When Mental Distress Comes Home

The panic spirals up from somewhere in Connor Langan’s midsection, and so quickly that his face changes; wild in the eyes, his upper lip trembling, he sometimes punches a wall in frustration. Such episodes resulted in Connor, 17, being placed on leave from high school late last year, and in early March he agreed to enroll at Mountain Valley, a New Hampshire residential program well known for addressing anxiety problems in young people.

But on March 27, in response to the growing threat of coronavirus, the facility temporarily suspended operations and began sending home some two dozen teenagers and young adults. The facility’s therapists have set up virtual connections to continue providing support for some individuals, but the change was abrupt for everyone.

“The night before I had this panic attack, almost a full-on psychosis, and the next day I really wanted to talk about it,” said Connor, who is now back at home with his parents in Bedford, N.H. “There was so much uncertainty, I knew it would be difficult to now bring these problems back into the family.”

His parents know the feeling. “We were nervous, to say the least,” said his father, Stephen Langan, who works in financial services. “This program was supposed to be the bridge to get him back on the track he wants to be on. Now there’s a big hole in middle, and he has to jump over it — while at home.”

Across the country, the coronavirus pandemic has scrambled mental health services, forcing thousands of people with disabling psychological distress, and their families, to adjust on the fly. Late last month, the Trump administration loosened regulations on psychiatric wards, allowing beds to be reallocated to handle Covid-19 patients, as emergency rooms in New York and other hard-hit areas became overwhelmed. Outpatient and community clinics have had to shut their doors; and many of the country’s hundreds of residential programs, like Mountain Valley, have either tightened admissions, barred visitors or suspended operations entirely.

“Program capacities are shrinking and staff are being laid off,” said Virgil Stucker, the former director of CooperRiis, a residential therapeutic program near Asheville, N.C., who now has a private consulting practice. “Families will need to take more family members back home who are experiencing acute and complex mental health conditions” and learn how to provide support themselves.

No family moves a loved one into long-term treatment, public or private, lightly; the moment often arrives at a breaking point. Two parents who were interviewed for this article subsequently asked to not be involved, in fear of reprisals from a grown child now underfoot and out of control.

“They’re literally scared for their lives, some of these families,” said Brad Richards, a New York-based mental health advocate who helps families find placements for loved ones in crisis. Many parents are on their own, he said, with multiple other children and little ability to defuse destructive situations.

Connor was fortunate, he said — the Langans are an intact, close family. The morning after he experienced serious panic, he packed himself into a car with his mother, leaving behind his therapist, his new friends and the highly regimented daily routine at Mountain Valley. He arrived home to a tight household, with his parents, two older siblings and the sister’s Czech boyfriend, who was stranded in the United States by travel restrictions. The two now share a room.

Connor was scheduled to stay at Mountain Valley through June, said his father. “But now with all the rigor of his day gone — well, any kid is going to backslide a bit into old habits, stay up late, get up late and spend time on XBox. For us, as parents, we need to be open and reflective about our role in his anxiety. It’s very tough to disentangle a 17-year-old boy from someone who has this severe anxiety. He sure doesn’t like people telling him what to do, and we’re getting pushback, that’s for sure.”

Connor agreed. “I’ve had some anxious episodes since I got back,” he said. “I got frustrated with this online schoolwork, and with my parents at one point.”

For individuals like him, some support is arriving over video services like Zoom and VSee, in the form of tele-therapy, although federal guidelines that restrict the practice from crossing state borders is limiting its use in some regions. “We’ve been working with families to connect them to local therapists, and for some residents we’ve developed a virtual program,” said Timothy DiGiacomo, the clinical director at Mountain Valley.

At home, Connor has virtual sessions with a therapist, and his parents are receiving online support as well. It adds up to a lot of personal sharing, in a tight space.

“The parent sessions have been good,” Mr. Langan said. “But my wife and I are doing them in a room, and it seems everyone in the house can hear what we’re saying.”

The full impact of the pandemic on people managing mental disorders will only become clear with time, experts have said, and will likely vary widely by individual, depending on the severity of the distress, family support and resources. Being stalked by an invisible enemy surely mortifies those with an obsessive-compulsive fear of germs, and deepens the distress of many who have experienced waves of uncontrollable anxiety before the epidemic. Individuals who have developed skills to manage their moods will likely fare well, experts said. Some people preoccupied with urges to commit suicide may feel more hopeless; others will shift to survival mode and put aside self-destructive instincts in the shadow of a wider threat.

For now, the displacement is what is being felt most acutely by people who have left residential programs. Calls to help lines across the country have risen sharply. Crisis Text Line, which offers free crisis counseling through text messaging, reported earlier this month that two-thirds of texters nationwide are describing more intense sensations of depression and anxiety linked to the spread of Covid-19 — nearly double the reported intensity before the outbreak, according to an analysis of text terms.

“Calls to our hotline were up 60 percent in the last two weeks of March,” said Matt Kudish, the executive director of NAMI-NYC, the city branch of the nonprofit National Alliance for Mental Health. “I don’t think trauma is overstating what some people are experiencing right now.”

Jennifer Eve Taylor, a therapeutic educational consultant in the Bay Area, said that her 19-year-old son John Hendrick, who has autism as well as anxiety and mild depression, had been doing very well in a young adult transition program in Burlington, Vt. He had a team of four advisers, including in occupational therapy, assisted living and social support. He had been taking college courses until that program, too, suspended operations, and he flew to Florida to stay with his father.

“Young adults like these, oh my goodness, they do not transition well,” Ms. Taylor said. “They can avoid life with technology and just retreat into video games and streaming shows. We are seeing this with John already. We don’t have the team to support him.”

Mr. Hendrick, reached by phone in Florida, said the loss of his stable, supported life in Vermont was so sudden that he was reeling by the time he joined his father. “Changes cause so much stress for me, that’s what it is,” he said. “But you know, after some time I usually start doing fine. I really like having a schedule — I need to keep a schedule.”

His father, Bud Hendrick, said he started planning for his son’s possible move as soon as the coronavirus emerged as a growing epidemic in early March. “The first week home, I let him adjust as much as possible,” Mr. Hendrick said. “But after that, I really had to start a daily schedule that replicates as much as possible what he had in Burlington. That has helped enormously.”

Connor said that so far, his panic attacks — often in response to academic pressure — have been mostly under control at home, in part because his family has come to better understand his occasional fits. “The most notable physical effect it has is my upper lip quivering,” he said.

“I’m lucky, very, I know that,” he said. “A lot of people I know, I really don’t think going back home is the best thing for them.”

At least for some them, the home stay could end soon: Mountain Valley announced last weekend that it plans to reopen on May 18, with new precautions in place, including daily disinfection of all surfaces and enforced hand-washing.

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