Take Note: Dr. Kelly Holder On Mental Health And Self-Care Amid The Pandemic

Sep 25, 2020

Kelly Holder, Director of the Office of Professional Mental Health at the Penn State College of Medicine and Hershey Medical Center

Kelly Holder is the Director of the Office of Professional Mental Health at the Penn State College of Medicine and Hershey Medical Center. She talked about mental health challenges and what people can do to to keep their minds active and positive during the COVID-19 pandemic. 

TRANSCRIPT:

Andy Grant: Welcome to Take Note on WPSU, I'm Andy Grant. As the Coronavirus pandemic drags on, mental health has become more of a concern for many Americans. The pandemic has disrupted summer plans and made normal activities difficult or even impossible. And this trend is likely to continue into the fall and winter months. So, what can we do to try to regain some semblance of normalcy? And what effect might these continued disruptions have on normal plans? Kelly Holder is the Director of the Office of Professional Mental Health at the Penn State College of Medicine and Hershey Medical Center. I spoke to Kelly from my home studio. Kelly Holder, thank you so much for joining us.

Kelly Holder: I'm glad to have this conversation with you today.

Andy Grant: So first off, how have you been these past couple months, it's been a few months since we spoke, how have you been?

Kelly Holder: It's, it's been a challenging time, I have so much to be grateful for. And so that's where I tried to put my focus on the things I can be grateful for. And there's been a lot of challenges a lot of uncertainty. And so I'm facing all the things everyone else is facing.

Andy Grant: Is that important? Trying to, you know, look at the positive, look at the things you're grateful for, and not focus on the sort of disruptive and negative effects this pandemic has had on our lives?

Kelly Holder: I find it very useful to refocus and focus on gratitude. The problems present themselves, we, we cannot look away from the problems and so being able to see the problems, but at the very same time notice what gifts, or some people call it silver linings, or just things that make me happy or bring me joy at the same time of my suffering. I think it really goes a long way. And it makes the days much more tolerable. And it aids us in recognizing what's truly important.

Andy Grant: You know, it's funny, you mentioned silver linings, I think sometimes people can feel a little guilty trying to pull positives or silver linings out of this terrible situation. But is it important for us to do that, to realize that, you know, in the middle of all the bad things that are happening right now, in our country and around the world, it's okay to realize that there are some silver linings, there are some positives that we can take away in our in our own lives?

Kelly Holder: I think it is important. While grieving and having sadness is a human experience, and we will experience it and it's okay to experience those things, I think being able to be grateful and look at the good helps us tolerate the negative much more it makes us fully appreciative of the breath that entails our lives, which holds both extremely negative and sad things, but also some really good things and some things that are positive.

Andy Grant: So what are, what are some silver linings that you've, you've noticed or taken away during this pandemic?

Kelly Holder: Well, I think-- I am a mom, I have three kids, and I'm working from home and all three of them are home with me. And this schooling during the pandemic is something else. And so while it's something that brings me stress, I also like to think about lunchtime. And typically I can take lunch with my kids, this was not something I was doing pre-pandemic, the fact that we could play a board game during lunch. Or I could say I want to take a break, and if I schedule it properly, we can all go outside and take a walk together. It's a very simple thing and really a very small piece of the day, but it helps me find some appreciation in all the other difficulties that have come with being home with three kids.

Andy Grant: Yeah, that extra family bonding time. Definitely nice for all of us to have, I think. So let's talk a little bit about how the pandemic has affected mental health services in this country. Are we seeing mental health services being accessed in greater numbers since the pandemic first hit in February and March? Are we seeing people needing and accessing those services on a larger basis than they were before the pandemic?

Kelly Holder: Yeah, I believe that there is an increase usage. Anecdotally, all my therapist friends, people I spend time with who own their own private practices, my colleagues who work within the medical center and do psychological services, they have continued to work and have a-- seems like an increase in the work that they have. So from my perspective, it looks like people are making use of these services. We do know the CDC has said that in June 40% of Americans are reporting some sort of mental health concerns whether it's depression, anxiety, substance use, and that is an increase from before. I think initially every one was in emergency panic mode. But now people are starting to think: I don't know how long this is going to go on. And I don't know how long the changes are going to impact me. And so there is this need for saying, I need to find sustainable ways to care for myself and care for my family. And oftentimes, therapy and use of mental health services is one of those things.

