COVID-19 & Your Mental Health: A discussion with NAMI CA Executive Director Jessica Cruz.
The coronavirus has brought stress and anxiety to every American. First, we'll hear from Liz and her story about how COVID-19 has impacted her and her family. Then, we will talk with Jessica Cruz, chief executive officer of the California chapter for the National Alliance on Mental Illness (NAMI), about how to work through these issues, the challenges presented, the resources available, and some helpful tips about what people and families can do improve their mental wellness.
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Hello, This is Fight Back, a podcast by the Health Care Consumer Rights Foundation. I'm Steve Poisoner, founder and executive director, are not profits. Mission is to help you navigate the complex health care system and understand your legal
rights, options and opportunities. When you encounter problems and obstacles, we want to empower you with the information you need to fight back and get the best possible care and to be your advocate to achieve positive outcomes. Today, our topic is mental health during the Cove in 19 Pandemic. As we all go through, stay at home orders, family Disruption and Financial Stress. Cove in 19 has brought a whole slew of stress and anxiety to all Americans. First, we'll hear from lives in her story about how the Cove in 19 Pandemic has impacted her and her family. Then we'll be joined by Jessica Cruz, chief executive officer of the California chapter for the National Alliance on Mental Illness, Nam E. For a conversation about how toe work through these issues, the resource is available, the challenges presented and some helpful tips about what people and families facing challenges from Cove in 19 can do to better their mental wellness. We will talk about Nanny, our nation's largest grassroots mental health organization. With over 600 affiliates around the country, Nanny improves the lives of millions of those with mental illness. Here is lives This story Hi, I'm lives. A married work from home. Mother of one. My daughter had her 18 month checkup just 10 days before Governor Newsome issued a statewide shelter in place ordinates. Now I've always been somewhat of an anxious mom. Since Day one, people looked at me cross eyed when I recuse, let my toddler play on public
face structures, share
toys in the nursery something or give everyone around the high five. So it was particularly unnerving with my over protection, suddenly seems entirely insufficient. But that wasn't quite a storing. As been seemingly overnight. Our little families way of life disappeared. There was no rewarding ourselves, but the trip to the zoo with end of the hard work week. No catching up with friends over coffee and playdates for completely out of question, even our church services of perfectly online. And I'm not sure how to mourn that loss. We can't tell our plans to visit my side of the family who live in eight hour drive away. At this point, it's been seven months since my daughter is seen Nana and Grandpa, and we have no idea where. Not next. As the number of Corona virus cases and fatalities rise, so does my concern keeping my husband and child thing once and almost mindless task. And now spend hours across multiple days carefully planning out grocery lists to limit the number of times any of us have to leave the house. Then it's a couple of hours more of diligently scrubbing down or repackaging groceries to avoid contamination and meticulously planning meals of nothing accidentally goes wastes all of this on top of the work deadlines, the dirty diapers and the inevitable default blur tantrums. And some often I think my felt that all I need is not short blocks some time out of the house or just one take out meal so I don't have to cook tonight. And that promise the downward spiral of worst case scenarios and guilt is that meal that walk that break really work first, being my family's help. On the other hand, can I be the mom my daughter needs me to be the wife. My husband means this crisis has added so much anxiety to our day to day lives. What can we do to adjust your new normal? Welcome to the podcast, Jessica.
Thank you. Thanks so much for having me.
Well, great. Yeah. Let's start off by telling us a little bit of back your background. How have you gotten into a career focused on mental health issues?
Yeah, you know, I kind of stumbled upon it. I have always been involved in nonprofits associations. I have a master's degree in public administration with emphasis and health services. But mental health was never really on my radar until I had a chance interview with NAMI almost 10 years ago, in which I actually cried in my interview because I didn't even realize that there was an organization out there for families who are living with loved ones who have a severe mental illness. And at that time, my mom was actually admitted into a psychiatric hospital, and so it was kind of serendipitous in how it fell into my lap. But ever since then it has been something that I have had a passion about and really was just more like everybody needs to know who know me is because there shouldn't be a family member that sitting in a windowless room talking to a social worker about their loved one and not having a resource available to them outside of that hospital. So that's kind of how it came about. And my passion has just taken off from there and really hoping to change. Um, the I guess the way that the path is for people living with mental illness. So that is very, very different for my Children and the next generations,
right? Yes. Of NAMI, the National Alliance on Mental Illness. You're the executive director here in California. Tell us a little bit more about NAMI.
