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‘Everybody feels it’: Mental-health challenges of working from home, pandemic confront Boulder County residents

John Tayer, president and CEO of the Boulder Chamber, participates in a remote meeting from his backyard on Tuesday at his home in Boulder. Tayer said his days have gotten longer since starting to work remotely at the beginning of the pandemic, as they have for many people working from home. (Timothy Hurst/Staff Photographer)
John Tayer, president and CEO of the Boulder Chamber, participates in a remote meeting from his backyard on Tuesday at his home in Boulder. Tayer said his days have gotten longer since starting to work remotely at the beginning of the pandemic, as they have for many people working from home. (Timothy Hurst/Staff Photographer)

Since John Tayer, Boulder Chamber CEO and president, began working remotely his dress attire has changed. While it still includes a button-up shirt and a tie, he has swapped dress slacks for comfortable shorts. Instead of going into the Chamber offices to work, his couch, or occasionally the dining table, is his office.

But working from home isn’t as relaxing as it sounds.

Tayer and other Boulder County professionals in high-stress jobs that are newly remote are learning how to balance family, household duties and work under one roof. Though he said he enjoys his role at the Boulder Chamber and his work energizes him, it’s inarguable that the stakes are higher, the days are longer, and the need for mental-health breaks is more necessary than ever.

A study by Mental Health America and Boulder-based FlexJobs Corp. found that of the 37% of respondents who are employed, 76% are currently working remotely and are working longer hours than they did before the pandemic began. The survey had 1,500 respondents from the U.S. Of those surveyed, about half were employed and the other unemployed.

As a result, employed workers are three times as likely to report poor mental health now than pre-COVID-19, according to the study’s findings.

To complete Tayer’s tasks — many dealing with helping Boulder businesses navigate public health restrictions and keep their companies afloat — he often gets up early and goes to bed late. Last week, he accidentally “slept in” until 6 a.m., and hurried to catch up on the three hours of lost work.

That’s Monday through Friday. Weekends are catch-up days, with some meetings and work-related communications.

Back-to-back phone calls, Zoom meetings and non-stop emails make the days feel longer. Tayer said that he’s used to all-day meetings, but they were in-person, happy hours or gatherings. Commuting from one place to another introduced “mental-health breaks” that he didn’t realize were there until they were gone.

“The thing that’s unique about this circumstance, especially in the Zoom world, is unless you program it in specifically, you don’t really get breaks,” Tayer said.

He added that with the normal workday disrupted, the boundaries for professional communication have changed. Before, he could rely on most of the email traffic to slow around 5 p.m., but now it’s not uncommon for his inbox to fill on evenings and weekends.

The Boulder Chamber has roughly 1,300 members, he said. Since the pandemic began, the Chamber has helped Boulder businesses access information on city and state coronavirus health mandates, co-sponsored a COVID-19 Small Business Relief Fund, and advocated for patio expansions, to-go liquor sales and other efforts.

“There was so much change coming at all of these businesses at such a fast and furious pace,” Tayer said. “All of us were having difficulty absorbing it personally and as business leaders.”

For Gretchen Wahl, senior director and community manager for First National Bank of Omaha, or FNBO, in Boulder, the school year couldn’t have come at a better time. While temporarily homeschooling her two children, then later spending much of the summer with them, she was juggling her work from home. She said she was on the verge of burnout, which the World Health Organization defines as “a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed.” Symptoms include feelings of energy depletion or exhaustion, increased mental distance or feelings of negativity towards their job and lessened professional efficacy.

“I’m pulled in a lot of different directions. I have two young children. I have a husband. We’re all here, we’ve been here all summer, you know, for five months, and the hard part is you have everybody pulling at you,” Wahl said. “When you’re at work, you have people pulling at you, but not in the same way, where you’re with each other 24-7. After a while, I think you just wear down, and you get really tired, so it’s hard to stay as mentally focused as you used to be.”

Early into the pandemic, the bank was hit hard while processing Paycheck Protection Program requests, one of the Small Business Administration loans for small businesses created by the Coronavirus Aid, Relief, and Economic Security (CARES) Act.

Wahl said that companywide, her employer processed 7,000 loans totalling between $800 million and $900 million. She said that the bank’s system was firing on all cylinders, with every division extended.

