From remote learning challenges to unemployment woes, feelings of anxiety, helplessness and grief are at an all-time high.

Lying on the grass outside her childhood home, Helena Federman shielded the sun’s rays with one hand as the other pressed her phone to her ear. On the other end of the call was her therapist, Jamie Olken, from her home office in the Upper East Side. At 1 p.m. for the past four weeks, Federman curled in the corner of her lawn to reflect on the previous week with her therapist, a position she finds herself in every Tuesday. While life may be on pause for much of the United States, for those struggling with mental illness, like Federman, their battle with anxiety continues unabated.

For Federman and the other 43.8 million adults who experience mental illness, coronavirus has redefined the nation’s mental health care system. Across the country, widespread social distancing has refigured mental health services, forcing many patients with psychological distress, and their therapists, to adjust from face-to-face meetings to virtual ones.

“Remote therapy has been difficult for me,” said Federman, 18, who has worked through her anxiety with a therapist for over six years. “When you do therapy on the phone, your communication skills need to be elevated. Jamie usually picks up my subtle body cues or can read a change in my expression when I see her in person, but now, she just hears my voice. I find it’s easier to fake progress. I catch myself lying sometimes, so it’s challenging. I have to be more honest with her, but also myself.”

Federman resumes her meetings in an open space where she can talk without fear of being overheard. Surrounded by her father’s fringe trees and its shaggy white flowers in full bloom, it is here where she feels the most comfortable. “Jamie suggested I walk around the neighborhood,” she laughed. “I did it once, and it was freeing. The only problem is I live in a really hilly neighborhood, and I got winded after five minutes. My favorite place is still outside. I just do it sitting.”

From remote learning challenges to unemployment woes, feelings of anxiety, helplessness and grief are at an all-time high. 45% of adults reported that the pandemic negatively impacted their mental health, according to a new Kaiser Family Foundation poll. This increase in numbers is because a majority of people, who never attended therapy sessions in the past, are experiencing increased anxiety levels brought on by the pandemic, mental health experts said.

“Since being back home, I’ve found that I’m more anxious than I was at school,” said Michael Conte, 19, over FaceTime. After a couple of years in therapy, the Union College sophomore stopped meeting with a therapist last year. However, since he moved back with his parents, he found his stomach aches, personal manifestations of his anxiety, getting more intense. The panic starts from somewhere in Conte’s midsection and causes him to squirm in his seat to push out the discomfort. Such increased episodes resulted in Conte having to find a new therapist since moving back home.

Conte is hardly alone. One in five college students reported that their mental health has significantly worsened since the pandemic, according to an April Active Minds survey of over 2,000 teenagers. While scientists and government officials urged people to practice social distancing to reduce the spread of the coronavirus, isolation brought home their own horrors. For those experiencing depression and anxiety, cutting them off from their regular routines and social networks caused preexisting conditions to worsen, said Dr. Justine Carino, 34, a licensed mental health counselor in New York.

“Since being home all these new anxieties like increased social media usage, not being able to engage with my social support system at school, and pent up tensions with family kind of layered themselves onto my already rocky mental health,” said Conte from his home in Briarcliff Manor, New York.

Like Federman, Conte reaffirmed the importance of finding a private place for therapy sessions: “I go to my car. It’s the one place I know I won’t be overheard.” At the foot of his garage, Conte conducted his sessions through Simple Practice, a platform that facilitates billing, scheduling, and client communication for health and wellness professionals. 

While Conte attends therapy sessions through Simple Practice, other telehealth therapy platforms have exploded into sudden prominence. So much so that Therapy Brands, owner of teletherapy platform, thera-LINK, saw more than 4,300 percent spike in telehealth use over one week. Many therapists are also making use of communication platforms like Zoom or Doxy that have the advantage of being HIPAA-compliant, meaning the personal data transmitted between patient and therapist is confidential.

