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Six months into the coronavirus pandemic, the countless stresses are taking a toll on the mental health of many in the Bay Area.
Those who were already struggling are likely dealing with even more distress. According to a CDC survey this summer, more than 40% of Americans are experiencing issues related to depression, anxiety and substance abuse because of the pandemic. In the 18-24 age bracket, 1 in 4 report serious suicidal thoughts, the CDC reported.
Twenty-five percent of young adults rated their mental health as fair or poor, according to the latest COVID Response Tracking Study by NORC at the University of Chicago. Psychologists say disordered eating has gone up too, especially among teenagers.
And in the past month, the hazards of California’s wildfires and horrible air quality have only compounded the physical and emotional challenges.
It can all seem overwhelming, but help and support are within reach. There’s no one way to deal with our mental health, but a compendium of resources, tips and advice from professionals can offer paths toward hope.
It’s all about having a tool kit and developing a plan.
(If you are having thoughts of harming yourself, tell someone right away. You can call the National Suicide Prevention Lifeline at 800-273-TALK (8255). You can text “Connect” to the Crisis Text Line at 741741 for free, 24/7, confidential support. Additional Bay Area crisis resources are listed at the end of this article.)
First step: Recognizing your distress
If you are experiencing negative mental health symptoms, experts say you are far from alone.
“I don’t know anyone who is not feeling the onslaught of health and environmental and political and social distress that has descended upon us,” said David Spiegel, psychiatrist and medical director of the Stanford Center on Stress and Health. “So feeling bad is not abnormal.”
But the pandemic and wildfires have limited many of our usual coping mechanisms, such as going out with friends or getting exercise outside. That can make distress much harder to manage. Sometimes, it can be taxing to even know where to start.
In those cases, Holly Anton, an integrative psychotherapist with Sutter Health’s Institute for Health & Healing, likes to use a metaphor: “If I hand you a map of San Francisco, and say, how do I get to the opera house, what’s the first thing you’d need in order to tell them?”
The answer is: where you’re starting from.
Taking stock of where you are emotionally, physically and socially can often be the best first step. Think of it like a self-assessment, Anton said.
Begin by paying attention to the way distress makes its way into your body. Recognizing both physical and behavioral signs of distress can help you figure out what you might need.
For physical signals, maybe you’ve noticed a disturbance in sleep, or a change in appetite, or a pounding heartbeat or increased sweating. Behavioral changes, like increased irritability or feeling more withdrawn, or calling in sick when you just don’t want to go to work, or an increase in substance abuse, might feel commonplace these days.
“I call them warning signs or a barometer check,” Anton said. “Rather than comparing it to some other time, you can give it a quantifiable rating scale.” Maybe it’s a number, from 1 to 5 or 1 to 10. Or maybe it’s even easier — low, medium, high. Sometimes noticing the circumstances in which the ratings fluctuate, and the levels they can reach, can provide helpful information for your road map to coping.
If that’s too difficult, or you need help more urgently, starting with a primary care provider might be the best place to start. They can direct you to mental health services, Anton said.
Support networks
No matter where you are in your process, taking an inventory of your support networks — both for coping and for professional assistance — can help. During a time where it’s much harder to meet casually, it’s important to make sure your support pantry is fully stocked.
Family and friends. Asking for support can be hard, but often just remembering that you have a network of people and reaching out to them can be rejuvenating. Being heard and acknowledged, or having someone to commiserate with, can have lasting effects for not feeling less confused and alone. If it’s hard to know how to start, you might ask a close friend if they’ve noticed anything different about you, or for a perspective on how it seems like you’re doing, Spiegel said. Or, you can try by asking someone else how they are — you might find that the people you assumed were doing fine are struggling just as much as you.
Support groups. Depending on what you’re struggling with, it can be very helpful to find a support group online of people who may share in your feelings. Maybe it’s a wildfire relief group, or a group aligned around the physiological symptoms of anxiety who can offer some tips, or a local parents group. Maybe it’s a group around grief and loss, obsessive-compulsive disorder, or Alcoholics Anonymous-related networks. These can be especially helpful if you often feel alone within your community around certain challenges.
Therapy
It’s not always easy to find a therapist, and during the pandemic when in-person contact is limited, it can be even harder to find a good fit. But understanding what you’re looking for can help make the process feel more comfortable.
Many therapists specialize in certain areas. The most reputable search engines are the American Psychological Association and Psychology Today, the latter of which is usually referred to by people in the field as the go-to stop for finding a therapist. You can sort by neighborhood, insurance, gender, age, areas of specialty, and more. If you’re looking for someone who can focus on anxiety, or LGBTQ issues, or grief, or bipolar disorder, you can filter for those while you browse.
It’s important to recognize the difference between psychologists, who offer psychotherapy, and psychiatrists, who have medical training and prescribe medication. While scrolling, you might see some terms like LMFT, LPCC, RDT, PsyD, PhD, LCSW and more. These refer to the different types of therapy degrees.
LMFT: Licensed marriage and family therapist
LPCC: Licensed professional clinical counselor
RDT: Registered drama therapist
PsyD: Doctor of psychology, usually prepares graduates for a career in clinical practice
PhD: Doctor of psychology, usually prepares graduates for a career in academia or research
LCSW: Licensed clinical social worker
ATR-BC: Board certified art therapist
AMFT: Associate marriage and family therapist
The degrees also offer different types of training, and depending on the length and level of their education, some therapists may charge more than others. If you have insurance, you should check with your provider to figure out what options and coverage are available to you. Medicare and Medicaid also offer low-income options.
