Erica Wassenaar provides remote services

Erica Wassenaar, a play therapist with Creative Living Center in Sheldon, has had to get creative since switching to telehealth appointments in March. She uses puppets and computer programs to engage children in storytelling during sessions held over Zoom.

REGIONAL—N’West Iowa mental health providers are seeing spikes in anxiety, depression and substance abuse as 2020 continues to pose new uncertainties.

“Anxiety here in August was high,” said Dr. Shawn Scholten, a therapist and co-director of the Creative Living Center. “Some of that is related to the pandemic and school starting with all the COVID type of things, but also just the whole state of everything in our world has just been hard.”

Creative Living Center is a mental health and counseling provider with offices in Hawarden, Orange City, Rock Valley, Sheldon and Sioux Center.

Scholten said mental health providers expected needs to surge in March when lockdowns created isolation. What she did not expect was how those needs would spike and change as months went by.

“Initially, it was heightened anxiety, people trying to conduct their lives with restrictions but on a fear basis with a lot of unknowns,” she said.

Summertime activities outdoors with family helped level things out but led to increased depression for elderly folks who could not be as mobile. Then return to school led to another spike in anxiety.

“There’s some anger and frustration here,” Scholten said. “Some people feel hopeful and then something else happens and we’re back to where we were.”

These spikes have increased needs for other services, according to Rebecca McCrackin, vice president of Community Behavioral Health Clinic operations for Seasons Center for Behavioral Health. Seasons offers a range of psychiatric and behavioral health services for all ages and has offices in 19 Iowa counties, including all of N’West Iowa.

“We’ve seen our crisis services increase and have higher demand with one-on-one therapy,” McCrackin said. “Our substance use and actually our domestic violence program, both of those have seen increases.”

Turning to telehealth

Telehealth services have helped providers meet increased demand for services, including to people who might not have utilized regular in-person services.

“We have clients that can be harder to reach because they have busy lives or they don’t always have an emphasis on their own mental health or substance use,” McCrackin said. “Being able to reach them is easier sometimes with telehealth because it can be done anywhere.”

Before March, mental health providers in N’West Iowa did not offer many phone or video appointments. Now that is almost all they do.

Erica Wassenaar, a play therapist with Creative Living Center in Sheldon, made the switch to telehealth within a week of Gov. Kim Reynolds’ emergency proclamation in March. She has telehealth appointments with children as young as 5.

“It was a quick hurry and scramble,” she said. “I’ve done some trainings on how to deliver telehealth to kids since then and that’s been super.”

Wassenaar said Creative Living Center will keep offering telehealth after the pandemic, although insurance companies may stop covering it once offices open fully.

Under the governor’s emergency proclamation, insurance companies must reimburse for telehealth services at the same rate as they would in-person services. The proclamation expires on Sept. 20.

Seasons continues to be fully telehealth. Since the start of the pandemic, it has tapped into county and state-level grants to provide Wi-Fi hot spots, but also things like diapers and food boxes to help clients address basic needs affecting their mental health.

“Counties and other locations are recognizing the issues that are happening,” said Taylor Prather, a Seasons prevention and education coordinator. “There are more emergency funding opportunities.”

All together now

N’West Iowa has a provider shortage, so there always is high demand for mental health services. This year stands out to McCrackin because everyone is affected.

“There’s not any specific group we’re seeing more or seeking out services substantially separate from what would normally have been,” she said. “It’s across the board. Everyone is seeking out services more for various reasons.”

Providers are feeling the toll of 2020, too, and not just in their professional lives.

“We as providers don’t live in this protective little bubble just because we’re a provider,” McCrackin said. “We are exposed also, we have the same concerns as the general population.”

Managing anxiety and depression remain the two biggest challenges, but, according to Scholten, grief and anger also play a role.

“The pandemic has produced grievers of all ages, and not necessarily just for death but lost activities and lost events,” Scholten said. “People didn’t have the graduation they planned on or that vacation or the wedding of their dreams.”

Physical health, too

It is too early to know if 2020-induced stress will have long-term affects on physical health but Karla Salem, a clinical social worker with Sanford Health System, has not ruled it out.

Prolonged uncertainty and fear brought on by COVID-19, the political climate or school reopenings trigger natural fight-or-flight responses that bodies are not meant to endure for long periods of time.

“Bodies can endure anything short-term, but over a long course of being constantly afraid or worried or just confused, all these emotions that are fear-based can cause more permanent damage to our bodies,” Salem said.

Muscle tension, headaches, increased blood pressure and cholesterol or gut problems could result. Over time, buildup of cortisone or adrenaline generated by stress could contribute to back problems, diabetes or heart issues.

Getting out and moving around, whether for a short walk or doing exercise, is a good way to purge those strong chemicals from the body and help it relax.

Salem cautions people not to fall down a WebMD hole trying to self-diagnose any symptoms and instead try to set realistic expectations for themselves and their health.

“Everybody is doing the best they can just with how they interpret their world and how to be comfortable in their life,” she said.