'Fear of the unknown'

Stressed families, health services restricted

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Grady - who prefers not to publish his last name - is a preschool teacher and a full-time student who has had to move to online platforms since the stay-at-home mandate by the state four weeks ago. However, he lives off the grid and has to come into town to his preschool office every day in order to access the internet for school and unemployment benefits.

He and his partner (still employed) are fostering a nephew's 2-year-old child, who requires their shared caretaking.

"I am adapting to a whole new way of life," Grady said resignedly over a phone interview. He spends an average of five to six hours a day on schoolwork online. And that is not to mention trying to navigate the site for unemployment benefits.

"There's a lot of different pieces - absolutely," he acknowledged. "I can't access [the unemployment benefits site] this week because their online site is flooded."

Amanda Dean works as an accountant to 12 different clients with Mayer Consulting. She is a single mom with three children: twins, who are 7 years old, and a 9-year-old, who all go to different local schools. She is also 18 weeks pregnant.

"During the day sometimes [I] work from home and mostly at night I do a lot of my work," she said. She still goes into the offices several times a week, and to her doctor's appointments, while her partner, a teacher who is now stuck in his own home, helps watch the kids.

"I am an organized person and have us all on a schedule," Dean replied to the question of how she is managing. "That is helpful. The kids do schoolwork in the morning with me, and afternoons they are on the computer and that gives me time to my work. I didn't realize how much I loved having the kids go to school and having quiet time to myself."

Regular sessions with therapists help both Grady and Dean (and her children) cope. But even that has changed - now all the sessions are online.

"There's a lot that's lacking - the accountability of showing up in the therapist's office and having that be part of that commitment to your therapy and growth," said Grady. "That emotional connection is so valuable."

Stressed out

It has been four weeks since the state decreed that all New Mexicans need to shelter indoors to halt the spread of the dangerous novel coronavirus gripping the globe. Schools have been closed since mid-March. Workplaces and institutions deemed "nonessential"--retail stores, gyms, movie theaters, art galleries, museums - have shuttered, leaving most workers either working from home or unemployed. Apple-converted-space

Health care facilities and shelters are considered essential services, but most centers are closing their actual doors and transitioning to online services - a challenge both to the clients left dangling and the facilitators themselves.

Domestic violence calls are down since mid-March, according to Taos Police Department Chief John Wentz. He reasoned that victims do not make these calls for help because they are "trapped at home with their abuser; hospitals (frequent source of outcry) are a dangerous place (fear of contracting COVID-19 if they go there) and are being avoided; and schools (frequent info source on child abuse issues) are closed."

Clinical professionals are worried.

Malinda Williams, executive director of Community Against Violence, noted similarly a large drop in the number of phone calls to its domestic violence hotline since the rules for self-quarantine went into effect.

However, she said: "We know from past studies and also emergency situations that domestic violence escalates when the victims are isolated and don't have safe avenues to help."

Elizabeth Sump, the clinical coordinator at CAV, has spent nearly four years developing creative new ways for family bonding and safety through fun outdoor activities like paddleboarding, whitewater rafting and river adventures. All of those activities have been shelved for the foreseeable future.

"It's been three official weeks that we've suspended group visits," Sump explained. "There has been a drop-off of 40 percent of our clients who were able to meet on an individual basis -- normally they would come in and meet face-to-face -- we see individuals and families and the LGBTQ population, which is small -- each therapist was seeing 20 clients once or twice a week. Clients are now at home and not able to leave, and they can't sit at home on the phone for an hour. So we do a lot of texting and give support."

Sump sees the stressors of job loss, financial straits, enhanced alcohol and substance abuse and inability to leave the house for school and work exacerbate already tense situations. "In average homes, tensions even are running high and so when you have domestic violence issues [tensions are] magnified and increased because people don't have coping skills."

In the worst-case case scenario, she described: "The perpetuator can isolate a person from family or school -- we don't have any of these resources right now at all. They have to manage that for themselves and the kids. There's going to be a moment where they can't stop the abuse. We talk to them to stay connected as much as you can, that you can go to the shelter. Now is not the time to do deep processing, but just keep yourself safe."

CAV counselors are doing emergency counseling by phone. When people call the hotline (575-758-9888), a CAV counselor will respond within 24 hours and provide a full session over telehealth.

