As COVID-19 has added stress and anxiety to people’s lives in recent months, access to mental-health services and supports has changed — and in some cases improved.
Mental-health providers have largely moved to video or phone visits with patients, enabled through a change in the way insurers reimburse providers for such telehealth services during the pandemic.
While people’s access to Internet and devices necessary for video technology varies, as does their access to a private space to talk at home, the ability to connect with a therapist without making what can be a long trip for an office visit has reduced the no-show rate, providers said.
“People have realized that they can access good quality mental-health care pretty easily,” said licensed independent clinical social worker Sarah Hazelton, who opened a new practice in Lebanon in January and is now providing therapy via video to clients from her home in Norwich, Vt.
The shift to providing therapy via video technology has meant that Hazelton, who specializes in treating anxiety and obsessive-compulsive disorder, can treat single parents without their needing to find someone else to care for their children. It’s also helped her reach people who may live far from Lebanon, she said.
Telehealth has helped Unity resident Mandy Dube, who has long struggled with mental illness — including bipolar disorder, borderline personality disorder and post-traumatic stress disorder — maintain her connection with staff at West Central Behavioral Health during the pandemic.
“It’s going really well,” said the 31-year-old Dube, who was a plaintiff in a lawsuit the state of New Hampshire settled with people with mental illness more than six years ago.
She speaks with members of her Assertive Community Treatment team, including a case manager, peer-support specialist and a therapist, three times a week by phone. She was offered a video-chat option but didn’t have enough memory to store the application on her phone. The team also provides her with a weekly medication delivery, although that schedule has been somewhat irregular during the pandemic, she said.
“It’s been a little bit of a double-edged sword,” she said.
In some ways the support she’s getting now is better than before the pandemic because she sometimes would miss appointments when she wasn’t able to get a ride to Claremont. But she said her cell service in Unity isn’t great, and work she had previously been doing with the ACT team on how to navigate public spaces without getting triggered is no longer taking place.
“The virus put a complete halt on that,” she said.
Some of her symptoms have worsened during the pandemic, she said. When she does go grocery shopping, she finds it difficult to remember the new rules different stores have instituted to prevent the spread of the virus, which can increase her anxiety, she said. Also challenging has been mourning the recent deaths of her grandmother and a close friend without the ability to attend in-person funerals, she said.
Like Dube, Wilder resident Carolyn Sanders, who has long struggled with anxiety and attention deficit hyperactivity disorder, is successfully managing her mental health these days. The 45-year-old Sanders, who is disabled due to heart failure and arthritis, said that the pandemic has disrupted her regular routine and caused increased anxiety due to concerns for her own physical health and that of an 80-year-old aunt in New Jersey.
Despite that, she has been able to manage her symptoms through exercise, gardening and music.
“Getting outside in nature is an important thing,” she said. By being still and listening to the birds, she finds she’s able to “get rid of all that noise.”
She also keeps in touch with her therapist through regular video sessions, she said.
“It’s been perfect,” she said of the therapy via video chat. Since she has a good Internet connection, she’s had “no real problems,” she said.
Telehealth has advantages beyond improving access to treatment, said Hazelton, the licensed independent clinical social worker. She’s found that people are more comfortable talking when they’re in their own homes. It also gives her a glimpse into their home lives, which can help her get to know her clients better and can help in her treatment of people with OCD. For people with a form of OCD linked to a fear of germs, COVID-19 combined with stress caused by changes in their daily lives “can be completely incapacitating,” Hazelton said.
While the pandemic has pushed some people with anxiety, depression and OCD “over the edge,” Hazelton said, it’s also given some people time for therapy that they wouldn’t have otherwise had.
“It’s a real mix,” she said.
Regardless of the change in the format of visits from in-person to telehealth, Hanover clinical psychologist Seoka Salstrom said her work and that of other members of her practice, Hanover Center of Cognitive Behavioral Therapies, remains the same.
“What connects us is being present, genuine, listening deeply, feeling what there is to be felt together, and laughing,” she said in an email.
Despite the new reliance on mobile devices and computer screens for therapy as well as for school, work and other health care, Salstrom recommended that people spend some time away from them, including spending part of each day outdoors regardless of the weather.
She recommended that people develop a “daily present moment practice,” such as meditation, to help them focus.
“When we remain in the present, anxiety has less pull,” she said. “The present can be painful enough; we don’t need to compound it with thoughts of the past and future.”
Both therapists advised that people seek to find balance in their consumption of news during the pandemic, remaining informed while leaving time for other things such as connecting with other people.
“You can choose to not worry,” Hazelton said.