Vicki Garner, LMHC, discusses the effects of these uncertain times 

As the COVID-19 pandemic has grown, increased mental health issues for Americans, which began almost immediately have caused high levels of emotional distress.

In a poll conducted by the Kaiser Family Foundation, more than half of Americans – 56 percent – reported that stress related to the outbreak has led to at least one negative mental health effect. Those include trouble eating or sleeping, increased alcohol intake, frequent headaches/stomachaches, shorter tempers, and other issues. Among frontline health care workers and their families, 64 percent reported a worsened state of mental health. Reports were similar for 65 percent of those who had lost income.

Orlando Medical News talked with Vicki Garner, LMHC, who is the director of behavioral health at CAYA Healthcare.

Garner has been a behavioral healthcare executive in the Central Florida area for over 25 years, working to develop and implement programs and services that streamline the system of care and reduce the stigma of mental illness.

She has an enviable record of accomplishment and advocacy for mental health.

She worked on the Mayor’s task force that brought Florida’s first Central Receiving Center to Orange County and later worked on a statewide task force to revise the Baker Act into what is now Senate Bill 12, requiring every county to have a Central Receiving Center.

Garner has been a strong advocate for mental health funding. She developed a jail diversion program with Orange County leadership, implemented Florida’s first Assertive Community Treatment Team and was honored by Governor Scott in 2016 for her leadership in assisting the community’s mental health needs in the aftermath of the Pulse nightclub tragedy.

She has presented at numerous state and national conferences and on many panels regarding multiple behavioral health issues.

OMN:   We are seeing reports sourcing some mental health call-in centers that say there is as much as double the number of calls as usual and reports of domestic violence, sexual abuse and drug use increasing. Is this the experience your group has been seeing? 

Vicki Garner, LMHC:   Mental health call in centers do not, as a rule, get reports of domestic violence or sexual abuse or even so much drug abuse. They would get calls for behavioral health services. We have seen some increase in requests for counseling services for the following problems: anxiety, depression, alcohol and other substances abuse, childhood disorders such as ADHD, fear and isolation and acting out.

There have been reported increases in some areas of increased calls to law enforcement for domestic violence and child abuse, but this is yet to be determined as to how much COVID will impact this while school is out. Since children are not leaving their homes, with no teachers or other mandatory reporters to intervene. The problem of child abuse could be much greater than even feared. This is the same for domestic violence if the victim is trapped in the home with her (or his) perpetrator.

OMN:   What are the most common specific anxieties and fears you are hearing from patients as a result of the COVID crisis?

Garner:   Fear of contracting the virus or fear of someone they love contracting virus. Fear of dying once contracting the virus. Fear of losing one’s job, home and way of life. The unknown is a big stressor to many people. The young people who were cheated out of graduations, proms and other meaningful rites of passage feel very depressed and sad but are sometimes shamed on social media, therefore making them feel worse.

Those who have actually lost jobs feel despair and worthlessness, hopelessness and that all is lost.

OMN:   Are the stories you are hearing generalized and/or non-specific or somewhat detailed revealing that people have been spending a lot of time focusing on their fears?

Garner:  Every story is different. People process their fears and anxieties based on their coping skills. One person may have a good support system with good coping skills and needs some additional time and a few additional tools to get through this rough time. Others are completely shattered and need a complete array of services to learn how to cope one step at a time. There is no cookie cutter approach to treatment for people who are experiencing anxiety due to any reason.

OMN:   How is the feeling of loss of control over one’s life playing a part?

Garner:  Loss of control is one of the worst feelings a human being can feel. Some individuals have a higher tolerance for experiencing it than others. When someone cannot tolerate the feeling, they may feel anxious, sad, depressed or completely despondent. If attempts to take control of one’s life don’t work or aren’t possible, like during the times of a pandemic when quarantines are in place and jobs are furloughed or lost, this may make some individuals very prone to these feelings. They should seek professional counseling and talk about ways to learn to cope with them. If they don’t, they may turn to alcohol or drugs or other self-destructive methods to cope which do much more harm in the long run.

OMN:   What part does pre-COVID PTSD in patients play in the current situation for those patients?

Garner:   COVID in and of itself would not cause PTSD but could exacerbate someone who had pre-existing trauma or PTSD. If a person has experienced trauma surrounding isolation, being sick, hospitalized or losing loved ones this virus could trigger those past traumas and make the memories come back causing the associated feelings or symptoms to return. If a person has been diagnosed with PTSD and has not had successful treatment to resolve it, then isolation, job loss, being quarantined with someone or people you don’t necessarily want to be with could cause PTSD symptoms to return, such as insomnia, exaggerated startle response, anxiety, depression, hypervigilance or substance abuse to name a few. If you or someone you know is suffering with these symptoms it is very important to seek professional help as soon as possible to keep these symptoms from getting worse and to alleviate suffering.

OMN:   What are signs for family members and healthcare workers to look for that indicate normal anxiety has turned into something more serious and threatening?

Garner:   When anything a person is doing that interferes with their normal daily activities of life, then that becomes time for family and friends to worry. Is the person not sleeping, or eating? Is he or she excessively talking about the virus or staying up all day or night on the internet researching conspiracy theories? If they say or do anything that appears they are thinking of hurting themselves or someone else, you must get help immediately. But, if their anxieties or worries are just that, normal worries about this scary virus that we all have around us, then let them talk about it. It is scary, it is something we all have to deal with and it is awful. If they continue to do what they have to do, go to work if they have a job, care for themselves, their house, their kids or dog if they have them and seem overall ok, then let them be. Eventually we will all be ok, someday.

OMN:   What are the treatments/drugs being prescribed to help people cope, especially those who have previously not relied on pharmaceutical support?

Garner:   For short term, situational anxiety related to job loss, the economy and societal issues, it would be unlikely that pharmaceutical support would be the first line of treatment. Evidence-based practice calls for a variety of counseling techniques to assist a person in building coping skills and reframing situations to assist in symptom reduction. Only in an extreme situation of a severe panic attack resulting in hospitalization would a short-term medication regime possibly be recommended. The majority of anti-anxiety medications are highly addictive and are only for very short-term use. If anti-depressants are called for, it would be after a diagnosis of major depressive disorder for over six months.

OMN:   Is the reopening of the economy creating its own set of issues for patients who now fear going out?

Garner:   Reopening the economy is not a problem for the patients who fear going out. They will continue to stay home and are well advised to do so, if they can. Absolutely nothing has changed with the virus or how it is spread. The world is opening back up specifically for the economy, nothing else. People who go out risk getting sick and those who fear going out know that. They are the ones who won’t get sick.

OMN:   What are you seeing in terms of anxiety, fear and burnout in our healthcare workers and what are you advising them?

Garner:   These are the people we need to worry about most. They are on the front lines, day in and day out. They are the healers, the counselors and caregivers. They work even when they aren’t working. They see it all, hear it all and take it home each night. We need to take care of them and remind them we are here for them. They need respite and love. We advise them to take care of themselves and rest when they can.