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When Mental Distress Comes Home When Mental Distress Comes Home
(5 days later)
The panic spirals up from somewhere in Connor Langan’s midsection, and so quickly that his face changes; wild in the eyes, his upper lip trembling, he sometimes punches a wall in frustration. Such episodes resulted in Connor, 17, being placed on leave from high school late last year, and in early March he agreed to enroll at Mountain Valley, a New Hampshire residential program well known for addressing anxiety problems in young people.The panic spirals up from somewhere in Connor Langan’s midsection, and so quickly that his face changes; wild in the eyes, his upper lip trembling, he sometimes punches a wall in frustration. Such episodes resulted in Connor, 17, being placed on leave from high school late last year, and in early March he agreed to enroll at Mountain Valley, a New Hampshire residential program well known for addressing anxiety problems in young people.
But on March 27, in response to the growing threat of coronavirus, the facility temporarily suspended operations and began sending home some two dozen teenagers and young adults. The facility’s therapists have set up virtual connections to continue providing support for some individuals, but the change was abrupt for everyone.But on March 27, in response to the growing threat of coronavirus, the facility temporarily suspended operations and began sending home some two dozen teenagers and young adults. The facility’s therapists have set up virtual connections to continue providing support for some individuals, but the change was abrupt for everyone.
“The night before I had this panic attack, almost a full-on psychosis, and the next day I really wanted to talk about it,” said Connor, who is now back at home with his parents in Bedford, N.H. “There was so much uncertainty, I knew it would be difficult to now bring these problems back into the family.”“The night before I had this panic attack, almost a full-on psychosis, and the next day I really wanted to talk about it,” said Connor, who is now back at home with his parents in Bedford, N.H. “There was so much uncertainty, I knew it would be difficult to now bring these problems back into the family.”
His parents know the feeling. “We were nervous, to say the least,” said his father, Stephen Langan, who works in financial services. “This program was supposed to be the bridge to get him back on the track he wants to be on. Now there’s a big hole in middle, and he has to jump over it — while at home.”His parents know the feeling. “We were nervous, to say the least,” said his father, Stephen Langan, who works in financial services. “This program was supposed to be the bridge to get him back on the track he wants to be on. Now there’s a big hole in middle, and he has to jump over it — while at home.”
Across the country, the coronavirus pandemic has scrambled mental health services, forcing thousands of people with disabling psychological distress, and their families, to adjust on the fly. Late last month, the Trump administration loosened regulations on psychiatric wards, allowing beds to be reallocated to handle Covid-19 patients, as emergency rooms in New York and other hard-hit areas became overwhelmed. Outpatient and community clinics have had to shut their doors; and many of the country’s hundreds of residential programs, like Mountain Valley, have either tightened admissions, barred visitors or suspended operations entirely.Across the country, the coronavirus pandemic has scrambled mental health services, forcing thousands of people with disabling psychological distress, and their families, to adjust on the fly. Late last month, the Trump administration loosened regulations on psychiatric wards, allowing beds to be reallocated to handle Covid-19 patients, as emergency rooms in New York and other hard-hit areas became overwhelmed. Outpatient and community clinics have had to shut their doors; and many of the country’s hundreds of residential programs, like Mountain Valley, have either tightened admissions, barred visitors or suspended operations entirely.
“Program capacities are shrinking and staff are being laid off,” said Virgil Stucker, the former director of CooperRiis, a residential therapeutic program near Asheville, N.C., who now has a private consulting practice. “Families will need to take more family members back home who are experiencing acute and complex mental health conditions” and learn how to provide support themselves.“Program capacities are shrinking and staff are being laid off,” said Virgil Stucker, the former director of CooperRiis, a residential therapeutic program near Asheville, N.C., who now has a private consulting practice. “Families will need to take more family members back home who are experiencing acute and complex mental health conditions” and learn how to provide support themselves.
No family moves a loved one into long-term treatment, public or private, lightly; the moment often arrives at a breaking point. Two parents who were interviewed for this article subsequently asked to not be involved, in fear of reprisals from a grown child now underfoot and out of control.No family moves a loved one into long-term treatment, public or private, lightly; the moment often arrives at a breaking point. Two parents who were interviewed for this article subsequently asked to not be involved, in fear of reprisals from a grown child now underfoot and out of control.
“They’re literally scared for their lives, some of these families,” said Brad Richards, a New York-based mental health advocate who helps families find placements for loved ones in crisis. Many parents are on their own, he said, with multiple other children and little ability to defuse destructive situations.“They’re literally scared for their lives, some of these families,” said Brad Richards, a New York-based mental health advocate who helps families find placements for loved ones in crisis. Many parents are on their own, he said, with multiple other children and little ability to defuse destructive situations.
