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Mental Health

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The first in a two-part series, this article highlights the ways COVID-19 exacerbated an already difficult mental health landscape on Long Island, particularly for adolescents. Amid isolation and uncertainty, residents had an increase in anxiety-related and mental health crises. Additionally, residents in acute distress who arrived at the emergency room sometimes had to wait hours or days for an inpatient psychiatric bed. In the second feature, which will appear in a future edition, mental health workers describe the challenges of their work during the pandemic.

COVID-19 has taken its toll on mental health throughout Suffolk County, as people in a range of ages confront challenges related to isolation, depression, anxiety and grief.

Area hospitals report that inpatient psychiatric beds are rarely empty. Indeed, patients have had to receive treatment in the emergency room at times for a day or more as they wait for an available inpatient psychiatric bed.

“Our emergency room has two behavioral health beds, but often, we have more patients waiting for admission to [the] inpatient psychiatry unit,” said Dr. Adnan Sarcevic, chairman of the Psychiatry Department at Huntington Hospital. 

While patients receive the same treatment in the emergency room that they would in an inpatient unit, some types of intervention, like group psychotherapy “cannot be provided in an emergency room setting,” Sarcevic said.

COVID also exacerbated the shortage of beds when some units had to close after an outbreak of the virus.

“We had periods when some psychiatric inpatient units were closed for a variety of different reasons including COVID outbreaks” which created a shortage of beds, Sarcevic added.

At St. Catherine of Siena in Smithtown, beds filled up as soon as one opened, said Dr. Michel Khlat, chief medical officer.

Adolescent strains

The pandemic exacerbated trends that already reflected the mental health strain among youth and adolescents.

For the previous decade, youth presentations for mental health crises in the emergency room had been increasing.

During the pandemic, those numbers climbed nationally and on Long Island. Estimates of anxiety among youth increased to 20%, which is dramatically higher than the 12% prior to the pandemic, said Dr. Vera Feuer, associate vice president in the School Mental Health program at Northwell Health. Depression has also reached about 20%, which was previously below 10%.

Additionally, the pandemic caused a three-fold increase in children with eating disorders, which is consistent with new Centers for Disease Control and Prevention data, Feuer added.

“There’s a real big increase in presentation to the emergency room” with youth who are considering suicide, particularly for girls who are 10 to 13 years old.

Additionally, adolescents are showing an increase in tic disorders, which are involuntary movements of the neck, eye or facial movements, Feuer said. While some studies suggest a link between depression and these movements, other research has linked them to the increasing use of social media.

As for the availability of mental health services, adolescents are continuing to find it difficult to become outpatients for an overburdened mental health care system, which increases the need for emergency services.

Community services are often “saturated,” Feuer said. “There are not enough child psychiatrists” which means that children go without care for longer, she said.

On Long Island, the wait for inpatient beds is not as long as it reportedly has been in other areas of the country.

“We do have kids waiting at least a day or over the weekend,” said Feuer. She suggested that access to beds and to crisis programs in school have mitigated some of the adolescent demand.

Dr. Stacy Eagle, director of Psychiatry at St. Charles Hospital, cautioned that the potential for addiction and substance abuse is “concerning. Even marijuana is dangerous, because you don’t know what it’s laced with and it can become incredibly addicting.”

Broader challenges

The shortage of inpatient beds predated the arrival of COVID, with mask mandates, social distancing, remote learning and at-home work altering routines and creating stressors that often increased anxiety and triggered the kind of self-medication that led to substance abuse.

“I’ve seen it step up on a daily, weekly, monthly basis” in terms of generalized anxiety disorders and panic attacks, said Dr. Jeffrey Wheeler, director of the Emergency Department at St. Charles Hospital in Port Jefferson.

Eagle said she has seen more anxiety, mood disorders and substance abuse, with more acute patients coming in from schools.

Doctors suggested that COVID itself can contribute to the worsening of a person’s emotional well-being.

“COVID certainly plays a role in mental health, both as a psychosocial stressor and due to the neurotropic nature” of the virus, said Sarcevic.

The types of treatment varies according to the severity of the symptoms, the underlying conditions, and any ongoing treatment plans.

“Some people come in who are in need of medication to be stabilized for depression,” said Khlat.

To accommodate the increasing need for non-acute psychiatric services, health care professionals have been offering telepsychiatry help.

In the last three months, St. Catherine of Siena expanded their telepsychiatry services, which had been offered primarily on the weekends, to seven days a week.

“Due to the influx of patients we’re having, with COVID depression we had to [expand that] to the rest of the week,” Khlat said. These services “helped us out a lot.”

Silver lining

Feuer suggested a few silver linings amidst the health care crisis.

“The attention to something we know has been a problem for a long time” will help the community, she said. “I’m hoping the right resources and interventions will come.”

Additionally, the increased vigilance of mental health challenges has enabled people to feel that asking for mental health resources is something they can, and should, do.

“It has normalized these conversations,” Dr. Feuer said.

Available resources

Dr. Gregson Pigott, commissioner of the Suffolk County Department of Health Services, urged people who think they need help to get it right away.

Those people seeking help for substance abuse or mental health can visit www.SuffolkStopAddiction.org to find a network of providers in the 2022 Suffolk County Directory of Behavioral Health Services guide.

