Webinar: Expert Insight on the Impact of COVID-19 on Mental Health and the Demand for Mental Health Services

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Dr. Timothy Legg, a clinical assistant professor and the track director for UND’s Psychiatric-Mental Health Nurse Practitioner master’s program, shares data and insight from his professional experiences to explain the impact the COVID-19 pandemic has had on mental health and the demand for mental health services.


Aysha Syed:

Slide 1:Hello, and welcome. Thank you for tuning into today’s webinar. We know you are busy and your time is valuable, so we appreciate you fitting us into your schedule. My name is Aysha Syed and I’m an enrollment advisor with the University of North Dakota. I work with and support students, who are interested in our online nursing program, from application through enrollment. Joining me today to discuss the impact of the COVID-19 pandemic has had on the demand of mental health services is Dr. Timothy Legg.

Slide 2:Dr. Legg is a clinical assistant professor and the track director for UND’s Psychiatric Mental Health Nurse Practitioner master’s program. He has taught nurse practitioner students for more than 20 years, as well as worked extensively in both inpatient and outpatient psychiatry, including several years in a comprehensive psychiatric emergency program in upstate New York. In addition to Dr. Legg’s current role here at UND, he remains active in private practice in the upstate New York area, where he works with those who struggle with addictive disorders, dual diagnosis and a wide variety of psychiatric and mental health issues.

He also maintains employed practice with AMD in Moosic, Pennsylvania, where he provides psychiatric care and services to individuals with substance use disorders, dual diagnosis and neuro developmental disorder. Additionally, Dr. Legg offers services to individuals in remote areas of North Dakota via tele-psychiatry. Beyond his clinical work, Dr. Legg served as a member of the editorial board for The Carlat Addiction Treatment Report, a peer reviewed publication for addiction professionals, and is also a member of the editorial review board for the behavioral health section of The American Journal of Recreation Therapy, as well as the Psi Chi Journal of Psychological Research.

Slide 3: Dr. Legg has also authored or coauthored a plethora of published work and participated in numerous presentations. Including one in August, 2020 with Dr. Fauci to discuss COVID-19 from a mental health perspective. He has consulted Healthline, Medical News Today, [inaudible 00:02:14] and Psych Central as the lead medical reviewer from psychology and psychiatry topics. As you can tell, Dr. Legg is a wealth of information and expert in the field of psychiatry and psychology. So I’m going to turn it over to him to share his perspective on how the COVID-19 pandemic has impacted mental health based on his experiences and extensive research/

Dr. Timothy Legg:

Slide 4:Thank you. It’s fantastic to be here today. Okay. So we’re going to begin our talk today by speaking about COVID-19’s impact on the world and not just nursing. Now, many of you have come from a nursing background today to participate in this webinar. But I’m going to just talk a little bit of more of a bird’s eye view as to how COVID-19 has impacted the larger picture. Here in the United States alone, we have had approximately 32.5 million cases. And again, this does continue to increase. There have been in excess of 578,000 deaths. And we continue to see areas of spike and recession.

Currently, we do know that some areas are continuing to be hit harder than others. Some current findings include increases in areas where individuals have not been vaccinated. Vaccination continues to be a significant challenge. As of May 4th, 2021, 147,894,671 people have received at least one vaccine, one of their vaccines. 106,168,588 people have been fully vaccinated. And just to put this in its proper perspective, we have 328.2 million people in the world… Or I’m sorry, in the United States. So as you can appreciate, we’ve still got a little bit of a way to go.

Slide 5:How has it impacted? And I’d like to change that question to, how hasn’t it impacted? COVID-19 is unlike anything that we have experienced in our life times. It has closed businesses. And with the closing of businesses, there has been an associated loss of income. And of course, if I’m not working, I’m probably not getting my healthcare benefits. Of course, precarious housing is an issue because if I’m not bringing in the income, then I’m having difficulty meeting the rent and mortgage payments. Some individuals have been struggling with food insecurity and probably a couple of dozen other areas that I haven’t even begun to touch on here. School’s closed. And parents who could do their work remotely have been struggling with childcare. Because on one hand, if they’re expected to be productive and get their work attended to, but yet when children see mom or dad at home, hey, it’s time to play or let’s do something. So that has been a challenge as well.