Andy Grant: Do you think this is a trend that will continue, you know, as this pandemic continues to drag out and continues to, you know, affect us and affect our country? Do you think that the amount of Americans that are accessing and in need of mental health services will continue to rise?

Kelly Holder: I think so. Prior to the pandemic, I used to tell people, when I would come into a room to give a talk, and I give all these mental health and wellness talks, I could almost feel people's eyes rolling in the room like, "Here we go again, here's mental health," right? And post-pandemic, I've had less of those experiences, it seems like people are so much more open to talk about their mental health, so much more open to saying, "Hey, there is something going on, and I want to find a way, what are the resources? How can I do this?" And I think just the decrease in stigma, and the increase in open dialog will encourage people to continue on this trend of taking care of themselves in this way.

Andy Grant: Is this simply a matter of more people seeking mental health help? Or are you actually seeing new issues emerge? Or have you seen issues that were maybe put a, you know, a smaller need in mental health services now becoming more prominent, so is it simply a matter of increased need for mental health services? Or is it really a change in the kind of services that people are requiring?

Kelly Holder: From my vantage point, I believe the pandemic has exacerbated problems that have already existed. So my guess is that there are some new cases and new issues that have emerged for some people. But overall, I see people who have anxiety and since the pandemic, it's much more challenging to use their own self help tools, or other activities to manage it, that they need more help than they've needed before. And I'm finding that with everything across the board, it seems like whatever was happening before the pandemic, and then the things that have happened during it had just exacerbated our underlying mental health concerns or issues that we've had all along.

Andy Grant: How are mental health professionals dealing with this? I mean, is there a risk of burnout from their end that there seems such an increased need for their services?

Kelly Holder: Yeah, I believe that this is a concern, it is a concern, because there's a lot more work to do. And so mental health professionals, just like everyone else are people. So I think about myself, and I have to increase my self help tools, I have to increase the buffers in my life, I have to be more intentional around my self-care, or I just will not be able to do the work that I do. And so it's really something we have to pay careful attention to, especially since aspects of our lives that allow us to care for ourselves have been removed.

Andy Grant: You know, we've heard in this pandemic about hospitals being overrun, you know, not being able to provide the services they needed, too many patients to be able to handle-- is that kind of a thing, a concern for the mental health systems in this country, that they too might become overburdened or overwhelmed at some point?

Kelly Holder: You know, that's not something I've thought a whole lot about, I think there's a potential just like with anything else. If there's not enough providers, then services could become overrun. I think different areas of the country have a different need, depending on the number of mental health providers and professionals within an area. So it is a potential problem, just like with anything else, I believe.

Andy Grant: Now, one of the big issues people seem to have these days is time, specifically either too much time or not enough time. For people like me with no children, you know, I have all this time on my hands. And it can be a challenge sometimes to, you know, fill your day and keep your mind active. Is that a problem for people? You know, all this time, boredom, things like that? I mean, is that something that people, you know, should be concerned about?

Kelly Holder: So the way I like to think about it is, there was a talk given on NPR and I wish I could remember-- I believe it was the director of NIMH who gave this talk and was saying that most people cope in one of two ways: we have our passive copers and our active copers. And those who are actively coping with things tend to make, make use of their time, they look at their day and they say, "Well, what can I do to engage? What can I do to plan." And so that's for both the people who have more time or people who have less time, they really are active in caring for their lives and kind of sparsing out that time. The challenge comes with those who are passive, passive copers in the sense like, "Well, whatever happens is what happens." And so from my perspective, moving people into being more active about what does your day look like? And how can you best have a day that makes sense? If you have a lot more time, then how do you create meaning around it? I think in many ways, boredom can be good for us, because it allows us to be creative. It allows us to think deeply about things. And so what do you want to be creative around? What do you want to think deeply around? Is there a problem that you can solve that you are in the position now to do then you weren't before? And those who don't have as much time, really getting mindful about how you're spending your time, maybe even keeping a time log in trying to figure out where is my time going? And how can I squeeze in, or make sure I get that time to take care of myself? Because of the pandemic, we have to make sure our lives are sustainable. And we have to put effort into that.