The following are resources available to those in crisis:

— Family Services League’s Diagnostic, Assessment and Stability Hub (DASH) program. This is a 24-hour stabilization response program for children and adults in crisis due to substance abuse, mental illness and other life stressors. They are located at 90 Adams Avenue in Hauppauge. Their phone number is 631-952-3333.

— A free 24-hour hotline: 631-751-7500, or www.responsehotline.org.

— A Comprehensive Psychiatric Emergency Program (CPEP) at Stony Brook Hospital at 101 Nicolls Rd in Stony Brook is available at 631-444-6050. CPEP has voluntary and involuntary emergency psychiatric services for children and adults every day.

“It is important for individuals to engage in self-care,” Pigott wrote in an email. “Listening to each other and recognizing the signs of mental illness and substance use can help mitigate a developing crisis.”

Sheriff Toulon said he intends to address mental health and substance abuse during his second term. Photo from Toulon’s office

This week, TBR News Media had an exclusive interview with Suffolk County Sheriff Errol Toulon Jr. (D). During our conversation with the sheriff, he addressed his battles with cancer, the challenges of steering the sheriff’s department through a pandemic and his surprising place in the history of the New York Yankees.

Sheriff, what is your professional background and how did you land in the Suffolk County Sheriff’s Office?

I started my career in 1982 as a New York City correction officer and I worked with the New York City Department of Corrections for 22 years on the uniform side. From 1982 until 2004, I worked on various assignments in numerous jails throughout the department. We had almost 25,000 inmates in our city system back then. I worked in our emergency services unit for almost 10 years. I was a captain there and also a captain in our detectives unit for almost three years before I retired. I also worked in the compliance division toward the end of my career.

I had to leave because I had some health issues. I’m a two-time cancer survivor. Uniquely, after I was able to recover from my illnesses, I went back to school to finish my bachelor’s, master’s and I received a doctorate in education. I worked with County Executive [Steve] Bellone [D] as his assistant deputy county executive for public safety for almost two years, where I tell people that I truly got an understanding of the landscape of Suffolk County. Then, I returned back to New York City as the deputy commissioner of operations, overseeing almost all of the operational aspects of the department from 2014 until 2017. I then decided to run for sheriff in September of 2017.

How has your battle with cancer impacted both your outlook on life and the work that you do for Suffolk County?

One of the things that I realized as a two-time cancer survivor is that you never know what the person next to you — whether you’re on the ball field watching kids play or you’re in the movie theater or the supermarket — you don’t know if someone has health issues, financial issues, relationship issues. I think I have become a lot more sympathetic and also empathetic to the plights that people are going through.

Earlier in your career, you worked at Rikers Island. How has that experience shaped your later approach as county sheriff?

My father was a warden on Rikers Island for 36 years, starting off as a correction officer. I remember during one of the early conversations I had with him, I asked him about his employment. He said, ‘We rehabilitate men and women who are in jail.’ That kind of resonated with me throughout my career. 

When I became sheriff, I noticed that almost 85% of the men and women that are in our custody are returning back to our communities. In order to help them and to have less victims in our communities, while we have them within our custody why not try to provide them with the resources so that they can be successful when they return back to our communities?

What are some of the struggles that your department had encountered due to the COVID-19 pandemic and how did you attempt to overcome them?

When I was the deputy commissioner, we had to deal with the H1N1 and Ebola viruses. When we learned about COVID-19 in Washington state in 2020, we started preparing for the possibility of there being an outbreak. By the end of February, we had our plans set. We implemented them around the second week of March because the first [confirmed] case of COVID in New York state was March 1 and the first case in Suffolk County was March 8. By that second week of March, we started implementing measures of social distancing; we had masks that were mandated to be worn; we started doing temperature checks; and we told our staff that if they were not feeling well or had any of the signs of identified symptoms for COVID-19, that they should seek out their health care professionals. 

With the jails, we cleaned our facilities three to four times per day. Inmates were required to wear masks. We were able to “cell skip’’ our inmates, so instead of inmates being in cells 1, 2, 3, 4 and 5, they were in cells 1, 3, 5, 7 and 9. We did stop visits because, if you remember, [former] Governor [Andrew] Cuomo [D] had said that if we shut down visits for two weeks, we’d be OK. We did shut down our visits for any individuals coming in and for any service providers entering our jails. It proved to be somewhat successful, but we had to do it for longer than we anticipated. 

From March, when we first implemented those measures, until the beginning of December, we only had five inmates that had tested positive — and I should say, three tested positive in the jails, two came into the jail positive. I think we were very successful.

What we also did was that every newly admitted inmate had to go into a quarantine for 14 days while our medical staff checked up on them three or four times a day. We wanted to make sure that our new admission inmates weren’t exposing any inmates that had been in our custody with any potential virus. 

You were recently sworn in for a second term as sheriff. What is your vision for the next four years at the department?

There are three things that I’m working on.

Mental health and substance abuse seem to be the primary traits for the majority of the men and women not only in our custody but throughout the nation’s prisons and jails. We’re working very hard to understand those two components because we want to be able to help those men and women, and even those that are not in jail — maybe there’s no criminal activity in their lifestyles, but they’re still suffering. 

We want to see what we can do, working with various community partners and service providers to look more holistically and see what’s going on. We do understand, even with some of our youth, who we are learning may have adverse childhood experiences, not only are they experiencing mental health and substance abuse in the home, but there are also traumatic issues, domestic violence issues and socioeconomic challenges. Those are the things we intend to focus on.

