“He told me he was experiencing a lot of anxiety witnessing a lot of death, he’d feel it was a heavy experience when he’d fail to save a life,” Mondello’s friend told the New York Post.
Dr. Lorna M. Breen, 49, was the medical director of the emergency department at New York-Presbyterian Allen Hospital. She died by suicide on April 26. Breen had no prior history of mental illness, her father, Philip Breen, told the New York Times, but she seemed “detached,” when she spoke about the onslaught of death she was witnessing at work.
“She was truly in the trenches of the front line. ... Make sure she’s praised as a hero, because she was,” her father said. “She’s a casualty just as much as anyone else who has died.”
Workers on the front lines of this pandemic are not only being put at physical risk. They’re staring down a massive mental health crisis, too. Tasked with treating tens of thousands of patients, often without adequate resources such as personal protective equipment, health care workers are experiencing hopelessness in the face of repeated exposure to death and illness, according to Jodi Jacobson Frey, a professor at the University of Maryland’s School of Social Work.
But these risks aren’t just limited to first responders and frontline workers. They’re felt by many of us who struggle with mental health issues, especially those with a history of suicidal ideation or attempts. A new study released Friday found that up to 75,000 additional people could die from “deaths of despair” — suicides and substance use — because of the Covid-19 crisis. That’s on top of a suicide rate that was already on the rise before the pandemic.
“There are many reports from crisis lines and other data collection sources that there has been an uptick in firearm sales, interpersonal violence, and personal financial crisis,” said Jonathan Singer, president of the American Association of Suicidology, adding that these are all factors that have long been correlated with increased suicide risk.
“In one worst-case scenario, you have someone who has been struggling with suicidal thoughts for a long time, recently lost their job, and is in a highly conflictual interpersonal relationship with no safe means of leaving,” he said. But with social distancing and self-isolation, resources and support systems are harder to access. Add the government’s failure to adequately respond to the litany of risk factors, and the mental health crisis will only get worse.
I know firsthand how risky this time is. A few weeks ago, I hung up on my therapist. My phone immediately trembled with a notification. Please fill out this safety plan, my therapist’s message read, reiterating what she had tried to tell me during our teletherapy session.
My life was in danger. Again.
Last November, after spending months suffering from untreated bipolar disorder and social isolation, I attempted suicide. Afterward, I needed to breathe life back into myself.
I planned on using this year to be with the people I loved, to travel to new places, and learn to transform my deep pain into building community. But just three months after I gave up hope on life, Covid-19 plunged me back into loneliness. I felt as though this critical year of healing had been stolen from me. And in many ways, it has been.
In the year after a suicide attempt, people are at their highest risk of attempting again and dying by suicide, according to a recent scientific review by Drs. Jennifer Schreiber and Larry Culpepper. It’s especially dangerous for people with schizophrenia, bipolar disorder, and unipolar major depression.
An article published last month in JAMA Psychiatry explores how social distancing — the practice of staying at home and remaining physically distant from others to reduce infection rates of the novel coronavirus — is connected to a higher risk of suicide. “Individuals experiencing suicidal ideation may lack connections to other people and often disconnect from others as suicide risk rises. Suicidal thoughts and behaviors are associated with social isolation and loneliness,” the authors write.
I know how feeling utterly alone and abandoned can make me think I’ve run out of options. A few times since I started social distancing, I’ve curled up in a ball and sobbed, weighed down by the feeling of isolation, the feeling that I had locked myself into a tomb. In a lot of ways, I feel I’m slowly returning to the space I was in at my worst. And I’m terrified.
Still, I know staying at home is the best way to prevent the spread of the coronavirus. I may be in danger because of my psychiatric conditions, but sheltering in place, I tell myself, is how I will keep myself and my loved ones safe. That doesn’t mean I’m not fighting like hell. And that every day, the government makes it more difficult.
The failed state response to this pandemic — from a staggering lack of widespread testing to an immense shortage of masks and other protective equipment — has resulted in more than 60,000 deaths and 26.5 million lost jobs. I’ve watched our president give medical advice that would literally kill us. Every day, another state rushes to reopen its economy, disregarding the advice of public health experts. Meanwhile, with diminished budgets, my writing career plummets and unemployment benefits feel impossible to receive. As our government fails to contain this virus, more people will die, not only from physical illness but from the mental despair they might succumb to.
