Take Note: Penn State Prof. Erika Saunders On Mental Health Effects Of The COVID-19 Pandemic

May 8, 2020

Erika Saunders is the chair of psychiatry and behavioral health at the Penn State College of Medicine and Penn State Health.
Credit Erika Saunders

The coronavirus pandemic has brought sharp awareness to physical wellbeing, shelter-in-place orders and social distancing practices aim to keep our bodies safe and healthy.

But what about our minds? What effects might longterm shelter orders and social distancing have on our mental health?

We talked about this with Erika Saunders, the chair of psychiatry and behavioral health at the Penn State College of Medicine and Penn State Health.

TRANSCRIPTION:

Andy Grant:

Welcome to Take Note on WPSU. I'm Andy Grant. The coronavirus pandemic has brought sharp awareness to physical wellbeing, shelter-in-place orders and social distancing practices aim to keep our bodies safe and healthy. But what about our minds? What effects might longterm shelter orders and social distancing have on our mental health? Erika Saunders is the chair of psychiatry and behavioral health at the Penn State College of Medicine and Penn State Health. I spoke to Erika from my home studio. Erika Saunders, thank you so much for joining us.

Erika Saunders:

Thank you so much for having me, Andy.

Andy Grant:

So COVID-19 the novel coronavirus is really a fairly unprecedented situation. The entire country now and much of the world are practicing social distancing measures. Most of the U.S. Is under some sort of lockdown or shelter-in-place order. You know, these social distancing and lockdown measures are obviously designed to keep us safe and slow the spread of the virus. But could they have potential mental health consequences for us?

Erika Saunders:

Absolutely. I would say almost everyone in our society has had their life disrupted because of the COVID-19 situation and the orders to shelter at home. Certainly here in Pennsylvania. We know that the entire state has been affected. And so I think we see two, two types of effects which are really rather starkly different. For all of us who are sheltering at home, that's limited our ability to go out, limited our social contacts, limited the way that we usually do things and the activities that we engage with. Which is very significant. The other effect is additionally compounded for our frontline workers. Our healthcare workers, our workers who are continuing to do their, do their jobs in either the same way or different ways, but in a different environment. And for those workers, they're experiencing something completely different than those who are sheltering at home and not going out. They're experiencing a higher amount of stress at work depending on the work setting. They may be interacting directly with patients who have COVID in their families which can be highly stressful. So it's been disruptive for everyone and in different ways.

Andy Grant:

That's a really interesting point, you know, that people are going to be effected by this virus in the situation around it in quite different ways. I mean, how, how do we try to make sure we are being cognizant of our mental health and taking care of our minds as well as our bodies during this time.

Erika Saunders:

So there are a number of things that we need to do. And the principles really that we use in behavioral health and mental health. We go back to the hierarchy of needs. And you know a fundamental level we all need to make sure that we have our basic needs met, food, shelter, water, and then social connection. And in times of extreme stress and in times of disaster, those basic needs can get disrupted. So I think the first thing is for people to remember that eating, sleeping, interacting with others in a social, stress relieving type of way are important fundamental needs. That if you aren't able to get those needs met, you can't be at your best and you can't be there for others. Now, in the case of someone like a frontline healthcare worker healthcare workers have, have always to some extent at times needed to disrupt those basic needs to care for others. But having time to recover rejuvenate and keep themselves healthy from that perspective is extremely, extremely important. The other type of disruption we're seeing is an economic one and many people don't have access to the types of resources that they had pre-COVID. So making sure that food, shelter, utilities, those types of needs are are met can be extremely challenging for people who no longer have a source of income. And that is we know greatly affecting our society right now as well.

Andy Grant:

A lot to unpack with that. But I'd like to focus on the frontline workers first. And you know, there's obviously been sort of an outpouring we've seen online on social media, all kinds of support for them. You know, people cheering and clapping and singing them songs, you know, sending them well wishes. But you know, I'm sure that helps. But again, based on some of the stories we're hearing in ERs, it's particularly in some of the hotspots around the country and how devastating it is and how difficult it is and just the amount of patients that they're having to deal with. I mean, how do they make sure that they are, as you said, getting that, that rest, that social interaction, that rejuvenation? I mean are frontline workers getting that and what, what could be, you know, the cost if not?