COVID-19 has also changed the way the children socialize with one another. And up to the COVID-19 pandemic, there was a great deal of concern among public health professionals about the amount of time that children have been spending with computers and in front of computer screens. And of course, some elements of obesity and social isolation have been linked with that phenomenon. Now, we have children who can no longer be with one another in school. They’re not seeing their peers. And now we have to use a telephonic methods and the internet to communicate with one another. It’s also changed the way we relate to one another. Interestingly, at the beginning part of the pandemic, if you went to a grocery store and you reached passed somebody for something, even though you had a mask on, they would step back from you and they would look at you with fear or suspicion.

We also know that there have been a lot of politically motivated narratives that have gone a long way in terms of being divisive among individuals. It’s also brought out violence and really turned up the volume on a great number of societal prejudices. Fear, again suspicion, politically motivated narratives, et cetera. There have been individuals who have been arrested for violence toward others for both wearing and not wearing a mask. So it’s been really unlike anything that we’ve probably seen in our lifetime. How is all of this relevant to today’s discussion? Well, it has negatively impacted the mental health of many people.

Slide 6: It has impacted, we know adults, children, older adults, healthcare workers. And it’s done it in ways that might be kind of apparent to us, but in other ways, it may not be as apparent. It has impacted people in terms of the development of new onset of depression, new anxiety disorders, insomnia. And not only does it represent new cases, but even individuals who are being well treated for these conditions have experienced worsening in their symptoms. So, let’s consider some numbers.

Slide 7: I’m relying heavily on data obtained from KFF, The Kaiser Family Foundation, and they’ve provided some really good information for us. Let’s start with the consideration of the number of adults reporting symptoms of anxiety and or depressive disorders during the COVID-19 pandemic by household and job loss status. Households with job losses since March 13th, 2020, we are seeing quite a high percentage in comparison to no household job loss.

In other words, among individuals that did not lose their jobs, we’re seeing anxiety and depressive symptoms coming in about 31.8%. But when there has been household job loss, we’re seeing well over a 20% increase in the number of percentage of individuals impacted by depressive and anxious symptoms. When we consider the percentage of adults who say that they have worries or stress related to coronavirus and that it has negatively impacted their mental health, we’ve looked to household incomes. And we see individuals… And I do want to impress that, yes, individuals have been impacted in terms of major or minor. But following every other disease trend, you typically find that individuals who are more socioeconomically disadvantaged have been having the more negative impact. So when we consider households that have a combined income of $40,000 or less, 35% have been reporting a major negative impact and 21% minor. When we move into the $40-89,000 per year bracket, we find that the percentage of major negative impact drops to 21%, but minor negative impact is higher at 30%.

Finally, when we consider those individuals who make $90,000 a year or more, we see that the major negative impact drops even a few further percentage points to 17, but the minor negative impact climbs by a percentage point from the 40-89. But represents a 10% increase over those individuals who were making $40,000 a year or less. When we consider the overall percentage under the 40,000 hours per year or less combined impact was about 56%. But when you consider those making 90,000 a year or more, that percentage drops to 48,000. So again, the take home message to this slide is that like every other public health issue, socioeconomics does play a role.

Slide 8: Okay. Let’s consider the share of adults who have been reporting symptoms of anxiety and or depressive disorders in terms of race and ethnicity. When we consider the other non-Hispanic group, we’re looking at 48.9%. Non-Hispanic Blacks were rating it around 48%. Those identifying as Hispanic or Latino at approximately 46%. It dropped when we consider all adults, that number is approximately 42.4%. But when you consider both non-Hispanic Whites and non-Hispanic Asians, they have been less impacted at 40.9 and 33.1% respectively.

