An increase in depression, anxiety and suicides could follow the coronavirus peak in Michigan due to widespread psychological trauma tied to social isolation and economic hardship, experts say.
The psychological effects of quarantine alone include heightened risk of stress, irritability, insomnia and depression — all factors that correlate with suicide, said Dr. Cathrine Frank, chair of the department of psychiatry and behavioral health at the Detroit-based Henry Ford Health System.
“There's a lot of things going on, so that it's sort of a perfect storm,” Frank said.
The nation is surpassed 100,000 deaths due to COVID-19 this week, while Michigan reported 5,334 confirmed deaths through Wednesday.
A study by Grand Rapids-based Pine Rest Christian Mental Health Services this month predicted a 32% spike in suicides in Michigan, likely due to job loss, stress related to a loss of a loved one, substance abuse or isolation and loneliness due to social distancing.
"The isolation. The unknown. The fear of exposure to a virus that can lead to death. All of that creates a lot of anxiety and uncertainties for people," said Dr. Debra A. Pinals, a psychiatrist and medical director for behavioral health at the Michigan Department of Health and Human Services.
"We've learned a lot from other pandemics and quarantine situations over decades and centuries, really, that these are things to worry about — that there are the mental health aspects that we have to pay attention to."
Michigan's mental health advocates are trying to dramatically raise public awareness of the trend and boost outreach so vulnerable people are directed to available resources and treatment.
Calls to suicide and crisis hotlines are up nationally and locally. Calls to the federal Disaster Distress Helpline soared 1,000% in April compared with the same month last year, according to a Substance Abuse and Mental Health Services Administration spokesman.
Common Ground, a 24-hour crisis services agency in Oakland County, has seen a jump in calls, texts and chats to its helpline (800) 231-1127 since the start of the pandemic, said Jeff Kapuscinski, the agency's director for business development.
Last year, Common Ground averaged just over 1,000 calls a week but has seen that number go as high as 1,450 a week, Kapuscinski said. Call volume has started to fall off a bit, but it's still ahead of last year's pace, he said Wednesday.
Common Ground is part of the National Suicide Prevention Lifeline, so any call from the area to that number comes into Common Ground's call center.
"The Resource and Crisis Helpline receives calls from the entire Metro area — mostly because neighboring counties don’t have anything like it," Kapuscinski said.
The state launched its Stay Home, Stay Well initiative, which includes a list of crisis helplines, guidance documents, videos and emotional-support services including the National Disaster Distress Helpline — all compiled at the website michigan.gov/staywell. May is national Mental Health Awareness Month.
"The problem is there’s been some public service commercials, but a lot of people don’t know it exists," Frank said of Michigan's initiative.
Using emergency federal grant money, the state is offering free confidential emotional support counseling available 24-7 to Michiganians who call the state’s COVID-19 hotline (dial (888) 535-6136 and press "8" when prompted). Those who don't want to talk may text the keyword RESTORE to 741741 for support.
The federal grant also supports expanded counseling to groups hit especially hard by the pandemic, such as health care workers and certain racial and ethnic communities, Pinals said.
"We have the COVID-19 information line, too. We know that giving information is one way of helping people manage their anxieties and their worries, so the COVID-19 information line is really important," she said.
The state has also made available to Michigan residents for free the usually subscription-based app Headspace for guided meditation to help manage stress, anxiety and depression.
At the University of Michigan, a doctoral student helped spearhead an initiative to target front-line workers from health care professionals to first responders to grocery clerks and delivery drivers.
MI Frontline Support is a free directory of 400 clinicians who have space to see new clients within a week, so exhausted front-liners don't have to spend physical or "emotional energy" negotiating with 10 different clinicians over scheduling, specialty and insurance, said Sara Stein, a UM trauma and domestic violence researcher.
"The purpose is to really reduce the common barriers to getting community mental health support, such as information about what insurances someone is taking," she said. "People end up giving up and saying, 'OK, it's too hard to find.' We really want to eliminate that."
Many on the list offer sliding fees, meaning they are willing to negotiate their typical rates to meet the financial constraints of a particular client when possible, she said.
Advocates say they are increasingly worried about insufficient funding for the public behavioral health system as the state faces a $3.2 billion budget shortfall in the current year and another $3 billion deficit for next year.
Kevin Fischer, executive director of the of the nonprofit National Alliance on Mental Illness in Michigan, said every community mental health department across the state was having budget concerns that predated the pandemic.
"Coming out of this — because of this projected increase need for mental health care, projected increase in suicides — we need more funding not less," Fischer said. "We’re terrified that where we already knew we were underfunded, we’re going to take a bigger hit."
Leaders are also concerned about lapses in health insurance for people who have lost their jobs amid the pandemic that could keep them from seeking help.
Several experts pointed to a well-known study suggesting suicide is predicted to rise 1.3% for each one percentage point increase in state unemployment rates. Michigan last week said unemployment is at a record high of 22.7%.
"The best thing we can do it get out in front of it and talk about it," Fischer said.
He said he has had a bunch of people reach out to him to say they're "on the edge."
"I have a call list. That’s a good way to get started," said Fischer, explaining he tries to call or text several people a day who may be struggling or isolated to check on them.
"Because most people just need that human interaction. They need somebody to hear them."
It's too early to know from death data whether there's been an uptick in suicides in Michigan or how they're related to COVID-19, but Frank noted that Hong Kong experienced a 31.7% increase in suicides for two years after the 2002-03 SARS epidemic.
Michigan was already in the midst of a suicide crisis before the pandemic hit, with suicides increasing about 33% since 1999. In 2018, the most recent year for which data is available,1,548 people took their own lives in Michigan.
"That's something to be mindful of: that there were other factors that were at play in our society that we've been trying to understand for a while," Pinals said.
"With all of these interventions, you almost can't measure when they have saved a life. One day, one reach out, one ability to communicate, one crisis call — you may have prevented that person from taking their life."
Something that hinders people coming forward for help is they think suicide is strictly related to mental illness, but it's not, Frank said.
"Somebody telling you that they're going to go kill themselves is a predictor but, unfortunately, there's all sorts of suicide risk factors that compel people, often quite suddenly, to want to take their life, even in the face of not having a mental illness," she said.
Frank advocates for screening all patients for suicide risk and making resources and counseling available 24-7, since crises aren't limited to the hours of 8 a.m. to 5 p.m.
"How we look at resilience and hope is extremely important in this COVID age," she said. "It's always been, but it's an extremely important issue in terms of staying well and staying healthy, both physically and mentally."