Erika Saunders:

In terms of the question of are are they able to meet those, those needs, of course it depends on the situation. Depends on where you are in the country. And New York is different from other places, you know, for example, in terms of the impact of the pandemic on the specific community. So, so there's a lot of variety. So I would say that, you know, in certain places, yes. In certain places, no. Now people who are in the healthcare field often go into that field because of the strong dedication they feel to caring for patients and caring for ill patients. That's what they do. That's the source of professional pride and the source of deep gratification for working in the field for so many healthcare workers. And that's really important and it's really important in times of stress that healthcare workers be able to feel comfortable drawing on that for themselves because that helps them do the work that they need to doIt has to be balanced with having time to rest and rejuvenate. But the other piece of that is having a strong and supportive team in healthcare. And so I know many healthcare settings are providing extra support to the frontline workers, particularly the workers of, of COVID units, the ED staff, by providing extra psychological, mental health support stress reduction support, providing extra stress reduction classes, for example. Making, making these types of supports easier for healthcare workers to access. I know many, many places are doing that. We're doing that at Penn State. So that is one, one thing that the system, healthcare systems, hospitals, clinics can do to really support healthcare workers in this time.

Andy Grant:

Let's talk about some of the rest of us as well. What kinds of, for those of us who are dealing with the, you know, the shelter orders and just the sort of fear and anxiety around this virus, you know, what are some of the issues or the problems that you're seeing people struggling with right now?

Erika Saunders:

So I think the the biggest issues that we're seeing are the effect of social isolation on people. And then the lack of access to usual resources. From the social isolation perspective it's really a matter of um...to some extent it's a matter of disruption of routine. So we all have our normal daily activities. We have our normal routines. We go out and see people. And a lot of what we do on a day to day basis, we don't think... If you're not, if you're not a psychologist or a psychiatrist or in mental health, you know, you don't think of it as, you know, "I'm going out and I am seeing someone for a social interaction." It's just what you do. So what happens in this type of situation is that those things that you do naturally, normally that are so beneficial, but you don't even necessarily realize how beneficial they are -- are disrupted.

Andy Grant:

Is that one of the difficult parts that, like you said, it's almost unconscious that we don't even realize how important those things are to us until they're gone? I mean, is that one of the things that makes this so difficult for people to deal with?

Erika Saunders:

Absolutely. Absolutely. So I think what we have to do to overcome that is be a lot more conscious and mindful and plan interactions. Where in the past we didn't have to do that. And I think it was actually even easier in the first couple of weeks of this because in the first couple of weeks we were all grasping with, you know, what has happened to our world and, and reaching out. And I heard a lot of stories of, of people hearing from other people that they hadn't heard from in a long time and you know, that type of thing. But as it's gone on and we all get a bit more used to the sheltering in place orders, staying at home, I think we have to be even more mindful to deliberately reach out, keep connections in whatever way we can. There are many ways to do this through social media platforms, through email, through video, chatting, through mail, through the telephone. But I think it's also important to realize how vital it is to have connection either through visual or through voice with other people. That is a fundamental component of, of getting that connection.

Andy Grant:

I think it's interesting you said we have to be a little bit more mindful and sort of plan some of these interactions out. And, you know, that kinda makes me realize that sort of spontaneous social interaction is almost totally gone these days. You know, bumping into someone in the office, walking around downtown, at a restaurant, you know, what is lost there? That sort of just daily spontaneous social interaction you might have. I mean, is there really a way to replace that or make up for the loss of that kind of interaction?

Erika Saunders:

That I think is very, very...that's very tough because everything does necessarily need to be planned to some extent. Now we can still walk around. We can still wave at neighbors from far away, but so much more of what we do has to be planned. So I think it helps to look for the little joys in life throughout the day that you may not have noticed before, but also to keep those types of interactions in your life is important. And for, for those of us who, who, you know, care for others to reach out to them perhaps more than we would if we're not physically in the same place.

Andy Grant:

You know, one of the other things you mentioned too is that this gets harder as we go along. And I'm curious, is there a cumulative effect to this, you know, will these issues, things we're struggling with without the social interaction, will that be compounded the longer this this goes on? Will that get more difficult with a loss of those interactions, sort of be more apparent to us the longer we are sheltering, the longer we don't have interactions with one another?

Erika Saunders:

Yes. I'm afraid that it will. To some extent we'll all develop some more creativity. And we've seen a lot of this all ready through different means of interaction, different you see the television programs doing this, right? So the nightly variety shows have you know, gone to an online format. So many of the other programs have done this. So there is creativity and people are figuring out different ways to do it. But I think there will be a longer term cumulative effect in terms of social impact that is felt. And in situations like this where it's a a sort of fundamental societal change, that's what we've seen in past. Is that the effects that we see on mental health don't necessarily start immediately, have sort of a delayed start. But then do build up over time. So as a field, we're talking a lot in mental health about how we can structure our services so that we can support people looking out into the future and what the needs are going to be.

