Crisis centers often take calls from people struggling with mental health issues, from anxiety to depression to suicidal ideation. And across the United States, calls from people in crisis have risen, including reported increases in Oregon, Massachusetts and New York.
Since California's shelter-in-place order took effect, the calls to CSS have remained around 120 to 130 calls daily.
For some, the isolation and uncertainly of COVID-19 can exacerbate existing mental health issues, and some people are even experiencing virus-like symptoms induced by their anxiety.
Daniella Bermudez, a crisis counselor at CSS, said helping callers determine if they are experiencing symptoms is the first step.
"Are they feeling very winded, like they just sprinted and even at rest, they can't catch their breath? — which is, you know, a good way to tell if somebody is having difficulty breathing. Or is the breathing connected to anxiety? Are they getting more anxiety from feeling like they can't breathe?" she said.
The next step is helping a caller figure out what to do next.
"Some people are like, 'Should I go to the hospital?' And right now we know that we don't want to put more people at risk by going to the hospital. So, what are the alternatives?" said Bermudez. "Who else can they involve in their care right now?"
Bermudez said she tries to refer callers to speak with an advice nurse, family members or friends — essentially, people who can help make choices about health care. She also provides them with factual information from the Centers for Disease Control and Prevention, which can help put their minds at ease.
Other organizations in the Bay Area say they haven't seen the same uptick in people reaching out for help, but they expect that as people continue sheltering in place, those numbers will rise.
Danger at Home
Some providers said one reason calls may not yet have increased is that people could be afraid to call from where they're sheltering, which may not be a safe or accepting place.
Aaron Almanza is the executive director of the San Francisco-based Lesbian, Gay, Bisexual and Transgender National Help Center. He said they've seen an uptick in online chats since the outbreak — about 55 to 60 per day, up from an average of 40 — but not yet an increase in calls. Almanza theorized that may be due, in part, to the nature of his organization's call center, where a lot of callers are closeted or in the process of coming out.
"They're stuck at home with people who are transphobic, biphobic, homophobic," Almanza explained. "So they can't really call us and talk to us on the phone like they normally can."
Some may even be experiencing domestic violence and are unable to make calls safely.
The Trevor Project, a nationwide suicide prevention and crisis intervention nonprofit focused on LGBTQ youth, reported increased mentions of COVID-19 from the youth who have reached out for support.
"For LGBTQ young people, many of whom already face unique mental health challenges due to increased experiences with discrimination and harassment, social isolation can mean being forced back into the closet or unsupportive, even abusive home environments," said Tia Dole, chief clinical operations officer for the nonprofit.
Finding Ways to Cope
It can be hard to emotionally navigate an unprecedented event like the COVID-19 pandemic. And Bermudez, who works the night shift for Alameda County's CSS, said she tries to remind callers that there's no "right" way to react.
"Really, all responses are OK and valid and appropriate," said Bermudez. "We're having our valid, true, genuine, appropriate responses to a very atypical, not-expected situation."
During his daily briefing on April 7, Gov. Gavin Newsom announced a series of guides to help people manage stress during the pandemic.
"The health impacts of coronavirus go beyond infection and COVID disease," said California Surgeon General, Dr. Nadine Burke Harris. "It’s important to know that these changes aren't just in your head, and to begin to identify how stress shows up for you – physically, emotionally and behaviorally."
The two "playbooks" rely on evidence-based guidance for how to relieve stress. One is for everyone; the other is specifically designed for parents and caregivers.
Here are a few other things you can do to help address the anxiety:
Acknowledge your feelings
Be it a loss of our jobs, routines or just a feeling of normalcy, CSS's Dillon said it's important to set aside some intentional time to identify and acknowledge our feelings.
"[To] actually name that, and give it space and allow ourselves to be upset as opposed to try and put on a brave face can actually help the negative feelings pass with less pain, as opposed to when we're trying to hold everything and pretend that we're going to get through this strongly," said Dillon.
Reduce your news consumption
"One of the ways that people can manage their anxiety would be to give themselves an allotment, [like]: 'I will check in X amount of times per day for X amount of minutes' so I can stay informed without becoming overwhelmed," Dillon said.
Connect with loved ones
Whether it's a phone call or FaceTime, finding ways to connect with friends and family can help alleviate moments of crisis.
"Even if you can't talk to people face to face, [it's] finding those different routes to finding the support that you deserve to have in your life," said LGBT National Help Center's Almanza.
Find ways to spend your time
Whether it's going for a walk, watching a movie, practicing yoga or meditation, or just listening to music — finding a way to get your mind off what's going on can help you mitigate your stress.
Whether you're in crisis, or just feeling anxious and overwhelmed, you can reach out for help.
"You don't have to be in crisis to call us," said Dillon. "We want people to call us when they're having a bad day as a way for us to prevent them ultimately being in crisis."
Here's a few organizations you can reach out to: