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For more news about the COVID-19 coronavirus, access the News Tribune Health section.

As Missourians deal with the effects of social distancing and job loss driven by the new coronavirus, mental health crisis centers and hotlines say more people are calling for help.

The COVID-19 outbreak is causing people to have less social contact, either because they're voluntarily isolating or are under a stay-at-home order. Thousands of people have lost their jobs already, and more fear they could be laid off in the coming weeks, adding economic stress to the fear and isolation.

Concern over a disease that's dominated the news can be stressful on its own, causing people to worry about their own and others' health. Dr. Laine Young-Walker, an MU Health psychiatrist, said anxiety can come from uncertainty about what each hour or day will bring or how long this will go on.

It's a recipe for poor mental health, and crisis hotlines are seeing more calls as a result.

Behavioral Health Response, a St. Louis-based agency that answers crisis calls on its own hotline and through others, has seen a "huge increase" in calls, said Tara Stevens, its community engagement liaison.

A 24-hour crisis line in the St. Louis area has seen a 10-15 percent increase in calls over the past few weeks because of COVID-19 concerns, Missouri Department of Mental Health Director Mark Stringer told the News Tribune on Wednesday.

The increase in calls has caused waiting times to go up at Behavioral Health Response, something the group is trying to address quickly, Stevens said. They're not alone. Brent McGinty, president and CEO of Missouri Coalition for Community Behavioral Health Care, said there's been an increase in calls to crisis hotlines in Missouri and in the number of people accessing online resources.

"This is increasing everyone's stress level; it's something we've never seen before," Stevens said. "Being isolated and alone isn't good for anyone's mental health, so we want to make sure people are getting the services they need."

As groups like Behavioral Health Response work to keep up with more and more people seeking help, they're also transitioning into the current reality.

Behavioral Health Response is a "safety net" for people who need mental health treatment, Stevens said. Clinicians give crisis support over the phone to people who call the hotline. Under regular circumstances, they can send out a crisis response team to meet with someone face to face within an hour, she said. They connect people with providers then follow up to make sure they're getting the services they need.

Now, the group's clinicians are answering calls from home to make sure they aren't picking up or transmitting COVID-19. The mobile response team has shifted to checking in over video calls, Stevens said.

McGinty said community mental health providers have been moving toward telehealth to limit face-to-face interactions in a time when public health experts advocate social distancing to slow the spread of COVID-19.

Community support staff are keeping in touch with patients to make sure they're doing OK and taking their medicine. Therapists and advanced practice nurses are moving to telehealth to visit with patients as well, McGinty said.

Providers are adapting, too. Because of the risk of COVID-19 spreading in close quarters, the Substance Abuse and Mental Health Services Administration has recommended using inpatient services only when necessary and transitioning more patients to outpatient and telehealth treatment. Outpatient providers are adapting by moving to telehealth or taking precautions like having patients wait in their cars instead of the waiting room.

Gov. Mike Parson has requested specific federal disaster aid to increase funding for community health centers to do outreach and engagement, and the state has relaxed some requirements, including allowing community providers to do much of their work by telephone, rather than face to face, Stringer said in a news conference Thursday.

"Our service providers have dramatically ramped up their use of telehealth and telephones, and we're exploring ways to stay in touch with people who cannot afford cellphones or extra minutes," he said.

Stringer told the News Tribune telehealth will help access, but meeting mental health needs during the coronavirus outbreak will be difficult because it's a widespread issue rather than a localized disaster like a tornado or an earthquake.

Accessing mental health issues can be difficult under normal conditions. Patients have to go outside their health insurance network to get mental health treatment at a higher rate than for other medical care. The increased out-of-pocket cost causes some patients to delay or forgo treatment, according to the Missouri Federation of Behavioral Health Advocates.

As with many medical issues, when people can't access specialized mental health care, either because the cost is too high or there isn't a provider available, they go to the emergency room. It's not the best place to go for mental health treatment, and patients can leave with a bill and no ongoing treatment or follow-up, Stevens said.

"What the health system doesn't need right now is even more people going to emergency rooms for their behavioral health needs," McGinty said.

Hotlines and crisis intervention groups can give people both immediate help and a longer-term plan, Stevens said. Behavioral Health Response's follow-up team knows the providers and resources in the area. They can help people find free services or services that work for their insurance, she said.

Mental health providers are taking lessons from the aftermath of the 2012 Joplin tornado, when there was a rise in people dying by suicide, McGinty said. That means making sure people have access to mental health care to deal with the stress that comes with the COVID-19 crisis, he said.

"Our mantra was, 'Don't let one disaster lead to another,'" McGinty said. "In this environment it's, 'Don't let one crisis lead to another.'"

Where can you go for help?

State and federal officials are promoting the national Disaster Distress Helpline (1-800-985-5990) for people to call when they're dealing with COVID-19-related stress. There are other hotlines available for people experiencing mental health crises, which have professionals to help on the line, and then can link callers back to local services.

Some numbers for people in Mid-Missouri include:

- National Disaster Distress Hotline: 1-800-985-5990.

- National Suicide Prevention Lifeline: 1-800-273-8255.

- Compass Health Network Disaster Hotline (Cole, Miller and Osage counties): (888) 237-4567 between 7 a.m.-7 p.m. weekdays, 1-800-833-3915 at all other times.

- Burrell Central Missouri Crisis Line (Boone, Moniteau and Morgan counties): 1-800-395-2132.

- Arthur Center Crisis Line (Callaway County): 1-800-833-2064.

What can you do to manage stress on your own?

People can manage the uncertainty driving their anxiety by focusing on things they can control, Dr. Young-Walker, the MU Health psychiatrist, said. Stay up to date on recommended precautions and implement them, like hand-washing and social distancing, she said.

"Try to plan your new normal. If you had a certain habit of doing things that now you can't do, what can you replace that with so that you can start to have new routines, new habits?" Young-Walker said.

Children are going to be watching and taking cues on how much they should be upset or anxious about what's happening around them, Young-Walker said. Communicating with them the precautions you're going to take and letting them ask questions will help, she said.

There are also online resources to help cope with stress. McGinty and the coalition are promoting their app, MyStrength, which offers free, on-demand videos on how to deal with stress, including COVID-19-specific videos, he said.

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