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The COVID-19 pandemic has dominated the health care spotlight for the last two years, continuing to reinforce its status as the top infectious disease crisis of the 21st century. But another medical issue has bubbled just below the surface, garnering far less public attention even as it impacts, to varying degrees, a vast majority of the population – the mental health crisis. And for many, it’s more than “feeling down” or having a general sense of discontent. Research from the Boston University School of Public Health, released in October 2021, indicates that depression among adults in the United States tripled in the early 2020 months of the coronavirus pandemic, jumping from 8.5% before the pandemic to a staggering 27.8%. That elevated rate of depression persisted into 2021 and even worsened, climbing to 32.8% and affecting 1 in every 3 American adults. The American Psychological Association (APA) reports that rates of anxiety and depression among U.S. adults were about four times higher between April 2020 and August 2021 than they were in 2019, with some of the sharpest increases among men, Asian Americans, young adults and parents with children in the home. According to the APA, reports of anxiety jumped from a range of 7.4%-8.6% in 2019 to a range of 28.2%-37.2% between April 2020 and August 2021. Similarly, reports of depression climbed from a range of 5.9%-7.5% in 2019 to a range of 20.2%-31.1% from April 2020 to August 2021. And a 2021 report from Mind Share Partners examining the state of workplace mental health issues indicated that 76% of those surveyed reported at least one symptom of a mental health condition in the past year; 84% reported at least one workplace factor that negatively impacted their mental health; and 50% of workers had left a previous role due, at least in part, to mental health reasons. The problem is real and persistent, experts say. Yet looking forward, there are still reasons for optimism as the pandemic wanes and a “new normal” of social behavior gradually emerges. Mental health and workplace stressors One of the most common sources of mental health issues is stress in the workplace, which often reflects the stressors experienced in an employee’s life overall, said Jennifer Becker, a licensed mental health counselor and owner of the Insight Therapy Group in Cedar Rapids. “People are still in the process of adjusting,” Ms. Becker said. “What we hear when we are working with our clients is that it’s a scramble to continue adjusting because it feels like the changes keep coming. I don’t even know what wave we’re currently in, in terms of COVID. (First), things are bad, then they get better, and people start to relax, and they start to feel like life might get back to normal, and then they’re swung into it again when another wave comes through.” From in-person work to a drop in social interaction, the lack of predictability has a cumulative effect on mental wellness, Ms. Becker said. “To say that these last few years have been a roller coaster is an understatement,” she said. “From a mental health perspective with adults, we are having to be on our toes all the time, and that’s not something that most of us are accustomed to, so that’s causing increased symptoms of anxiety. It’s causing increased mental health symptoms overall. We’re definitely seeing a lot more depression, more trauma related symptoms. These things are hitting people harder, and they’re having less time to recover.” “The most common workplace stressors that contribute to mental health challenges among employees across all industries include concerns about getting exposed to the virus at work and employment security,” said Christopher Razo, an attorney with Polsinelli in Chicago, in an August article published by the Society of Human Resources Management (SHRM). “The pandemic has brought us circumstances that were unexpected and continue to pose challenges, including to our mental health,” added Amy Siegel Oran, an attorney with Kelley Kronenberg in West Palm Beach, Florida. “Employers should continue to acknowledge and address these challenges facing employees.” Education, health care facing specific challenges While many students have transitioned back to full-time in-person learning, others continue to operate on a hybrid model, and others have chosen a fully-remote option where it’s available. Those dynamics create challenges, not only for the students but also for educators – and even for the parents who may be working from home. “A lot of kids did homeschooling for a long time because they weren’t able to be in the classroom, and some parents kept them home longer due to their own choices,” said Thea Bedell, another mental health therapist at Insight who specializes in treating school-aged children. “A lot of kids now have started going back to school, and those transitions have been really hard after being home for so long, whether it be having a hard time leaving their parents or interacting with kids and teachers again. And that’s not to mention parents who may be working from home more. It creates very different dynamics than kids are used to.” One of the most significant issues, Ms. Becker said, applies to students and adults alike – a lack of social interaction. “Socialization is so incredibly important, and from the beginning of this, we were all told to socially distance,” she said. “Teenagers feel whole and feel most comfortable when they’re around their friends. It helps them figure themselves out, determine who they are and helps with their identity development. That’s one of the hardest pieces. There’s a reason that in the correction system, they use social isolation as a punishment. And that’s a part of this heavy level of stress – the inability for us to see the people who support us in an unfettered way.” Also, while the mental health stressors for health care workers may be obvious – a dramatic uptick in COVID-19 infections and hospitalizations – self-destructive behaviors by patients have also soared, from assaults and attempted suicides to high-speed accidents and abuses of legal and illegal substances. “Even when we unlocked a lockdown, we actually had an increase in demand on health care because of people delaying care,” said Gerard Clancy, a professor of psychiatry and emergency medicine and a senior associate dean for external affairs at the University of Iowa’s Carver College of Medicine, during the Corridor Business Journal’s Health Care Summit Feb. 11. “And then we have the self-destructive behaviors that society has put on top of itself. Then the delta variant hit, and it was amazing seeing the morale come down. Then omicron hit. “People are out of gas,” he added. “With the nursing pool that we have in America, almost 50% would like to get out of nursing, which is something that we really have to plan for (now) to retain. So much talent could be leaving the workforce. (And) physicians’ burnout has gone from 39% to 61%. I’m having physicians confidentially telling me, ‘I am not in good shape, I’m angry, I’m frustrated. I just don’t enjoy being a doctor anymore.’ And that worries me very much.” Even those trained to offer mental health counseling have struggled at times, Ms. Becker said, as counselors aren’t immune to the same stressors their clients face. “The pandemic started, the shutdowns began, and we kept working,” Ms. Becker said. “We arguably worked much harder than before. We transitioned to telehealth so we could keep working with our clients. And our caseload was exploding. Referrals were already heavy, and then they got heavier. On top of that, we were dealing with all of the same things that our clients were dealing with at the same time. That is a recipe for burnout. It has been a very rough year.” New services, optimism emerging While the pandemic is far from over, the decline in COVID-19 cases and hospitalizations in recent months is offering a sense of hope, experts say, and along with that trend, the need for new mental health services continues to be addressed, with new workplace task forces forming to provide ongoing mental health services to their employees. In mid-February, the MedQuarter’s Faith & Medicine Task Force rolled out GetHelpNowCR.com, a new “toolkit” of mental health services and resources to offer help and guidance. The website and mobile site is a one-stop-shop designed to offer immediate information and assistance to anyone needing mental health guidance in Eastern Iowa. The site contains a community toolkit of options, with a menu of services specifically designed to direct users to the best local mental health service for their specific needs, including guidance for crisis mental health, suicidal thoughts, alcohol and substance abuse, gambling and domestic violence. Ms. Becker said she’s looking forward to seeing a “new normal” that will present less chaotic turbulence, even if not free of everyday challenges. “I would hope that as we transition from pandemic to endemic, people can experience less crisis,” she said. “I’m hoping the hills on the roller coaster will be a little bit lower, and a transition will make it easier for people to cope because it will become more a part of everyday life. If those intense changes can become not quite so intense, they become more tolerable. When we hit that point, I will feel more optimistic about there being a calming effect.”