This article is part of State of Health, a series about how Michigan communities are rising to address health challenges. It is made possible with funding from the Michigan Health Endowment Fund.

Kevin Fischer, executive director of the National Alliance on Mental Illness-Michigan (NAMI), says the COVID-19 pandemic threw mental health practitioners "a very serious curveball" that's resulted in a positive transformation in Michiganders' engagement with their services.

Stay-home orders led to relaxed federal and state regulations that allow mental health providers to use telehealth and virtual sessions with patients, and providers wasted no time in taking advantage of that new flexibility. (Michigan Gov. Gretchen Whitmer has indicated that behavioral health services are essential services, making it possible for those who required in-person services during the pandemic to receive them as well.)

"I am really impressed with the way my NAMI affiliates have switched from in-person to virtual programming and how quickly providers were able to ramp up telemedicine," Fischer says. "I'm also impressed with how people who live with mental health disorders embrace it. I have heard a lot of positive feedback from providers and people who receive services."

Dr. Debra Pinals.

The Michigan Department of Health and Human Services (MDHHS) has developed its own strong online presence for mental health as well. The state has launched a Stay Well website offering mental health resources, a crisis counseling text line (available by texting 741741), and a peer support warmline (available by calling 888-PEER-753). All have been heavily used. The StayWell website has had about 29,000 views, the peer warmline had received 7,354 calls as of late July, and the crisis text line had hosted more than 1,200 conversations with 1,000 texters as of early August.

"We see the activity continuing and that tells us there's a need out there," says Dr. Debra Pinals, MDHHS' medical director of behavioral health and forensic programs. "... This is an unprecedented situation with a lot of uncertainty and worry. [People are] dealing with direct loss of those who have died, plans shifting with work and unemployment, and dealing with kids at home. The loss of graduations and celebrations causes a lot of grief in addition to loss from the virus itself."

More Michiganders need mental health help

Pinals notes that in Michigan, like everywhere, people are finding themselves increasingly stressed as they experience change, worry, and anxiety. Susan Sheppard, COO of Arbor Circle, a provider of mental health counseling, substance use treatment, and family development programs in West Michigan, agrees.

"We know people are feeling more mental health distress. That's understandable, given all that we've been dealing with," Sheppard says. "Any time humans' safety is at risk, our bodies go right into that emergency crisis response, fight-or-flight instinct. For the population we work with, that is layered onto already existing mental and behavioral health concerns."

Since the pandemic shifted most care to virtual formats, Arbor Circle has been doing more than 300 telehealth sessions a day. While summer usually means a slowdown, that has not been the case this year.

"People's normal instinctive ways to cope have been compromised," Sheppard says. "They can't do what they would normally do. All that is interrupted."

Susan Sheppard.

Fischer agrees that the stresses inflicted by the pandemic — social isolation, unemployment, disruption of schooling, and the disease itself — have exacerbated mental health issues for people who already were experiencing them and caused them for others who had not experienced issues before. Some Michiganders living with mental health issues are experiencing increased symptoms including depression and anxiety because social distancing has cut them off from their traditional social supports.

"I hear it from many people," Fischer says. "A mother whose teenage daughter was doing well in her mental health recovery told me how shelter-in-place became a tipping point. The daughter stopped her meds, ran away from home, and faced some really serious challenges. The pandemic intensified everything."

While texts and warmlines fill the gap, they also connect people to crucial, urgent care. When counselors and peers on the other end of the phone encounter a caller with a serious crisis, such as someone contemplating suicide, they dispatch emergency services.

"You can never know for sure how many lives are saved," Pinals says. "And you don't know how close to crisis people touching these services are. It is super important to get the word out, get the website out there so people can tap into it. We definitely know that people are taking advantage of these resources and using them. We see the activity continuing and that tells us there's a need out there."

Will COVID-19 reduce stigma?

Fischer says the big question is whether the social stigma around seeking mental health services will lessen as more Michiganders seek help through these new platforms.

"We still have quite a few people suffering in silence, people who have never been diagnosed but they know they are not quite themselves. They know they are experiencing anxiety or depression, but they won't call it that," he says. "I've had friends call me. One said, 'Hey I'm scared. I'm sitting here in my apartment [and] haven't got my unemployment check two months in. My son is in college and I can't pay.' I asked him, 'What are you doing to take care of yourself?" He said, 'Nothing.' He didn't want to come out and say, 'I'm depressed and concerned about my mental health.' Stigma is still very real, a huge barrier."

Sheprd hopes that as more people seek services, they will share their journeys within their family and professional circles, and seeking mental health help will become normalized.

"Mental health and behavioral health are very important factors of a person's overall wellbeing. The more we do talk about it and engage in dialogue, the more we understand that," she says. "People have gone through so much trauma in their lives that impacts their bodies, behaviors, thoughts, and emotions. It's important to understand and normalize that for people so they have a very clear and easy path for services."

Post-pandemic Michigan: What will mental health look like?

With virtual treatment options having had such success in the wake of COVID-19, organizations like NAMI, MDHHS, and Arbor Circle hope that regulations remain relaxed after the pandemic has passed.

"I talk to a lot of providers who are really hoping the state and federal government will continue that funding and programming and not take it away once this crisis has passed," Fischer says. "We've learned there's been a significant increase in compliance to treatment plans for people with transportation issues or who, for whatever reason, are not able or willing to take part in in-patient treatment plans. We don't want to lose that."

Pinals believes virtual options will remain in place.

"The phrase we use is 'Build back better,'" she says. "We want to look out to the future, take these lessons learned, and continue in a positive way to intervene, turning warmlines and crisis counseling into referrals for substance use challenges or mental health needs going forward."

Pinals, Fischer, and Sheppard also agree that virtual platforms will never remove the need for face-to-face delivery of crucial mental and behavioral health services.

"We don't want legislators to think that this is the silver bullet and works for everybody because it doesn't," Fischer says. "Some people are not comfortable with it or don't have access to a smartphone or internet."

They also hope that, post-pandemic, more Michiganders feel comfortable seeking mental and behavioral health services as a means of improving their overall quality of life.

"That is a potential positive," Fischer says. "There are some people, some measure of society, that this has been their first experience of mental health issues like depression and anxiety. Maybe that does help us move forward to reducing stigma about getting mental health care and being more understanding of it."

A freelance writer and editor, Estelle Slootmaker is happiest writing about social justice, wellness, and the arts. She is development news editor for Rapid Growth Media, communications manager for Our Kitchen Table, and chairs The Tree Amigos, City of Wyoming Tree Commission. Her finest accomplishment is her five amazing adult children. You can contact Estelle at Estelle.Slootmaker@gmail.com or www.constellations.biz.

Kevin Fischer photos by Doug Coombe. All other photos courtesy of the sources.