The winter of 2021 has been grueling for just about all Mainers, as the coronavirus has sickened tens of thousands of people and killed hundreds across the state.
Even if residents were not directly touched by the pandemic, they likely suffered some other form of loss.
Children lost the structure and socialization that comes from in-person school, while eager young adults could no longer disembark for college, jobs, relationships, or adventures. Their parents lost a reliable form of child care and many even their incomes.
Vulnerable seniors and people with disabilities were stuck at home, isolated from friends and family. Those recovering from a drug or alcohol addiction could no longer attend in-person support meetings. Frontline workers felt more danger on the job, either from the virus itself or customers who refused to follow health protocols.
The losses have added up in the year since COVID-19 was first detected in the state. And between the recent fall and winter, they seem to have taken a particularly heavy toll on the mental health of Mainers.
‘A breaking point for so many people’
The demand for outpatient therapy and emergency psychiatric services has been way up compared to the same time last year, according to national data and reports from some Maine organizations. In January, more people died of a drug overdose in Maine than in any month of 2020. Some of the state’s recovery and crisis hotlines have also seen upticks in calls.
Similar trends have played out across the country. Four out of ten U.S. adults reported symptoms of anxiety and depression in January, a nearly fourfold increase from the first half of 2019, according to national surveys. Some of the greatest challenges have fallen on children, young adults, mothers and people of color.
Mental health experts have pointed to myriad factors that have contributed to the recent uptick.
They include the duration of the pandemic, uncertainty over when it might end, prolonged social isolation, job losses, stress on families, interrupted life plans, divisive national politics, increased substance use and new barriers to accessing support services.
Exacerbating all of those was the arrival of colder, darker conditions in winter that made it harder to leave the house.
Those factors have pummeled people already diagnosed with anxiety or depression, and induced symptoms in those previously unaffected, according to Simonne Maline, executive director of Consumer Council System of Maine, a statewide group that advocates for people living with mental health challenges.
“You add the layers of these societal things that, some we have control over and some we don't, and the sheer length of time, it then comes to a breaking point for so many people,” Maline said. “It’s just the cumulative and the length of time that we’ve been struggling with this.”
But just as the nation may be at a turning point in the pandemic — with growing availability of coronavirus vaccines, infection rates significantly down from their January peaks and warmer weather on the way — advocates expressed cautious optimism that that the picture will soon improve as Mainers can safely gather with friends, family and classmates again.
“So much of this is about lack of connection,” Maline said. “It really shows us how much we need that, not just if you’re living with a mental health challenge, but everybody needs that social connection.”
Long Waitlists, Busy ERs
State health officials and private medical providers have generally done a good job of ensuring that mental health treatment could still be offered safely during the pandemic, according to Maline and other experts.
But there have still been barriers for people seeking care in Maine and across the nation, some of which predated the pandemic.
One of the greatest has been a surge in other people trying to get help. That new demand has far outpaced the supply of trained professionals and translated to bottlenecks for some services in recent months.
For Tri-County Mental Health, an agency that provides a mix of outpatient and crisis services across western and southern Maine, more than 200 patients were waiting for services at the start of March. CEO Catherine Ryder says the agency has rarely had waitlists in the past.
One persistent challenge has been relatively low reimbursement rates from the state’s Medicaid program, which have made it harder for organizations such as Tri-County to offer the competitive salaries needed to recruit new workers, according to Ryder.
Another agency, Aroostook Mental Health Services, has seen surging demand for individual therapy in some, but not all, of its coverage area, which includes Aroostook, Washington and Hancock counties, according to Lorraine Chamberlain, program director of behavioral health and integration. Its services have been especially disrupted in areas where COVID-19 outbreaks have flared up, making it too dangerous to see patients in person.
At Northern Light Acadia Hospital in Bangor, 1,620 adults and 570 children were on a waitlist to receive therapy at the start of March, according to a spokesperson. At the same point last year, the psychiatric facility had no waitlist and was able to get people in for appointments within two weeks.
Acadia Hospital staff have also been more busy providing emergency care through a consultation program with 17 other Maine hospitals. During the last three months of 2020, Acadia saw a nearly 50% jump from the previous year in the number of consults it offered for patients coming to those hospitals for emergencies including suicidal behavior or attempts, self-harm, behavioral outbursts, anxiety or substance use.
Some of those patients were kids struggling with factors such as the remote schooling that has been required during the pandemic, according to Jamilyn Murphy-Hughes, who directs Acadia’s telepsychiatry consultation service. There was also a “general increase” in the acuity of patients coming during that time, she said, including more suicide attempts, more dangerous substance use and longer stays in the hospital.