S. O NAMI is a national organization. It was created about 40 years ago from parents who were basically cut out of their loved ones. Treatment plans Ito win. When all of these state hospitals started to close down, the psychiatric hospitals closed down and all over their loved ones went into the community in a lot of ways. The families were the ones that were there to take care of them, but also simultaneously blamed for the illness before it became an actual brain disorder that has been recognized now through scientific research. On DSO, parents were just fed up and saying No, we need to have our voice We need to be a part of this conversation and PS We are the ones that are taking care of our loved ones when they're not in psychiatric hospitals on DSO, NAMI kind of came out of a grassroots movement to really have our voices be heard. US family members and since then we have grown over the years to being not only an advocacy organization but also offering programs and services support groups, educational, um, offerings to the public and within California, where the largest affiliate within the nation as a state organization and we have about 62 local affiliates and our local affiliates are the ones that really provide that direct service. They're the ones that are volunteering as family members, running the support groups, offering the courses, talking with their local faith based leaders to really get the awareness out about people living with a serious mental illness as well as well as their family members and the issues that we go through on a daily basis and at the state level, we dio a lot of capacity building for our affiliates to make sure that they're available. So when we call, say, call NAMI, they're there to help. But also, we do a lot of statewide policy advocacy, working with State Department's creating state white part partnerships to really get the word out and have people be able to connect to NAMI when they need it the most.
Right? I love the grassroots nature of Tommy. It's, uh, fantastic mission here. You know, the topic we wanted to talk about today is mental health during the Cove in 19 Pandemic. And you know, we all know that it's just impacted everyone so severely everywhere around the country, around the world. Uh, and it's just so anxiety building and people are under a lot of stress right now. What are things people could do to help mitigate some of this anxiety and stress that we're all under?
Yeah, I think you know the first thing that we need to recognize is that people with pre existing mental health conditions need to continue with their treatment plans during emergency and making sure that they're monitoring any new symptoms I've been talking a lot about, like three buckets, and the three buckets are the first of those people with pre existing mental health conditions or even those people who are on the brink of developing a new, serious mental health condition. The second bucket is kind of that mental wellness piece that we've heard a lot about, and I know even for myself, I'm struggling with making sure that my anxieties don't go out of control. And so how do I take care of them and wellness? And then the third bucket is that those people who are on the front line or essential workers, our medical staff that are gonna no doubt have some trauma after this is all over. But for for people who are in that second bucket of trying to make sure that we're taking care of ourselves, it's so important we you know, there's several different ways and tips and tools, and one of that is making sure that you're just being gentle with yourself in general, you know, not having too high expectations off having to get everything done in one day, but maybe taking a break and setting some goals and priorities whether that's for the day for the week, uh, trying to stay connected to people as much as possible. I think that we're all finding new, innovative ways to be more connected while we're physically distanced from each other. So that's, you know, having a FaceTime call a text stream. I've actually been starting to right hand written letters a little bit more huffed in now, just to make it so that as I'm putting pen to paper and I'm also connecting with the person that I'm writing Teoh on And then, of course, just taking care of ourselves, both with our nutrition and our physical activity. As anxieties and depression dealing start to come up identifying where they're at, and then also making sure that if they do cross the line of inner fearing with our daily activities or more substance use that we really reach out to your provider in some way to make sure that that doesn't then spiral into something that could go much
right. Uh, let's talk about a few specific ideas that that people can implement everyday. Where does meditation fit in, you think? And if and how do you what's the best way to learn how to meditate.