If you’re planning to pay out of pocket, you might consider a few institutes and centers that offer sliding scale sessions, like clinicians at the California Pacific Medical Center Internship, the California Institute of Integral Studies, Well San Francisco, Haight Ashbury Psychology Services, and others. Here is a good list of additional options.
Many therapists work from one or a variety of psychological orientations. Getting acquainted with what they mean can help greatly in narrowing — or broadening — your search. These are just some of the many:
Psychoanalytic: Therapy focused on the unconscious, the psyche
Psychodynamic: Therapy focused around childhood experiences, the way unconscious processes become beliefs, finding patterns in emotions and thoughts
Somatic: Therapy focused on the relationship between the mind and the body, often used in coping with trauma
Mindfulness-based therapy: May incorporate mindfulness practices like meditation, breathing, and observing the body
EMDR (Eye Movement Desensitization and Reprocessing): A method of therapy proven to greatly help with post-traumatic stress disorder. Involves an 8-phase treatment using eye movements that help attend to memories of trauma.
CBT (Cognitive Behavioral Therapy): Often seen as a more hands-on, practical form of therapy that involves different exercises to change patterns of thinking around anxiety, OCD, fears, etc.
There are many more, including art therapy, attachment-based, play therapy, hypnotherapy, dance/movement therapy and family/marital therapy. One effective strategy is to filter for what you know you want, and then reach out to a few therapists for a phone consultation. Talking over the phone may reveal some treatment options you didn’t know you’d want.
If you progress to the stage of a full-length appointment, Anton recommends giving it three sessions to figure out how you feel. “Unless there’s something so egregious in the first session that you want to leave — that’s a good indicator — I would give it three sessions and I would be direct.” Anton recommends telling the therapist what your concerns and doubts are, even if they’re about them.
“It’s very difficult, but it does two things,” Anton said. First, it gives the therapist a chance to meet you and validate, modify or clarify anything that was misunderstood. Secondly, if a therapist can’t handle it or reacts poorly, it might be a sign that you should try someone else, she said.
Anyone in crisis should seek immediate help
Experts emphasize that if you are having thoughts of harming yourself, tell someone right away. The following options are available to you 24/7: You can call the suicide prevention hotline or psychiatric emergency services (numbers listed below), or go to your nearest emergency room. If you are in immediate physical danger, call 911.
National Suicide Prevention Lifeline: Call 800-273-8255 to reach a counselor at a locally operated crisis center 24 hours a day for free.
Crisis Text Line: Text “Connect” to 741741 to reach a crisis counselor any time for free.
Psychiatric emergency services in Bay Area counties:
Alameda County Crisis Support Services: 1-800-309-2131
Contra Costa Crisis Center: 1-800-833-2900
San Francisco Emergency Psychiatric Services: 415-206-8125
Marin County Crisis Stabilization Unit: 415-473-6666
Napa County Mental Health Crisis Hotline: 707-253-4711
San Mateo County Crisis Intervention and Suicide Prevention Center: 650-579-0350
Santa Clara County Suicide and Crisis Hotline: 855-278-4204
Solano County Mental Health Crisis Services: 707-428-1131
Sonoma County Crisis Stabilization Unit: 707-576-8181
San Francisco’s 24 Hour Hotlines:
Crisis Line: (415) 781-0500
HIV Nightline: (415) 434-2437 or 1-800-273-2437
HIV Textline: (415) 200-2920
Drug Information Line: (415) 362-3400
Relapse Line: (415) 834-1144
PWSS Support Line: (415) 288-7160
TTY: (415) 227-0245
More hotline resources:
National Domestic Violence Hotline: Call 800-799-7233 or chat with an advocate on their website at www.thehotline.org.
Veterans Crisis Line: Vetereans, service members, National Guard and Reserve and their family members and friends can call 800-273-8255 and press 1 for confidential, 24/7 support. Text: 838255. Support for deaf and hard of hearing: 800-799-4889.
The Institute on Aging’s Friendship Line: A crisis hotline for people aged 60 years and older, and adults living in disabilities. Call 800-971-0016 Note: The Institute on Aging offers a gamut of therapy options, and sessions begin at $50. Call 415-750-4111 for more information.
Additional ways to wellness
• Remember to engage in enjoyable and pleasurable things. “These are usually the first things that fall away, but they’re the things that tend to keep our boat afloat,” Anton said. Reconnecting with the things that you used to enjoy can remind us of larger life truths, that’s it’s not all crisis.
• The Chronicle reached out to mental health experts to put together seven day-to-day strategies that can help you manage uncertain times. Check it out here.
• Give back. Sometimes the most helpful thing for our own mental health is helping others. Whether that’s helping contribute to a community food fridge, or reaching out to someone you know who may also be struggling, checking in on your neighbors, finding ways to give back to areas of your community that may need it the most — getting out of our own minds for a moment can be salves.
Annie Vainshtein is a San Francisco Chronicle staff writer. Email: avainshtein@sfchronicle.com Twitter: @annievain