The rise in people spiraling into crisis suggests that the pandemic is affecting a broad swath of society but that there have not been enough community-based resources to support all of them, according to Dr. John Campbell, senior physician executive at Acadia Hospital. He noted that the mental health system was facing some capacity challenges even before the pandemic.
“If the system is working the way it should or could, you’re not going to see these problems in the ER,” he said.
A Year of Isolation
The rapid rise of videoconferencing programs such as Zoom has made it much easier for organizations to keep offering some recovery and treatment programs during a pandemic that has made in-person meetings more dangerous. That expansion has been a silver lining of the crisis: in the long-run, telehealth is expected to broaden access to care for people who can’t travel to receive it.
“I think of one gentleman who is on my board. He really had to struggle with Zoom,” said Maline. “But once he got it, he was going to his church and all these other things via Zoom. You could just see his face light up.”
But according to Maline and others, the increasing reliance on technology has been a double-edged sword — many Mainers can’t take advantage of the innovation for lack of a reliable broadband connection or wireless device, or they just prefer face-to-face contact.
Dot Treadwell, 68, struggles with anxiety and seasonal depression that she said has grown worse during the long isolation of the pandemic. With mobility challenges and concerns about catching COVID-19, she has left her Auburn apartment on just a handful of occasions this past year, instead relying on her daughter to pick up groceries and run other errands.
Treadwell does have access to the internet, and some people have recommended she try to find a therapist, but she says she has not made the effort.
“I guess I could, but I just havent had the ambition,” she said. “Being depressed and stuff, I haven't wanted to do anything different.”
Treadwell said her depression has also made it hard to get too excited about the recent announcement that she and other Mainers in their 60s are eligible to receive the coronavirus vaccine, but added that it may sink in when it’s finally safe to see her grandchildren and go outside for one of her favorite hobbies: drawing and painting in the sun.
Treadwell noted that she is luckier than many people to have the brief moments of contact with her daughter, as well as weekly occupational and physical therapy sessions in her apartment that have helped lift her mood. She also has a lovebird — a type of parrot with red and green feathers — named Rosie, but added, “She’s not very lovely.”
A longtime volunteer for a number of charitable causes, Treadwell urged anyone who’s struggling to seek out help.
“I used to be the one who would get resources for people,” she said. “I know there are a lot of resources.”
‘A degree of hope’
That’s a message that everyone interviewed for this piece readily agreed on: many resources are still available for people struggling with the stress and isolation of the pandemic.
One of the key resources they pointed to are coronavirus vaccines, which should help society return to some normalcy as more and more people receive them. While the shots are still not widely available in Maine, they are already protecting many vulnerable groups such as nursing home residents and health care workers.
Campbell, the physician executive at Acadia Hospital in Bangor, said he has been buoyed by his recent experience volunteering at the coronavirus vaccination site at the Cross Insurance Center in Bangor.
“For the older folks in the observation area, it was like they were blossoming,” he said. “They were saying, ‘We haven’t seen our friends in a year!’ Humans are social animals.”
The coronavirus pandemic has provided a reminder of the need for Maine communities to do more to reduce the stigma around mental illness so that more people feel comfortable sharing their feelings and asking for help, according to Greg Marley, director of suicide prevention at the Maine chapter of the National Alliance on Mental Illness. He said the challenge is especially great for men and in more rural parts of the state.
Since last spring, Marley said he has been convening groups of stakeholders — from school staff to church groups to business leaders — in different parts of the state to get that message across and talk about the available resources.
The goal of those sessions, he said, is to offer “a degree of hope.”
He asked Mainers to consider whether they or someone they know has been feeling sad for long stretches of time, or so anxious that it’s interfering with their life and work, or spiraling deeper into drug or alcohol use.
“Those are signs that you may need extra help and to reach out, and to know that help is available,” Marley said.
He continued, “If your heart was beating irregularly, if you fell and you can’t stand up because your ankle was swollen and throbbing, you would immediately get help. Mental health is health, so how do you allow yourself to get the help you need? How do you encourage your loved ones to get the help they need?”
If you or someone you know is suffering from depression or other mental health disorders, help can be found at:
Maine’s 24-hour crisis hotline (1-888-568-1112 or text HOME to 741741)
The Intentional Warm Line, which provides free all-hours phone support to adults seeking mental health recovery (1-866-771-9276)
The FrontLine WarmLine, which helps health care workers responding to the pandemic (207-221-8196)
The state’s StrengthenME phone line, which provides free stress management resources during the pandemic (207-221-8198)
NAMI Maine’s teen text support line (207-515-8398)
