SPRINGFIELD — Take time for yourself during this COVID-19 pandemic.
That’s the advice of Baystate Health psychiatrist Barry Sarvet.
The medical complications of COVID-19 can be complex, but so, too, Sarvet noted, are the behavioral health impacts of the novel respiratory illness.
Its global spread has not only infected nearly 4 million and killed more than 200,000, but also upended normal life for people of all ages in its disruptions to businesses, schools and events planned.
“It is stressful to have a pandemic going on," said Sarvet who chairs Baystate’s department of psychiatry.
"It is stressful not to have any money because you do not have any any coming it from your employment or business. It is stressful to not know what the future holds. All this adds up to stress and influences the risk for mental health conditions. All the standard conditions, whether it is depression, anxiety, bipolar disorders, schizophrenia, psychosis, all these conditions are aggravated by stress.”
While most “everyone is working so hard and doing their jobs to make ends meet to support their families,” Sarvet said it is important to “check in with yourself for what you need.”
“This is a challenge when there is so much work to be done and everyone is focused on how to survive,” Sarvet said.
“But you need to step back and do a mindful pause to not deprive yourself of things that you need to heal or that make you happy in some way.”
Sarvet called this “being realistic” and not selfish.
“You can’t take good care of anyone else unless you take good care of yourself,” he said.
“It is a cliche, but it is true. If you don’t show generosity and kindness to yourself, you are probably not going to be very nice to other people.”
He urged people to “be aware of signs and symptoms encountered” with mental health conditions.
“Depression is an area to consider,” Sarvet said.
“What does it look like, what are the signs of it. Its cause can be unresolved grief and people are experiencing this in losing their jobs and having their lives becoming impoverished and and not being able to grieve that loss.”
Sarvet urged people with mental health symptoms to “call your primary provider" for support in addressing them.
“More and more primary care providers have resources to help with this. Baystate providers have behavioral health integrated into in their practices and can help individuals sort out what is going on and start the ball rolling."
Sarvet said he has concerns around particular behavioral health issues with the pandemic.
“One thing I worry about a lot are substance use disorders," Sarvet said.
"When people are at home they lose the structure of their lives. There is a risk that they are going to start to have difficulty managing what needs to be managed around substance use disorder. Routines helps people manage in recovery. Substance use disorders are often fueled by the need to self medicate for managing stress, so that is another factor and a big concern.”
Sarvet also noted “that the frequency of patients who are coming into emergency psychiatric services has gone down in the immediate circumstance of the pandemic."
“People do not want to come to the hospital unless they absolutely have to so people are deferring their mental health needs,” Sarvet said.
“This is understandable in the acute phase of what is happening in the world, in the country and our state. But, it is not going to last. These problems that we have been dealing with do not go away. They really cannot be temporarily diverted by other more immediate needs. They still simmer beneath the surface.”
He urged people to continue to seek help with ongoing behavioral health issues and noted that much support is available through telehealth therapy, both on a one-to-one basis and with groups now meeting through online platforms.
“Some people may not have confidence going to a virtual group instead of their regular in-person group but many people are finding those virtual groups are very helpful," Sarvet said.
"Most of the programs in the community have been able to virtualize their programs so people can access that without being in person. I am encouraging people to be open minded about that.”
Sarvet said he also worries “a lot about children and adults in terms of the risk of domestic violence.”
“When people are busy, going to work and about their lives they are distracted from some of the day-to-day triggers in terms of problems with anger management,” Sarvet said.
“Being more cooped up in the house together and under stress is like a bad toxic stew and creates worries for increased rates of child abuse and domestic violence.”
He noted hotlines for those experiencing domestic abuse remain operational.
He added Baystate has “done a lot of work with families about how to structure time at home and talk with their kids about what is going on" to help with stresses around the pandemic.
“Kids are more likely to act out and get really difficult with there is stress and they have no one to talk to about it,” Sarvet said.
"You might have a kid who has behaviors that are provocative to parents who are stressed and have their own anger management issues. You want those kids to be able to have conversations with their parents about what is going on and how they are feeling.”
He added, “One of the things parents can give themselves is to let their kids watch some TV."
“There are parents too scrupulous about following the usual recommendations on this,” Sarvet said.
"These are not usual times so putting your kid in front of the TV to make some less stressful time for the family can be a good thing. This, of course, does not mean all day.”
He advised parents to “design a schedule that includes some downtime and also includes some physical activity and time to talk for kids to talk with parents and time to do chores.”
“These are all the different things that you would think are good for kids to do but organize a schedule to make sure these things are happening,” Sarvet said.
“Make sure your kids get the right amount of sleep. If you leave kids to their own devices because they don’t have to get up for school in the morning, bedtime starts drifting later and later and then then you start losing control of when they are eat. Everything starts to fall apart when sleep schedules get disrupted.”
When asked about a survey that showed people in their 20s and 30s the most likely age group to seek help for mental health issues during the pandemic if it were offered free, Sarvet said the results did not surprise him.
“People in their 20s and 30s are concerned about their health and want to take precautions,” Sarvet said.
“They are in a stage of insecurity in which they have yet to settle down to what their life is going to be like and they worry about the future.”
He added the results as well “may be a reflection that we have made some headway in terms of reducing the stigma around seeking out mental health treatment."
“People in this younger age group represent a new generational attitude about treatment," Sarvet said.
Sarvet said that while there are “a lot of troubling signs in how people are reacting to stress," including people with guns enraged at government leaders over restrictions designed to limit coronavirus transmission, he noted many are “rallying” and pulling together during the pandemic and its deep impact on all aspects of life from social to civic to economic.
“Trauma disrupts your expectations for everything that you take for granted,” Sarvet said.
“It cracks open your vision of life and undermines your sense of security."
He added, “This pandemic is a trauma and it is a shared trauma for a whole society, which makes it better in some ways than personal traumas suffered alone.”
"It is easier to acknowledge together, not that it does not have private dimensions as everyone has personal experience within trauma, but for the whole society to go through something connects everyone together and presents an opportunity to lean on each other for support and makes people more resilient as long as we don’t start fighting.”
He called “heartbreaking” family unable because of restrictions to reduce the spread of COVID-19 to be with a relative dying in hospital or nursing home of the disease.
“It is heartbreaking to have to let go of a family member without being able to hold their hand and be with them,” Sarvet said.
“There are resources, including religious organizations, in the community, helping support families with such loss.”
Sarvet said people “rally in times of crisis.”
“People are rallying and there is a tremendous amount of resilience that is being demonstrated. This inspiring,” Sarvet said.
“The bigger challenge psychologically is long-term. People can have these bursts of goodwill and energy to cope in the middle of crisis, but we are going to be vacillating between opening things up and then shutting them down for however long the pandemic lasts and this is going to be hard on people. Managing the stress and anxiety is going to be a long-term process.”