Andy Grant:

If you're just joining us, this is Take Note on WPSU. I'm Andy Grant. We're talking with Erika Saunders, chair of psychiatry and behavioral health at the Penn State College of Medicine and Penn State Health. Erika, I want to follow up on something you just said. And I'm curious, do you think we're going to see different short term and longterm effects of this? And are those going to be different? So as this drags out from weeks into months, potentially years until there's, you know, an effective vaccine you know, how are we going to see the effects of what we're all living with and dealing with change and evolve over that time as we go from the short term to the long term?

Erika Saunders:

Absolutely. Complicated question, but I think we can think about it in a couple of ways. So there's, there's the short term effects and the longterm effects. And then there are the direct effects and the indirect effects. In the short term, how do we cope with social isolation until things change in the need to continue to to stay at home? So, you know, eventually what we're hearing is that there will be changes in what we're able to do, but that there will be a longterm change as well. And a lot of that's just uncertain now. So a lot of what we're dealing with right now and in the past six weeks has been uncertainty. There's the effect of what I'm going through now and the effect of I don't know what it's going to be like and I can't plan for the future. And so I think that's a big part of it as as well, in terms of those those effects on individuals for people who have loved ones who've been affected by COVID-19, affected by the illness, there's of course an additional layer of difficulty that they've had. Because oftentimes people who have a loved one affected by COVID-19, they can't be in the same place with them physically to help them. And then of course, if they're in the hospital, they may not be able to visit with them physically. Many hospitals are setting up virtual ways to visit and that's useful. So the direct effect of the illness is felt by those families and those ones who have loved ones who are ill and the societal changes both short and longterm. And the uncertainty around that affects us all.

Andy Grant:

You know, we've been talking a little about longterm effects and societal changes that you just brought up. And you know, one of the ways I've heard this pandemic referred to is as a train wreck in slow motion. And what I took that to mean was that the effects were devastating, but that the crisis itself unfolds over a long period of time. You know, how does this crisis, this coronavirus pandemic compared to some other national traumas we've suffered, something maybe that has a more immediate, you know, singular event around it, like say 9/11 or some of the natural disasters we've experienced. You know, how as a country do these affect us differently and how do we process this event compared to some of those other sort of, you know, more impactful, very immediate devastating events versus something like this that tends to unfold over a much longer period of time?

Erika Saunders:

That's a great question. So we want to think about one-time versus ongoing stress. So if you have an event that's a onetime, all at once disaster or a tragedy -- like 9/11, Hurricane Katrina -- in the immediate aftermath, those who are directly affected have what we call an acute stress reaction that is related to the biological stress and the psychological stress of, of going through the event. And that has various physical and psychological symptoms and ramifications that stress reaction can develop into what we call post traumatic stress disorder or PTSD. That can last for years and be an ongoing reaction to have lived through something like 9/11, Hurricane Katrina.

Andy Grant:

Can that affect people that weren't necessarily directly affected. So even if, you know, I didn't lose a loved one during 9/11, or even if someone I know or I personally don't contract coronavirus, just because of the stress associated with these events, can, can people who aren't necessarily directly affected by it still have some of these, these mental health concerns?

Erika Saunders:

So absolutely. You can people who are not directly affected but indirectly affected because of being in society and, and having indirect ramifications. Absolutely. That causes a different kind of stress and a different kind of anxiety and mental health consequences from from that. It can, doesn't always. So that's an indirect effect that we see. And that's generally much more widely spread. So, so we all felt the tragedy of 9/11. If we, if we didn't have someone directly affected and we weren't in New York City we all as Americans were affected to some extent. However, in this type of situation we have, as you said, an ongoing, an ongoing crisis. And that ongoing crisis has multiple parts to it. We've talked about a lot about the social implications and then there's going to be the ongoing economic implications for our country. So that creates a different type of stress and anxiety and mental health consequences, which is really, I think essentially any type of stress of the types that we've been talking about worsens all mental health problems. So I think we see a much more varied reaction depending on the individuals' circumstances or the family circumstances. But as mental health professionals and as a society, I think we need to prepare for how to best support our communities in these next weeks, months, years. Because we know that these effects will be there.

Andy Grant:

Right. And one of the things we often hear after any of these tragedies or crises, and this one is no different, is the idea of sort of getting back to normal or returning to normalcy. And inevitably the normal after one of these events is different than it was before. But again, this, the coronavirus seems to be a little different in that that return to normal might be more protracted and the normal we go back to might be starkly different from the normal we left before this all began. I mean, how do Americans, how do we as a country start to prepare for that idea that the return to normal or the new normal might be significantly different than it was two, three months ago?

