The medical impacts of COVID-19 go beyond the physical disease itself. Along with the threat of the novel virus, the Tahoe/Truckee region is experiencing a mental health calamity.
Local mental health responders have noted increases in support needed for individuals struggling with depression, anxiety, substance abuse/misuse, thoughts of suicide, and violence in the home during the last few months under the stay-at-home order, first issued March 19 by Gov. Gavin Newsom.
Paul Bancroft, executive director of Kings Beach-based nonprofit Sierra Community House, says the phone hasn’t stopped ringing at the social services center for months because the pandemic and its consequences barreled in with subsequent waves of hardship for the community. As the stay-at-home orders came down the pipeline, SCH first saw initial direct hunger needs as paychecks stopped coming in, to which the organization launched a broad response of support. Then came the massive financial and rental crisis (see Rent. The Crisis that Follows a Crisis on moonshineink.com). Bancroft told Moonshine that a mental health fallout is what he sees as the current “wave we’re in.”
“We all have our crystal balls, and they’re all equally foggy,” Bancroft said, but he predicts that people dealing with mental health issues stemming from the residual effects of a global pandemic will be an increasing problem in the region.
These days, “it’s kind of the calm before the storm,” he said.
The next wave
SCH’s crisis hotline existed before the pandemic hit, but pre-COVID clients seeking aid would often come in person. Now a dramatic local spike in cases at a rate not seen before, spanning from abusive relationships or violence to rent or utility assistance, from drug or alcohol abuse, to depression or suicidal thoughts, has been redirected mostly to virtual or remote support. Roughly 150 people called in April, about half for financial support and half for mental health services. As of his mid-May interview with Moonshine, Bancroft said May numbers of calls were trending on a similar course. A typical month would see between 20 and 30 calls, pre-COVID.
Worryingly, violence in the home is on the rise, Bancroft said. Reports about sexual or domestic violence have gone up in recent past, which Bancroft thinks is related to the stages of reopening. Community members in abusive relationships feel safer making that phone call to request services.
Bancroft said there have been “frightening” consequences of stay-at-home and COVID-19 for those in abusive relationships.
“It impacts people differently in different relationships … In particular, undocumented women have more impacts because of fear of retribution, fear of requesting services, and limited access to information and resources,” he explained.
Meanwhile, the abuser is often feeling a lack of control in such uncertain times, so they seek more control where they can, and that’s in the home.
Seemingly an outlier in all of this has been child abuse cases, which Child Protective Services told Bancroft has come “almost to a standstill” in the region. Sadly, this is not because child abuse is on the decline, Bancroft believes, but simply a matter of reporting. Coaches, teachers, and other mentors aren’t seeing their students in person and aren’t noticing issues, which they would then report.
Tahoe Forest Hospital also saw a marked increase in substance-related visits in the initial days of the pandemic, which landed some patients in ICU, Tahoe Forest Health System CEO Harry Weis said. The healthcare system couldn’t give numbers of cases, Weis said, as it does not track them on an individual basis.
Amy Vail, a clinical psychologist who has had a private practice in the region since 2006, saw a parallel trend to Bancroft’s “waves.” Existing clients booked sessions during the initial weeks of COVID-19 and its long social and economic shadow. Few new clients contacted her … until weeks into lockdown.
People were “literally frozen in place,” Vail said, “not knowing what to do, where to go, to be told not to go anywhere … Often, in the land before this COVID world, people could go out, they could do things to distract themselves more.”
Without an outlet or distractions, people’s struggles went inward, she said, and after a “couple of weeks [they] started to unfreeze. And then it went into fight-or-flight mode and that’s when more people were reaching out.”
Elizabeth Creger has lived off and on in Tahoe Donner since she purchased her home there in 1997. She runs a recruitment business from home both from Truckee and out of Walnut Creek, where she rents another home. Creger chose to adhere to the stay-at-home order up in the mountains, and upon arriving at her Truckee home just before the governor’s official order, she felt more than physically isolated through feeling unwelcome as a part-time resident.
Creger has occasionally struggled with anxiety and depression before. With her back-and-forth work schedule, she’d been connecting to therapy through video calls for a few months, but COVID greatly increased her stress and in the middle of all this, she fired her therapist.
“I said [to my therapist] I have been so depressed and so stressed about what to do … it’s surprising that my neighbors haven’t found me hanging from a tree in my backyard,” Creger told Moonshine. “She said nothing. She just kind of was silent.”
The ramp up of Creger’s mental health distress is a recognized issue.
