Mental Health & Social Distancing

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Katherine Ponte had been obsessively watching the horrors of the Iraq war on cable news in 2006 when she took a hammer to her television. She suffers from severe bipolar I disorder with psychosis as well as major depressive disorder, and the images of a war-torn Middle East triggered a manic episode that caused her to be hospitalized. If Ponte isn't careful, the current coronavirus pandemic could have a similar effect on her. 

"I have to be careful when there is a significant world issue going on because it has been a trigger for me in the past," said Ponte, who went on to found ForLikeMinds, a support network for people coping with mental illness, substance abuse or stressful life events.

Ponte has had three manic episodes that led to hospitalization and one that caused her to be arrested; all four were triggered by major world conflicts or crises. And she is certainly not alone. An estimated 1 in 5 people in the U.S. suffer from mental illness, and 1 in 25 from severe mental illness, according to the National Alliance on Mental Illness (NAMI). They and their loved ones face even greater challenges as coronavirus continues to spread. 

"This is an increased anxiety for everyone," said Dr. Ken Duckworth, medical director of NAMI. "So if you already have an anxiety disorder, or obsessive compulsive disorder, or unstable housing, or you're already isolated, this is going to compound your problems."

Ponte said she now has several medications that she did not have in 2006, which have helped prevent her from being triggered by the coronavirus outbreak. But even with the medication, learning about the spread of the virus has made her more anxious and has caused her to increase her sleep medications. 

"She can become very preoccupied with news, with tragedies, with politics and with people being mistreated," said Ponte's husband, Izzy Goncalves. "So anything that is widely disseminated in the media can become very impactful. In the worst case, it can set in motion a preoccupation that can spill over into lack of sleep and in the very worst case, precipitate a manic episode."

This is common in people who struggle with mental illness, according to Dr. Ashwin Vasan, the president and CEO of Fountain House, a leading mental health nonprofit in New York City.

"Folks are really challenged by mental health and mental illness to really understand the information that's being presented and rapidly changing [during a crisis]," he said. 

The mortality behind the virus isn't the only thing that can be triggering. Those with mental illness are often on medication, in therapy or dealing with other health issues that require frequent visits to a health care professional. The outbreak is interfering with receiving the routine help they need, which can not only leave their mental illness untreated but can also become a source of more anxiety. 

"The anxiety started when talking to my psychiatrist," said Ponte, who lives in New York City. "He told me I should get 90 days supplies of medications and I kind of started to freak out about that  because I am on six medications. He said some of the compounds are sourced from China. He said everybody is going to be asking for extra medication now."

Ponte had to wait four times as long to get her medication due to long lines. She also had to pay out of pocket for the extra supply since her insurance only covers 30 days' worth at a time. This is standard with many insurance companies, leaving those who cannot afford it out of luck. 

Ponte worried about relapsing if she wasn't able to get the medication she needed.

"I've been stable for four years now, I don't want to get sick again," she said. 

Goncalves has been a huge source of support for Ponte in managing the additional anxiety. Vasan says people with mental illness especially need these types of social connections during anxiety-inducing events such as the coronavirus outbreak. Those with mental illness are already among the most isolated people in society. 

People with severe mental illness, like schizophrenia, bipolar disorder, severe depression, PTSD or other conditions, are often "pushed to the margins by virtue of the illness they have as well as by a lot of societal stigma and discrimination that exists today," Vasan said. He likened their amount of social contact to those in solitary confinement at correctional facilities. 

Organizations like Vasan's Fountain House work to rebuild social connections for this population. But the "social distancing" required to slow the spread of coronavirus has complicated the process. 

"Coronavirus is attacking… our ability to bring people together in a therapeutic and supportive way and combat the isolating effects of mental illness," Vasan said. 

As a result, Foundation House has developed a virtual community in response to the crisis. And Duckworth encourages people to also use other online resources, such as teletherapy. Vasan adds that while not everyone struggling with mental illness has access to these new technologies, we've come a long way from what was available in the past. 

As someone who also works with the mentally ill, Ponte expressed concern that a stressful public crisis like this could lead to a new onset of mental health issues in people who had never been diagnosed before. She encourages all people to stay as connected as possible. 

"Instead of using the term 'social distancing,' perhaps we should refer to it as physical distancing," Ponte said. "Even though we are distancing ourselves physically, we should not be distancing ourselves socially. In fact, this collective crisis should bring people together in spirit and support if not in proximity." 

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