The COVID-19 pandemic has brought mental health issues to the fore.
But as more people have been willing to acknowledge their struggles, the provision of mental health services has become a major challenge.
Dr. Robert Shulman, director of clinical services and acting chair in the Department of Psychiatry and Behavioral Sciences at Rush University Medical College, said he has seen a “tremendous demand” for services since the onset of the pandemic.
“I think our emergency department is busier than ever with people presenting with behavioral health issues,” Shulman said.
The provision of mental health services has also become a major issue in the Chicago mayoral campaign. A number of Mayor Lori Lightfoot’s challengers have criticized her decision not to reopen mental health clinics closed by her predecessor, Mayor Rahm Emanuel.
As a candidate for mayor in 2019 Lightfoot promised to reopen the clinics but now favors an approach that utilizes a network of nonprofits to help provide care.
Shulman said he has noticed an increasing number of children showing up at emergency rooms presenting with self-harming behaviors and substance use.
“When we talk to community providers, especially the ones who work with children and adolescents in the community — therapists, psychologists, social workers — they have all been stating for the last couple of years that their practices are packed full,” Shulman said. “They can't keep up with the phone calls; they can’t keep up with the demand.”
Even prior to the pandemic, Shulman noted that referrals for adolescents were on the rise because of the impact of social media and the pressures it places on children and teens, in particular.
“We have seen an increase in suicidal ideation and self-harming behaviors,” Shulman said.
While the data is not yet in, Shulman believes we will see a continuing pandemic impact on childhood development.
“My own personal feeling is that when these kids hit adolescence, we're going to see a lot more anxiety disorders and panic,” Shulman said. “We'll probably see more things like obsessive compulsive kinds of disorders, picking disorders, germ phobias and such. Right now, we’re 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 surged over 200% during the pandemic.
“In the midst of COVID we were the 311 for the city,” James said.
She emphasized 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 simply someone to talk to, James said.
“We have a very sophisticated platform, and we certainly have an intake structure, but our intake is narrative form, so we really let people lead the conversation,” James said.
One thing she is grateful for is that the pandemic appears to have advanced the conversation around mental health issues.
“I'm grateful and hopeful that it has, thank God!” James said. “Because we are in the biggest mental health crisis hopefully we ever see. The conversation has changed because more people are identifying symptoms of mental health issues and we know the main way to decrease and remove barriers and stigma is to come out and talk about it.”
Part of advancing the conversation may simply be changing how we talk about it.
Shulman said he prefers not to talk about “mental health” but instead “difficulties” and “wellness.”
“As a society,” Shulman said, “we’ve lost sight of how to maintain wellness.”
And in relation to the impact of the pandemic, Shulman said that rather than talk about “anxiety,” he prefers to frame the issue as “trauma.”
“One can talk about trauma without bringing in the whole mental health stigma,” Shulman said. “We're talking about community, and so I think that if we were to take a societal approach to what has happened to us and put it into context, (the pandemic) was traumatic for everybody, and people experience trauma and respond to trauma in different ways.”
According to Shulman, in order to meet the increased demand for services there is a need to think differently about how we provide that care.
“We actually have to innovate a little bit and change our models of care so we can reach a greater population,” James said. “The venue for these things can be almost anything. …We can actually provide care in churches, libraries, barbershops and beauty salons if structured in a certain way. So, we can go out to the community and we can go out to any community … and actually set up modes of treatment that are different than what we do today.”
To reach the NAMI Chicago helpline: 833-NAMI-CHI (626-4244)
To reach the National Suicide & Crisis Lifeline: 988