Expert Q&A: How living through a global pandemic for a year has affected Houstonians’ mental health

Isolation, loss and anxiety due to the COVID-19 pandemic has led to an increase in mental health issues for residents of the Greater Houston area over the past year, according to Renae Vania Tomczak, president and CEO of Mental Health America of Greater Houston, a regional mental health education and advocacy organization.

Someone struggling with mental health may exhibit a combination of symptoms such as changes in eating or appetite; feeling sad, hopeless or worthless; mood changes; loss of interest in normally enjoyable activities; withdrawal from others; changes in sleep patterns; and problems in concentration, she said. If multiple symptoms persist for a prolonged period of time, Vania Tomczak said it is important to seek help.

In addition to providing education and training services, MHA of Greater Houston connects local residents to resources including free online screenings to help individuals gauge their mental health.

This interview has been edited for length and clarity.

How has the pandemic affected the mental health of Houstonians? To what extent has demand for services increased in the region compared to 2019?

We’re awaiting data for the early months of 2021, but throughout 2020 our local screening data has consistently demonstrated that people are struggling. We’ve seen significant increases in depression and anxiety; alcohol and substance use; eating disorders; and youth at risk for emotional, attentional or behavioral difficulties. While this is troubling, what the screenings have also accomplished is identifying a help-seeking population earlier than ever before, giving us new opportunities to address mental health concerns long before they become a Stage 4 crises.

By May of 2020, we saw triple-digit increases in the number of people recognizing their symptoms and looking for ways to support their mental health. It’s important to note that even before the pandemic, a public health challenge existed as demand for services increased and access to care was difficult for many. While this statement is true across the country, here in the Greater Houston region we have had to deal with trauma as a result of devastating hurricanes, school shootings, the pandemic as well as the recent winter storm—and that’s just in the last four years.

From our experience in addressing trauma, particularly as related to a disaster, recovery occurs over time and in phases, with movement in and out of phases. Some disasters, due to their scope and magnitude, take more time for individuals and communities to recover.

What are some examples of healthy and unhealthy coping mechanisms people have turned to?

Healthy ways to cope with stress include taking a break from watching, reading or listening to news stories. Early on in the pandemic I learned I need to limit my intake of news and social media to no more than 30 minutes a day.

Because the stress we feel impacts us both physically and mentally, taking care of our body is important. Spring has arrived, and it’s time to return to outdoor activities—walking, bike riding and other outdoor pursuits has a tremendous effect on our wellbeing. Try[ing] something new—yoga, meditation, mindful practices—can lower the anxiety you feel.

Connection is so very important as we are social beings. Create your own support network by making a list of friends and family who bring happiness to your life, and reach out when you’re feeling low. Engaging with your faith community can also bring you comfort and a means of support.

Unhealthy mechanisms include criticizing yourself for not managing your emotions, becoming aggressive or reacting negatively such as yelling, [or] using alcohol or other substances to minimize impact. Due to the fear many have experienced during this time, it’s important we are not self-isolating in that there are safe ways to gather and connect.

When looking at demographics of age, race and socio-economics, do certain groups struggle with mental health more than others? Which people groups might have more problems accessing mental health resources?

As you might expect, those who struggle in meeting their needs for a better quality of life are at a greater risk for mental health challenges. Persons dealing with food insecurity, economic risk, unstable housing, lack of access to transportation and unsafe neighborhoods face impacts on their overall health. Some experts have said a person’s ZIP code is a stronger predictor of their potential health outcomes than genetics. Those in rural areas face more challenges than those in areas of higher population with access to care being a determining factor.

The events of 2020 had profound impact on those from different racial and ethnic groups. Looking at the national screening data, 30% of Black people seeking support—the highest percentage of any group—cited financial problems as a reason. In addition: 27% of people with mixed race seeking support cited current events. Seventy-four percent of Hispanic/Latina/o/x help-seekers cited loneliness or isolation. Thirty-nine percent of Native American people seeking support cited loss or grief, 63% cited past trauma, and 44% cited relationship problems. And 27% of whites and Hispanic/Latina/o/x people seeking support cited coronavirus.

Limited access to care is not for lack of patient motivation. A 2018 survey from the National Council on Behavioral Health showed that 56% of patients want to access a mental health care provider, but many face care barriers. These barriers include limited health insurance access or in-network care, a national mental health professional shortage and long wait times, travel distance for those without reliable transportation, language barriers, as well as cultural barriers as patients feel the pressure of societal stigma and avoid visiting a mental health professional.

What the American Psychiatric Association tells us is that most racial/ethnic minority groups overall have similar—or in some cases, fewer—mental disorders than whites. However, the consequences of mental illness in minorities may be long lasting.

Is anything being done at the state or county level to expand the availability of resources?

We’ve been encouraged by the increasing awareness of the importance of mental health demonstrated on both a state and a county level. We see law enforcement officers training in mental health to respond more effectively when incidents arise, educators learning to spot signs and symptoms of mental health issues in students and seek out assistance, and lawmakers including mental health resources in their responses to significant state and local events.

As we all know, our investments reflect our true priorities. State and local governments have dramatically increased funding dedicated to mental health supports in recent years. Is it enough? No, it’s not. Additional funding could increase access to care for tens of thousands of Texans—more could always be done. That said, Texas’ significant strides to include mental health as part of the public conversation are exciting. We look forward to increasing opportunities to create safe, supportive and resilient communities across the state.

How can employers best support their employees as more companies begin returning to work and normal routines? What about for those who have transitioned to permanent work-from-home situations who may deal with isolation?

We have reached the one-year anniversary of the declaration of a worldwide pandemic and seen the impact play out in terms of the mental health of our nation. Change is difficult, and just as it was difficult to transition from work to home, the transition back will likely require patience and an offering of grace.

Providing support and understanding is crucial—promote an open and supportive culture encouraging feedback from employees to help decrease work-related stress and enhance motivation. It’s important for leadership to share that seeking help for a mental health concern will not jeopardize their career and value to the organization.

Other ideas include leaders modeling healthy behaviors like taking a walk at lunch or sharing healthy snacks, encouraging employees to use their PTO and vacation time in ways to reduce burnout, and allowing for flexibility to meet health appointments and managing care for children.

Also, make sure your health benefits include access to an Employee Assistance Program offering free and confidential assessments, short-term counseling, referrals and follow-up services to employees who have personal and/or work-related problems, and promote it often. Consider offering Mental Health First Aid training to management so they are better equipped to have a conversation with an employee who is struggling.

In terms of permanent work-from-home situations, the advice is the same—making time for connections is extremely important. It’s also important to determine fit. Some people thrive in a quiet, private, semi-isolated environment. Others crave physical interactions constantly. So you have to figure out the type of person you are and the impact on your family.