It makes sense hospital workers are at risk. In early March, the US only had 1 percent of the required masks experts estimated it would need to address this crisis. Hospital workers were failed by a system that did not provide frontline health care workers — including nurses, sanitation workers, and medical assistants — with enough personal protective equipment, so they wouldn’t have to watch their colleagues die.
Then there was our government’s refusal to enact stay-at-home orders earlier in the crisis, which caused hospitals to become flooded with Covid-19 cases. Meanwhile, hospital workers were further failed by the lack of sweeping rent and mortgage cancellations, or economic safety nets that would ease some of the stresses of having to go out and work and be exposed to the virus.
On top of the essential workers on the front lines of this crisis — many of whom are underpaid black, indigenous, and brown people — there are other vulnerable populations to be concerned about during this time: domestic violence survivors trapped with their abusers, feeling like there’s no escape because they can’t afford a hotel and all the shelters are closed. People who’ve lost hope because they’ve become houseless or because they can’t feed their families. Those who couldn’t hold their loved ones’ hands as they died from this disease. People struggling with substance misuse are also endangered, especially if they’ve previously experienced an overdose, which is linked to a higher risk of dying by suicide.
Then there are the mentally ill people who can’t afford life-saving treatments and medicines they need, or who don’t have the community resources to keep them alive. Then add to that an 85 percent increase in gun purchasing during March, and people are two to 10 times more likely to die from firearm suicide than other kinds of attempts.
Gabriela is a recent college graduate who has depression and anxiety. She has no idea how she’ll find work or get health insurance. She told Vox that this instability, as well as being away from her family, friends, and partner has caused her to struggle with suicidal ideation.
As a resident of Puerto Rico whose entire undergraduate experience has been filled with natural disasters, she says our governments need to assume responsibility for this mental health crisis. “I wish they would just do their job and their part in ending the pandemic as soon as possible,” she tells Vox.
For me, it’s one thing to be in recovery. It’s another to do so with the fear that if I were to have a psychiatric emergency, the facility I’d be transported to might have a Covid-19 outbreak due to policies, neglect, and psychiatric patients’ specific vulnerabilities. Then there is the middle-of-the-night panicking about what the future of our world is going to look like.
The more prepared our health care workers are, the more effective our leaders can be, the more at ease those of us who struggle with mental health issues can feel.
Frey tells Vox that there are ways to address this issue, primarily increasing our investment in mental health and substance use treatment. She also points out that it’s critical to consult those who have firsthand experience with mental illness and substance misuse. “People who have gone through the experience should be part of finding solutions,” she says.
I am mourning the critical year of healing I thought I’d have. But to stay alive, I have to also embrace the year that lies before me, however uncertain it may seem.
So, to continue my healing, I speak with people I love through video calls, meme-sharing group chats, and daily check-ins. I attend psychiatry appointments online, and get my prescriptions delivered. I do constant internal work, journaling, and reflecting. I keep the suicide hotline number nearby. I grasp at hope wherever I can find it. I try to love deeply, I try to forgive myself for things I may regret. I try to find joy wherever I can.
I dream of a different world. And when I feel rage, I try to use that rage to imagine how I can help make those dreams a reality, like becoming a health care worker in communities of color. Despair is everywhere. But so is the desire for change, the hunger for revolution.
Dese’Rae L. Stage — an artist, suicide attempt survivor, and creator of Live Through This, a series of portraits and true stories of suicide attempt survivors across the US — has also struggled with symptoms since the crisis started. “Once this is over, we’re going to fundamentally change as people,” she says.
Frey says she’s hopeful when she sees people increasing their awareness about mental health issues and disparities, saying that the Covid-19 crisis is like a mirror that shows us how broken our society is. “And the mirror is shattered,” she says. “So if we don’t learn from this and we don’t improve. … I almost can’t even stomach the thought. People are going to continue to die if we don’t do something to change the system.”
Nylah Burton is a Denver-based writer. She covers mental health, social justice, and identity. You can follow her on Twitter.