“We were working around the clock, I mean people were working into the wee hours of the morning trying to push loans,” she said. “Everybody from the commercial lending team to the retail team to the servicing to dock coordinators, everybody was involved.”

The bank has sent out regular, formal wellness assessments to the entire company. Wahl said that additionally, she touches base with her department weekly to discuss taking sufficient time off, taking breaks and finding flexibility with work.

The mental-health crisis

Burnout and workplace stress is on the rise, but even more severe mental-health concerns are increasing as a result of the pandemic.

There’s more than one emotional fallout from this crisis, said Vincent Atchity, Mental Health Colorado president and CEO: isolation from social-distancing, uncertainty over the future, financial stress from the economic downturn, fear for the health of oneself and loved ones and grief of lost life and a sense of normalcy.

Mental Health Colorado, a nonprofit that advocates for legislation that supports mental-health access and works to destigmatize mental illness and an affiliate of Mental Health America, records the monthly screenings for different disorders and illnesses.

The most common screenings haven’t changed much since last year — depression being the highest, followed by anxiety, bipolar disorder and alcohol and substance use — but the amount of each has nearly doubled.

According to the state nonprofit’s records, 835 Coloradans received screenings for depression between April and June in 2019. For the same time period this year, 1,462 screenings were documented.

And it wasn’t just depression that dramatically increased for that duration compared with last year. Anxiety screenings increased 105% and bipolar screenings by 87%. Alcohol and substance use increased 39%.

Atchity predicts that the mental-health impacts will outlast the pandemic. Emotions are heightened even more with Black Lives Matter protests and the 2020 presidential election overlapping with COVID-19, he added.

“This is kind of unprecedented for the mental health of the community, and the pandemic is just sort of the context for all of it right now,” he said.

Registered nurse and licensed professional counselor Suzanne Conversano, left, and psychiatrist Emily Bucy demonstrate what an in-person counseling session would look like in a large conference room at Boulder Community Health’s Della Cava Family Medical Pavilion on Monday in Boulder. The behavioral health unit has not seen a large increase in patients since the onset of the pandemic but have seen patients exhibiting more severe symptoms. (Timothy Hurst / Staff Photographer)

The need for professional mental-health services in the Boulder region has always been considerable, said Jill Eriksen, director of nursing for behavioral health at Boulder Community Health. But while her division has only seen a slight increase in incoming patients, the conditions and symptoms are more severe. This was across the board, including general anxiety, depression, substance use and other conditions.

Eriksen oversees an overnight and inpatient unit, outpatient behavioral health and other unrelated departments.

Betsy Duckett, director of integrated clinical services for physician clinics for BCH, echoed the same findings of worsening mental-health statuses. Part of the Integrated Clinical Services includes behavioral health specialists at 11 of BCH’s primary-care units.

Duckett said that both primary-care physicians and behavioral-health specialists are seeing higher acuity, or needing more professional care, in patients. This points to clients seeking or receiving help at a later stage than normal.

When someone has an underlying anxiety disorder and presents normally, going without  treatment degrades that person’s condition, Duckett said.

“When that goes on at a heightened level for a longer period of time, those patients are now moving into depressive episodes as well,” she said.

Those with other pre-existing diagnoses such as bipolar disorder also are displaying worsened conditions, she added. She’s noticed increased substance-use disorders, suicide ideation and patients experiencing first-time mental-illness episodes.

BCH is preparing for acuity to increase this fall and winter, Eriksen said. BCH always sees a higher rate during that period with seasonal affective disorder and stress around the holidays, but this year’s preparation revolves around the coronavirus crisis. After living under the uncertainty of the pandemic for around half a year, she expects depression and anxiety to continue around food, housing and financial insecurity.

“A lot of people have a certain amount of resources and resilience — and I’m talking about financial resources, child-care resources — a lot of those are starting to be depleted,” Eriksen said.

Behavioral health specialist David Lopez, right, and physician Alyssa Carlson demonstrate what a meeting concerning a patient would look like at Boulder Community Health’s Dakota Ridge Family Medicine on Monday in Boulder. Betsy Duckett, director of integrated clinical services for physician clinics for BCH, said physicians are seeing patients who need more professional care, which she said points to people delaying seeking mental health care amid the pandemic. (Timothy Hurst/Staff Photographer)

Deb Sprague is interim vice president of clinical care for Mental Health Partners, a nonprofit behavioral health provider treating mental health and addiction in Boulder and Broomfield counties.

