimate the benefits of simply reaching out to others. “People are really wanting to know ‘Are you OK?’ and sticking around for the answer,” Merriam says. “I think a lot of us are having deeper, more meaningful conversations.” Her main message is to keep talking: “Talk about how you and your family members are really feeling. Let’s not change the subject when loved ones are expressing things that are uncomfortable to hear.”
And all of us can also help each other by just slowing down, Merriam says: “Pause a little bit and be a little more patient, try to focus on kindness to one another, whether we’re driving or at the grocery store, or we’re talking to co-workers.”
The pandemic could have long-lasting developmental impacts on youth, says Dr. Anthony Guerrero, a local child and adult psychiatrist who serves as chair of the UH medical school Department of Psychiatry and chief of psychiatry at The Queen’s Medical Center. “Families are stressed by illnesses, deaths, job impacts and multiple other disruptions,” Guerrero says. And now, kids have fewer opportunities for activities—arts, sports, enrichment—usually provided in school and after. Still, he’s encouraged by community response and initiatives that emerged even with the soaring demand. He says prioritizing mental health will make a difference in healing from the pandemic. “Please get help and encourage others to get help,” he says. “Take care of each other.”
SEE ALSO: Hawai‘i Doctors Talk About Mystery Illnesses, Diagnostic Breakthroughs and Practicing in a Pandemic
How to Find Help
• For free support, call Hawai‘i Cares—formerly the Crisis Line of Hawai‘i—at (800) 753-6879 or text ALOHA to 741741. Professionals staff the line around the clock every day. hicares.hawaii.gov
• Kū Makani – The Hawai‘i Resiliency Project is a new program funded by a $2.1 million pandemic relief grant that offers counseling, education, information and resource navigation while promoting healthy coping, empowerment and resilience through trained crisis counselors. Access this program through the Hawai‘i Cares line and on Facebook.
s in crisis, call the National Suicide Prevention Lifeline toll-free at (800) 273-TALK (8255) 24 hours a day, seven days a week. The service is confidential and available to anyone. suicidepreventionlifeline.org
• The Trevor Helpline is a national 24/7 hotline for LGBTQ youths, (866) 488-7386. thetrevorproject.org
More local resources:
• Mental Health America of Hawai‘i has information on apps, video training, printable materials and social media links. mentalhealthhawaii.org
• National Alliance on Mental Illness Hawai‘i includes information on support groups and classes. namihawaii.org
Build An Emotional Toolkit
Kathleen Rhoads Merriam suggests these simple steps to stay in tune with your mental health.
• Try to establish a routine, especially if it has been disrupted in the past year. Wake up and go to bed around the same time. Slow down and turn off electronics near bedtime. Set personal boundaries around negative news, people, places.
• Complete daily check-ins.
– How am I feeling right now?
– What can I do for self-care today? Go for a walk, take a bubble bath or sit quietly for several minutes.
– Has my patience or tolerance been triggered today? What can I do to relax and respond with aloha?
– When is it time to talk about my feelings with someone else? A friend, a family member? A call center? A mental health professional?
• Mental Health America of Hawai‘i’s Mestisa Gass says strive for small consistent life changes that can be sustained over time. She compares self-care to baking.
• Start with the basic ingredients: food that nourishes, hydration, sleep and exercise.
• Add in a rising agent that helps keep us motivated: connecting with nature, reaching out to friends and family, and practicing daily self-care and coping techniques that calm the nervous system including mindfulness, deep breathing and leaning into your core beliefs.
• Then add “the sprinkles” that enrich your life: gardening, jumping in the ocean, sweating at the gym, keeping a journal, reading, baking, dancing, and other activities that help you engage your senses.