On May 4th, 2020, The Washington Post published an article titled as follows, “The coronavirus pandemic is pushing America into a mental-health crisis.” It talks about the rise in the mental health needs of communities and the increased call for tele-mental health services while mental health clinics are already overwhelmed. It narrates the traumatic situation that will remain as an inevitable environment for many days to come.
The trauma of this pandemic, COVID-19 is going to stay fresh in our memories forever. More than 60 days into the lock down and we are still struggling to find a way to resolve this problem, understand the days that are to come and imagine what is going to be our new normal. Life is not that simple anymore. We are in a complex state of human life, a state where we need to isolate ourselves to ensure to be with our loved ones. We need to be alone to be together. We are living in a state of contradictions and confusion. Our practices and approaches in behavioral therapy have been reversed.
I have been in the field for more than 15 years now in multiple roles. My current roles involve working full time as a Care Manager for a Managed Long-Term Care company (MLTC), a mental health therapist in a Mental Health Clinic in New York City, in addition to running my consultancy Resolveera that works with parents of children with disabilities. This wide age range has given me the opportunity to see a newer and more complex versions of isolation & loneliness, stress, anxiety, depression, anger, frustration, helplessness, obsessiveness, adjustment disorders and trauma. It is interesting to see how behavioral therapists are using our skill sets to address the unmet needs of our clientele while we ourselves are facing the same issues. We are also scared and worried about the future, a potential global economic depression if the COVID-19 crisis persists longer. While our clients are facing lack of space, they are tied up in homes dealing with adjustment issues, or isolation because they have nowhere to go, on the other hand, we professionals are also juggling between our professional commitments and personal responsibilities. As a professional, I do not see a therapist and a client. Today, we are just “us” and we are all waiting for this exceptionally long and painful episode in life to reach its climax. It is not that we never face counter transference especially in behavioral therapy or that we do not practice self-care when the work gets to us, but it is the way we have been dealing with our own stress and anxiety lately. The community, both clients and therapists are facing multiple layers of confusion and crisis. It is an inter-connected mesh of emotions arising from the following triggers: financial insecurity, health complications, loss of familiar support, fear of the unknown and fear of death. Let us understand the crisis from a low income, legally documented South Asian immigrant perspective.
Financial Insecurity: Talking about NYC, most of the low-income group South Asian community members do odd jobs at various stores and restaurants. A big number of South Asian men are usually the yellow and green cab and/or the TLC cab drivers. Model minority is a myth as all South Asians are not in IT or are not doctors or scientists. Most of the females from these households are often the care givers of seniors with MLTC services, since the South Asian communities have senior family members living together. Due to COVID-19, men are unable to drive cabs, the women are earning through MLTC services to the seniors at home. I am focusing on only those families that are enrolled in these services. However, many are opting to quit the care giving jobs to file for unemployment with an expectation to get some more financial help. This kind of insecurity has led many families in major food crisis. Many such families facing major financial crisis are not used to online shopping hence these families are relying on community resources. Potential risk about the economic crisis is a stress that can lead to unimaginable behavioral outbursts and patterns for this community where we still find mental health issues as a taboo.
Health Complications: Community members with an underlying health conditions are at risk of getting COVD-19. Many low income South Asian families live in lower income group housing or small apartments where maintaining social distancing is difficult. Often large families are in a small apartment or multiple families live together. Most of the South Asian seniors have high diabetes, cardio-respiratory problems and asthma. A carrier of COVID-19 in such a household can bring in additional stress, blame for the carrier and unwanted trips to the ER or urgent care. As a Care Manager, I observe patients often describe that until they have a life-threatening situation they will not got to ER or urgent care. I agree to tell patients to wait until they think that they should call 911 when they think that they cannot handle things anymore. Most of these patients are limited English proficient and cannot even describe their concerns when without a family member around. ER and urgent cares have become the hotspots for COVID-19 exposure, and patients cannot trust their providers anymore as non-carriers of COVID-19. Hospitalized patients cannot be with their families and the worse of all, many have died or will die alone and breath their last without being with their loved ones, but only virtually.
Loss of support: Most immigrant families have had the initial loss of support when they decided to get displaced and move or settle in another country. These immigrant families find support in the community among neighbors, peers and the biggest support being their Primary Health Care Worker who often is one who speaks the language these immigrant families prefer. So is the case with South Asian community. However, over the lockdown the community has lost a lot of healthcare providers and doctors leaving their patients in shock, in immense anxiety and stress. South Asian community members often ask for help as they do not know who to contact to get a medication refill, sign a prescription for a much-needed medical supply or as simple as getting a follow up consultation from a doctor who could speak their language and understand their concern in their own way. South Asians treat doctors as representatives of God who can cure everything and make someone perfect again. With doctors falling sick and dying, the community stands shaken in disbelief.
Fear of the unknown and death: It is by default that we want to die amongst our loved ones. We all want to be held tight, smiled at, prayed for and loved when we are breathing our last. Sadly, for many, COVID-19 has brought the exact opposite experience. People across the political boundaries in the world have died alone, away from their loved one and buried during mass burial. For many bodies are waiting to be claimed and many more awaiting. Families have not received the closure they need, there has been no bereavement process for those who lost their loved ones due to COVID-19. This is even more devastating to imagine for immigrant families as they are often split between their country of origin and the country they moved to. Many are left alone here as their immediate families have not returned due to the travel ban. Fear and anxiety has grasped the community to the extent that even after multiple falls, potential injuries and with symptoms of stroke, a patient would refuse to go to the ER fearing that he/she can contact COVID-19, a kiss of death! People fear that if hospitalized, they will be isolated and eventually die alone. Especially for South Asians, death is marked with spiritual and cultural practices that directly connect with faith. Bereavement and closure are more of a spiritual process. For South Asians lack of this process is very depressing and scary. Unfortunately, these concerns are often the unspoken and unmet needs that trigger behavioral concerns but are never addressed appropriately.
It has been awfully hard to come to terms with this pandemic and associated self-quarantine because we never imagined that we would face a lock down for so long. I have observed that the multi-layered issues leading to the current behavioral changes and individual traumatic outcome is not just due to the virus. It is the ripple effect this pandemic has created in our daily lives that has not only changed our behavior towards ourselves and our family and friend, but also shaken us up to understand that certain adjustments are possible. This trauma will stay for a long time. It will take months before we regain the trust to shake hands, exchange items, sit beside one another without being concerned about contacting COVID-19.
Along with clients, South Asian therapists are in a similar crisis with a need for support groups. The author is involved in created such support groups for professionals and can be reached at firstname.lastname@example.org. For more information, visit resolveera.org