The COVID-19 pandemic has exacerbated economic and health care challenges and barriers in the United States. The Kaiser Family Foundation recently released a brief documenting that 4 in 10 adults have reported symptoms of anxiety or depressive disorder, and other negative impacts on their mental health and well-being. These symptoms include difficulty sleeping or eating, increases in alcohol consumption or substance use, and worsening chronic conditions related to worry and stress.
University of Minnesota Community-University Health Care Center Case Manager Rachel Fuller talks about mental health and substance abuse challenges she is seeing in her practice.
Q: How does stress impact an individual’s well-being?
Fuller: I have found that stress has a significant, negative impact on the well-being of my clients. This takes place regardless of one’s age, gender, culture, background or family situation. Stress can impact my client’s medical health by causing them to have trouble sleeping and making it hard for them to prioritize fitness and healthy eating habits. It is common for the stressful situation to demand first place in their order of priorities. I have seen the way that many people tend to react in more emotionally charged ways when they are under stress. This heightened emotionality often causes family conflict and may present significant problems at work and school. As a result of these problems and conflicts, my clients tend to have a deep sense of shame or guilt that carries into many facets of their daily lives. All these dynamics make it difficult for my clients to move forward on the goals we are working towards.
Q: Why do large stressful events like the pandemic trigger addiction or symptoms of anxiety or depression?
Fuller: Stressful events are overwhelming, and I have seen a clear correlation in my work with my clients that I think is important to address. Due to the sense of discouragement that can result from heightened stress in situations, such as a pandemic, I have seen that many people will look for ways to self-medicate.
This, unfortunately, can be the result of the healthcare system being overwhelmed — during a pandemic doctors are not always as available, appointments are only happening virtually, wait lists are long for new services and treatment centers, government benefits are changing their application processes and so on. When people are unable to get the help that they are hoping for during large stressful events, it is common that they will have heightened symptoms of anxiety and depression. Many people then reach a point of desperation that leads them to take things into their own hands and find creative ways to cope with their problems right away. Oftentimes this looks like excess use of substances that can give the “quick fix” that people feel they need when their service providers are not able to care for them in the ways that they may require.
Q: What has the pandemic revealed about health care support for those experiencing mental health or substance abuse challenges?
Fuller: The pandemic has revealed that the health care system cannot be the sole source of support for any person. Individuals who are living with mental illness or who are trapped in addiction need friends, family, neighbors, church community, coworkers and classmates to support them along their journey towards recovery and/or sobriety. Of course, there is a very important role that health care providers bring to the table — the professional support. Doctors, psychiatrists, psychologists, pain clinics, treatment centers and rehabilitation centers can give the professional help that is crucially needed for someone who is mentally ill or addicted to drugs or alcohol. However, I firmly believe that the involvement of those members of someone’s local community is of vital importance as well and should not be overlooked.
Q: How can health care providers connect their patients with additional resources during this time?
Fuller: During this difficult time, health care providers can best support their patients with additional resources by encouraging them to deepen relationships with their friends and family, and helping them to connect with non-professional supports around them in their neighborhoods, workplaces and places of worship and study. I also believe that continuity of care is very important in helping people to recover well from addiction and mental illness. I would suggest making referrals to long-term supports and services as opposed to short-term or emergency-basis services as much as possible.
Patients need to be able to establish trusting relationships with providers who will be by their side through the long and arduous journey that recovery from addiction so often entails. As much as possible, having patients receive care from many of their different providers within the same clinic or health care system is ideal. This interdisciplinary practice is helpful to increase coordination between doctors and professional staff by staying within one clinic or care system. Overall, the thing that is most important is communicating openly with a patient to help them decide what services will be the most beneficial and explaining what each service will offer to help them on their journey.
Q: What else are you doing to further public understanding of mental health and substance abuse?
Fuller: I have been able to attend multiple training sessions this year related specifically to mental health issues and substance use in the Twin Cities and surrounding communities in Minnesota. These training sessions have been a huge help to me in my work as a mental health case manager. I am encouraging other people who are working in this field to take advantage of any opportunities to learn as they come up. There is always more to learn and so many things in the health care system are changing on an ongoing basis!
I also continue to talk with people in my church and local community about ways that we can better engage with the people around us who are in the midst of these battles. How can we be better friends and neighbors? How can we live, even when we’re off the clock, in a way that brings love and support to the people in our own circles who may be living through these struggles of mental health and substance use?
Rachel Fuller is a case manager and patient service representative at the Community-University Health Care Center in the Phillips Neighborhood in Minneapolis.