She said one of the reasons clients delay mental-health treatment is the same for physical doctor visits: limiting risk for COVID-19 exposure. She said that early symptoms of depression, such as insomnia and fatigue, are often addressed with physical health-care physicians first. Therefore, some patients with diagnosable conditions aren’t included in mental-health data.

But it’s safe to say that everyone is experiencing pressure on their mental well-being, Sprague said.

“The number of people who are affected by this is really, to be honest, everyone. On some level, everyone is experiencing a disturbance in their life,” she said. “Each and every time we venture out, put on a mask, we’re reminded that things are not the same.”

Remote mental health care

Mental-health services have also gone partially remote. Though there were concerns over how effective counseling through telemedicine would be, in some ways it opened up abilities for MHP, Sprague said.

Children and senior citizens are among the most vulnerable populations to suffer from social distancing, she said. Play therapy, a method that lets professionals examine and treat psychological issues through toys and conversation, is a common tool MHP uses with children.

Sprague said that some children are more receptive in their own environment, and will show off their own toys and rooms to their counselors.

Shaw said that she’s grateful for having remote capabilities, as 80% of MHP clients are Medicaid recipients. It’s increased accessibility, while minimizing their health risks during the pandemic. MHP’s no-show rates to appointments have dropped as a result, she said.

Telehealth also allows clinical workers to see into the home life of a client. While enlightening, it can be disheartening. Sprague said some clinical staff bear witness to disputes. There’s also concerns about whether some patients are in a safe place to speak freely.

Registered nurse and director of nursing Billy Carestio works at his desk on Wednesday at Mental Health Partners’ Ryan Wellness Center in Boulder. The nonprofit behavioral health provider has started offering remote counseling sessions to continue treating patients who prefer not to visit the office out of concerns of exposure to COVID-19. (Timothy Hurst/Staff Photographer)

Duckett said that her team at BCH used phone calls for telehealth options until recently, when they added video capabilities.

“The concerns were sometimes not having eyes on somebody, not really being able to know what their self care was,” she said. Duckett added that seeing a patient is important, as professionals can observe if they are taking care of their personal hygiene, sleeping and eating properly.

BCH is also navigating remote work within its own staff. Eriksen, as both a health professional and manager, has scheduled mental check-ins with her staff. She encourages them to schedule breaks, take care of their physical well-being and learn to shut off their devices at the end of the work day.

BCH provides its employees and patients with a free login to myStrength Inc., a digital behavioral-health platform, she said. In addition, Boulder-area residents can use a community access code, “bchcommunity,” to access the application.

MHP helped support the continuum of care through its COVID- 19 Relief Fund for Clients. Of the $30,000 raised in March and April, part of the funds went toward providing more than 50 phones for clients, said Cindy Cohagen, director of philanthropy for MHP.

The organization was also a grant recipient of Colorado Spirit Crisis Counseling Assistance and Training Program. The Federal Emergency Management Agency approved $1.8 million to the state of Colorado for CCP in June. MHP received $600,000, and is using it to ramp up its community-outreach program and provide resources and information about COVID-19 through social media and in-person visits. The funds allowed them to add seven employees to the team, Shaw said.

Talking about mental health at work

MHP offers suicide prevention and crisis training. Though normally more individuals than groups participate in training, Shaw said that several businesses have also reached out for group classes.

The behavioral-health center has a goal of training 4,098 people in suicide prevention before the end of 2020. So far, MHP has reached 3,649 of its trainee goals.

MHP officials say some signs of suicidal ideation to look out for in friends, family and coworkers are withdrawing from activities, sleeping too much or too little, saying goodbyes, expressing symptoms of anxiety or depression or displaying a sudden good mood after a depressive episode.

While stigma around mental health is challenged by the way COVID-19 has impacted work and life, there’s still a disconnect between mental and physical wellness. Atchity said that a main goal for Mental Health Colorado is to make the two whole.

“As soon as we start segregating our physical health and our mental health, we are failing to understand our healthy nature or potential for health as humans,” he said. “This pandemic has actually gone a long way to promoting that understanding because even folks who are not thinking about mental health, as soon as this dramatic threat to our physical health as a community comes along, everybody feels it. We feel it in our mental health.”

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