Andy Grant: What are some strategies people can use, specifically those, those of us who have a lot of time on our hands, maybe don't have, you know, kids or family members to take care of, you know, what are some strategies people can use to, to as you said, bring meaning and bring value to that that downtime and maybe avoid, you know, boredom?

Kelly Holder: Yeah, I would suggest-- I'm big on journaling. So I would say get out your journal and start to write down, write down the things you enjoy, right? Outside of the mindless kinds of-- mindless scrolling on social media, the mindless flicking of channels or bingeing. Outside of those things, what do you really enjoy? What brings you joy? Is there someone that you can serve? It could even be, you know, maybe you, you enjoy cooking, and you could share a part of your meal with a neighbor, who might not have enough time to cook, thinking of creative ways or ways to be outside of the box that allow you to engage with others and bring meaning to your own life. And that's going to be different for everyone. And so I would say, get out your journal and start to write, what do I enjoy? What gives me value? What are the things that I would like people to remember about me? And then start trying to enact them. And a lot of those things could be free things that you could do so, so thats how I'd encourage someone to start.

Andy Grant: Right. Can I just be more constructive with our time rather than just thinking about this time as just time to kill, you know, just trying to find ways to fill it with interesting meaningful activities and ideas.

Kelly Holder: Yeah.

Andy Grant: Yeah. Well, what about-- you talked about this a little bit, but what about the opposite side of that coin? Right, the people that do have kids or elderly family members, maybe that their caretakers for, you know, for people in that situation it seems like the opposite is the problem. Maybe, you know, not enough time for themselves, not enough time to sort of decompress. You know, what, what sort of concerns or issues do people, caretakers in that situation need to be aware of?

Kelly Holder: Yeah, you know, you mentioned it before about burnout. And I think burnout can be a major thing. Burnout chronically over time can lead to all sorts of mental health concerns: depression, anxiety, substance use. So it's really important to notice, how is the work that you're doing wearing away at your ability to care for yourself and function at your at your best levels? When you notice that, the first thing I would suggest is to reach out and ask for help. And that might mean seeking mental health support so you can have somebody who can talk you through how to better solve your problems. Maybe it might mean asking someone to share some of the burden. And I would also encourage people that if the first time you ask for support for someone, it doesn't work out, don't say, "See, nobody can help me." Figure out maybe there's someone else who can help you. Try to be creative and how you think about sharing support and time. Maybe there's someone in a similar position where you could take turns doing different things. And then making sure you're connected, well-connected with people where you can talk openly and honestly about what you're facing. And hopefully that person can give you some emotional support. And because they know you, they'll be able to kind of point out different ways in which you could increase your own self-care practices. And sometimes it's just good to have a place to vent. Hopefully that venting can move towards change and action, venting of itself can turn negative if there's no positive direction at the end, but being able to have a place to connect, and then also knowing you're not alone, for me, all this working at home, parenting, homeschooling, I like to remind myself, I am not the only one doing this. People across the nation are doing this. People across the world are doing this. And when I remind myself I'm not alone, it takes a little bit of the edge off. It doesn't just feel like a daunting task, like, "Oh, why, why me?" It's "why us?" We all are facing this. And so we just have to do the best we can with what we have.

Andy Grant: Yeah, that's a good point, remembering that we're all going through this can kind of help that sort of, you know, collective burden that we're all bearing can help to sort of maybe lessen it a little bit to know that we're all in this situation together.

Kelly Holder: Yeah.

Andy Grant: Well, if you're just joining us, this is Take Note on WPSU, I'm Andy Grant. We're talking with Kelly Holder, Director of the Office for Professional Mental Health at the Penn State College of Medicine and Hershey Medical Center. Kelly, this summer was a little weird, right? Strange summer. How was your summer? Was it a little disrupted? Did you have plans that you had to cancel or modify because of the pandemic?

Kelly Holder: This summer was the most unusual summer. I had to keep reminding myself that it was summer because we didn't do any of the things we normally do, not a one. So it was completely unusual for me.

