LEWISTON — Laid off and struggling to get unemployment benefits, some Mainers are getting deeply depressed.

For others, the problem is anxiety — not even grocery shopping is easy right now.

Removed from friends, family and everything that helps them cope, others are thinking about suicide.

“Isolation is a factor that really puts people at greater risk,” said Leslie Mulhearn, senior director for crisis intervention services at Sweetser. “I worry a lot about folks that can’t get out. … Those kinds of things are connections that can bring people back to reality, make them think about hope. All the things that keep us wanting to stay alive. Isolation is tough.”

As COVID-19 continues its course through Maine, mental health providers here are seeing more people seeking help for anxiety, depression, suicidal thoughts or substance use, or their client numbers are steady but they’re seeing more severe problems, more crises.

Providers understand exactly the stress their patients and clients are under. They’re feeling it, too.

“All day long I think, ‘Where are my hands? What have I touched? What have I not remembered to do? Who have I come in contact with?'” said Marcia Chastanet, a Tri-County Mental Health Services consultant based at Central Maine Medical Center in Lewiston.”Your mind is playing this tape over and over again in the background as a reminder. ‘Don’t forget your gloves, don’t forget this, don’t forget that.’ You’re constantly monitoring yourself, your environment, your co-workers and the patient. That takes a lot of energy.”

‘RIDING AN EDGE’

COVID-19 has put a strain on almost everyone in some way — through job loss, illness, fear of illness, isolation, working from home, going to school from home. Just finding everyday essentials has become stressful.

“The stress levels are only increasing on a regular basis right now,” said Malory Shaughnessy, executive director of the Alliance for Addiction and Mental Health Services in Augusta. “People are kind of at the end of their rope. I think we’re seeing that throughout communities, where people are kind of riding an edge.”

For people already dealing with mental health issues, it’s a particularly bad situation.

“I’m critically aware … that there’s a radical increase in the amount of anxiety and depression overall that folks are experiencing,” said Catherine Ryder, chief executive officer of Tri-County Mental Health Services, a mental health agency in Lewiston. “I know in some instances that has led to some suicidal ideation and some suicidal behavior.”

Age doesn’t matter.

“I’ve been hearing a lot, too, from the health care coordinators who specifically work with teens and young children that they’ve seen an increase in depression as well and an increase in some behavioral issues at home just because they’re bored. There’s not a whole heck of a lot to do,” said Jennifer Pelletier, manager of Tri-County Mental Health’s behavioral health home and outpatient services.

At Maine’s Intentional Warm Line — a toll-free peer-to-peer mental health support line — calls have increased about 57% since March, when the first positive COVID-19 tests were announced in Maine. The line now gets about 94 calls a day, up from 60. Call time is up 71%, from 1,133 total minutes in March to 1,940 minutes now.

There aren’t more callers to the Maine Crisis Hotline — a free, confidential call, text and chat line that helps individuals and families in a mental health crisis — but the types of callers have changed. The hotline is now hearing more from families with children, people struggling with isolation, anxiety and depression, people dealing with domestic violence and people who are thinking about suicide.

It’s also hearing more from teens and young adults.

“The continued stay-at-home order is beginning to impact people’s level of functioning,” said Karen Turgeon, vice president of programs for the Opportunity Alliance, the South Portland-based agency that runs the hotline. “Young people with unstable home environments do not have outlets they normally have. Now that school has been virtual for eight weeks, families are really feeling the pressure. This is mostly related to isolation. In addition, financial stressors and figuring out how to meet basic needs is causing increased worry.”

And while hotline calls haven’t increased in number, they are more challenging.

“The calls are intense, new folks calling, text has increased and (texts) take more to manage than a call, and the length of calls is longer,” Turgeon said. “Supervisors who are usually available for consult with staff are having to take calls and staff are exhausted due to the intensity of the calls.”

Mental health care providers and agencies statewide are seeing a similar trend during the pandemic — either more people are seeking help, like at the Intentional Warm Line, or people’s mental health problems are more intense, like at the Maine Crisis Hotline.

For St. Mary’s Regional Medical Center in Lewiston, it’s a little bit of both. Adult in-patient psychiatric treatment numbers are about normal or slightly higher. People with substance use problems are “sharply on the rise.” Fewer kids are going to the hospital for mental health issues, likely because schools aren’t referring them as often during this period of virtual classrooms, but their problems — at least when it comes to suicide — are more acute.