We’re also looking to create the first network of information sharing for jails and prisons throughout the United States. We think this will be very beneficial. We know that most police departments are sharing information with each other, but jails and prisons throughout the country are not. We want to tap into that resource because if we learn of different trends that are occurring, we can also alert our law enforcement partners to these things that are occurring, specifically in the jails and prisons throughout our region and our country. 

Your office has donated bulletproof vests to the people of Ukraine. What are some of the other philanthropic initiatives that your office has been part of to benefit both Suffolk County and the greater global community?

That was a start by donating those decommissioned vests, but one of the things we are embarking on is that the Suffolk County Sheriff’s Office is now an advisory component to a sheriff’s foundation. This is not run by the Sheriff’s Office, but by a group of individuals. They’re a 501(c)(3) and their goal is to have fundraising events. We do so much in the community that they want to assist us in really helping these kids that are having certain issues. Whether it is donating school supplies or the various community events that we want to do, we want to strengthen the bond between the community and the Suffolk County Sheriff’s Office.

Also, we really want to engage our youth because they are the ones that we want to make sure are on the right path, that they look at law enforcement as a positive role model, and that they maybe even want to come join our forces and work at the Suffolk County Sheriff’s Office.

You are the first African American elected as Suffolk County sheriff. What does that distinction mean to you?

To me, and I know that’s something that has been said to me a lot, my first goal is to be the best sheriff possible, regardless of my race. I do realize that being the first African American not only as sheriff, but the first African American elected to a nonjudicial county-wide position on Long Island, Nassau or Suffolk, it’s something that I’m very cognizant of wherever and whenever I go somewhere. 

I know there are a lot of people looking at me, some favorably and some unfavorably. I think I need to be who I am and not necessarily who people perceive due to the color of my skin. 

Baseball season is now underway and I have learned that you also occupy a place in the history of the New York Yankees. Could you elaborate on this?

Yes. I was fortunate enough in 1979 and 1980 to be a bat boy with the New York Yankees. They had just come off of back-to-back World Series championships in 1977 and 1978. Tragically, in 1979 our captain, Thurman Munson, was killed in a plane crash and we fell short of making the playoffs that year. Subsequently, in 1980 we did make the playoffs, but we lost three straight to the Kansas City Royals. In the third game, I was the ball boy down the right field line watching George Brett hit a three-run homer off of Goose Gossage, which went into the upper deck. I realized then that my career as a bat boy had quickly come to an end. 

What are your thoughts on Aaron Judge’s contract fiasco? 

I hope they do sign him. I think he’s proven to be not only a great ballplayer when he’s not injured, but more importantly a great role model. Mr. [Joe] DiMaggio and Mr. [George] Steinbrenner — both of whom I was fortunate enough to meet and speak with — would say that he is the type of person they would want to be a Yankee for his entire career, very similar to Derek Jeter.

Sheriff, thank you for taking this interview. Is there anything else that you would like to say to our local readers?

Yes. I firmly believe that the Suffolk County Sheriff’s Office is changing the paradigm of criminal justice, not just in Suffolk County but throughout New York state. We’re continuing to look for partners, both from the governmental side but also the community side, to make sure that we are not only able to engage but also help those that need us. That’s why we’re here. We’re really here to help our community.

CVS Pharmacy

People might soon be able to grab their prescriptions, a bag of potato chips and pick up soap as they head into a new therapy service at their local CVS.

The nation’s pharmacy retail giant has started a new service at several of their stores across the U.S. — offering both walk-in and scheduled sessions for mental health treatment. These appointments are available beyond typical daytime hours, including nights and weekends.

According to a spokesperson with CVS Health, the company began adding licensed clinical social workers trained in cognitive behavioral therapy to 13 locations in the Houston, Philadelphia and Tampa metro areas in January of this year.

These providers will offer mental health assessments, referrals and personalized counseling either in person or via telehealth through MinuteClinics inside CVS HealthHUB store locations.

The spokesperson said the company is planning on expanding to 34 locations this spring. 

“We anticipate expanding mental health services into additional markets in the coming months,” the representative said in an email. “We expect to have more detailed information soon.”

Rite Aid and Walmart have started similar programs, too. 

Dr. Adam Gonzalez.
Photo from Stony Brook Medicine

And although MinuteClinics and the like are not available in New York state yet, Dr. Adam Gonzalez, director of behavioral health and founding director of the Mind-Body Clinical Research Center at the Stony Brook Renaissance School of Medicine, said this could potentially be a good day if such facilities were to come close to home. 

“The COVID-19 pandemic has brought about many challenges and disruptions to our way of life,” he said. “We have seen an increase in depression, anxiety, increased stress overall and grief responses. Recent mental health data from the CDC also highlights an increase in mental health problems, especially among young adults, and importantly, unmet mental health needs.”

According to Gonzalez, a recent CDC report indicates that during August 2020 through this February “the percentage of adults with recent symptoms of an anxiety or a depressive disorder increased from 36.4% to 41.5%, and the percentage of those reporting an unmet mental health care need increased from 9.2% to 11.7%. Increases were largest among adults aged 18–29 years and those with less than a high school education.” 

“There is a great need for mental health awareness and treatment at this time,” Gonzalez added. “A silver lining of the pandemic has been the expansion and use of telehealth as a platform for treatment, allowing patients to participate in mental health treatment from the comfort of their home. However, a limiting factor for accessing care is the availability of providers.”

