Counseling offered in video sessions as COVID-19 anxiety builds

Gregg Krupa
The Detroit News

Detroit — Change is often difficult. And when it is abrupt and massive, like the changes being wrought by the coronavirus pandemic, variation from the normal is even harder to accommodate.

With face-to-face counseling sessions canceled because of social-distancing rules, mental health professionals in Michigan are resorting to online video sessions. But the full impact of the crisis on mental health is still emerging.

Dr. Arash Javanbakht, a psychiatrist, offers online sessions with patients from his Ypsilanti home during the pandemic. His dog Jasper sometimes sits in on therapy sessions.

“Here, we have a very rapid, immense, huge transition from one style of living to another," said Dr. Arash Javanbakht, assistant professor of psychiatry and behavioral neurosciences at Wayne State University. "It has affected all the different areas of life. And the transition was not planned. It just happened.”

Add uncertainty over who is carrying the contagion and who is not, and how long the pandemic will last. Compound it with such a lack of control that staying at home is the only remedy, and conditions for mental health concerns like anxiety and depression are rampant, Javanbakht and other practitioners said.

“Today, I was in the virtual clinic and people are stressed,” said the psychiatrist who specializes in trauma, stress and anxiety. His practice has moved online, like many others.

Freed from office hours, therapists are working from home with video sessions. Because office appointments are canceled and not all patients wish to participate in telepsychology, some therapists have more time available for those having a difficult time.

Officials of the Michigan Department of Health and Human Services said that in general, the state is experiencing an increase in mental health issues. But it is too early to quantify.

Some providers are concerned the demand for help is actually decreasing because people are afraid to go out publicly to seek it.

“It is a pent-up demand,” said Robert Sheehan, chief executive officer of the Community Mental Health Association of Michigan, which represents mental health care providers and plans. “Once the state order is lifted, you are going to see people starting to show up."

Like much about the pandemic, the mental health impact is only emerging.

“I think it’s kind of really too soon to tell,” said Marianne Huff, president of the Mental Health Association in Michigan, which advocates for the mentally ill and their families.

Huff said the consumers of mental health care are benefiting from some looser restrictions on what computer platforms may be used in telepsychology, to conform with the federal Health Insurance Portability and Accountability Act of 1996.

She also said some insurers are waiving co-pays for mental health care through later this spring. “There seems to be a real strong understanding there are going to be a lot of mental health implications of this coronavirus,” Huff said. 

For doctors, nurses and other health care workers, the workload and anguishing human tolls of the pandemic are markedly impacting mental health, according to a host of reports. Neurocore Brain Performance Centers, located in West Bloomfield Township, is offering free tele-health counseling sessions to medical professionals and first-responders.

“We know that those people on the front lines are probably the ones dealing with high levels of stress and anxiety, depression and feelings of hopelessness and helplessness in this situation,” said Mark Murrison, Neurocore's CEO. He said they are seeing a spike of 10 or 12 of these workers reaching out each day.

Therapists generally find the online sessions are of considerable value, and have some advantages over in-person sessions, despite the lack of a proximate human presence.

“When I was asked to start doing it, part of me was like, 'Well, I don’t know how this works,'” Javanbakht said.

“But, then I was provided with research data that shows it’s as effective as face-to-face, if not more. Patient and physician satisfaction is the same or higher.”

Since the shelter-in-place order began in Michigan, the mental health services staff at the John D. Dingell VA Medical Center in Detroit have done nearly 17,000 video and telephone sessions with veterans, said William Browning, chief of volunteer and community relations.

Virtual appointments occur in homes, clinics and hospitals operated by the Veterans’ Administration, as well as in private homes of veterans, VA officials said. In Detroit, veterans are using nearly two dozen web and mobile computer applications that provide online access to services, including therapy and prescriptions.

Amanda Dillard, a psychology professor at Grand Valley State University, studies how emotions and the perception of risks affect health behaviors.

“When people are highly anxious about processing information about a health threat, they'll actually take in information about the threat less carefully,” Dillard said.

It can be as simply as adopting misapprehensions as if they are fact.

“Also, at the heart of anxiety is uncertainty," she said, "and people are going to want to exert some of that control by, for example hoarding.”

Especially when mixed with the complications that confusion can instill, anxiety may also lead to depression, she said. “Anxiety is one of those things that motivates you to do things even if the response isn't accurate. When it drives you to buy and properly wear a mask, it is good.

“But,” Dillard said, “it can lead you to process things less carefully and to do things that are not based on reason, really.”