Oh, that's so that's such a good question, because I know for myself meditation is really hard. My mind races a 1,000,000 miles an hour, and I have really tried toe learn that practice. There are some really, really good APS out there. I know. I use headspace Onda. Actually, NAMI has a really good partnership with headspace as an app. You can get certain parts of head space for free, but then there could be like a monthly subscription to it as well. What works for me is actually at night. I do my meditation because I have a hard time falling asleep after the day's activities. And so there are some really great meditation techniques for when you wake up in the morning first thing in the morning. There are other anxiety tools and tips, as well that you can use throughout the day. If you find yourself needing a little bit of separation, something that I use is a breath technique as well, which is this is a form of meditation that brings you back to the present, and what I would usually do is I'll draw square with my finger and every side of the square is a breath in, in out, um or you could do where you you can't afford your building the square with the breath in. And then when you re trace this, we're back breath out, And that really brings at least for me back to the present and free focusing. And then you can use meditation on anywhere within the day on, and if you don't know where to start their some really great tools, but it really brings you back to purpose and present, um, been kind of, but what it does is it decreases your heart rate as well to help. You kind of be a little bit more at peace when you feel your anxiety is getting high.
Yeah, they're spent some great studies out of, I think Harvard Medical School in other places that really documents the benefit to your short and long term health when you condense, meditate for a few minutes each day. And so I think that's a great brakes. Have advice we have there.
Absolutely. And you know, it's a part of just mental wellness. Whether you live with a serious mental health condition or you are going through some anxiety times. Right now, it's just a way to keep track of your wellness. There's so much that we conduce you to make sure that we're taking care of ourselves. And it's different for everyone, right? What works for me may not work for you or the next person, but we have to figure out what works best for us to keep us on the right healthy path for our wellness during this time and really beyond
for me, you know, being locked up in our house here. The thing that I really look forward to every day to help me reduce dresses by my walks with my dog. I know that you know, you're a former basketball player from college. Where does exercise fit into stress reduction? From your point of view,
I think it's key, you know, and it looks different from everybody, right? For me, exercise has always been a part of my everyday life. I know. If I don't, if I don't exercise for a couple of days, I'm I just feel off those endorphins that it brings to your brain again stipulates Andi. Positive, I guess chemicals within your body, but it looks different for everybody. Not everybody enjoys exercise may be the way that you and I dio, but there's different ways again of engaging in physical activity. You know, for my mom, the one who lives with severe mental health condition for her going outside and gardening is something that releases those in orphans. And so you confined exercise and physical activity in so many different ways. But being active is definitely something that helps reduce the stress and anxiety by increasing those endorphins within your
brain. Right? You know, one thing that I know reduces well, actually, what people need to think about in terms of reducing stress, that one thing that increases my anxiety and stress is when I watch too much news and when I when I have reduced the amount of news that I'm watching, it's actually help. May I mean, do you think people are you really need to control the amount of that intake? Because it could be quite, you know, just depressing. You know, watching the news, you know, for hour after hour, every day. Don't you think?
I think so? In all the different media outlets that are now available to people whether it's Twitter, Facebook or Instagram. I know there's other social media outlets that I don't even know about because I think I'm beyond that age group that has all of the information about every single social media outlet that it's so important. Teoh really limit the information that you're receiving from trusted sources. And so, you know, there's a lot of information of a lot of opinions out there about Cove in 19 and the next steps and the political aspects as well as a scientific aspects of it. And so it's really important. Teoh, put your phone down. Turn off your television when you start to feel that anxiety. And I think the underlying piece of this is really staying in tune to yourself, understanding what causes you anxiety, being aware of your mood changes and why that might be, especially when we're in a home with our family members and trying to some cases work from home. Being a homeschool teacher, you know you need to really pay attention to what is causing you, your stress and anxiety. What are some of your triggers? And I think for a lot of us that is in a new practice, Um is trying to recognize what are triggers are. And I know news being on social media can help in some ways make you feel connected to people. But in others really making sure how you're limiting the amount of information that is being brought to you and filtering it to make sure that it's from trusted sources on that it is not causing you or triggering you into any kind of anxiety pressure.