He said throughout the pandemic, SBU’s Department of Psychiatry and Behavioral Health saw a great increase in the need for mental health care — so large, it developed a call center.

“Throughout the pandemic we have consistently been receiving over 7,000 calls per month,” the director said. “Evaluating our outpatient data for the three months before the pandemic and the current last three months, there has been a 50% increase in number of visits scheduled for outpatient mental health services. Of note, the number of visits scheduled is limited by the number of providers available to provide services.”

With the need for mental health providers continuing to grow, Gonzalez said additional services — like the ones at the CVS pharmacy chain — could be helpful.

“I think having services available at CVS could help with normalizing mental health treatment and increasing access to care,” he said. “The more mental health service options available to the community, the better. One consideration is the type and quality of care to be delivered. Although it is important to increase access, we also want to make sure that the quality of care being delivered is high.”

But if and when the retailers open up shop on Long Island, Stony Brook Medicine is working on finding ways to reduce feelings of hopelessness and distress. 

“We are actively working on investigating various methods of delivering care to help with increasing access to treatment and addressing the mental health needs of the community,” Gonzalez said. 

These methods include expanding group-based services, utilizing a collaborative care model that involves working closely with primary care physicians and behavioral health care managers for medication management, and utilizing skills-based single-session interventions. 

“We have been working with Dr. Jessica Schleider in the Department of Psychology at Stony Brook University to implement and study a problem-solving single-session intervention,” he added. “Initial data indicates that these sessions help with improving agency — motivation for change — and reduce feelings of hopelessness and distress.”

Pixabay photo

By Leah S. Dunaief

Leah Dunaief

Probably because of COVID-19, there has been more discussion in the media about depression, anxiety and mental health in general. CVS, the nation’s largest retail pharmacy, and the one owned by the Melville Corporation, (the company started by local philanthropist Ward Melville by the way) is creating a new niche for its many stores. It has been hiring licensed clinical social workers for a pilot project in several cities and will offer walk-in sessions or by appointment. 

The social workers are trained in cognitive behavior therapy or CBT. I believe that is generally a form of short term therapy in which the immediate problem is discussed and treated using evidence-based techniques. According to an article in The New York Times, May 10, social workers will offer assessments, referrals and counseling. They will be available during the day and also on evenings and weekends, and also by telemedicine. They will partner with the company’s nurse practitioners and pharmacists for prescriptions when needed.  This will be yet another nonemergency health care service the chain is providing, as they have most recently offered coronavirus vaccines for the public.

Now others beside pharmacies like Rite Aid and Walgreens, who are also planning mental health care, are seeing opportunity in the health field. Albertsons, a grocery chain, offers injectable antipsychotic drugs as well as injectable medication to help treat substance abuse. And a while ago, I got my first shingles vaccine in a drug store.

What a change from the pharmacy of my childhood. I well remember walking down to the drug store five blocks away in New York City with my dad, before I was even of elementary school age, to buy ice cream. That was the only place with a freezer, and the selections were Breyer’s vanilla, or chocolate, or vanilla, chocolate and strawberry together in half gallon containers. They were in a freezer chest, like a foot locker, and when I leaned in to pick the selection, the cold took my breath away. The pharmacy also had a counter where we could sit and get sundaes and milkshakes. But most of the time, we carried the ice cream carton home, hurriedly so it wouldn’t melt, to eat together with the rest of the family.

Another recent focus in the mental health field is on food. And sadly the foods we typically turn to when we are stressed, inevitably sugar-laden and of high fat like ice cream, pastries, pizza and hamburgers, now are on the mental wellness bad list. Nutritional psychiatry is an emerging field which looks at the relationship between diet and mental health. The idea that what we eat can affect our physical health is an accepted one, and now the same concept is extended to our mental wellbeing with the following physiological specifics thanks to research. 

“A healthy diet promotes a healthy gut, which communicates with the brain through what is known as the gut-brain axis. Microbes in the gut produce neurotransmitters like serotonin and dopamine, which regulate our mood and emotions, and the gut microbiome has been implicated in mental health outcomes,” states The New York Times in a May 18 article by Anahad O’Connor.

People who eat a lot of nutrient-dense foods, like fruits and vegetables “report less depression and greater levels of happiness and mental well-being,” according to the NYT.

There is a bit of a chicken-egg conundrum here concerning which comes first? Do anxiety and depression drive people to eat unhealthy foods or are those who are happy and optimistic more likely to choose nutritious foods that further brighten their moods? Recent research has borne out that healthy foods do improve moods.

“Seafood, greens, nuts and beans — and a little dark chocolate” is the basic dietary advice of Dr. Drew Ramsey, a psychiatrist and assistant clinical professor at Columbia University College of Physicians and Surgeons. His jingle comes with the message that food can be empowering.

*This article was revised on June 1, 2021.

Older folks are going to be struggling mentally this holiday season, as with current travel and gathering restrictions it will be harder to connect over long distances. Stock photo

Before, during and after major storms, state and local officials typically urge residents to check on elderly friends and neighbors to make sure they have what they need.

While the pandemic hasn’t torn up trees or left a physical mess strewn across impassable roadways, it has triggered the kind of problems residents might have during an ongoing storm.

Indeed, after a brutal spring that included school and business lockdowns followed by a summer respite when the number of infected people declined, the fall has proceeded the way many infectious disease experts had anticipated, with a resurgence in positive tests, steadily rising hospital bed occupancy and the possibility of renewed lockdowns.

