Mental health care workers stretched thin to address urgent need in pandemic

Liv Jones, a licensed professional counselor and art therapist, says her agency in Ohio has nearly doubled its staff over the last year to address the need for mental health care during the coronavirus pandemic.

Yet, even now, there’s still a waitlist for clients who wish to start therapy, she says.

“We’ve had caseloads that we’ve had to push our limits,” Jones told ABC News. “We have people come into our intake department and [they say], ‘I need to see someone as soon as possible. This is really urgent. I just got out of the hospital. I got connected here because I was told I’d be able to get treated.’”

“Obviously, an urgent need,” she said. “[It’s an] urgent need that we can’t fill.”

Jones treats a wide range of clients from children to adults who experience everything from anxiety and depression to severe dissociative and substance use disorders.

“We’ve seen a lot of hospitalizations in the past few months because it’s been hard for people to get treatment,” she said. “Telehealth made things a lot easier for some, and harder for others. A lot of them don’t have a laptop or a cellphone; they have a flip phone or they don’t have a phone at all.”

Jones has had five or six clients since July that she says have “gone AWOL” since they don’t have a cell phone, permanent address or any phone number that she can use to track them down. She says she avoids looking at obituaries out of fear she might find a client’s name there.

Jones also said there’s been a dramatic increase in the relapse rate within her substance abuse group.

“They weren’t able to feel as connected. We were just having them meet over the phone so you’re not even able to see a face,” she said. “Along with hospitalizations and suicide attempts, relapses have shot up.”

Jones’ agency has implemented a 360 degree camera that can stream the conversations between in-person and remote clients, making it easier for the group to engage for a more effective session.

With a packed schedule, Jones is lucky to have her own therapist, who she says “gets her through the day.”

Experts are seeing the same increase in the need for mental health services on a national scale. According to Mental Health America organization’s annual report, the number of people looking for help with anxiety and depression has skyrocketed in 2020, seeing a 93% increase in anxiety screening and 62% increase in depression screening, compared to 2019.

Dr. Nikole Benders-Hadi of Doctor On Demand, has seen an “unprecedented” influx of patients requesting mental health services. Her company offers patients direct care from health care providers, all completely online. She heads the company’s department for behavioral health.

This year, therapy visits on the online medical service have more than tripled, with clients whose ages are across the board. Benders-Hadi said 18- to 24-year-olds and seniors comprised the highest increases.

She said that mental health care providers across the country are taking on “high visit demand and longer hours” and that there’s great importance in taking “care of this work force” by “educating our practice on compassion fatigue and burnout.”

The pandemic has also greatly affected the work of Daniel Flores’ agency A New Awakening in Albuquerque, New Mexico.

He used to be able to offer his clients a cup of tea and some cookies -- sometimes the entire tin -- as a small way to comfort and connect with them.

Flores, a licensed professional clinical counselor, loves to feed people, especially when he says it’s likely the only food a client will eat that day.

He and his team have struggled to address the urgent need in the community while worrying about their own exposure to the virus in an ongoing pandemic.

Flores says he’s at risk and is concerned about catching COVID-19, or worse, bringing it home to his wife, who has pre-existing conditions.

“There’s a whole bunch of people not taking it seriously. I worry about it,” Flores said. “Therapists have problems, [too]. We just have better knowledge and better tools to deal with them.”

Flores spends his days working with a broad range of clients, including people who are generally low-income, convicts, suspects in pre-trial, people on probation and those who are experiencing homelessness.

While he is licensed to practice therapy, his work extends far beyond that, including helping people in the community with housing, medicare, employment and more. He says there’s been a noticeable uptick in reports of anxiety from both clients and providers.

“They worry about food, housing and money. I also see that many of my clients are beginning to go ‘stir crazy’ and feeling isolated as a result of the stay-at-home and quarantine orders,” he said. “Other clients are relapsing on drugs and alcohol as a way to cope. Those clients are having difficulty seeing past the loneliness that comes from isolation.”

If the agency can’t meet with clients remotely, the clients are asked to come into the office, exposing everyone to the risk of COVID-19.

“I believe that we are just experiencing a shortage in the entire health field both the physical and mental sides,” Flores said. “I am hopeful that this situation will subside but am unsure what will happen when the next catastrophic event happens since this one is showing some serious cracks in the system.”

Mary, who asked to be identified by only her first name, is dually licensed as a counselor and treatment provider for sex offenders.

Mary says her goal through the treatment she provides is simple and crucial not only to the client but to society at large: no more victims.

This includes helping sex offenders gain a deeper understanding of sexual behavior, impulse control and boundaries. She’s seen the results of insufficient treatment during the pandemic.

“The consequences can be very, very severe. I have had several guys be unsuccessfully discharged lately -- I’d say about five or six in the past two months,” she said. “The majority of the discharges were for basic rule violations like curfew, but I did have one who was looking at child pornography. Another using an unauthorized cell phone to contact minor females.”

Before the pandemic hit, Mary was able to lead in-person groups where members could give each other feedback and advice and work together on assignments. Now, without internet access, she leads the groups from her home with a dozen men on speakerphone.

Under pandemic restrictions, their interactions with other people have been severely limited behind bars. Mary says “this presents a treatment issue, too, because they can't practice the skills they learn in treatment.”

Especially for longtime offenders, treatment over the phone is “so much harder,” she said, since their behaviors are more “ingrained.”

Mary said she could also really use mental health care for herself during the pandemic. Working from home and working long and unpredictable hours has left her with her own problems separating work from her personal life and wellbeing.

“There’s a lot of stigma behind the word ‘burnout’ or ‘vicarious trauma,’” she said. “I’m one of a few females in this field. If I say I’m feeling burnout, it’s, ‘Oh, you poor little thing,’ from [other] therapists. There’s not a lot of available resources. There’s this false belief that we can do it on our own because we know it automatically.”

Clinical and forensic psychologist Heather Sheafer also works with clients in the criminal justice system.

The pandemic has tested everyone’s coping skills, like exercising and seeing loved ones, she said. For people behind bars, it’s even harder.

The people Sheafer works with are often being held before trial, meaning they haven’t been convicted. In many cases, she says their court appearances have been delayed because of the pandemic. In addition to not seeing their loved ones, it’s also difficult for them to meet with their lawyers, she said.

She said that in many cases, experts believe that a person could change their life if they have access to mental health care or if they have access to substance abuse treatment. The longer mental health care is delayed, the more it impacts not just the inmates’ lives but their families and communities as well, she said.

“Unfortunately, for some people, when they’re in jail, that’s the only mental health treatment they get,” she explained. “A lot of people in jail have severe trauma histories. There are people who maybe don’t have anything major going on, but they’ve never had somebody to sit and listen to them before. It makes a huge impact.”