CAV still maintains an emergency shelter for seven families and is able to house people in danger at undisclosed shelters in Taos.

Where Sump sees an immediate higher need is among women over 50 who find themselves in unbearable social isolation.

These women had formerly been in therapy, left abusive partners and created a new life for themselves, and are not actively in therapy. "Now that they are in quarantine, they aren't getting social connection, and they are people in total isolation. We are creating a Zoom group for them--they are learning to use the new technology with new friends who are distant," said Sump.

Choosing physical safety over mental health

Eric Mares is the clinical director at Taos Behavioral Heath, formerly at Children, Youth and Family Center. The main stressor he sees at this point in the pandemic lockdown is the "fear of the unknown."

"It is never comfortable for anybody to ask for help. Now people are really afraid - and asking for help - these are two hard issues. People are managing the stress the best they can - but if you don't have the supports you need, there is more likelihood for abuse, drug abuse, domestic violence, etc."

"It has been [four] weeks in isolation," continued Mares. "A lot of people are referred to us by medical advisers - people are not sure how to prioritize day-to-day functioning -- there is a lot of depression, anxiety about the unknown. We help them process. On top of that we have community referral, self-referred clients and schools, too - we are helping parents managing."

Mares described how parents now have become the teachers. "We have a personal relationship with most of the schools, Taos Municipal Schools, six or seven programs already. We talk with officials and help them navigate the content - especially giving help with anxiety on how to access Zoom technology."

He noted that TBH has moved most of its services to Telemed: "We are keeping our offices sterile and cleaned and limiting group sizes to five in the offices - and on a very case-by-case basis after health screening to meet face-to-face. But we prefer to work by phone or Telemed."

Mares stressed that physical safety for people is now a priority, not accessing mental health services. But he sees the need will increase soon. "Referrals will probably increase 10-fold in the next months because people need to access resources. People will start finding they don't have the resiliency to make wise decisions - they will reach out to health services to help them process emotional stresses."

Danger of relapse

Trina Kaiser is a clinical mental health and licensed alcohol and drug counselor at Trauma and Recovery services based in Silver City. She was summoned to the El Prado office of Trauma and Recovery in early April to address the emergency transition from face-to-face counseling to online. Apple-converted-space

"The mental health agencies were closing down and going online and we said we couldn't all of a sudden shut the doors," she said. "So I came up here to help maintain some services until we could transition online."

Kaiser describes the center as an intensive outpatient program for mental health and substance abuse clients, providing mediation, organic meals, cognitive work, yoga, drumming and pottery - much of which the staff now needs to provide either online, through Zoom, or daily and weekly deliveries. Kaiser said there are an average of 12 clients in the intensive outpatient program.

"Client families needed to know we weren't shutting the doors on them until we had other services in place - such as deliveries to their homes," she said. All the clients were given smartphones and the clinic went online successfully Monday (April 6).

Like Sump - who speculates that numbers of people in crisis "will go up in the next couple of weeks - the longer this [mandated social isolation] goes on the more people reach out" - Kaiser sees this as a time of "high need."

She watched people "spin out," she described, from "fear especially - isolation is not good for anybody especially for those with mental health disorder."

Strategies for coping

Grady, the preschool teacher and student, expressed strong regret having to abandon the face-to-face relationship with his therapist. "There is a lot of power in somatic expression and face-to-face therapy and the switch to virtual therapy has a lot of variables that are difficult," he said. "I have access to this format but not everybody has that access."

For single mom and accountant Amanda Dean, "the schedule really helps," she said. "One day at a time."

In terms of managing anxiety about the unknown, Mares recommended "grasping what we do have control over: healthy habits, self-care, daily routine, healthy eating, not exposure to unsafe conditions, not spending all your money - and using the web to access resources."

For parents navigating children stuck at home, who can't see their friends and do sports, Sump recommended "not to micromanage behavior. Children often act out."

She suggested: "Going for a walk, finger play, playing in mud. It's very tricky for all kids but especially for kids in domestic violence situations who don't know the coping skills and need that extra support."

As the duration of the quarantine continues, Sump emphasized: "We need to be compassionate and think outside of the box. It is going to take some creative thinking." Apple-converted-space

Grady concluded: "There's also a beautiful piece of surrendering, too - to the process and from a day-to-day basis and being able to adapt and cope with the changes without any expectations of what to do next."

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