Break of Day Mental Health Group warned that the industry is in “a state of crisis” in Maine because of a lost sense of community during the COVID-19 pandemic.
Anxiety over whether to wear a mask or not with a record-setting number of positive COVID-19 cases at LincolnHealth in early December is inhibiting people from participating in regular community events such as attending Mass, or even knocking on their neighbor’s door to see if they need anything, President and Executive Director Amber Lavigne said.
“But it’s more important now than ever,” she added.
A new report from U.S. Surgeon General Vivek Murthy found that symptoms of anxiety and depression doubled during the pandemic, and emergency room visits for mental health reasons increased dramatically.
Reminders to practice self-care and decompress with a walk or a bubble bath are becoming increasingly prevalent, but “we also need to take the time to connect to community,” Lavigne said.
The holiday season is filled with excitement, but it is also the pressure and stress to create a specific experience that can leave some feeling lonely, especially with shorter, darker days.
“Something as simple as knocking on a neighbor’s door if the roads are slick and saying: ‘Hey, I’m running to the store, do you need anything?’ makes a difference, especially if they are older or have a history of mental illness,” Lavigne said.
The Patriotic Club of Bremen runs a local project called ‘Christmas Cheer,’ and brings poinsettia plants, cookies, candy, and other foods such as applesauce to a handful of people in town that need a boost during the holiday season, president of the group Cordelia Goth said.
Most of the people they visit are recommended by word of mouth.
“We’re a community,” Goth said. “If you know somebody that’s down, then go over there.”
In the absence of strong community ties, people lose their sense of self, which contributes to symptoms of depression and compounds other struggles people are facing, Lavigne said.
“If you suspect someone is struggling, you should reach out to their natural supports,” she said, such as a mother, brother, or close friend, and ask if they’ve noticed the person has become more withdrawn and irritable, and sleeping or eating less.
Without asking what’s wrong, the family member or close friend should acknowledge something is off and offer support, said Stephanie Field, licensed clinical social worker and program manager for behavioral health integration at LincolnHealth.
“Saying ‘I’m here for you when you want to talk’ about it gives them some control in case they’re not ready,” Field said.
Recommending resources such as Break of Day and clinicians involved with LincolnHealth directly is another way for family members to support someone who is struggling. At Break of Day, family members are allowed to accompany patients for their initial assessment, which can help relieve some anxiety or fear.
Traditionally, mental health patients were referred to an outpatient therapist, outside of the primary physical care space. But that is changing, Field said. Concerned family and friends can encourage someone who is suffering from depression or anxiety to call their doctor to help find a mental health specialist for emotional help.
“That’s a very valid reason to call your doctor,” Field said.
It can be difficult for people struggling with depression or anxiety to organize their thoughts or gather the motivation to reach out for help.
“Any opportunity to connect with neighbors, whether it is shoveling snow off their sidewalk or knocking on the door and saying ‘Hey, I haven’t seen you out and about, everything OK?’ can make a difference and let the person know you care about them,” Field said.
Maine’s mental health care crisis
But across the country in both rural and urban areas, there is a growing shortage of clinicians and mental health specialists to assess and treat anxiety, depression, and eating disorders.
As the pandemic nears its two-year mark in the U.S., Lavigne said the skyrocketing number of referrals hasn’t slowed down since the start of the pandemic. The agency is consistently getting double the number of referrals it used to with less than half of the staff needed to meet the demand.
“It feels just as bad today as it did at the start,” Lavigne said.
However, throughout the pandemic frontline health care workers such as clinicians and social workers chose to leave the field because of anxiety over exposure to the virus working with patients in person. Low wages for social workers in behavioral health, who are reimbursed by the state at rates that haven’t changed in about 20 years, are also driving people out of the profession, Lavigne said.
The number of Break of Day employees in the field dropped from 50 to 17 over the last two years.
“The state of Maine is truly in a crisis when it comes to mental health services,” Lavigne said.
The group’s Daily Living Skills program, which supported people in the community to maintain their homes and hygiene, was forced to close after two staff members left, leaving those who needed the program without services in the area.
“Why would people spend their time driving around the state motivating people to get out of bed and take a shower when they could make the same amount of money flipping burgers at McDonalds without having to drive,” Lavigne said.
The state is conducting rate studies, which will potentially urge lawmakers to increase rates by July 2022. Otherwise, entities like Break of Day will “continue to see more programs close,” Lavigne said.
Of the nearly 400 mental health professionals in schools who responded to a survey by the Maine Department of Education, 90% reported an increase in symptoms of both depression and anxiety.
And one-third to a half of patients visiting MaineHealth’s emergency departments are in need of behavioral health care, according to the health care organization.
Professionals like Lavigne have been raising the problem of mental health resource shortages to the state legislature for a number of years before the pandemic, driving up to Augusta to sit in on hearings and drafting legislation that would help fill the gaps. But the virus was “the straw that broke the camel’s back,” she said. “We’re screaming that we need help.”
Field has been a social worker for 25 years, and the “sheer volume of patient need during the pandemic is the highest” she has experienced, she said. “We are in a national crisis with scarce resources to meet high demand.”
The silver lining, however, is there has been what Lavigne describes as a “mild increase” in the number of young people reaching out on their own for help, or people walking into the office on Belvedere Road in Damariscotta recognizing they need help and wondering where to start.
And self-referrals have come from people living homeless in the woods and needing support in getting a job, as well as fully employed people with families.
“Mental illness doesn’t discriminate,” Lavigne said.
Whatever a patient is struggling with, Break of Day’s case management program connects people with food banks, clothing banks, housing assistance, and therapy resources.
“People with mental illness sometimes struggle to complete tasks,” and the case management program helps them make the phone call, Lavigne said.
Concerned family members can also reach out directly to resources like LincolnHealth or Break of Day for advice on how to encourage a struggling loved one to reach out for help or take action if individual check-in conversations aren’t helping, but high demand should not dissuade people from reaching out for help, Field said. There are about 60 clinicians connected with MaineHealth that also specialize in areas such as substance abuse recovery, women’s health, and neurology.
The National Alliance on Mental Illness Maine also has a website with information on state resources at namimaine.org. The website 211.org also logs local resources, including a variety of support groups.
If you are concerned about yourself or somebody else, Maine has a 24-hour mental health crisis hotline at 1-888-568-1112. The national hotline is 1-800-273-8255.
Chat with a crisis counselor online at suicidepreventionlifeline.org/gethelp/lifelinechat.aspx.