“I’m seeing more kids who have acted on suicidal thinking compared to kids who are thinking about suicide,” said Dylan McKenney, associate medical director for pediatric behavioral services. “I think it reflects a deeper trying to hold on and not come to the hospital, and so we’re seeing things getting to a point that’s a little more severe before coming in for help.”

WEARINESS

Providers themselves are not immune.

“There is a seeping in of weariness that’s taking place, even among caretakers,” said Ryder at Tri-County.

Providers, particularly those who work in hospitals, worry about contracting the virus or bringing it home to their family. They worry about keeping their jobs or having to shift to a new one. They worry about their patients.

“The kids in mental health residential, their parents can’t come in and visit them (as a pandemic precaution). Their family can’t come in. That’s all weighing on staff and residents,” said Shaughnessy at the Alliance for Addiction and Mental Health Services. “I think we’re definitely seeing everything is kind of getting stretched.”

In April, the state created a confidential Maine FrontLine WarmLine specifically to help support stressed first responders and health care workers dealing with the pandemic. About 100 volunteers, all of them in the health care field themselves, staff the line 12 hours a day, seven days a week.

It’s unclear exactly how many calls the line has gotten since it started a month ago, but Susan Peixotto, a member of the supervisory team, said the calls can be intense.

“The people who do call are in deep distress,” she said.

Chastanet, the Tri-County consultant based at CMMC, knows exactly how anxiety-provoking it can be to work on the pandemic’s front lines. She works in a hospital where COVID-19 patients are treated. She shares an office that is so small that she can’t maintain the 6 feet of distance experts recommend. She constantly monitors where she is, what she’s doing, which precautions she needs to take to stay safe.

“The anxiety goes up in accordance with what we’re asked to see. Obviously, if we have to go to the ICU or in the ED (emergency department) where there’s potential for COVID, of course we’re taking bigger precautions,” she said.

Chastanet knows she’s not alone.

“It is anxiety provoking because we cannot see the virus. We don’t know where it is,” she said. “I think the anxiety comes from the unknown. The fear factor is one that each person has to navigate on their own. You may not think about it but then all of the sudden one day someone is overwhelmed.”

‘THIS TOO SHALL PASS’

As stress, anxiety and mental health problems grow, support has grown, too.

When it became clear the pandemic was going force them to limit face-to-face contact, mental health providers in Maine switched almost overnight to telemedicine, immediately moving appointments online, on video and through the phone.

“We got a presentation at the MaineCare Advisory Committee last week … on just the telehealth claims,” Shaughnessy said. “From an average of a thousand on a bi-weekly basis (before the pandemic), they project probably 90,000.”

Some patients have struggled with the technology or miss the in-person interaction with their therapist, but the virtual appointments have been a blessing to others, particularly those who have had trouble finding child care or transportation or those who have an easier time talking about their problems when they aren’t face-to-face. Providers say the change has overall been successful and they expect a number of people will choose to continue virtual visits even when in-person appointments are available again.

However, some worry there isn’t enough funding for mental health and substance use disorders as the pandemic continues and more people need that help.

“A wave is coming and we’re not prepared for it, kind of like we didn’t get really solidly prepared for coronavirus when it came,” said Shaughnessy. “Now we’re going to have a different wave of another sort.”

To help people who have needs now, health care providers have gotten more creative. Some case managers have dropped off pet food to clients whose animals keep them from spiraling into depression or have stopped by clients’ homes so they get to see a familiar face that day, even if it’s through the barrier of a window. Some hospital staff members have become surrogate family to patients who can’t have visitors or they’ve found ways to allow families to “visit.”

“We have somebody up in the ICU who is a quadriplegic and his wife was very distraught because she couldn’t come in. She was sleeping in her car in the parking lot,” Chastanet said. “What the nurses did was they would FaceTime with her and with him and they would actually roll the bed up to the window at certain times when he was off his tracheostomy and the wife would wave to him and he was able to wave back. That’s normally not something that is expected of an ICU nurse … but everybody is going the extra mile.”

For providers themselves, there’s the new confidential support line, which recently added a texting feature. There are formal support services offered by employers.

And then there’s the informal support of colleagues who know exactly what they’re going through.

“I talk to staff on a daily basis, some of which I don’t even immediately supervise anymore, who are just calling because they need someone to talk to. I’m hearing a lot of increased depression, increased ‘I don’t want to get out of bed in the morning.’ Like, ‘I haven’t showered all week long because I don’t feel like it.’ It’s constant,” said Pelletier at Tri-County. “It’s just been a lot of listening and helping them to see that this too shall pass. Hopefully.”

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