“Human beings are not designed to be socially isolated, and for those with mental health disorders, this isolation shows an exacerbation of depression resulting in a need for more intervention,” said Weis. “So if somebody already has some tendency or mental health disorder, social isolation can really exacerbate depression and other health challenges that they have, and our team’s already seeing that.”
Weis also echoed Vail and Bancroft that the region is in the “early stages” of its mental health impacts. TFHS usually sees an increased need for mental health services during shoulder seasons, but if COVID cases spike again and/or stay-at-home continues in the fall, Weis said, we will see an even more exaggerated increase.
For many people seeking help, Vail said, the issue of finding the right therapist is always a complicated one, and “the concern is even greater when people are in crisis and trying to find a therapist to work with remotely.” Yet Vail believes remote therapy (sometimes referred to as telemedicine) does have value; she’s been at it for years and has found that in these times of COVID, the process of starting new clients has been surprisingly smooth.
“[I’m] surprised by how quickly new people are bonding and connecting with me, including couples,” said Vail about clients she’s treating over Zoom, telephone, or other telemedicine technologies.
According to the American Psychology Association, remote therapy is productive. “More than 20 years of research demonstrates that psychotherapy delivered via the phone is as effective as the care delivered in person,” according to a report released in 2018. “A review of 13 studies found significant reductions in symptoms of anxiety and depression when therapy was provided via telephone.”
Gen Z copes
Peter Mayfield is the executive director of Gateway Mountain Center, a youth outdoor wellness and mental health program based in Truckee. Gateway currently manages 49 youths, with a sharp increase post-COVID of nine new referrals. Between May 19 and June 2, Mayfield’s organization provided 116 hours of therapeutic support for individuals ranging from 5 to 24 years of age, many of whom have severe challenges.
Anxiety about virtual learning led one Gateway client and local high school senior’s anxiety levels to go “through the roof” during the pandemic. In an ironic twist, it was virtual support that helped her survive.
Mariana (not her real name because as a minor seeking treatment her identity is protected) lives in Kings Beach, and the transition to distance learning at the end of her senior year had her worried that without the one-on-one teacher time she normally gets, she wouldn’t be able to independently motivate to finish her studies and graduate. The added academic anxiety piled on top of mental health struggles she faced before the pandemic. The pressure was debilitating during the initial days of lockdown.
The “stress and anxiety would come up where I could feel so much tension and anxiety to the point where I wasn’t able to breathe,” Mariana said.
She turned to Gateway Mountain Center. Through remote contact and video lessons like her school classes, she found ways to effectively cope. She says the best tools she’s learned from Gateway are meditation and breathing techniques.
Zack Wise is a 19-year-old who split his childhood between his dad’s place in Pennsylvania and his mom’s in Truckee. Wise said he has experimented with a variety of substances throughout his life, culminating in oxycodone as his drug of choice, and that prior to this year, he hadn’t been sober for more than a week since he was 14.
Then in February, just before the pandemic hit, he had a major wake up call in the form of a near-fatal accidental overdose. He had taken oxycodone laced with fentanyl one night in his mom’s house, not knowing it was laced and justifying the oxycodone as a way to sleep rather than using up all the cocaine he had bought. His mom and sister found him in his bedroom the next morning, where he lay unresponsive.
“They saved my life,” Wise said, who doesn’t fully remember the incident. His next memory after taking the drugs is coming to in the hospital many hours later.
That overdose experience “stopped me in my tracks,” Wise said. His personal experience was compounded by the fact that other young people who also overdosed didn’t make it. After his scare, Wise had connected with Mayfield and Gateway Center. A robust mentorship program and the ability to get out on adventures like skiing and rock climbing facilitated organic conversation about his struggles. But three other young people in Gateway’s circles perished from overdoses this year.
“It’s something that I’m still processing to this day,” he said. “Some days I wonder why I survived that day and not them.”
Wise was solidly on the road to recovery before the novel coronavirus hit, but during lockdown, with the continued help of Gateway, he remained sober from all substances. Like Mariana, Wise said that meditation and breathing techniques have been among the most helpful tools he gleaned. He also landed a summer internship that will lead to a paid position with the organization. He sees himself on a trajectory to use his story and voice to uplift other young people who’ve struggled with addiction.
“The most important thing for me was waking up with gratitude. Even if it doesn’t lead to the best day, at least you’re thankful for what you have in that moment,” Wise said. “Sometimes we often get destination addiction. We’re always looking to the horizon, what’s next? And we don’t really stop to appreciate what we do have. After almost losing my life, that had a lot of meaning to it.”