Connor was fortunate, he said — the Langans are an intact, close family. The morning after he experienced serious panic, he packed himself into a car with his mother, leaving behind his therapist, his new friends and the highly regimented daily routine at Mountain Valley. He arrived home to a tight household, with his parents, two older siblings and the sister’s Czech boyfriend, who was stranded in the United States by travel restrictions. The two now share a room.Connor was fortunate, he said — the Langans are an intact, close family. The morning after he experienced serious panic, he packed himself into a car with his mother, leaving behind his therapist, his new friends and the highly regimented daily routine at Mountain Valley. He arrived home to a tight household, with his parents, two older siblings and the sister’s Czech boyfriend, who was stranded in the United States by travel restrictions. The two now share a room.
Connor was scheduled to stay at Mountain Valley through June, said his father. “But now with all the rigor of his day gone — well, any kid is going to backslide a bit into old habits, stay up late, get up late and spend time on XBox. For us, as parents, we need to be open and reflective about our role in his anxiety. It’s very tough to disentangle a 17-year-old boy from someone who has this severe anxiety. He sure doesn’t like people telling him what to do, and we’re getting pushback, that’s for sure.”Connor was scheduled to stay at Mountain Valley through June, said his father. “But now with all the rigor of his day gone — well, any kid is going to backslide a bit into old habits, stay up late, get up late and spend time on XBox. For us, as parents, we need to be open and reflective about our role in his anxiety. It’s very tough to disentangle a 17-year-old boy from someone who has this severe anxiety. He sure doesn’t like people telling him what to do, and we’re getting pushback, that’s for sure.”
Connor agreed. “I’ve had some anxious episodes since I got back,” he said. “I got frustrated with this online schoolwork, and with my parents at one point.”Connor agreed. “I’ve had some anxious episodes since I got back,” he said. “I got frustrated with this online schoolwork, and with my parents at one point.”
For individuals like him, some support is arriving over video services like Zoom and VSee, in the form of tele-therapy, although federal guidelines that restrict the practice from crossing state borders is limiting its use in some regions. “We’ve been working with families to connect them to local therapists, and for some residents we’ve developed a virtual program,” said Timothy DiGiacomo, the clinical director at Mountain Valley.For individuals like him, some support is arriving over video services like Zoom and VSee, in the form of tele-therapy, although federal guidelines that restrict the practice from crossing state borders is limiting its use in some regions. “We’ve been working with families to connect them to local therapists, and for some residents we’ve developed a virtual program,” said Timothy DiGiacomo, the clinical director at Mountain Valley.
At home, Connor has virtual sessions with a therapist, and his parents are receiving online support as well. It adds up to a lot of personal sharing, in a tight space.At home, Connor has virtual sessions with a therapist, and his parents are receiving online support as well. It adds up to a lot of personal sharing, in a tight space.
“The parent sessions have been good,” Mr. Langan said. “But my wife and I are doing them in a room, and it seems everyone in the house can hear what we’re saying.”“The parent sessions have been good,” Mr. Langan said. “But my wife and I are doing them in a room, and it seems everyone in the house can hear what we’re saying.”
The full impact of the pandemic on people managing mental disorders will only become clear with time, experts have said, and will likely vary widely by individual, depending on the severity of the distress, family support and resources. Being stalked by an invisible enemy surely mortifies those with an obsessive-compulsive fear of germs, and deepens the distress of many who have experienced waves of uncontrollable anxiety before the epidemic. Individuals who have developed skills to manage their moods will likely fare well, experts said. Some people preoccupied with urges to commit suicide may feel more hopeless; others will shift to survival mode and put aside self-destructive instincts in the shadow of a wider threat.The full impact of the pandemic on people managing mental disorders will only become clear with time, experts have said, and will likely vary widely by individual, depending on the severity of the distress, family support and resources. Being stalked by an invisible enemy surely mortifies those with an obsessive-compulsive fear of germs, and deepens the distress of many who have experienced waves of uncontrollable anxiety before the epidemic. Individuals who have developed skills to manage their moods will likely fare well, experts said. Some people preoccupied with urges to commit suicide may feel more hopeless; others will shift to survival mode and put aside self-destructive instincts in the shadow of a wider threat.
For now, the displacement is what is being felt most acutely by people who have left residential programs. Calls to help lines across the country have risen sharply. Crisis Text Line, which offers free crisis counseling through text messaging, reported earlier this month that two-thirds of texters nationwide are describing more intense sensations of depression and anxiety linked to the spread of Covid-19 — nearly double the reported intensity before the outbreak, according to an analysis of text terms.For now, the displacement is what is being felt most acutely by people who have left residential programs. Calls to help lines across the country have risen sharply. Crisis Text Line, which offers free crisis counseling through text messaging, reported earlier this month that two-thirds of texters nationwide are describing more intense sensations of depression and anxiety linked to the spread of Covid-19 — nearly double the reported intensity before the outbreak, according to an analysis of text terms.