Erika Saunders:

I think the important thing to remember about returning to normal is that it will be different. It will be a new normal. And in that new normal, there are opportunities for creativity, for change in a good way. And so and this gets to the idea of resiliency. Picking up from, you know, our last topic, we were talking about the stressful effects of disasters and crises. And, and humans are also very much biologically and evolutionarily built to be resilient and grow from and find good solutions to problems when they occur in crisis. So at the same time that we have stress and anxiety, there will be plenty of opportunities for creativity, growth, new developments, new changes at the individual and societal level. So I think as best we can focus on how to do that as a community and how to support the areas where that's more difficult and how to support others in our community who who, who are struggling. Because in some, in some areas it's going to be much, much easier than in others. That will, I think as a, as a society help us move toward whatever is next. But I think the key point is that it's not going to be back to what it was in many situations.

Andy Grant:

Right, the normal is truly going to be a new normal after all of this. And what role might mental health professionals and mental health services play in helping Americans adjust and adapt to this new normal?

Erika Saunders:

We become concerned about mental health when people have difficulty functioning, difficulty doing the things that they need to do because of things like, feelings of despair, hopelessness, feelings of depression, feeling down, feelings of worry, anxiety, just to name a few. Often these feelings, these changes cause significant problems with sleeping, eating, changing... Changes in activity levels. And that's when we get worried about someone's mental health. We have a lot of different ways in the field of mental health to provide treatments support, counseling, lots of different types of counseling. We have different medications that are sometimes helpful if there's a an illness as well. So there's a lot of different ways to interact with the mental health system and there's a lot of different types of help that, that can be provided. In the beginning of March the restrictions on what's called telehealth or providing mental and behavioral health treatment through the telephone or through a video link. Um the restrictions were lifted. Various types of restrictions, federal restrictions and state restrictions. And many of the insurance companies and state and federal programs that pay for healthcare are now paying for telephonic and video telehealth solutions. So many providers of mental health services are moving to this type of care which as a field I think we see that is a development that can provide an easier way to access services and provide much more convenient services for patients. So there's a lot of chatter in the field of mental health about how we can continue to be able to provide tele services longterm and make that easier for patients. That said, there are some things that we need to do in person, so we need to figure out how to do both. And we need to continue to work with our community partners that also provide counseling and support services faith based organizations, county or state based organizations, primary care offices, others in, you know, all of the healthcare fields that we work with and support who can provide mental health and behavioral care as well. I'll say I've not mentioned addiction yet. So in this time of isolation and this time of change, many of those who struggle with addiction find that illness to be worsening. So everything that I just said for mental health services absolutely applies to addiction services. So we're trying as a field to figure out how to make those services more accessible and available for patients who, who need them.

Andy Grant:

You know, roughly 40 million Americans a year access, mental health services and about half of all Americans will access mental health services in some way during their life. And I'm wondering, do you see that number increasing? Do you anticipate a even larger need for people to access and utilize mental health services as we sort of emerge from this pandemic and get back to whatever that new normal is going to look like? Do you see, you know, sort of an increased need for us to have more professionals and broader access to mental health care as we move out of this pandemic and into whatever the next phase is?

Erika Saunders:

Absolutely. so we see the need growing because of the effects of this crisis. And that is happening on the backdrop of the fact that we as a country and a healthcare system didn't have adequate access to begin with. So we already knew that we had a greater need for behavioral health services than we as a health system could provide. We are not training as many psychiatrists as are retiring. We don't have nearly enough mental health care workers in the field of social work and therapy and psychology. So we knew that there was a need. And we've broadly across the United States mental health professionals have been coming up with creative ways to to it to address that. One of which is really working with our primary care colleagues,uto, to support the provision of behavioral health services in primary care, which is so important. This will compound that problem. Ubecause the need to provide support is, is greater. So I think it will just emphasize the need for mental/behavioral health specialists, addiction specialists to pair with primary care doctors and other practitioners. To pair with community organizations. So that we can create networks of support as best we can. You know, the other fact is that we,uhave an ongoing effort to reduce the stigma around getting help for mental illness. Mental illnesses are,uillnesses of the brain, just like physical illnesses are physical illnesses of other parts of the body. They affect our brain and therefore they affect our behavior because our behavior is created in large part in our brain. Ubut we have many ways to help people who have mental/behavioral health issues,uand struggles,uas well as,ustruggles with addiction. Uand,uwe want to make all of those ways to help people accessible so that people can choose what,uwhat works for them.

Andy Grant:

Erika Saunders, I feel like we've barely scratched the surface here, but unfortunately we are out of time. But thank you so much for joining us and for talking with us today.

Erika Saunders:

Thank you. I really appreciate the opportunity.

Andy Grant:

We've been talking with Erika Saunders, chair of psychiatry and behavioral health at the Penn State College of Medicine and Penn State Health. We've been discussing the potential mental health effects of the coronavirus pandemic and how people can take care of themselves during these difficult times. To hear this and other episodes of Take Note, go to wpsu.org/takenote. I'm Andy Grant, WPSU.