The COVID-19 pandemic has brought mental health issues into the limelight.
But as more people have been willing to acknowledge their struggles, mental health service delivery has become a major challenge.
Dr. Robert Shulman, director of clinical services and acting chair in Rush University Medical College’s Department of Psychiatry and Behavioral Sciences, said he has seen an “enormous demand” for services since the start of the pandemic.
“I think our ER is busier than ever with people presenting with behavioral health issues,” Shulman said.
The delivery of mental health services has also become one major issue in the Chicago mayoral campaign. Several challengers to Mayor Lori Lightfoot have criticized her decision not to reopen mental health clinics closed by her predecessor, Mayor Rahm Emanuel.
As a mayoral candidate in 2019, Lightfoot promised to reopen clinics but now prefers an approach that uses a network of nonprofits to help deliver care.
Shulman said he has noticed an increasing number of children presenting to the emergency room exhibiting self-harm behavior and substance use.
“When we talk to community providers, especially those who work with children and adolescents in the community — therapists, psychologists, social workers — they’ve all said over the past couple of years that their practices are jam-packed,” Shulman said. “They can’t keep up with the phone calls; they can’t keep up with the demand.
Even before the pandemic, Shulman noted that referrals for teens were on the rise due to the impact of social media and the pressures it puts on children and teens, in particular.
“We’ve seen an increase in suicidal ideation and self-harm behavior,” Shulman said.
While data is not yet available, Shulman believes we will see a continued impact of the pandemic on childhood development.
“My personal feeling is that as these kids reach their teens, we’re going to see a lot more anxiety and panic disorders,” Shulman said. “We’ll probably see more things like types of OCD, picking disorders, germ phobias, and so on. Right now, we are seeing delays in maturation and learning.
At NAMI Chicago (NAMI stands for National Alliance on Mental Illness), CEO Alexa James said calls to the organization’s Chicago helpline have increased more than 200% during the pandemic.
“In the midst of COVID we were 311 for the city,” James said.
He stressed the need for equitable access and “for people to be able to consume mental health services in a way that feels good for them.”
NAMI Chicago’s mission is to “engage, educate, empower and equip” people with the tools they need to live in recovery, but what that looks like in practice depends on an individual’s needs.
Some people may need therapy, some crisis intervention and others just need someone to talk to, James said.
“We have a very sophisticated platform and we certainly have a hiring structure, but our hiring is a narrative form, so we really let people lead the conversation,” James said.
One thing she’s thankful for is that the pandemic seems to have moved the conversation around mental health issues forward.
“I am grateful and hopeful that this is the case, thank God!” said James. “Because we are in the biggest mental health crisis, hopefully, that we have ever seen. The conversation has changed because more people are identifying symptoms of mental health issues, and we know the primary way to diminish and remove barriers and stigma is to come out and talk about it.
Part of advancing the conversation might just be changing how we talk about it.
Shulman said he prefers not to talk about “mental health” but rather about “hardship” and “well-being.”
“As a society,” Shulman said, “we’ve lost sight of how to maintain well-being.”
And in relation to the impact of the pandemic, Shulman said that rather than talking about “anxiety,” he prefers to frame the issue as “trauma.”
“You can talk about trauma without introducing the whole mental health stigma,” Shulman said. “We’re talking about community, so I think if we were to take a social approach to what’s happened to us and put that into context,[the pandemic]has been traumatic for everyone and people experience trauma and respond to trauma in different ways.”
According to Shulman, meeting the growing demand for services requires thinking differently about how we deliver that care.
“We actually need to innovate a little bit and change our models of care so that we can reach a larger population,” James said. “The place for these things can be almost anything. …We can actually provide assistance in churches, libraries, barbershops and beauty salons if structured in a certain way. So, we can address the community, and we can address any community…and actually set up different ways of treating than we do today.”
To reach the NAMI Chicago Helpline: 833-NAMI-CHI (626-4244)
To reach the National Suicide & Crisis Lifeline: 988