Andy Grant: Yeah, I think that was a common experience. In a way it almost feels like these last couple months were even more disruptive than the first couple months of the pandemic. You know, at the beginning, we were all sort of scrambling and reacting to the situation. And it was really kind of like day-to-day, one day at a time. Yeah, over the summer, you know, plans that were maybe in place for a long time were disrupted, family vacations, you know, no summer music festivals, obviously. Do you think in a way that's one of the reasons we saw the rise you talked about earlier in mental health, people accessing mental health services was because of just how disruptive this summer was? And in a way it was even much more disruptive than the massive disruption at the start of this pandemic.

Kelly Holder: Yeah, I think that could be part of it. I mean, oftentimes, especially as a parent of small children, summer is a time that we look forward to all sorts of things, it's the break from the usual and even for those of us who work during the summer, we look forward to having these events and these times away. At the same time, we also had something, you know, really happen, our country was disrupted by racism, the police shootings, the death of Black lives, and that impacted our summer greatly as well. And so that also colored the way in which we approach the summer and approached everything, too.

Andy Grant: No that's true. This summer was disrupted and different than most summers in many ways. The political issues, the social issues we're all dealing with as well as the pandemic and, you know, all those things happening together just seem to exacerbate the disruptive nature that any one of those events might have had.

Kelly Holder: Yes.

Andy Grant: And do you see that trend continuing? Now we're getting into the fall, people are returning to school, whether it's, you know, grade school, high school, colleges, but they're obviously going to be very, very different. In some cases, they're all online, you know, fall sports, football season in particular, which is huge in this country has been, you know, canceled or greatly modified, depending on what part of the country you live in. And, you know, before, you know it we'll be in the winter, and it'll be the holiday season. You know, how can people sort of deal with these coming and these mounting, you know, disruptions? How can they-- are there ways that they can sort of prepare themselves for the disruptions that we know are going to continue through the fall? And then the new disruptions that are coming in the winter?

Kelly Holder: Yeah, I would, I would say that these disruptions are losses. And so in many ways, we're grieving. We're grieving that schools not the same, loss of sports, knowing that the holidays are not going to be what we might have imagined that they were going to be-- what they were last year at this time. And so because we are grieving, I would encourage around creating rituals that aid us with grieving. We know that based on grief work, individuals who have a ritual around a loss tend to do better than those who don't. And so because we're grieving football season and the school and all these changes and the holidays, maybe this is now what time to say, "Here, this is going to be our pandemic celebration," like we don't have our sports. But maybe I can go and enjoy playing a game or something outdoors with one or two friends as we celebrate, well, or, acknowledge the change of this season. And we share that together. Holidays, travels not going to be the same, we're not going to get together with as much family as you may or may not have before. And so you may need to come up with a tradition just for this year, something to symbolize how different this is, and to honor what we all are experiencing. It won't take away from the loss, but it will aid us in being more resilient in the face of all these losses.

Andy Grant: Now, that's interesting. I'd never thought about that, thinking about these things, you know, they feel like a loss, obviously. But in a way, it seems kind of silly to say, "Oh, I'm grieving football season" or "I'm grieving the loss of holiday plans." But, you know, that's an interesting way to think about it and finding those rituals could help to sort of-- help with those losses and build new, as you said, new celebrations for us all to, to have, instead of the ones that we normally have planned at this time of year. That's interesting. Now, do these disruptions have a cumulative effect? You know, first, it was like spring breaks early on were thrown into chaos or cancelled. And then it was summer plans and vacations, as we talked about, and now football and next the holiday. You know, will each of these things become like increasingly difficult for people to deal with as these normal parts of our lives are continually disrupted? You know, is each one sort of dealt with individually, or are there cumulative mounting effects as each one of these new disruptions are sort of introduced into our lives?

Kelly Holder: I think it's challenging to separate them. And I believe the losses will be cumulative, because we don't live our lives in isolation, right? Anything that impacts us, continues to impact us. And so it's-- it makes it even more important for us to engage in healthy self-care practices as we move throughout this process. The longer this goes on, the more challenging it's going to be on our mental health and, you know, other various aspects of our lives. So taking the time to really consider what's happening, and to face it and to deal with it as healthfully as we can is really important. I think improving our perspective is very helpful. And that's not just painting rainbows and unicorns and that kind of thing, but really understanding that we're in a situation that's beyond any one person's control. And while none of us have chosen this, we are all in it. And while we are in it, how can we exist at the best level possible? And so sometimes that's acknowledging our pain, and other times that's acknowledging our joy. Other times that means being in therapy and really talking deeply about the issues that have come up for us. Other times that is enjoying time with friends and making sure we stay connected, even if it's just virtually. So figuring that out for yourself is really important. And for each person, there's going to be a different kind of nuance. It's not going to be exactly the same for all of us. So I would encourage people just to dig in and do the work necessary to make your life as best it can be in the presence of what is.

