Rebecca Hoffman Frances, senior director of clinical innovation and training at Maine Behavioral Healthcare in Portland, works from home on March 24, 2020. Credit: Contributed photo

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As hospitals across Maine deal with the novel coronavirus, mental health professionals are thinking about the potential fallout from weeks of social isolation and the shutdown of life as most know it.

Physically distancing oneself from others is essential to slow the spread of the virus, but it can exacerbate depression and anxiety, according to several Maine counselors, who are largely switching to meeting with clients over video conference. Regardless of whether people have a diagnosed condition, losing control over the basics of one’s life can trigger a flood of stress.

The stress, represented by surging cortisol levels, slows down people’s ability to plan and reason through their situation, and leads to more reactive decision making, which in turn can create more stress.

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“Folks are scared. They have every reason to be, but how we cope with fear is really paramount to our mental health in general,” said Jim LaPierre, a licensed clinical social worker and the executive and clinical director of Higher Ground Services in Brewer.

Unlike other disasters, the coronavirus pandemic affects everyone, the therapists said. What the future aftermath will be is, as yet, unclear. But Rebecca Hoffman Frances, senior director of clinical innovation and training at Maine Behavioral Healthcare in Portland, is expecting an increase in demand for services over time.

Some agencies will likely postpone counseling sessions for those facing less critical needs. So clients with underlying depression or anxiety, who normally fare well but now need more attention, may struggle to find care, said Hoffman Frances, who is a licensed marriage and family therapist and oversees a staff of about 20. Without support, people could deteriorate psychologically over time and ultimately require more care, potentially in the emergency room.

She also expects many frontline health care workers will need to debrief about what they’ve endured.

Chuck McKay, a licensed mental health counselor in private practice in Brewer, questioned whether life will become simpler for some. “Part of me predicts that things will get worse, and people will struggle. A part of me thinks people will get better because we’re going to be less busy, less hectic,” he said.

[Coronavirus could overwhelm Maine hospitals. Social distancing can save beds and lives.]

When stress becomes toxic, it tips over into becoming a trauma, Hoffman Frances said. While she worries about more and more people reaching that tipping point, there are ways for families and communities to bolster their resilience.

It starts with connections. Her two children are writing letters to other kids, for instance, she said. Her 8-year-old son has talked to a friend over Facetime where they showed each other Pokemon cards. She knows of adult women getting together on the video conferencing site Zoom at 5 p.m. for happy hour. Other people are going for group walks outside but maintaining distance between them.

At the same time, people of all ages need some structure to help them feel safe. “Kids aren’t little adults. They process information differently. Their lack of routine to them may be very, very scary,” she said.

Adults should also have a plan for themselves. “Have you decided to shelter at home? What does that mean if the neighborhood kid knocks on the door? What does it mean when the mail comes?” she said. “Having a plan helps us get control back.”

Therapists also emphasized the importance of reaching out to others. Practicing kindness has the added benefit of releasing the feel-good hormones oxytocin and dopamine.

“When I’m stuck in my own fears or depression or worries, the very best thing is to be of service to others,” said LaPierre, with Higher Ground, who recommended reaching out to local organizations that are helping the elderly or those with addiction to see what they need.

Jesse Speed has begun offering doorstep puppet shows for children in his Fairmount neighborhood in Bangor.

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“Hearing the kids laugh, joke and dance with the puppet is enough to lift my own spirits and makes me remember that we still need to fight for the future of our children because this will be their world someday,” Speed said.

People can also reflect inward. Recently Brent Scobie, vice president for clinician services and quality at Northern Light Acadia Hospital in Bangor, talked with someone who shared that, when they weren’t thinking about home or work, they were thinking about the coronavirus outbreak. Then their worries spiraled.

“Pay attention to that. Be mindful of it,” Scobie said. “Try to direct yourself back to something that’s more productive to think about.”

Beyond mindfulness, another strategy is for people to periodically write down a list of activities that calm them, such as reading a book, listening to music or talking on the phone with a friend, Scobie said. Then, when stress arises, people can turn to their ready-made list instead of reacting in unhelpful ways.

[Interactive map: The number of confirmed coronavirus cases in each state]

The current situation will not last forever, Scobie said, and there is some comfort in that.

“In particular it will pass much more readily for us if we pursue the recommendations given to us by the CDC and other organizations to have social distance and avoid large crowds,” he said.

Some people have experienced a good deal of social isolation in their lives. Their situations are now exacerbated, said Christine Brown, program director of community integration at Aroostook Mental Health Center, which serves Aroostook, Hancock and Washington counties.

And while anxiety will likely compound in the short term, she believes “that among the long-term effects will be significant feelings of loss and grief.” Grief may come from losing loved ones or from losing “a way of life that may never be the same.”

She oversees a number of services, including two group homes, in Presque Isle and Madawaska, for people with severe and persistent mental illness. Residents may have a range of diagnoses, such as schizophrenia, schizoaffective disorder, bipolar disorder or severe post-traumatic stress.

There are now no group outings and no visitors are allowed in the homes to control the spread of the virus, called COVID-19, Brown said. Residents have reacted in different ways. Some are fine.

“They’re safe. They’re getting their meals. They’re getting their counselors on site. In many ways, life hasn’t changed all that much for them,” she said.

[What you should know about social distancing, self-quarantine and self-isolation]

For others, the virus contributes to their delusions and anxiety.

“If it’s someone who has a phobia of germs and already has a delusional thought pattern, that’s going to feed in. That’s not delusion. It’s reality-based now,” given that COVID-19 is invisible and people can die from it, Brown said. In response, staff tell them what the homes are doing to keep them safe.

The strategies for the public to stay well are basic, she said: Eat as balanced a diet as possible, drink plenty of water, get enough sleep, be aware of the effect of caffeine and sugar on your anxiety, exercise regularly, take deep belly breaths throughout the day, limit news and social media consumption if it creates stress, find a creative outlet, keep track of the reasons you have to be grateful, and write in a journal that your children could read one day.

Brown said she focuses on what is possible. “Remaining calm. Staying focused. I have my work,” she said. “It’s as much as possible being part of a solution.”

Watch: What older adults need to know about COVID-19

Erin Rhoda

Erin Rhoda

Erin Rhoda is the editor of Maine Focus, a team that conducts journalism investigations and projects at the Bangor Daily News. She also writes for the newspaper, often centering her work on issues of sexual...