Looking at the long term mental health effects of COVID-19

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Dr. Clinton Martin is dual board certified in child and adult psychiatry, with numerous recognitions over the years testifying to his expertise as a teacher, clinician and leader in his field.

For the last year, he’s served as regional chair for the department of psychiatry at UAB Huntsville Regional Medical Center, while also serving on several national committee for boards including the American Psychiatric Association and American Academy of Child and Adolescent Psychiatry.

In short, Dr. Clinton is a very smart man. But what comes through even more than his credentials is his compassion.

And what he sees happening, is concerning.

There is no blueprint in current psychiatric research for the long-term effects of a pandemic. Looking at COVID-19 as a purely physical threat, health officials have drawn parallels to the influenza outbreak of 1917-1918. Of course, an exact correlation is impossible. More than a century later, this is a different disease and we are a far different society.

Looking at COVID-19 as a mental health threat, some have compared it to the days following 9/11. As a nation, that may be our closest frame of reference but it too, is an impossible comparison.

This drags on, day after day, week after week, an invisible threat with tangible losses – the death of a friend or loved one, a job suddenly gone, the lonely family members you love too much to visit.

While some of us are finding this a time of quiet productivity, others find the time heavy on our hands and hearts. We are worried, stressed, fearful, anxious and lonely.

Crisis hotlines report domestic violence calls are soaring. With schools closed, vulnerable children have lost their “safe place.” Relationships are struggling.

And we have no way of knowing when it will all end.

It was within this backdrop that we interviewed Dr. Martin.

Here are our questions and his answers:

While we’ve been watching all this unfold in the past weeks and days, where have your thoughts gone as a mental health expert?

Dr. Clinton Martin: “As you can imagine, in a communicable disease like this, there’s a lot of uncertainty, especially at the beginning of such an illness. So, there’s a lot of distress among health care providers and everybody else, in general. I want everbody to know it’s a normal reaction to feel anxious during this time, regardless of if you are directly exposed to the illness or not.

Many of us with children I think have struggled on how to explain this to them, because we ourselves aren’t sure how to process it and now we’re trying to create a new normal with them. They’re not at school. They’re away from their routine, which so many children need to feel secure. What would your recommendation be for our children?

Dr. Clinton Martin: “You’re right. It is unprecedented times. As a child psychiatrist and as a parent, as well, I know some of these struggles firsthand. So, what we recommend is try to have an open conversation with kids and encourage questions and answer them as honestly as you can without giving unrealistic promises. And be prepared to answer the same question repeatedly because that might be a way a kid is trying to seek reassurances. Maintain a structure, as you mentioned, which helps with routine and consistency and encourage your children to do online educational activities, fight boredom with playing games and use social media and TV as appropriate to fight some those frustrations and boredom. The only caveat is, sometimes too much media, especially from unreliable sources can worsen some stress.”

There’s been a change in how people are reacting to this from the early days to now, as we see the number of cases rise every day. Do you see a corresponding rise in anxiety levels?

Dr. Clinton Martin: “Yes, and we’ve seen that in our clinics as well. We’ve been getting several calls. The people who are most vulnerable are people who have a preexisting condition of maybe trauma, maybe delusion symptoms or people with untreated symptoms…and in such times, they might have worsening symptoms of anxiety and distress. We can help by making sure there’s an adequate supply of medications without creating any interruptions in their treatment to prevent any relapse or hospitalizations.”

Does that become more difficult when so much of what you do is sitting, talking to people face to face?  How does that change how you practice mental health?

Dr. Clinton Martin: We’ve adapted as well, like everybody else. Fortunately, the Alabama Board of Medical Examiners and various medical entities, including the insurance companies have relaxed and become more flexible to where they pay most clinicians for telehealth services. The rules around HIPAA and video conferencing have been relaxed and also, the requirement to have a patient-doctor relationship prior to prescribing any controlled substance has been suspended, during this time of emergency. So, while in-person meeting is always preferable, we are adapting.  The important thing is for all healthcare providers to be available for our patients, during this time. It’s our calling and we have to honor our service. Also keep in mind that as healthcare workers, we are very vulnerable ourselves, especially nurses who are at the front lines. So we have to make sure our basic needs, including eating, drinking and sleeping are met, so we can be ready and available for our patients.”

At a time when so many people, who are normally psychologically very healthy, are seeing elevated levels of anxiety – how do you separate that from someone who has an issue that now needs to be addressed? 

Dr Clinton Martin: “That’s a good point. It’s important to know that these feelings and feelings of loneliness is a normal reaction to a stressful situation like this. What we need to keep in mind is keep track of our level of frustration and sometimes possibly anger might be severe reactions to a situation like this.”

What about families that are already in crisis? Maybe there are financial stressors; someone in the home with a substance use disorder; someone is struggling with drinking too much. They’re stuck at home and they’re worried about their jobs, this seems like a crisis that is perhaps just waiting to happen. What do you tell people who might be in a home like that?

Dr. Clinton Martin: “We encourage to promote psychological well-being by maintaining some consistency. Avoid increasing alcohol intake, smoking or drug use because in times like this, it’s easy to go up on those habits. Stay in touch with loved ones because knowing your loved ones are safe and secure also enhances your own efforts to quarantine.”

“We can promote some relaxation techniques, (also things like) exercise during these times, to try to help with reducing some of those stress levels.”

We talked about health-care professionals. Is there anyone else who may be particularly vulnerable during prolonged periods of isolation?

Dr. Clinton Martin: “Military families, especially if they have loved ones deployed are vulnerable. Single parent families are vulnerable and these are the folks that we need to be mindful of and check on periodically.”

Is there anything in history that you, as mental health experts, can look to that might guide you as you try to figure out how we get to the other side of this?

Dr. Clinton Martin: “So again, this is unprecedented on how it has affected so many people. One of the things we have learned from communicable illnesses is there is a stigma associated with such illnesses. We all know stigma can hamper any of these efforts to try to contain such illness. So, what we recommend is to refer to people who might have this illness as people with COVID-19. Do not refer to them as suspects or cases and try to avoid stigma by attaching race, ethnicity or even regions to the illness and avoid calling this ‘Wuhan virus’ or ‘Chinese virus.’ That way we can try to avoid the stigma of this virus and try to contain it sooner.”

Has there been any discussion in your profession about the potential effects of such a long-term crisis?

Dr. Clinton Martin: “We’re all concerned about the prolonged duration of this stress. Especially since research has shown longer days of 10 days or more of quarantine measures can take a toll on one’s emotional well-being and it might takes days, weeks or even months for a person to get back to their usual routine.”

What would you maybe tell that person who, for whatever reason, might not ever have an opportunity to sit in an office with you or a colleague?

Dr. Clinton Martin: “What I would tell anybody who is thinking about this crisis and is worried about it – if there’s one take-home message is – that we are all in this together and everybody is having a certain level of distress and anxiety toward this. So, it’s a very, very normal reaction to have that fear of not only not getting infected but your own well-being and being worried if you have adequate supplies. These are fears that are normal for everyone. Trying to stay positive and hopeful and being available for your loved ones, should help us get through some of these things.”

Recommended resources from the Alabama Psychiatric Physicians Association, District Branch of the American Psychiatric Association:

For immediate help

  • Disaster Distress Helpline  Call 1-800-985-5990 or text TalkWithUs to 66746
  • National Suicide Prevention Lifeline  Call 1-800-273-8255
  • Crisis Textline – Text TALK to 741741

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