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Empty streets, closed businesses and picked-over food shelves continue to serve as a reminder of the toll COVID-19 is taking on society, but its effects on mental health, while less visible, are just as profound. Dr. Sally Beck, a therapist at Anchor Counseling in Jordan, said the outbreak is increasing feelings of depression and anxiety.

"Anxiety is fear-based and depression is a feeling of hopelessness, so this pandemic feeds into both," Beck said.

Beck characterized anxiety as an "anticipatory dread," or fear of the future — a feeling many people currently experience as COVID-19 cases spread and developments are broadcast throughout the day. Even everyday chores, like a trip to the grocery store, can trigger anxiety — with shortages of hand sanitizer, canned food and toilet paper. 

But it doesn't all have to be doom and gloom, Beck said. In fact, these instances often present an opportunity to look at the world in a different light.

"We live in abundance," Beck said. "You walk in any store and there is a total abundance of food, fresh vegetables and fruits. This is an opportunity for a lot of people to change their lifestyle to a healthier lifestyle. If people see it as an opportunity, and not a stalling of their life, but actual opportunity to grow, that gives a person a sense of purpose and well-being."

Beck recommends people use the sheltering period constructively by reading books, learning new skills, developing healthy habits, cooking and eating with family and getting exercise. Many of these activities help combat feelings of depression, too.

"People who suffer depression isolate anyway, their social connections are very limited as it is. Now this creates another layer of isolation for them, which really exacerbates their feeling of depression," Beck said.

Despite Minnesota's shelter-in-place order, connecting with other people has never been easier. Through the help of video communication technology, family reunions, hangouts with friends and catching up with loved ones are a few clicks away.

"There are wonderful ways of managing all of this," Beck said. "Even if it's talking with someone virtually, it's still making a human connection."

Beck knows first-hand the power of video technology —  she's been using telehealth services to communicate with out of town or homebound clients for years. Now she's allowing clients to use it as a preventative measure during the outbreak. About a quarter of Beck's clients are now attending counseling sessions remotely — others follow social distancing guidelines during their sessions.

"People still feel pretty comfortable," Beck said. "(Telehealth) may increase as the potential of the threat increases."

Decrease in patients

Lisa Zietlow, a clinic coordinator for Behavior Health Services, or BHSI, which operates a clinic out of Shakopee, said despite the increased need for mental health care during a time of heightened anxiety, her clinics — which have transitioned almost completely to telehealth appointments — have seen significantly fewer new clients. She thinks it's because many people who need help right now don't know the clinics are still open, and if they do, they may not feel comfortable meeting someone online for the first time. 

"People don’t realize that we’re still open," Zietlow said. "With all of the shutdowns, they assume we’re closed." 

Normally, across all six BHSI clinics, Zietlow said there are between 80 to 100 new patient evaluations each week. Last week, there were eight new patient evaluations across all the clinics. That's a problem, she said, considering the anxiety that is surely pulsing through many people amid a global crisis. 

"The level of anxiety is incredibly high," Zietlow said. "Even for our teenagers that we see it's extremely high, because everyone is so uncertain with how this is going to play out. People don’t know how long this is going to last."

Director of the Scott County Mental Health Center Dr. Terry Raddatz said she hasn't seen as drastic of a decrease in new patients as Zietlow, but numbers are down slightly. The mental health center saw more than 4,600 patients just last year, and everyone who has been using the center received a notification that it would be going online, so most of the regular clients were able to smoothly transition, she said.

Some aspects of telehealth appointments are more convenient, Raddatz said, including the ability to fill out paperwork online and being able to slot in more appointments since the psychiatrists and therapists haven't been traveling between schools, since Scott County Mental Health Center services students, too. 

And while in-person therapy appointments sometimes means waiting lists if a patient has a specific schedule or needs, telehealth conferences offer more flexibility for both the patient and the clinic. Raddatz said there are still waiting lists in some areas, but those lists are smaller now. 

Zietlow encouraged anyone who is struggling with anxiety or their mental health to set up a telehealth appointment at BHSI or through another clinic, adding that from what she's seen, most insurance providers are covering telehealth appointments the same way they would cover a normal mental health appointment. One barrier that's difficult to navigate, she said, is getting appointments for those who don't have access to technology, or for people who don't have a space at home they feel is private enough to talk.

"We encourage people to go in their car, or go sit in their backyard."

In addition to keeping clients and staff safe, Beck said the increase in telehealth conferences has given her a better understanding of some clients.

"One of the things I do is create a safe place for people, sort of a mental imagery of where they feel the least vulnerable and often it's their bedroom or a cozy place in their home," Beck said. "It's neat because they're sharing with me the visual world they know that I haven't experienced. It's actually been a vehicle for connection in ways I didn't expect."

A universal piece of advice in these times, whether someone is undergoing counseling or not, Beck said, is to remember to laugh.

"Laughter is just magical, she said. "It changes the chemistry of the body."

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