As the third wave of the Covid-19 pandemic fills hospitals to capacity, mental health providers are seeing a surge of their own.

“People are under so much stress,” said Ryoko Chernomaz, a licensed clinical social worker at the San Francisco Free Clinic.

Issues at home – from increasing childcare responsibilities to domestic abuse – are compounding financial anxieties triggered during the early stages of the pandemic, driving an uptick in mental health needs. Sine the pandemic began, Chernomaz has seen a 30% increase in appointments.

At CommunityHealth – a free clinic based in Chicago – licensed clinical social worker Ornella Razetto has observed a similar trend. “It began with anxiety, depressive symptoms and financial insecurity,” said Razetto, but now, “reality has sunk in.” As the pandemic drags on, many of her patients’ initial anxieties are manifesting into chronic depression. Razetto has seen a 75% increase in referrals since March.

On this episode of the podcast, we speak with both Chernomaz and Razetto about how the pandemic is affecting their patients’ mental health and what they expect the long-term consequences to be.

Direct Relief regularly supports safety-net clinics, like CommunityHealth, with mental health medications and funding to expand mental wellness programs. Since January, Direct Relief has sent nearly 600 shipments of critical supplies, including mental health medications, to 71 clinics and health centers across the United States through the organization’s monthly Replenishment Program.

Transcript:

When the pandemic hit, Ryoko Chernomaz saw a surge in patients.

“I wasn’t that busy before the pandemic, but since March I’ve been so super busy.”

Chernomaz is a licensed clinical social worker at the San Francisco Free Clinic. She provides counseling services and support to uninsured individuals in California’s Bay Area.

“A lot of them are undocumented immigrants. And people come from all over the area, not just people in live in San Francisco.”

In the beginning of the pandemic, financial stress was the major complaint among her patients. Many lost their jobs overnight and–because of their immigration status—were ineligible for unemployment benefits The stress manifested as anxiety and depression and for Chernomaz, a nearly thirty percent increase in appointments.

“Before I always felt like I could do something; I could help. But this is just me because of the number of people and just the degree of the incident. It’s felt like, Oh my God, there may not be, I may not be able to help, uh, all these people.

At CommunityHealth—a free clinic based in Chicago–Ornella Razetto was experiencing something similar.

“A little bit before the end of March is when they began to see a, the beginning. Of what was to be the surge of referrals to the counseling program,” said Razetto who oversees CommunityHealth’s mental wellness program. “I began to see this surge of referrals, exclusive to anxiety, exclusive to stress and chronic stress.”

Like Chernomaz’s patients, many had lost their jobs and didn’t qualify for unemployment—and the social isolation was making matters worse. “It’s not just the health effects of COVID, but I what I was seeing more so was the social isolation effects of COVID and how that was triggering so much anxiety and panic attacks. You name it and it was there.”

As the pandemic wears on, these initial anxieties have been exacerbated by relational issues. Chernomaz calls it the second wave. “Now it’s been like 6 months, I believe we are going to start seeing a second wave, which I sort of started seeing already: Increase in divorce, abuse, neglect, those kinds of cases.”

She says there’s been an influx of women and children, which reflects broader trends.

According to a recent study by CARE—a non-profit international aid organization– women across the globe are nearly three times as likely as men to report mental health issues during the pandemic. While the causes are varied, many experts attribute the discrepancy to women’s role as caregivers. According to US Bureau of Labor, 55% of employed women do housework compared to 18% of men. With children home from school and loved ones sick with the virus, these caregiving responsibilities have increased significantly, and the burden has largely fallen on women.

Razetto says her patients are feeling the weight.

“It’s this piece of how much more can I give of myself if I was already giving so much before? And there’s this expectation where I have to give more, just because we all have to give more because in COVID everyone has to give until we’re empty”

On top of taking on more responsibility, women are also likely to be victimized by an increase in domestic abuse. According to the CDC, one in three women experience domestic violence in their lifetime compared to just 1 in 10 men. And, during the pandemic, domestic abuse has increased by up to 60% in some countries, according to the World Health Organization.

The United States is one of the few to report a decrease. But, advocates says it’s likely because survivors aren’t reporting it. Many police precincts require complaints to be filed in person.

Regardless, Razetto says her patients are struggling. While she hasn’t received an increase in complaints, she says many of her patients were dealing with domestic abuse before the pandemic. Now, it’s harder to escape.

“Whereas for example, if someone says, ‘I’m tired of being at home, listening to him talk all the time and insulting me,’ well before they could have just left the home. Right? Walked out, gone to see a friend, maybe just done something outside of the home. Now, where are you going to go?”

Not only is it more difficult to find support in friends and family, it’s also harder to get professional help. As counselling sessions go virtual, some patients are reluctant to talk wit their therapist.

“Patients did not want phone consult for counseling,” said Razetto. Understandably, they didn’t feel comfortable talking about their partner inside their home. “I had some weeks where I had, if. If I was lucky, maybe six patients scheduled in a week in a week. Now that she’s back to doing face to face visits, her schedule is booked. There’s even a waitlist.

While many of these issues are likely to subside once the pandemic is over, some may be more long lasting. Similar to the Great Depression or even the 2008 Recession, the Covid-19 pandemic could permanently alter how people perceive the world. Before, daily routines were reliable. Future plans were guaranteed. Now, that sense of security has been undermined.

“If COVID could have come out just from nowhere, what else could come all of a sudden from nowhere and be here to stay as long or possibly longer,” said Razetto.

Many of Razetto’s patients are still unemployed. As the pandemic drags on, they have little assurance their financial troubles will be remedied. Experiencing this kind of stress over a long period of time can have lasting impacts, from anxiety and depression to PTSD. Razetto fears it will cause her patients to be in a constant state of panic. “A long-term consequence will just be that of the perpetual needing to create one’s own safety net.”

Chernomaz says she expects a third wave of mental health issues to emerge in the aftermath of the pandemic. Those who lost loved ones or experienced a family separation of any kind may be grieving for years.

This is such a huge disaster, she says. It could take generations for people’s mental health to recover.

This transcript has been edited for clarity and concision.