Counseling Through Corona

Each year, one in five New Yorkers experiences some form of mental illness, according to data from the New York City Department of Health and Mental Hygiene.

That number has skyrocketed this year as residents grapple with the sudden lifestyle changes caused by the COVID-19 pandemic, according to a number of mental health professionals interviewed by Straus News. Their message: Help is available, even when social distancing means logging in from your own couch.

“We're seeing a big spike in anxiety and panic, both among those who might have a propensity towards more panic states, and those who haven't experienced that,” said Daniel Cook, a licensed mental health counselor and director of Embodied Mind NYC in lower Manhattan. “With the disruption of people’s day-to-day lives, their routines, their resources, let alone the potential of becoming sick and what that might also be bringing up for folks.”

Cook made the decision last week to move all sessions at his practice to remote platforms, a choice that allows him and his colleagues to continue their work without spreading coronavirus.

“The technical piece I think was a little bit harried,” Cook added. “Fortunately, legislation really got pushed quickly to ensure that clients were able to receive health insurance coverage for telehealth services, which hasn't always been the case.”

New York is one of 22 states that require Medicaid and private insurers to cover telehealth services — services provided by clinicians remotely, often online — thanks to the New York Health Parity Law, which went into effect on January 1, 2016. The state expanded the number of long-distance services eligible for Medicaid coverage in February 2019.

Going Remote

Straus News reached out to the Mayor’s Office for details on how the city is working to address mental health care needs in response to the pandemic. In response, ThriveNYC Director of Communications Joshua Goodman gave the following statement: “During a stressful time, it’s common to feel anxious or scared. New Yorkers should stay connected to friends and family, check in on one another by phone, text, or email, and, if needed, reach out to NYC Well, the City’s free, confidential, 24/7 helpline, at 888-NYC-WELL.”

On March 17, the Trump administration expanded access to telemedicine for the United States’s 62 million Medicare beneficiaries in a bid to maintain standard health care services without sending patients into hospitals or clinics where they might risk infection.

At the same time, stringent confidentiality requirements imposed by the 1996 Health Insurance Portability and Accountability Act (HIPAA) have constrained how therapists may communicate with patients, eliminating most commercially available video conferencing apps.

As therapists pivoted en masse to HIPAA-compliant video apps last week, “People were scrambling and there was talk of price gouging,” said Kayla Schwartz, LCSW, a counselor with Mindful NYC in Midtown.

That frenzy died down after the U.S. Department of Health and Human Services announced that it would allow providers to contact patients through commercial programs like FaceTime and Skype without risking fines or penalties. (Public-facing applications like Facebook LIVE and TikTok are still no-gos, HHS noted in its memo.)

Loss of Control

While administrative questions like which app to use may seem quibbling in an atmosphere of extreme upheaval, eliminating insurance red tape allows mental health professionals to provide uninterrupted care when their patients most need it, though not everyone is happy with the shift.

“It's a loss, you know, but of course everybody is experiencing a loss of control in general,” said Randy Faerber, a psychoanalyst on Central Park West, “so this is just one more loss of control. Their routine is broken.”

Faerber compares some of the behaviors New Yorkers have exhibited lately to a need to re-establish order in their lives. “People go out and say, ‘Oh, OK, if I have a lot of toilet paper, I'm safe,’ or ‘If I have a lot of bread and peanut butter and jelly, I'm safe’ ... We're trying to control what we can't,” she explained.

Every mental health professional stressed the importance of establishing new, home-based routines for regaining composure.

“Many of us are trying to start a new routine or sort of morph an old routine into the new circumstances,” Schwartz said. “Like if you used to go to the gym, maybe you want to take time to go running, maybe at the same time ... Or maybe you're used to getting your coffee at Starbucks every day on your way to work, and that's your organize-your-brain time, maybe you to choose to make your coffee and bring it out onto the stoop or bring it to a certain place in your home that feels like it's different.”

The key, Schwartz advised, is to structure your time without focusing too rigidly on recreating normalcy before social distancing.

The New Normal

Many of the tips mental health care providers shared with Straus News reflected their own strategies for staying open and responsive while also contending with the COVID-19 crisis.

“Many people are experiencing similar intensities ... the mental health providers are also then taking in all of their patients' stress and anxiety and concern and holding that for them,” said Rory Rothman, Psya.D., a psychoanalyst and faculty member at the Center for Modern Psychoanalytic Studies, whose patients include a number of therapists. “I would say that while well-trained clinicians are hopefully adept at being with their patients and listening and taking in, and containing what the patients are expressing, right now what's being contained is compounded by the intensity of the current situation.”

“Certainly, we're not on the front lines in the medical realm, but on some level, we're on the front lines in the emotional realm,” Rothman observed.

For some clinicians, emergency response means adapting business practices to the new normal. Cook is already looking into expanding Embodied Mind NYC’s reduced-price counseling services to people whose livelihoods were cut off by mandatory social distancing.

“It's a health crisis, an economic crisis and a mental health crisis as well,” he said. “I want to mobilize that so we can support those who are on the front line, and I think that's a way that we can be on the front line.”