Dr. Youssef Hassoun, the medical director at South Oaks Hospital, offers advice with connecting to the elderly over the holidays. Photo from Northwell Health

All of this is happening against the backdrop of a time when elderly residents typically welcome friends and extended family during Thanksgiving and through the December holidays. Many people have canceled or postponed seasonal rituals indefinitely, things that normally offer an opportunity to reconnect.

Holidays are a “needed process that are embedded in our culture and society and, for most, bring significant joy and purpose,” said Dr. Youssef Hassoun, Medical Director of South Oaks Hospital. “For the elderly, that is exaggerated, simply because that is their time to connect back with their loved ones.”

Elderly residents are managing, though they are feeling numerous stressors.

The mental health toll on elderly residents has increased since the pandemic began. In the first few months after the virus upended life on Long Island, the number of elderly residents seeking mental health support declined at Stony Brook, according to Nikhil Palekar, Associate Professor of Psychiatry and Director of Geriatric Psychiatry at Stony Brook University’s Renaissance School of Medicine.

In the last few months, “we have seen a significant increase in referrals our center has received for mental health services,” Palekar explained in an email.

Stony Brook has not had to increase their staffing yet, but if the demand for mental health services continues to be as high as it has been for the past couple of months, the university “will be hiring more clinical staff to provide care,” Palekar explained.

Elderly residents are trapped in a battle between the fear of contracting the virus and the impact of loneliness, which can increase the rate of depression, anxiety and cognitive impairment, Palekar added.

Indeed, the number of nursing home residents contracting the virus has increased in the country and in Suffolk County, according County Executive Steve Bellone (D) during a Tuesday call with reporters.

For people who are battling against the loneliness triggered by isolation, “our recommendation to our elderly patients is to use televideo conferencing to connect with their loved ones, peers and support groups,” Palekar wrote.

Ongoing Stress

For Baby Boomers, concerns about loneliness predated the pandemic, said Adam Gonzalez, Founding Director of the Mind-Body Clinical Research Center and Assistant Professor of Psychiatry at the Renaissance School of Medicine at Stony Brook University.

“COVID adds a whole ‘nother layer of barriers that might get in the way of people connecting,” Gonzalez said. “It’s definitely a high-stress and overwhelming time for many.”

Indeed, ongoing stress, including from concerns about COVID, can trigger cognitive stress.

“Stress can make it harder for people to think,” said Chris Christodoulou, Research Assistant Professor of Psychiatry & Behavioral Health and Neurology at Stony Brook University’s Renaissance School of Medicine. When people are thrown out of their habits, that can be “disorienting and stressful.”

‘For the elderly, [that need for holiday joy] is exaggerated, simply because that is their time to connect back with their loved ones.’

—Dr. Youssef Hassoun

A stressful situation can also reveal cognitive vulnerability for people who are suddenly unsure of themselves and their environment.

“Chronic stress changes our brains in ways that are not healthy and may contribute to lots of diseases, including those affecting the brain,” Christodoulou said.

As for what to pay close attention to when checking in on elderly residents, Palekar suggested that people listen for key words or phrases, such as “feel lonely,” “don’t like myself,” “poor sleep and appetite,” or “can’t stop worrying.” Additionally, members of a support network should pay close attention if others feel helpless, can’t concentrate, have lost interest in doing things or are tired all day.

Solutions

Christodoulou said activities like yoga and aerobic exercise can prevent and slow the decline in cognition.

Hassoun also urged residents to have an open conversation with elderly family members.

“We are very good at assuming that someone appreciates” the risks of larger or even medium-sized family gatherings, Hassoun said. People may understand those risks differently.

The South Oaks Hospital medical director suggested conversations begin not with the unknowns related to potential sicknesses or even new tests, treatments and vaccines, but rather with the knowns of what’s working. While residents may be tired of hearing it, the reality is that masks, social distancing and hand hygiene have reduced the spread of COVID-19, along with other pathogens and microbes that might spread through family contact during the holidays.

Doctors and mental health professionals urged people to be creative in their efforts to connect with others this year.

“How can we get dad, who has never enjoyed looking at an iPad, let alone using it, to find it more fun to have a zoom Thanksgiving together?” Hassoun asked.

He added that these unconventional Thanksgiving interactions could be a way to connect relatives and even children who may not participate as actively in group discussions during these holiday meals.

Residents can improve the holiday during this challenging year by making the most of each interaction, even if it’s not in the familiar personal setting.

Stony Brook University's CPO Department has focused on student's mental state following the ongoing COVID-19 pandemic. Photo by Julianne Mosher

Stony Brook University knew that students might have a hard time this year as they returned to school in the midst of a global pandemic. 

But for those who went home to participate in hybrid and virtual learning, they too could use someone to talk to. That’s when the school stepped up and implemented new programs to help kids on campus and at home, near and far, to give them resources and let them know everything will be OK.

‘Now more than ever, we need to connect and feel a sense of belonging — and these spaces are intended to do just that’

— Danielle Merolla

The Center for Prevention and Outreach is collaborating across different university departments to support students’ mental health, and is in the process of hiring more mental health staff.

According to Danielle Merolla, a clinical psychologist and assistant director of mental health outreach and community-based interventions at CPO, her group offers ongoing support through various virtual and hybrid programming. 

