For someone with a mental health diagnosis, disruption in routine or ability to continue treatment can be dangerous, which means the upheaval caused by the current coronavirus outbreak has put mental health providers on heightened alert.

The state has seen an increase in calls to both its crisis hotline and the “warm line” for non-crisis situations, although the actual numbers have not been tabulated, officials said.

Greg Marley, clinical director of the National Alliance on Mental Illness in Maine, said anxiety and stress are elevated among everyone right now, but those with existing mental health diagnoses are at greater risk for self-harm or suicide.

“I’m not only talking to people who have those mental health needs but to treatment providers who are trying to figure out how to do this,” he said Friday. “I was talking to a friend who’s a therapist. She had 33 clients scheduled for appointments and said, ‘I don’t know if I can serve them.’ Her agency was essentially shutting down.

“So people are trying to maintain a level of care, but it’s a scramble. Some systems of care are better prepared,” he continued. “What’s really hard is someone who has an emerging mental health crisis and needs to be diagnosed.”

Most behavioral health care providers are still operating but have moved as much as they can online or over the telephone. Prescriptions, for those who need them, are still being filled or refilled without an in-person appointment.

“People in Maine have been in situations where they have been socially distanced, including severe weather,” said Dr. Jessica Pollard, director of the Maine Office of Behavioral Health, formerly the Office of Substance Abuse and Mental Health Services. “But I would say that the level at which the public health response has mobilized, that’s a new experience for people.”

Pollard said the state saw increased volume last week in calls to both the statewide crisis line and the state’s “warm line” for non-crisis calls.

“We’re tracking those numbers and don’t have specifics just yet. But we anticipated this was something that might happen,” she said. “We are specifically looking at how we can staff our crisis services and looking at ways we can step up support to our warm line for those who are maybe not in crisis but just need someone to talk to.”

Suicide is always among the biggest concerns among those with mental health diagnoses and rates already have been rising steadily over the last two decades.

The suicide rate in the United States increased by 30 percent between 1999 and 2016 and suicide ranks among the top 10 causes of death, with 44,965 people dying from suicide in 2017. The rate of suicide in Maine has been increasing at about twice the national average, from 12.7 per 100,000 people in 2009 to 18.8 per 100,000 people in 2017. There were 274 suicides in Maine in 2017, up from 226 in 2016. The highest rate is among males 75 and older, a population that is likely more isolated than ever because of the coronavirus.

Also in Maine, 56 percent of suicides are caused by firearms, which is concerning in light of the fact that more people are buying guns and stocking up on ammunition since the coronavirus outbreak.

“It’s that sense of hope versus hopelessness,” Marley said. “Hopelessness is a hallmark of depression already and is such a driver for suicide risk.”

Rob McCarley, vice president of medical affairs and intensive services for Maine Behavioral Healthcare, said mental health crisis beds are still available across the state – including at Spring Harbor in Westbrook, which he manages – and all new intakes are still happening face to face. Almost everything else has moved online.

“We haven’t closed down any clinics, but we’ve taken all our appointments and made arrangements to do them remotely,” he said. “It’s amazing how much we’re doing by phone. The transition was anxiety-provoking, but it has gone well. It’s certainly a different thing for counselors. You can read body language, so that can be tricky.”

McCarley said patients have been appreciative of the minimal disruptions in service.

Pollard agreed that the biggest shift in mental health services has been toward telehealth. Patients who might normally be used to seeing their counselor or therapist face to face are now doing so via phone or video, if possible. She said providers are asking for flexibility in how different programs can be staffed. Others are concerned about whether they will continue to be supported financially and keep their doors – or at least their phone lines – open.

Maine lawmakers passed a bill last week, which was signed by Gov. Janet Mills, that allows for MaineCare reimbursements for telehealth services used by patients receiving targeted case management services, including behavioral health.

Additionally, on Friday, U.S. Sen. Angus King, I-Maine, joined a bipartisan group of 26 senators in calling on the Federal Communications Commission to increase subsidies to health care providers through the Rural Health Care Program. That money would be used to expand telehealth services.

Those on the front lines of providing services, who are some of the most at-risk when it comes to dealing with the increased stress, have seen their support shift as well

“At NAMI, we do tons of face-to-face trainings and support and all that’s gone right now,” Marley said. “So  we’re scrambling to put what is evidence-appropriate online. Every day we’re doing a Facebook live segment for people.”

Mental health experts said it’s hard to compare the current crisis to anything in the past.

Marley said the most recent example was the economic recession of 2008, which stretched on for several years.

“That was a period when many lost their jobs, lost access to health care,” he said. “It was primarily an economic stress, but that’s something that increases stress, mental health concerns and suicide risk.”

Sometimes, unaddressed trauma that builds up over prolonged quarantines and periods of social isolation can have public health repercussions that last years. In other cases, people might self-medicate more with drugs or alcohol, which could lead to dependence or addiction.

But other types of crises, like a natural disaster or a war, sometimes prompt people to “come out of their self-focus.”

“So, suicide rates actually go down during these points of crisis,” Marley said.

The current situation, he said, feels like a combination of both.

“Because everyone is focused on this virus – it’s impacting everybody – we’re being invited out of ourselves to look at the larger picture,” he said. “But on the other side is the inequality of who is being impacted. We can’t lose sight of them.”

SUICIDE AND MENTAL HEALTH RESOURCES:

Maine Crisis Hotline: 1 (888) 568-1112

Maine’s warm-line for non-crisis calls: 1 (866) 771-9276

Other state resources in Maine: 211

National Suicide Prevention Lifeline: 1-800-273-8255

Additional resources are available online:

The National Alliance on Mental Illness, Maine:
https://www.nami.org/getattachment/Press-Media/Press-Releases/2020/
COVID-19-and-Mental-Illness-NAMI-Releases-Importan/COVID-19-Updated-Guide-1.pdf?lang=en-US

Maine Department of Health and Human Services:
https://www.maine.gov/dhhs/samhs/coronavirus.shtml

U.S. Centers for Disease Control and Prevention:
https://www.cdc.gov/coronavirus/2019-ncov/
prepare/managing-stress-anxiety.html