Right? Can we talk about working moms for a second? You know, we heard lives at the beginning of this podcast working mom. Ah, child in diapers. She still has Teoh working to earn income in addition to taking care of the family husbands laid off under stress. Financially lives has to spend so much time now this planning out every meal it had a grocery shop that you know in a very efficient way. What can you say about working moms out there that have this just, you know, wearing so many hats under under under special stress here?
Yeah, I think that there e I may be biased because I have a working mom, but there's a special place for for moms, right? now who are also trying to work and manage and balance the household. You know, I think my my partner is amazing in that he really takes over a lot of the homeschooling piece of it because he happens to be an educator himself. So it's easy. That's kind of an easier transition. But there is this under laying our underlying pressure for moms to be the ones that are managing the house right, whether that's again grocery shopping, laundry, keeping the house clean, making sure the kids are fighting of all the while trying to focus on the 8 to 5 job requirements that, um, are putting pressures on them as well. And so again, I think it's a matter of making sure that you're connecting with other moms. I know what's helping me is being able to talk to my friends. We have a weekly zoom, call, some of my girlfriends and I just just to talk and chat about some things and world different, right some of my friends or stay at home moms, and so this is nothing really new to them other than managing. Now they're partner is now working from home. There's moms like me who have kind of a higher pressure job who also is trying to be the superwoman. But I think it's just making sure that we are gentle with ourselves and again. We normally have a lot of expectations on making sure that our family is taken care of not only moms, but Dad's two and partners, and it's really important to communicate with each other. Setting boundaries has been really helpful with my family and with my co workers, as well as making sure that there are certain boundaries set. They know that I'm available at any time, from 8 to 5, and then I have very limited access after that because that really needs to be me focusing on being a mom and a wife and a family, a contributor to my family as well. And so I think the biggest advice for for any working mom or working dad family members is just one be gentle with yourself on, and then to to really set some good, healthy boundaries with your love ones, having that conversation about what the expectations are and it could be daily. I know within our household it's like going over our schedule cat This call. I'm in this meeting. I'm not going to be available. We even have that conversation today as I'm sitting here like Okay, I'm not available. And I actually need you guys to go outside and take the dogs for a walk so that I could have my time to be able tow work. But it's really being communicated with your family.
I think that makes a lot of sense open and honest communication, setting boundaries and expectations. That's really, really good advice. You know, I was reading this morning, Jessica, that there's been a 34% spike in the use of anti anxiety prescription drugs during the cove in 19 Pandemic crisis here. Are you surprised by that spike in? Are you worried that that there may be overuse of of these prescription drugs?
I'm not surprised because we've also seen a increase in the number of individuals contacting our crisis Lines are warm. Lines are suicide prevention loans. Um, it doesn't It doesn't make me worry, because it actually makes me hopeful and that people are recognizing that this their own anxieties. Um, I think that when we talk about medication, it's important to understand that medication is only one component of a treatment plan. And so again, everybody's different in how they're going to respond the medications and also treatments in taking care of their mental wellness. For me, it provides hope that people are actually reaching out to their provider and saying, I need some sort of help. What worries me is that it's a one and done take this prescription and now you should be better when we know just in the mental health community that there are various components to somebody's mental illness, a lot of which we've already talked about on. Sometimes medication can be an addition to that. But I went on, and what I talked to my mom about a lot, too, is you know, when we go over her medications and how she's doing and things like that is also, how are you taking care of yourself when in addition to your medication right, what are you doing? The things that you like are you continuing to have connections with your family members and your friends? Are you staying physically active and eating well? So I'm not surprised, and it does only worry me in that right now it's really hard to be working with a doctor on it. Complete full treatment plan. So what worries me is that the doctors might just be writing a prescription of someone and done and thinking that that's going to be helpful for the individual when it takes a lot of medication.