With programs like Let’s Talk, a brief nonclinical conversation with a counselor, also workshops for coping and connection, balancing levels of care for self and others, and mindfulness, CPO provides suicide prevention bystander intervention training called Question, Persuade, Refer for students, faculty and staff.

“We have trained over 800 students since the onset of COVID via virtual platforms,” Merolla said. 

CPO has also implemented three mental health peer education programs called Chill, Global Minds Alliance and Minds Matter that have been developed and created spaces for students to connect and receive information about how to care for themselves and each other, according to the assistant director. 

“The resources on campus are intended to support students’ overall health and well-being,” she said. “We want to make sure students know that they are not alone, and there are supports literally at their fingertips as many of our resources are accessible virtually.”

According to a recent study with the Journal of Medical Internet Research, the COVID-19 pandemic has brought the vulnerable population of student’s mental health into focus. The study interviewed 195 students at a large public U.S. university to understand the effects of the pandemic on their mental health. 

Of the students questioned, 71% indicated increased stress and anxiety due to the coronavirus crisis. Multiple stressors were identified that contributed to the increased levels of stress, anxiety and depressive thoughts among students. These included fears and worry about their own health and of their loved ones, with 91% reporting negative impacts due to the pandemic, and 89% reporting a difficulty in concentrating. 

“Now more than ever, we need to connect and feel a sense of belonging — and these peer spaces are intended to do just that,” Merolla said. 

With an unusual mix of students either staying on campus or learning from home, CPO decided that it needed to make all its resources available to students within Stony Brook and abroad. 

“We adapted all our programs to meet the virtual needs of our students,” said Smita Majumdar Das, a clinical psychologist at CPO. “We also adjusted programming time — offering training at 6 a.m., or later in the day such as after 9 p.m. — to accommodate our students who are dispersed all over the U.S and also in international locations.”

Das said that at CPO, she has seen a five-fold increase in the utilization of virtual Let’s Talk since the onset of COVID-19 — not only domestically, but with their international students in France, India, Korea and Japan, as well. 

“CPO has worked with various employees to provide the needed training so they can be effectively present for our students and provide them the best support and care possible,” Das said. “It is impossible to pour from an empty jar, so as an organization we are extremely mindful to make sure staff feels cared for so that they can pay it forward to our students.”

Another program called Healing Arts provides students with engagement and learning opportunities around the themes of creative expression, self-care, coping skills, social support and campus health and wellness resources. 

During the age of COVID, the program looks a little different. 

“We adapted the Healing Arts model to create Healing Arts at Home in March,” said Christine Szaraz, coordinator of sexual violence prevention and outreach programs with CPO. “These programs offered livestreamed, interactive events through CPO’s social media, where students could participate in a virtual Healing Arts event using materials commonly found at home and engage with CPO staff and peer educators through the chat feature.”

Szaraz added that CPO provided a variety of synchronous and asynchronous virtual Healing Arts events throughout the summer and over Stony Brook’s opening weekend. 

“Using Facebook and YouTube live forums, we engaged students with professional staff and peer educators in conversations regarding coping and self-care in response to COVID, and in relation to their transition to the fall semester at SBU,” she said.

And since school started, students are feeling the weight of the world on their shoulders. 

“Often, we hear and feel that everything feels out of control which can lead to feeling unmotivated and/or stuck,” Merolla said. “It is important to acknowledge we have many choices throughout our day and there is power in each and every choice.”

“We must recognize we are stressed or struggling in order to choose to attend to what we may need,” she added. “The sooner you reach out the better. There is tremendous strength and resilience that comes from reaching out.” 

Sunshine Prevention Center in Port Jefferson Station created a "Blessing Box" for people to take necessary items when they need it and drop it off as a donation. Photo from SPC Facebook

It’s been a stressful time. 

In the age of COVID-19, more and more organizations are attempting to adapt to the influx of people needing mental health. 

Last month, Steve Chassman, executive director of the Long Island Council on Alcoholism and Drug Dependence, said in a press conference in September regarding potential Suffolk healthcare cuts that substance abuse has skyrocketed because of the coronavirus crisis. “We have propelled to where we were six months ago,” he said at the time. 

And that’s why the Sunshine Prevention Center in Port Jefferson Station is here to help. Carol Carter, CEO/co-founder of the community youth and family agency that offers support and education in the areas of drug/alcohol prevention, socials skills, leadership and alternative education, said in the age of COVID, they had to adapt to help more people. 

“When COVID-19 first hit, we really scrambled,” she said. “We worked really hard to build a reputation in the community for still providing services.”

The center quickly learned how to Zoom and create Facebook Live and YouTube videos for kids and families to watch at home. 

“We had close to a thousand people watching them,” she said. 

According to Carter, the group learned that the rate of anxiety and depression was getting higher at the start of the pandemic, and domestic violence increased to at least by 20%. She and her organization knew how important it was to help people during such a trying time. 

“We would drop off [worksheets/exercises] to homes,” she said. “We tried not get so caught up in the fear, but we wanted to be there to help them.”

As the pandemic evolved, so did their online learning. Carter began writing daily, weekly and then monthly newsletters. “They would have resources and positive messages for the day,” she said. “We’d mention other programs that were running. … We tried to stay connected that way.”

The center began to Zoom meetings for kids, young adults and parents at night, but more recently in September, they began socially distanced in-person adult groups again. 

