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We鈥檝e all heard the stories by now about health care providers on the frontlines of the COVID-19 crisis who are still working without proper protection equipment, not to mention the lack of adequate sleep and meals. Many of us have responded within our capabilities to help鈥攕everal groups and individuals have taken to sewing face masks, neighbors have created GoFundMe accounts to collect donations to provide breakfast, lunches, and dinner for hospital staff, among other acts of kindness. 

But other first responders on the frontline facing extraordinary challenges who we鈥檙e not hearing much about are mental health providers. 

Therapists, counselors, and social workers are providing vital support for community members as well as other first responders, with many also having to put themselves at risk by continuing to go into an office space, as well as providing services with limited resources. Some have had to shoulder the cascading impacts of rapidly moving their services entirely online, while others have lost half of their caseloads because clients won鈥檛 try online sessions, according to therapist and telehealth consultant Tiffany Chhuom. And then there are those who lack access to reliable video software that provides the same privacy and confidentiality as in-person sessions. 

Mental health professionals are also experiencing elevated symptoms of anxiety and depression themselves. Despite their own challenges, providers are quickly creating and sharing resources and solutions to the technology, access, and insurance problems that the novel coronavirus crisis has created. Because of their impressive efforts and the resilience they hope to instill in those they work with, some of the changes forced by a temporary acute crisis may last longer than COVID.

New Ways of Working with Clients

Practitioners doing remote evaluations and intakes are able to meet with family members together in one video-conferencing session, which is giving them a much fuller picture and sense of clients鈥� background than they were used to getting when meeting with clients individually, according to psychologist Sara Woods, Ph.D., a private practitioner in Lacey, Washington.

鈥淜ids are also loving showing me their pets and homes and other things that help me get to know them better. I wouldn鈥檛 normally get to see all of that!鈥� says Woods, who also works at the University of Washington Autism Center in Tacoma.

In a COVID-related survey to three large Facebook groups, which Chhoum administers, she found that clients who are willing to participate in virtual therapy or telehealth sessions can be more relaxed and receptive to the difficult work of therapy since they are in familiar, safe environments that they can control, rather than a therapist鈥檚 office, which she says can feel clinical and sterile to some. 

鈥淪ome clients actually feel more comfortable opening up to their providers on video compared to in person,鈥� Chuuom explains. 鈥淎dditionally, telehealth might be helpful specifically for clients with traumatic brain injuries who may have memory challenges and mobility limitations. Because telehealth enables automated appointment reminders, it allows clients to remain in their homes and facilitates smoother coordinated care among the client鈥檚 providers who can stay in touch more easily with text and video consultation with the proper end-to-end encryption, of course.鈥�

Danielle Jenkins, a psychologist in Washington and blogger, says the telehealth sessions are making the hard work of supporting clients much easier. 鈥淕roup practices [are] creating affordable support groups online for people who cannot do traditional therapy at this time, and experts [are] letting people join their trainings for free,鈥� Jenkins says. 

It鈥檚 the first time she鈥檚 used telehealth services, and she says she loves it. 

Jenkins says she plans to keep telehealth as an option going forward. 鈥淚 see primarily new and expectant moms as well as immunocompromised clients and this option expands location and minimizes time constraints.鈥�

This new telehealth frontier isn鈥檛 limited to talk therapy. Providers are pioneering online eye movement desensitization and reprocessing鈥攁n effective treatment for trauma鈥攆or clients, and training their colleagues around the world how to pivot from in-office EMDR treatment to EMDR online. They鈥檙e also hosting brainstorming calls for how to continue therapy online for various topics: working with children, working with domestic-violence survivors, combating loneliness-related depression, and more. 

Similarly, providers are creating transcontinental support groups for their clients, for those being hit especially hard by the social distancing and isolation requirements, as well as for fellow therapists. 

Resources for the Greater Good

Therapists and their professional organizations are creating free resources for their colleagues and for the community. Dr. Matthew Whalley and Dr. Hardeep Kaur have written  to living with fear and uncertainty and are now coordinating its crowdsourcing translation into many languages. And the  is offering free continuing education units that providers are required to complete every year to maintain licensure.

Beyond the increased need for virtual sessions with new or existing clients, COVID-19 is highlighting the need for therapists who specialize in working with other therapists. Large, multistate medical systems such as Providence are responding to that need by rolling out mental-health services for their mental-health providers. Therapists are offering pro bono telehealth to first responders, but the challenge is finding ways to connect those offering services with those who need them.

Washington state, the first U.S. epicenter of the pandemic, has enlisted several professional organizations to keep records of therapists available and trained to work with other first responders: , the ,  and the .  

Other providers are turning to social media to facilitate those connections. Brooke Fina, LCSW, BCD, Associate Professor-Research in the Department of Psychiatry and Behavioral Sciences at the University of Texas Health Science Center at San Antonio, is asking mental health professionals to promote their skills, resources, and organizations under the hashtag #ImTrainedImHere, with the goal of helping community members know where they can go for mental health resources. 

Maintaining Healthy Connections

Virtual connection is our primary option right now. Businesses, therapists, and, increasingly, congressional representatives, medical centers, and governmental agencies are providing regular live updates through their Facebook pages, YouTube channels, and Twitch accounts, where they answer questions in real time from anyone tuning in. However, even with this new level of access to authorities, Roxane Silver, professor of psychological science at the University of California, says, people should take caution.

鈥淩esearch does make it clear that social media is a larger source of misinformation and rumor than we typically get from traditional media,鈥� Silver says. 

Julianne Holt-Lunstad, professor of psychology and neuroscience at Brigham Young University, echoes Silver鈥檚 concerns.  She doesn鈥檛 believe tech tools should remain the centerpiece of social connection after the crisis ends. 鈥淚t鈥檚 concerning to think of [virtual connection] as becoming a predominant means of communication鈥攍osing face-to-face connection could lead to a longer-term public-health crisis,鈥� she says. 鈥淲e need to regain a sense of normal face-to-face connection once this crisis is over.鈥� 

Even as we may still be at the beginning of this crisis and its effects, mental-health providers have already done so much work to make support and resources available to as many people as possible, even as they themselves are struggling. And while their work is not done, the contributions they鈥檝e made to healing from this collective trauma are already taking effect.