Slide 9:When we consider essential and nonessential workers, the share of adults who have been reporting mental distress and substance use as of June 2020, we begin by considering symptoms of anxiety or depressive disorder. Among essential workers the rage was approximately 42% and among the non-essential workers, that rate drops to 30%. When we consider those individuals who started or increased substance use in an attempt to cope with the stress or emotions associated with COVID-19. Among essential workers we’re looking at about 25%. That rate plummets to 11% when we consider our nonessential workers. When we consider those individuals who seriously considered suicide in the past 30 days. Among our essential workers that rate was approximately 22% in the sample. But again, among nonessential workers, plummeted to 8%. Some very important information here, the burden of mental health and stress and substance use really has fallen on our essential workers. And of course, these are the individuals who have to be out there every day, dealing with the stress of the pandemic, because the nature of their work precludes their ability to work remotely.

Slide 10:And now when we consider the share of adults in households with children under the age of 18 who reported symptoms of anxiety and or depressive disorders during the pandemic. By gender, we see that women had a higher percentage of reported symptoms of anxiety and depression in comparison to males. So again, this also follows many of the demographics that we see with public health issues, where women tend to be more negatively impacted than men. Which of course continues to speak to several gender inequalities that we see in healthcare.

Slide 11: In terms of what I’ve seen as a mental health care provider, I can tell you, many of my clients who struggle with substance use disorder have relapsed. When you consider that all nonessential functions face-to-face were basically stopped. Many of the individuals who were involved with AA and NA were no longer able to meet, go to their meetings.

And of course, yes, AA and NA meetings, and many of the other groups have turned to online. But that also speaks to the fact that you do have a reliable computer and internet. So the digital divide has really become something that many people haven’t thought about. For those of you right now who are watching this webinar, you probably were hoping that you’d have… If you’re at work, or if you are traveling, you are probably hoping, I hope there’s really good wifi so that I could watch this. But other than that, you probably have stable sources of internet and you probably have a reliable computer that you could use. And when the pandemic began and individuals were being… Children were being transitioned to online school, the digital divide really became quite apparent because not everybody had access to computers and internet. There was also a significant challenge transitioning to telehealth because not many people again had that type of computer software, computer hardware, et cetera.

And of course there were some bugs to be worked out along the way. I think I first recognized that things were going to be changing in the way I delivered mental health services when one of my clients during a telehealth session suddenly stopped talking, and it was clear that he was speaking with somebody else. I didn’t realize that his child was home and just came up to him because he saw dad sitting there and asked him for some homework help. So I’ve included the beautiful little picture here of Mesopotamia, because the question the son was struggling with were the two main rivers in Mesopotamia. And my client actually asked me if I had any idea what they were. And for some reason, my sixth grade social studies kicked in and I somehow recalled the Tigris and the Euphrates. The client and I to this day, laugh about it. But I’ve also gotten pretty good at fifth and sixth grade math. So, it’s interesting to see how the pandemic has changed so many things.

Slide 12:The question that many people ask me is, is psychiatric mental health nurse practitioner a viable role? And here are my experiences. Every day I receive anywhere between four to eight calls asking me if I’m taking on new patients. I also have, from time-to-time, what I do open my patient roster, I will activate my psychology today web advertisement. And I typically will only keep it open for a week and then I have to shut it again because the number of requests that I get for taking on new patients is well beyond the number of slots that I have. So unfortunately I do have to turn away a significant number of people.

Just this morning, I received a text message. This was an interesting one. I usually receive emails or phone calls about jobs. Would I be interested in coming to work for Telepsych? But recruiters have become a bit more clever. I’m not sure how my personal cell phone number got out, but I was being offered a job via text message in psychiatry, in corrections. And I can also expect each day a few calls from referral requests, from psychologist colleagues or other mental health counselors that I work with in the community seeing if I can possibly squeeze in just one more for medication management. And I can tell you on an ongoing basis, I do regularly receive requests from my own patients saying, “I’m really concerned about my sister’s kid. Boy, my wife’s brother-in-law, or my wife’s brother, or my husband’s dad.” And when you hear some of the stories, you feel horrible. But again, I only take on a patient load that I know that I could, of course, manage, so that I could also have time built in, in the event that a patient needs an emergency session.