Yeah, on a related note there that people who have a current mental illness or there in a substance abuse program or they're they're having, you know, regular treatments from a doctor. And now, now there, there in person meetings or group meetings, you know, no longer available to them. You know what? What should those folks do right now is that was the best way for them. Toe handle being away from their caregivers and their in their doctors and their support groups.
Well, you know, there's kind of some silver lining that's happening right now in that aspect, and that's that telemedicine piece. Telemedicine has been really difficult. Teoh have access to prior to over 19. A lot of it has to do with the funding streams for telemedicine on the reimbursement rates. But right now what we're seeing is there's a riel shit in making sure that individuals are able to receive the services that they need through telemedicine, whether a telephone call or even an in person, video type zoom call for us at NAMI, we are offering a lot of our support. Groups are virtual now, and so you could find that I know that a in Allen on are also doing their courses virtually as well. And so I think that we're starting to see the shift in in our offerings of services, and I know that in before over 19 have been, um, it was the fear of not having that personal connection. I know with the nominee, it was really hard for us to even talk about a virtual class on git was you know, there's that that connection piece that is so needed when you are going through some traumatic and crisis events. But what we're noticing now is that we're still able to get that connection, and actually, these courses in these support groups virtually are contributing to the feeling of being connected to individuals. And then, after Copan 19 it's just gonna be so good toe have then the additions to the in person treatment. So we're seeing a lot of doctors and clinicians turn into this telemedicine. I know that even within the county behavioral health system, they're trying to figure out the best way to deliver their services through telemedicine so that we are leaving people behind. I think that the challenge comes when there's this digital divide rate. So a lot of people with serious mental illness may have zero access to any kind of technology, whether it's even a bone I let alone a computer with Internet and where they would access that would be their libraries, their public libraries, which are now closed. And so a lot of our concern is around how we provide some sort of technology and treatment to those people who have zero access to that. And so that's been the challenge right now. Within NAMI, we have been advocating for doctors to almost prescribe technology in a way that reimbursable somehow so that people have that connection and that access to treatment
right? Maybe there is a little bit of a silver lining in there because, you know, telemedicine isn't it is a fantastic option in certain circumstances. I'm nothing like face to face as well. But If this opens the door to mawr reimbursements by insurance companies, more openness by providers. Teoh, you know, work sometimes online instead of in person that could open the door to even more treatments being provided. Yeah,
more access to treatment is what's really needed. And access points are Ah, lot of what has, especially in the behavioral health world, has been a contributing factor to, ah, lot of, um, I guess, the need to find services so well we hear about, you know, the Kaiser not being able to provide mental health services in a timely manner. It could be a way to bridge that gap is to have this telemedicine piece of that. People are able to get the assessments that they need in a timely manner without having to go through the hole in person. Behavioral health centers, which creates a stigma barrier in and of itself. When you ask somebody to actually walk through a door to a behavioral health center, it causes a stigma of actual physical stigma barrier for somebody that walk through that door, let alone having to go through the hours of assessments and right being in person. And so this could really open up the doors for people to be able to get assessed easily and access the treatment that they need in a
Yeah, absolutely could very well happen. It could could be something that people perceive as easier to do. Reduce barriers. You know, there's so many sad, terribly sad aspects to this whole pandemic crisis. But one of the things that you know, of course, is one of the saddest is when people died due to the covet 19 and unfortunately, has been, you know, thousands of people that have died from it and then family members. You can't be, you know, with their loved ones when their their loved ones air on their death beds, you know, locked in the hospital someplace. And, you know, we've seen on TV you know, these final face time conversations between people or whatever using zoom. But still, it must be just unbelievably traumatic when you lose a loved one and you can't be with them. Can't even go to the funeral, you know, which has possibly been banned. Any advice on how people can deal with that particularly difficult grieving process?