Among the therapists using Zoom is Dr. Ilana Rosenberg. “The visual teletherapy platforms are better than just phone calls or primarily audio-based services because you can see the person, their facial expressions,” said Rosenberg, who specializes in anxiety, depression, and loss treatments. “You can see if they’re crying, their body language — not all their body language but some of it. You can just see what’s going on.”

Rosenberg, who runs a private practice out of Scarsdale, New York, has twenty years of experience working with patients but has never conducted virtual meetings before shelter-in-place. Although the transition was weird at first, after a while it became normal, she said.

“So far, the transition has been good,” Rosenberg elaborated. “Connectivity issues are a challenge because sometimes my patients will freeze. And the other issue is that if I’m in the attic, there’s no lock on the door so often my five-year-old son will come in and demand my phone or something. It depends on what my husband is doing, but most times he’ll corral him. That’s the hardest part, being interrupted by him.”

Carino said she had noticed a slight shift in practicing online as well. “With virtual therapy, people are so distracted,” she said. “Phones go off, animals walk into the room, brothers and sisters bust in, people lie in bed half asleep. The energy needed to connect through the screen just isn’t the same.”

To ease the strain on mental health, many therapists offered additional time slots. While this accommodates more patients, Carino shared that it has taken a toll on her wellbeing. “There is no break,” said Carino. “I’m on duty with my son in the morning, then I’m on duty with my clients and then I’m home. It’s been harder to make some time for myself.”

In between seeing patients, cooking dinner, cleaning the house, and keeping her five-year-old son entertained, Rosenberg, struggles to prioritize her wellbeing. Despite these battles, she still tries to provide some semblance of normalcy in the form of weekly newsletters for her patients. Open-heartedness was the subject of last week’s newsletter.

“We may compare our suffering with others in either direction, whether we have more or less suffering, but this doesn’t truly help us feel better,” she wrote from her laptop in the kitchen, which functions as her makeshift office for the time being. Reaching out to social support systems and taking advantage of free virtual resources are vital in safeguarding your mental health, according to Rosenberg.

Other experts interviewed, like President of Child Adolescent Mental Services (CAMS) Alice Guberman, echoed similar sentiments. “It’s important to stay connected with family and friends by reaching out and using FaceTime or Zoom,” said Guberman.

Guberman started as a Drama major in Tisch School of the Arts, but transitioned to study psychology after battling personal mental health issues. As a rising junior, she leads CAMS with the goal of improving adolescent mental health within the community. CAMS on Campus aids in career development, but also provides resources for the continued improvement of student body wellness, outside of the College of Arts and Sciences, according to Guberman.

Guberman hosted a virtual Zoom mixer where CAMS faculty, members and their friends had the opportunity to check-in with one another, last Friday. “We have tried to move online the best we can,” she said over the phone. “Along with sending out our weekly CAMS newsletter, we are adding positions such as an outreach chair to increase our presence as best we can during this time.”

To cope with the regular uncertainty of the crisis, Guberman recommended that people adopt all the typical self-care activities: sleep, cook, watch TV and connect with friends and loved ones. “It’s important to continue to do things that make yourself happy,” she elaborated.

The full impact of the pandemic on people managing mental disorders will only become apparent with time and even then, vary on an individual basis depending on the severity of distress, family support and resources, mental health experts said. For now, helplines across the country are feeling the immediate weight of the crisis as service usage has significantly risen. Two-thirds of texts received in April described intense battles with coronavirus-related depression and anxiety, reported Crisis Text Line, a free crisis counseling service.

As the coronavirus pandemic developed, therapists observed an equally threatening secondary crisis of long-term mental illness unfold alongside it. While lawmakers are aware of these psychological traumas lingering beyond the pandemic, they have made little to no strides to address mental health, experts said. Gov. Andrew Cuomo, who employed more than 6,000 mental health providers to help New Yorkers during the onset of the pandemic, is an exception.

For the time being, teletherapy sessions provide a glimmer of hope. “The hour with Jamie is like a breath of fresh air,” Helena said. “Instead of all my problems building upon each other, she allows me to work through them so I can start the next week afresh.”