Andy Grant: You know, is that kind of thing going to become even more difficult as we get into the winter and the weather changes? You know, in the summer I think about, you know, a lot of people found, you know, solis in outdoor activities. I don't know about you, but here in State College it is pretty much impossible to find a bike in any store in town, you know, biking has become the new hot trendy activity to do because people can go outside and do it, they can stay healthy, they can do it sort of isolated, or in small groups. I think, you know, those rituals and those activities you're talking about-- people have done a pretty good job, or at least tried in the summer to find new things to, you know, have those rituals of grieving or to fill the the empty time that we had talked about. Is that going to become more difficult in the winter? I mean are we facing potentially an even more, you know, from a mental health perspective, an even more difficult time as we get into the later fall and winter and a lot of those sort of outdoor activities are going to become, you know, less possible or impossible?

Kelly Holder: Yeah, the winter presents new challenges just because daylight is shorter. We know that Seasonal Affective Disorder is a thing. So getting less sunlight does impact our mood and our ability to function, and more significantly for some. So it's going to be really important that people really start to think outside the box. As a person who does not like the cold, and I really, yeah, I don't like the cold at all. I'm already, in my mind, thinking about-- alright, I need to make sure I have a little fireplace (it's like one of those gas fireplaces). I'm gonna make sure I have enough gas, because maybe I'm just going to enjoy time in front of my fireplace, and that means maybe I need to get new books to read. And maybe I'm going to need to stock up on candles, because those are the indoor things that bring me joy. And so for each of us, we're really going to have to say, "Alright, if I can't be outside for long periods of time, what can I do to bring myself joy and enjoyment inside the house?" For other people, it's gonna be different. There are people who really like the cold. So you just get out there and bundle up and sled down a hill or something, you know? So we're just gonna have to get really creative. We can't give up. That's the point. We cannot give up. We have to keep trying to figure out how to best take care of ourselves during this time.

Andy Grant: You know, Kelly, it's funny, we've been kind of talking about this in almost short-term chunks, you know, almost seasonally. And it seems like that's kind of how it started, right? Like, get through the spring, and then the warmer weather of the summer, you know, might make things a little better. And now it's kind of like, "Oh we'll get through the summer, and hopefully by the end of the year or early into the next year maybe we'll have a vaccine of some kind." You know, do we need to adjust our thinking to be a little bit more long-term? You know, do we run the risk of sort of like getting to the end of the short-term chunks and being disappointed that things aren't better like we hoped? Do we need to adjust the way that we look and think about this pandemic in that regard?

Kelly Holder: I think it is really important for us to have a healthier perspective of what's happening, instead of trying to get our hopes up about, well, what will happen in two months or three months. Being able to believe that we'll be able to meet whatever challenge lies ahead when we get there. And so having that kind of perspective of being able to say, "You know, everything is so uncertain. I have to focus in on the present as much as possible, yet at the same time having enough hope to believe that I'll have the tools, the support, or even know the right people to ask for help for when I get to the next stage." Because the truth is, is things are changing so much. We have no clue what's going to happen next. And I think that's scary for a lot of us, all the uncertainty. But being able to know that we have the tools that can help us meet the challenge when we arrive at the challenge I think is really helpful and it can aid us in improving our own sanity.

Andy Grant: Well, Kelly, I can't believe it. I feel like we just scratched the surface, but we're already out of time for this episode, so thank you so much for for talking with us today.

Kelly Holder: Yeah, you're welcome. Glad to have been here.

Andy Grant: I've been talking with Kelly Holder, Director of the Office for Professional Mental Health at the Penn State College of Medicine and Hershey Medical Center. We've been discussing the importance of mental health in the pandemic and how people can keep their minds active and positive during such a disruptive time. To hear this and other episodes of Take Note, go to wpsu.org/takenote. I'm Andy Grant, WPSU.