Scuffling out from the scrub brush at Juniper Ridge in Bend, pushing a green-hand-me-down medical scooter on one foot with no toes, Todd Yoder heads to the Mosaic Medical mobile van.
His leg that rests on the scooter is bandaged. The homeless man isn’t healing from his latest amputation surgery, his third in the past year, because he keeps falling.
“I already have trouble getting to town,” Yoder said. “I have so many pills. It’s hard to remember to take them.”
Yoder was reluctant to talk about his mental health. He said many of his issues stemmed for years of living a hard life that included drug use.
Drug use often is associated with mental illnesses such as depression, schizophrenia, bi-polar disorder. More than 8 million people in the United States had both a substance use disorder and another mental illness, according to the National Institute of Mental Health study in 2014. Nearly 1 in 5 U.S. adults live with a mental illness, according to 2017 data.
Miles from town, the 51-year-old Yoder receives care for his host of problems that have grown worse because of the COVID-19 pandemic.
People with anxiety and depression have suffered since the lockdown ordered by Gov. Kate Brown began mid-March. The effort to contain the virus has isolated people who need treatment for mental health conditions.
“As far as mental health goes, people are struggling,” said David Nieradka, a Central Oregon Veterans Outreach manager. “Here in town, many are on their own.”
Behavioral health and medical professionals have responded to the restrictions put in place to contain COVID-19 by offering phone visits or video meetings. But it’s easy to hide true feelings on the phone, Nieradka said.
The pandemic has made it hard for anyone experiencing mental health issues to navigate. From finding a shelter that’s not full to filing an unemployment claim, it all takes persistence, Nieradka said. Under normal conditions, these activities take a toll on people’s mental health.
“Everyone is skittish right now,” said JW Terry, Central Oregon Veterans Organization executive director. “If you already have mental anguish now and you’re one of those who is an over thinker, you have a lot of struggle right now. We’re just seeing the effects of what (COVID-19) is doing to people.”
Each day up to 70 people come to the COVO offices on Third Street seeking help for food, clothing, bicycles and camping supplies, he said. The organization helps connect people to services, not just veterans.
Deborah Nichols, a Central Oregon Veterans Outreach case manager, helps one veteran who feels isolated, paranoid and depressed on a normal day and her feelings are compounded by the stay at home order. Nichols talks to her several times a day almost every day to keep her depression at bay.
“Her paranoia is kicking into high gear, and she can’t be seen by her behavioral health team,” Nichols said. “The virus is blowing everything out of proportion. It’s added excess strain for them.”
Another young veteran in her mid-30s is attending Central Oregon Community College, said Nichols. But when the classes went online in the middle of the winter term, it was a struggle to launch the right software, connect with the virtual classroom and quell the panic that kept the student veteran from achieving success.
“I have to text her before I call because she’s stressed out,” Nichols said. “She’s afraid to go out. She’s afraid she’s going to fail her classes. It’s gotten overwhelming for her.”
A lot to think about
Even for well-adjusted working residents, COVID-19 can be trying, said Rick Treleaven, CEO of Best Care Treatment Services, a residential substance use treatment center.
The pandemic is trying everyone’s resiliency, he said. Everyone is stressed, but for those experiencing addiction or in the early stages of recovery, the stress of the virus can send them right back to where they were, Treleaven said.
People experiencing mental health disorders depend upon personal connection to remain healthy and accountable, he said. While the clinic has set up virtual services through Zoom or telemedicine, it’s not the same.
“It’s a different experience when you have to wear gloves and masks,” Treleaven said. “If you’re already struggling with serious mental illness piling on something like COVID-19 can really take you over the edge.”
A new normal
County crisis lines have not shown a surge of calls, despite what health care professionals are seeing on the front lines. At Mosaic Medical, which launched a new behavioral health hotline at the start of the pandemic, there have been quite a few calls for patients and non-patients concerned about the virus, access to medicine and asking for coping tips. The hotline is staffed by behavioral health providers during the day, but goes to a national distress hotline during the weekends and after hours.
Patients who were at risk before are at a higher risk of experiencing a crisis in mental health now, said Kim Swanson, Mosaic Medical’s director of behavioral health.
“We’ve had people call us with heightened anxiety or depression,” Swanson said. “They’re worried they’ll catch the virus. They’re worried about the impact on their families. They’re feeling anxiety and panic. The COVID-19 anxiety is very real. It’s an invisible threat that lives all around us.”
Mosaic, like other medical centers, has shifted to mostly online services. Using a video service behavioral health therapists “see” their patients. While online services are not optimal, it’s the best that can be done now.
“Patients that are calling our hotline, if it’s COVID-19 related, they are concerned and overwhelmed by the changes in work environment, staying at home, and social distancing,” said Elise Davenport, Mosaic Medical behavioral health supervisor. “I’ve noticed a lot of people are having a tough time with not being able to connect with their support group face to face.”
Other patients are tapping into the skills they’ve been taught and applying them to the COVID-19 situation, Davenport said.
Behavioral health specialists call that resiliency, said Molly Wells Darling, Deschutes County Health Services program manager.
“Usually, people will be able to draw on their resiliency during the first portion of a crisis event,” Darling said. “The community comes together in a cohesion. We’re probably still in that phase. Then they move to disillusionment, especially for those people who lost their jobs.”
People react the same way during a holiday. They power through their emotions and then afterwards, they crash, Darling said.
“Anxiety and depression or feeling isolated are normal responses to a really abnormal event,” Darling said. “It’s super normal to feel unsettled.”
Seated outside the medical mobile unit, Yoder said the mobile medical team has kept him from having to go to the hospital.
While the medical professional cleaned and applied a new bandage to his amputated leg, Yoder ate a free lunch provided by a local church that comes to the area. The medical professional asked Yoder how he is doing and if there’s anything else he needed.
“It’s not happy today,” Yoder said of his leg. “I don’t want to go to the hospital now.”