So, I can tell you that on an ongoing basis I regularly have to turn people away. So, yes, the psychiatric mental health nurse practitioner role is a viable role. There are approximately over half of the states in the United States do give nurse practitioners independent practice capability. So those states, of course, are quite booming for psychiatric mental health nurse practitioners. And for the remaining states that have some type of restrictive practice can certainly continue to do as you do, but with physician involvement in some way, shape or form. I do have a collaborating physician for patients that I see in Pennsylvania, who does work with me as well. So there is definitely a considerable need for psychiatric mental health nurse practitioners.

Slide 13: What about the future? First and foremost, let’s talk about the survivors of COVID-19. A question is, did treatment or the disease itself result in trauma or PTSD? There are many people, and I challenge you to consider what it’s like if you did get sick with COVID-19, especially surrounding a lot of the negative reports that we received about the variance of the virus and the severity of the illness. Imagine what that would be like being very sick, waiting for God’s other shoe to drop. Is this going to kill me? What is this like? What’s going to happen? And if I do die, what’s going to happen to my children, my family, et cetera? Will rates of PTSD increase? Time is going to tell us. We also know that there are emerging reports of the neuropsychiatric sequelae of COVID-19, which it’s believed… And again, I’m just giving some very, very preliminary information on this. The question is, is it a result of the treatment? Is it a result of hypoxia? Or is it a result of generalized systemic inflammation resulting from the COVID-19 virus impacting the central nervous system?

Individuals have been diagnosed with depression, anxiety, cognitive impairments and still perhaps even other symptoms that have yet to be written about. Again, this is the tentative nature of science and we do need to be mindful that this is developing. What about changes in how we’ve practiced and what is this going to mean for the future? Many of my patients are already starting to ask me, do I have to come back to the office when COVID-19 is over? And many of them are saying, “I can’t wait to come back to the office after COVID-19 is over.” What about managing medications remotely? There have been some considerable challenges with that. I do also work with some individuals who work in Suboxone clinics and… I’m sorry, methadone clinics, and who also prescribe Suboxone. They were telling me about many of the challenges they’re facing in terms of making sure that clients receive their medications here in the middle of the pandemic. So again, the future, it’s still wide open. But I can tell you that psychiatric and mental health nurse practitioners will be playing an important part.

Aysha Syed:

Slide 16:Thank you, Dr. Legg. That was eye opening and informative insight. Before we end today’s webinar, I would like to share a bit more detail about UND’s online Psychiatric Mental Health Nurse Practitioner master’s program.

Slide 17: Our program features 100% online coursework, paired with in-person clinicals to deliver a well-rounded experience, so you graduate confident and ready to take on the role of a psychiatric mental health nurse practitioner. In as few as eight semesters students earn the same high quality master’s degree as you would on-campus, just in a more flexible format designed with working professionals in mind. Our goal is your success. We have a dedicated staff member who assists students in securing clinically placements and our expert faculty post virtual office hours multiple times per week. Students are also assigned a dedicated student support specialist who works closely with you from enrollment through graduation to help you succeed. We also boast an impressive pass rate on the certification exam. Most recently achieving 95%.

Slide 18:When it comes to quality and commitment, you can be confident in UND. The university was founded in 1883 and has built a reputation for providing high quality education, both on-campus and online. Our online master of science with a major in nursing program is accredited by the Commission on Collegiate Nursing Education. And the university is accredited by The Higher Learning Commission.

Slide 19: Both UND and our online program have been highly ranked and recognized with numerous accolades from a variety of industry organizations, including being ranked among the best national universities and top public school by U.S. News and World Report.

Slide 20: If you are interested in learning more or have questions about the program, admission requirements, and materials, financial aid or anything else, my team and I are always happy to help. Reach out via the phone number or email address listed on this slide and either I or one of my fellow enrollment advisors will get back to you as quickly as possible. Thank you again, Dr. Legg, for joining me today and providing such valuable information. I’d also like to thank all of you for tuning in. Have a great day.