“We started in-person because of the demand,” she said. “They need more of the social interaction. … We’ve been told ‘thank you.’ We tried to get back to some type of normalcy. Although people are still afraid, they’re grateful.”

But along with the substance abuse problem as described by Chassman, everyone is feeling more anxious than before.

Further east at the North Shore Youth Council in Rocky Point, Dana Ellis, director of mental health and wellness programming, said she has seen a dramatic increase in anxiety among young adults. 

“Anxiety is the biggest thing I’m seeing more so compared to last year,” she said. “The amount of kids and interests approaching doubled. … A lot more people are looking for help and support during this time.”

Before COVID-19, her group would work with Rocky Point school district to help students with their mentoring program. This year, however, they were unable to meet because clubs were canceled. 

“My biggest thing is giving kids opportunities to socialize, meet people, talk with each other and recognize things will be OK,” she said. “Our goal is to increase mental health programing in general.”

The youth council also decided recently to restart in-person group meetings, because they know how important it is for young adults to talk about how they’re feeling. Upon arrival, they give temperature checks, must wear masks and have the option to Zoom in, if they choose. 

“I’ve definitely started off my groups with coping skills,” Ellis said. “I started treating them like stressless groups because more than ever kids are stressed, and I’m trying to make that the forefront of the groups that I run.”

In those groups, people talk about the worries they face in day-to-day life. ““I  think that’s from a variety of things,” she said. “In general, it’s a very stressful time we’re living in.”

Smithtown fifth-graders visited with residents at St. James Nursing Home on Oct. 30 to bring them some Halloween cheer. Photo from Smithtown school district

With the approaching emotions of the holidays, Suffolk County residents may face persistent and unwanted changes in their lives, from not seeing a cherished family member to remaining confined to the same house where they work, live, eat and study. Between now and the end of the year, TBR News Media will feature stories about the impact of the ongoing pandemic on mental health. The articles will explore how to recognize signs of mental health strain and will provide advice to help get through these difficult times. This week, the article focuses on youth.

School districts are letting their students know that it’s okay to be in touch with their feelings.

During this unprecedented and scary time, district officials across the North Shore said they immediately knew that they needed to buckle down and implement different mental programs to accommodate the changing landscape of education and the COVID-19 pandemic worry.

Jennifer Bradshaw, assistant superintendent for instruction and administration with Smithtown Central School District, said they started the school year with training for all staff members in social and emotional learning. 

“We’ve always privileged student and staff mental health and wellness, so we’re doing what we did in years past, just a lot more of it,” she said. 

Smithtown fifth-graders visited with residents at St. James Nursing Home on Oct. 30 to bring them some Halloween cheer. Photo from Smithtown school district

Smithtown has been including ongoing contact among school counselors, social workers, psychologists, administrators, teachers and other staff members to evaluate student and family needs for food, technology, mental health, counseling, and academic support.

Farther east in Rocky Point, Toni Mangogna, a social worker at Rocky Point High School, said they have been seeing an increase in student anxiety surrounding the pandemic. “Coming back to school is so different,” she said. “We’re trying to get our services out to as many students and families as we can.”

As part of their SEL programs, the district offers a virtual classroom that students can access at home or while in school to request an appointment with a school counselor or psychologist. 

“It’s a great option for kids who are working from home,” she said. “I think students miss that one-on-one connection.”

The virtual office also offers breathing exercises and tips for practicing mindfulness. Mangogna said she sees students sharing the services with their family and friends. 

“These students are really in touch with their feelings,” she said. “If we can make that connection with parents and students, I think we’re really making a difference.”

The Rocky Point social worker added that while the kids are stressed, parents are seeking help, too. 

“Parents have anxiety,” she said. “It’s difficult for parents to be that support for students when they’re having their own struggles and anxiety.” 

Her colleagues have been working to help and refer parents to local psychologists. 

“Because we don’t have that face-to-face opportunity anymore, it increases wanting to talk to social workers,” she said. “Just to have somebody in front of them that can validate that feeling. I think students miss that one-on-one connection.”

Dr. Robert Neidig, principal at Port Jefferson Middle School, said they are implementing different programs specific to his and the high school’s students. 

“At the middle school, we have a wellness and mental health curriculum with different types of activities students can do,” he said. 

Dr. Robert Neidig, the PJ Middle School Principal, talked about the different programs the district implemented for student’s mental health. Photo from PJSD

Neidig said they’ve had the program for a while, but during the COVID crisis, they “suped it up and since implemented character education lessons.” Since September, they hired a full-time psychologist for the middle school and the high school.

“During this time, it’s taken on new meaning,” he said. “Stress levels, anxiousness — we’re all feeling the effects of it. We’re trying to do the very best we can.”

He added that every teach is going above and beyond to make sure their students are doing alright.

“It doesn’t matter if you walk into a health class, an English class or math class,” he said. “Teachers are taking the time to check in students they understand if kids aren’t there mentally, the learning will be lost.”

Three Village Central School District’s executive director of Student and Community Services Erin Connolly said they also implemented a virtual program to continue and promote SEL. 

“Our district really values mental health,” she said. “We have been working on return to school protocol and mental health plan for students and family for pre-k through grade 12.” 

Their three-tier plan has a strong emphasis on supporting the district’s staff. 

“By supporting them, we’re supporting the students,” she added. “It’s a dynamic plan.”