You know that one is so tough because it's a new world for us, right? Like the grieving process in and of itself is hard. And you now put in these layers of not being able to have your final goodbyes, not being able to even hold Ah, funeral or a memorial service in their honor with the people that are together. Because a lot of the grief tactics to helping people get through grief is staying connected to people, family members, faith leaders, you trusted people. And that's hard to do right now. And so again, it's just, um, letting yourself feel that pain, um, trying to connect with your loved ones as much as you possibly can. But this grief, uh, coupled with the isolation that people are in right now, is going to emphasize and almost like a ticking time bomb. In some leas, um, it will culminated to probably some riel trauma induced mental health conditions that, um, we haven't seen before. So I think it's a matter again. A lot of what we've talked about it's checking in with yourself, understanding what your triggers are, but I think it's the mental health community, but we have to really do is be prepared for this this trauma that is going to be taken place not only again for those frontline essential workers, but also for those people who have been severely impacted by the devastating outcome of Kobe in 19.
Right? It's just one final question looking forward, you know, as as the country begins the ener, possibly some type of new normal. When you know, we slowly but surely begin toe open up the you know, the country again. You know, I suspect it will be difficult for some people to even want to leave their homes, you know, feared about going to a movie or a restaurant or just being around people. A fear of getting infected. Do you anticipate this being another challenge for mental health professionals toe help folks deal with?
Yeah, absolutely. I know that, um, even for some of my co workers, when we first shut down the office, we had a couple of people who the the last few days before we shut down wouldn't even come into the office. And so there are people out there who have severe anxieties. Timo CDs, other pre existing, again underlying mental health conditions. But then there's also those people who could be at risk. And again, a traumatic event like this can trigger somebody's mental health condition and going back into large groups. It's gonna be similar to when somebody has been impacted by a traumatic event that has happened, for instance, some of the devastating Impax it of hammer or crisis events that have happened to large groups. I get concerts and things like that. It's gonna take time for people to adjust to getting back into, uh, the community and society. And so so our advice is to take it slow. Um, again, Listen, Teoh the professionals and listen to those people who are driven by research in science and take it easy on yourself, right? You know, you don't have to go. Just because the world is open again doesn't mean that you have to necessarily jump right in and and be okay with it, right? And there's gonna be some PTSD associated with a similar to win or military servicemen come back from from war. It's hard for them to re integrate back into society. And so it's just being gentle with yourselves, again checking in with yourselves. If you're noticing that it is affecting your daily activities in a meaningful way. Talking to a provider about that s oh, it's going to have a lot of PTSD and some trauma that is going to affect some people. I'm in a larger way. It's just a matter of one adult community being prepared for that and then to really learning from a lot of these traumatic events And again, those those veterans and soldiers and how me treat that PTSD aspect of it and intrude back into, ah, world that is going to look much different than when we're currently at and being a little bit more careful, uh, without letting it affect our day to day activity.
Right. Thank you. Jessica. Jessica. I know you have a fantastic website you mentioned Ah, a few minutes ago about a crisis hotline. Can you mention that the best way for people to connect with Mommy when they need help either over the phone or online?
Yeah, absolutely. So our nominee California website, www dot NAMI See a god work has a list of resource is available not only for Cove in 19. We have a bunch of the crisis lines. We have our NAMI warm lines, which are, um, in our affiliates. But we have also, um, crisis lines available. Also a lot of supports and services on our website. It has everything that you need to find kind of where you want to go. Ah, lot of people call NAMI as almost a resource center toe. How? Triage them into the best person to talk to the best place to go. So you the best way to get a hold of any of that information is on our website at NAMI. See a dot
Excellent. Jessica, Thank you so much. This has been very, very helpful. Appreciate talking to you today.
Wonderful. Thanks so much for having me. I want
to thank you for listening to today's fight back podcast. Our mission is to be a resource and provides you health care information in a refreshing and interesting format. I also want to thank Liz for sharing her story and Jessica for all
of her great insights. For more information about Nam e, go to our website www dot health care consumer rights dot org's. You can check out additional podcasts or access more information and resource is to help you navigate this health care system. can get the care you deserve. We also welcome your input in stories that we can use on future podcasts. This is Steve Poisoner, and this is Fight Back. A podcast by the Health Care Consumer Rights Foundation. Thanks for listening. I look forward to our next podcast talk with you standing.