In March 2020, Senior Psychiatric Social Worker Kathleen Sapp completed her last in-person therapy session at the Hennepin County Mental Health Center before it closed from COVID.
Over the next 15 months, Sapp and her colleagues continued providing mental health services remotely from their homes. They also began implementing new protocols for critical in-person appointments.
In this article, Sapp and her colleague Senior Clinical Psychologist Dr. Yohance Pickett discuss four things the pandemic taught them about mental health.
COVID has worsened mental health, and these effects are disproportionately impacting people who already experience health disparities.
Percent of U.S.
COVID worsened mental health. According to one CDC report which surveyed adults from across the U.S., 31% of respondents reported anxiety or depression, 13% reported increased substance use, and 11% reported having serious thoughts of suicide in the past 30 days. These numbers are nearly double the rates that would have been expected before the pandemic.
Sapp and Dr. Pickett saw COVID’s impacts immediately, and the murder of George Floyd added another layer of trauma, crisis, and complication.
“There was a shift to focusing even more on basic needs,” Sapp says. “People couldn’t get their meds because their pharmacy had burned down. People couldn’t get their groceries because stores were closed or deliveries were suspended.”
She helped clients by researching what aid options were available. “I was finding out that this place is open and this place isn’t,” Sapp says. “For example, ‘I know there’s a YMCA in your neighborhood and it’s giving out food.’ I was trying to connect people with whatever they needed to connect with in that moment.”
Not only did the pandemic and the murder of George Floyd make it more difficult for people to access basic needs, it also increased isolation and trauma symptoms. “I did a lot of checking in with people – asking them not only how they were doing emotionally but also, ‘Are you safe?” she says. “Many people were already fearful to leave their home due to the pandemic, and the impacts of George Floyd’s murder only compounded this. The focus of therapy needed to change.”
When the Mental Health Center began providing remote services during COVID, some clients stopped attending their appointments because they didn’t have laptops, Internet or the right computer software.
“A client in transitional living stopped coming to group therapy,” Sapp says, by way of example. “We found out that the seventh floor of the transitional housing unit where they lived did not have good wireless Internet, and they didn’t have money for data. Trying to problem solve has been hard – and important.”
“There are people without computers and people with computers but without the right software. It’s not as cut and dry as ‘do you have a computer?’” adds Dr. Pickett. “It’s do you have the right kind of computer? Do you have Internet? Are you borrowing your computer from someone? The nuance of the disparities became more evident to me.”
In addition to technological access, space access was apparent. “Many clients didn’t have the ability to do a psychological evaluation at home without distractions,” Dr. Pickett says. “They had kids at home. Imagine doing a psychological evaluation asking you about sexual trauma and there is a 10-year-old in ear shot.”
In some cases, remote therapy didn't only impact access – it impacted accuracy. “You can lose something when you’re not face-to-face,” Dr. Pickett says, noting that during evaluations he observes sensory details and motor functioning – like the way a client walks – to figure out the best way to care for them.
“Some of these details can be observed by video and some can’t,” he says. “For example, I can’t tell if someone smells of alcohol.
The Mental Health Center has been working to reverse these disparities. For instance, the center distributed laptops to over 1,000 clients. And mental health providers continued to conduct a proportion of psychological evaluations in-person.
“We wore masks, gloves, and goggles and tried to wipe everything down,” Dr. Pickett says. “We became a hazmat crew as well as a clinical crew.”
While remote mental health services widened health disparities for some, others thrived in the new model.
“For some clients being at home is a safe place,” Sapp says. “Maybe they’re wrapped up in a blanket, maybe they don’t have to get on a bus afterward. Some people had trouble getting themselves to the clinic – affording bus fare, finding someone to watch the kids. I’ve had people do therapy who are literally sick in bed at home with COVID. Remote therapy has provided that access.”
Dr. Pickett echoes this sentiment. “For psychological evaluations, some people need to cloak themselves in the security of privacy,” he says. “When face-to-face, some people might be guarded, but video creates a different set of eyes into someone’s private corners.”
Not only can remote services be more accessible and less intimidating – they also allow providers to connect with clients in new ways. “We’ve gotten to meet each other’s pets,” says Sapp, whose cats Bernelle and Mr. Thumbs often join her therapy sessions. “People have introduced me to their birds, lizards, snakes, and rats. They’ve asked me, “What’s this cat’s name?.”
If there’s one thing that COVID has underscored for Sapp and Dr. Pickett it’s the importance of being an ally and activist.
Dr. Pickett, who identifies as a black man, first learned this lesson from his parents. “My mom worked in public education all her life and my father was in law enforcement,” he says. “From them, I learned the importance of being an ally within the system. Sometimes you have to be within a system to make a change. My father experienced police brutality but had a 35-year career with the Cook County, Illinois Sherriff’s Department, reaching the rank of sergeant. Someone who had experienced policy brutality decided he wanted to be an ally within the system.”
“We need to continue serving the community and advocating for people’s mental health – not just diagnosing,” he adds. “It’s important to try to see the whole person and to figure out ways that we can be more accessible.”
Sapp agrees. “I’m getting to be more of an activist as I get older,” she says. “People deserve the very best care we can give them. You can have the best tools and therapeutics, but it’s not enough. Instead of pathologizing people, we need to dismantle pathological systems.”
Hennepin County COPE provides mobile, 24/7/365 support for adults and children experiencing a mental health issue.
The center serves Hennepin County residents and people who use county services, including:
Call 612-596-9438 for an appointment or referral.
Anywhere in Minnesota round-the-clock, seven days a week, people contemplating suicide or experiencing a mental health crisis can text MN to 741741 to connect to a trained counselor.
Free, confidential support 24 hours a day
Written by: Lori Imsdahl