“Calls to our hotline were up 60 percent in the last two weeks of March,” said Matt Kudish, the executive director of NAMI-NYC, the city branch of the nonprofit National Alliance for Mental Health. “I don’t think trauma is overstating what some people are experiencing right now.”“Calls to our hotline were up 60 percent in the last two weeks of March,” said Matt Kudish, the executive director of NAMI-NYC, the city branch of the nonprofit National Alliance for Mental Health. “I don’t think trauma is overstating what some people are experiencing right now.”
Updated June 16, 2020 Updated June 22, 2020
A commentary published this month on the website of the British Journal of Sports Medicine points out that covering your face during exercise “comes with issues of potential breathing restriction and discomfort” and requires “balancing benefits versus possible adverse events.” Masks do alter exercise, says Cedric X. Bryant, the president and chief science officer of the American Council on Exercise, a nonprofit organization that funds exercise research and certifies fitness professionals. “In my personal experience,” he says, “heart rates are higher at the same relative intensity when you wear a mask.” Some people also could experience lightheadedness during familiar workouts while masked, says Len Kravitz, a professor of exercise science at the University of New Mexico.
The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth.The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth.
The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave.The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave.
So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.
Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.
A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.
The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.
Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.
States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.
Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.
If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)
Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.
The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.
If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.
If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.
Jennifer Eve Taylor, a therapeutic educational consultant in the Bay Area, said that her 19-year-old son John Hendrick, who has autism as well as anxiety and mild depression, had been doing very well in a young adult transition program in Burlington, Vt. He had a team of four advisers, including in occupational therapy, assisted living and social support. He had been taking college courses until that program, too, suspended operations, and he flew to Florida to stay with his father.Jennifer Eve Taylor, a therapeutic educational consultant in the Bay Area, said that her 19-year-old son John Hendrick, who has autism as well as anxiety and mild depression, had been doing very well in a young adult transition program in Burlington, Vt. He had a team of four advisers, including in occupational therapy, assisted living and social support. He had been taking college courses until that program, too, suspended operations, and he flew to Florida to stay with his father.
“Young adults like these, oh my goodness, they do not transition well,” Ms. Taylor said. “They can avoid life with technology and just retreat into video games and streaming shows. We are seeing this with John already. We don’t have the team to support him.”“Young adults like these, oh my goodness, they do not transition well,” Ms. Taylor said. “They can avoid life with technology and just retreat into video games and streaming shows. We are seeing this with John already. We don’t have the team to support him.”
Mr. Hendrick, reached by phone in Florida, said the loss of his stable, supported life in Vermont was so sudden that he was reeling by the time he joined his father. “Changes cause so much stress for me, that’s what it is,” he said. “But you know, after some time I usually start doing fine. I really like having a schedule — I need to keep a schedule.”Mr. Hendrick, reached by phone in Florida, said the loss of his stable, supported life in Vermont was so sudden that he was reeling by the time he joined his father. “Changes cause so much stress for me, that’s what it is,” he said. “But you know, after some time I usually start doing fine. I really like having a schedule — I need to keep a schedule.”
His father, Bud Hendrick, said he started planning for his son’s possible move as soon as the coronavirus emerged as a growing epidemic in early March. “The first week home, I let him adjust as much as possible,” Mr. Hendrick said. “But after that, I really had to start a daily schedule that replicates as much as possible what he had in Burlington. That has helped enormously.”His father, Bud Hendrick, said he started planning for his son’s possible move as soon as the coronavirus emerged as a growing epidemic in early March. “The first week home, I let him adjust as much as possible,” Mr. Hendrick said. “But after that, I really had to start a daily schedule that replicates as much as possible what he had in Burlington. That has helped enormously.”
Connor said that so far, his panic attacks — often in response to academic pressure — have been mostly under control at home, in part because his family has come to better understand his occasional fits. “The most notable physical effect it has is my upper lip quivering,” he said.Connor said that so far, his panic attacks — often in response to academic pressure — have been mostly under control at home, in part because his family has come to better understand his occasional fits. “The most notable physical effect it has is my upper lip quivering,” he said.
“I’m lucky, very, I know that,” he said. “A lot of people I know, I really don’t think going back home is the best thing for them.”“I’m lucky, very, I know that,” he said. “A lot of people I know, I really don’t think going back home is the best thing for them.”
At least for some them, the home stay could end soon: Mountain Valley announced last weekend that it plans to reopen on May 18, with new precautions in place, including daily disinfection of all surfaces and enforced hand-washing.At least for some them, the home stay could end soon: Mountain Valley announced last weekend that it plans to reopen on May 18, with new precautions in place, including daily disinfection of all surfaces and enforced hand-washing.
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