Dr. Alison Herrschaft, a social worker at Three Village, said that early on in the school year, counselors and social work staff met with each and every student in the school. 

“By doing that, it gave those kids the opportunity to put a face to the staff who can help,” she said. “They’re more likely to seek out help if they’re really struggling and acknowledge that it’s okay to not be okay.”

By integrating themselves more into the hallways and classrooms, Herrschaft said the kids who might not have been aware of the staff before, now see these staff as “rock stars.”

“We wanted to normalize asking for help,” she said. “It’s accessible to anyone who needs it.”

Although Three Village buckled down during the pandemic to make mental health more available, they won’t stop their program even if a second wave hits. 

“A big goal with the plans we developed is if we had to go remote again, based on numbers, our SEL plans will continue while we’re out,” Connolly said. “It was really important to have a seamless transition so that doesn’t change, and it still gives kids points of contact if they’re home again, they’ll be well-versed.”

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With the approaching emotions of the holidays, Suffolk County residents may face persistent and unwanted changes in their lives, from not seeing a cherished family member to remaining confined to the same house where they work, live, eat and study. Between now and the end of the year, TBR News Media will feature stories about the impact of the ongoing pandemic on mental health. The articles will explore how to recognize signs of mental health strain and will provide advice to help get through these difficult times. This week, the article focuses on youth.

In a normal year, when school is out, the number of referrals Dr. Sharon Skariah, Director of Child Adolescent Psychiatry at South Oaks Hospital in Amityville, declines during the summer.

Dr. Sharon Skariah says parents should recognize their own issues in order to help their children. Photo by Sharon Skariah

That’s not the case this year, as children continued to seek help for mental health challenges caused by the loss of a parent, the loss of financial or health security and the decline in social contact amid social distancing.

“We’ve been seeing significant anxiety and depression,” Skariah said. “Part of that is the prolonged time that [children] have been out of school.”

Skariah expects that the ongoing pandemic losses and restrictions will likely continue to cause those figures to increase.

Several mental health professionals shared their dos and don’ts for parents with grieving children.

Grieving Dos

For starters, Skariah suggests that parents should recognize their own anxiety and depression.

“If they find that they are themselves overwhelmed with the chaos of the pandemic, they should be aware that their own anxiety and mood can play a role in their children’s behavior,” she said.

Dr. Meghan Downey, clinical psychologist and Director of Northwell Health’s OnTrackNY, urged people to maintain a routine.

“Often, a holiday can exacerbate our stress levels,” Downey said. “Changes to our routine can increase stress. Continuing with the same sleep wake routine, normal eating and [finding time] for joy and relaxation provide a good foundation for managing grief.”

Based on prior group traumatic events, like the 9/11 terrorist attacks and the SARS virus, Skariah said the restoration of order happens over time and depends on personal and predisposing factors.

She urged families to be genuine and open and actively listen to what children say. Downey suggests children need to feel that they are allowed to mourn.

A support network can and should consider showing empathy, care and concern. Approaching people when they are calm, rather than in a distressed state, can provide some mental health relief.

People who are experiencing grief also can benefit from staying connected, even through holiday letters, phone calls, or a card, Downey said.

When Downey gives presentations to children and educators in school, she advises people working with young children to allow them to play death, to display their emotions through play.

Grieving Don’ts

Telling children platitudes like “time heals all wounds” may not be helpful for someone who is “acutely grieving,” Skariah said.

Downey added that telling children that a loved one is “sleeping” or that they should “stop crying, other people might get upset” provides mixed and confusing messages.

Telling children that “at least [the person who died is] not in pain anymore, they are in a better place” often doesn’t help and distracts people from feeling their emotional intensity, Downey said.

Downey cautioned youths, and their adult guardians, to manage over-indulgent behavior, such as with food or with excess spending.

While those indulgences provide temporary relief, they can also contribute to feelings of guilt, which can exacerbate grief, Downey cautioned.

Bradley Lewis, Administrative Manager for School Based Mental Health Services for South Oaks Hospital, said he has received numerous requests during the pandemic for support related to COVID-19.

Lewis said Downey’s presentations to some of the 11 school districts went beyond the thought of death, but include losses in other areas, like access to friends, senior awards dinners, and graduations.

“A lot of families appreciated the opportunity to learn more about grief and loss, to understand the different types of grief their children might be going through,” Lewis said.

With parents, Lewis urges parents to “end the stigma of mental health,” he said.

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County Executive Steve Bellone (D) reminded Suffolk County residents as they grapple with the mental health toll from the public health and economic crisis of the services that can help.

Residents can reach out to the Family Services League at FSL-LI.com. They can also call a hotline that is available 24 hours a day and seven days a week at (631) 952-3333.

Residents who know people who are struggling with their mental health or substance abuse that are exacerbated by COVID-19 should reach out to these services, Bellone urged.

As for the viral data, the numbers continued to move in a favorable direction for a region that is still recovering from the virus.

Over the last 24 hours, an additional 45 people tested positive, bringing the total to 41,253. These positive tests represented less than a percent of the total tests.

An additional 18,816 people tested positive for antibodies.

Hospitalizations remained steady, with one person leaving the Intensive Care Unit, bringing that total to 25.

Hospital occupancy was at 70 percent, while ICU occupancy was at 60 percent.

An additional three people died in the last 24 hours, bringing the total for the region to 1,978.

The county distributed 20,000 pieces of personal protective equipment in the last day.