VIRGINIA — Members of the public could benefit from guidance on how to maintain positive emotional health, reduce conflict and stay connected to the world, despite mandates to socially distance themselves physically from others to help prevent the spread of the new coronavirus, or COVID-19, according to psychologists.
In many ways, mental health is as important to staying physically healthy during the current crisis. Because of the importance of social connections to mental health, psychologists wish government officials had not adopted the term “social distancing” to get people to stay at least six feet away from each other to help prevent the spread of the coronavirus. While they fully endorse efforts to keep people from getting too close physically, psychologists believe the widespread use of the term is sending the wrong message.
Now is the time when people need to find ways to be more social as long as they keep their physical distance from each other. People who are vulnerable to mental health issues as well as people who haven’t struggled with anxiety disorders or depression are being put to the test by the loss of their social networks during the coronavirus crisis.
“I'm uncomfortable every time that word is used,” said Carol Williams-Nickelson, a counseling psychologist with the Atlantic Counseling Group in Loudoun County. “We're talking about physical distancing, not social distancing. We encourage you to actually connect even more socially, but just not in close physical proximity.”
In retrospect, people would be better off if government officials had adopted the term “physical distancing” to describe what they wanted people to do, she said.
Finding ways to build tighter social connections is becoming more critical by the day as the number of people infected increases and the period of time in isolation grows. Closer connections will help people, especially vulnerable members of communities, cope with the major changes taking place in their lives. Building stronger social connections also will help people develop empathy for members of communities who are coping with the crisis in different ways.
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Williams-Nickelson, who has two teenage girls in Loudoun County Public Schools (LCPS), has served as the chief executive officer of the American Psychological Association of Graduate Students and the American Medical Student Association and Foundation. She also has chaired the Loudoun County Public Schools Special Education Advisory Committee and served as a member of the LCPS School Counseling Services Advisory Committee.
“We’re in a crisis about how to stay healthy. But the mental health piece of that hasn’t been incorporated into those discussions yet,” Williams-Nickelson said in an interview with Patch. “I can’t help but to wonder about what’s going on behind closed doors in homes right now. In uncertain times like these, it challenges even the most mentally healthy and balanced people. It’s a recipe for a mental health upheaval if people don’t start thinking about how to take care of their mental health as well as their physical health.”
Buffering The Stress
One of the primary messages she gives her patients is to focus on controlling what they can in their lives. “In a pre-coronavirus world, being controlling was not always considered a positive characteristic. But I think that’s wrong now. Routines and schedules are especially important because they provide stability and certainty,” Williams-Nickelson said.
People should work on having a fixed set of daily responsibilities at home, whether they’re a teenager, a student home from college, or an adult working remotely from home. Bringing control to one’s daily routine can buffer the stress when everything has been thrown off and “we find ourselves in a state of predictable unpredictably because things are constantly changing,” she said.
Williams-Nickelson also emphasized the importance of being socially aware and knowing when to pull back from judging people. "One of the dangers of being isolated and not socially connecting is that isolation can sometimes engender a sense of elitism — like my way is the only right way to do this, which is why staying connected and asking what other people are doing from an open, nonjudgmental place will help you find new ideas for yourself and better empathize with how others are dealing with this changing world based on their unique circumstances," she said.
Due to efforts to prevent the spread of the coronavirus, children aren't able to have birthday parties. Proms and graduation ceremonies are getting canceled. "That engenders a sense of loss," Williams-Nickelson said.
"Some people feel like their losses are being dismissed or considered less important in the grand scheme of things," she said. "I would hope that people would try to refrain from coming across as dismissive about things that matter to others. These experiences are a real loss for them."
Looking out for one's mental health in uncertain times also means allowing one to grieve and then, when the time is right, focus on finding a sense of hope and optimism.
"We have the option to stay focused on what’s not here anymore and all of the doors that have been closed," Williams-Nickelson said. "Or we can become aware of the new opportunities that are unfolding as a result of them. Optimism is about staying open and aware of the possibilities for the future and it’s about holding a favorable or positive view of the future."
Research shows, according to Williams-Nickelson, that having an optimistic, hopeful perspective changes the wiring in the brain and the chemicals that are released. "Being able to acknowledge and grieve and then working actively to move from having that grieving and loss experience to a place of adopting a hopeful and optimistic mindset is one of the things I would encourage people to do," she said.
As the coronavirus crisis has worsened, doctors have switched to online platforms to provide health care to their patients — unless it's vital the doctor see the patient in person. Williams-Nickelson, who returned to practicing psychology last year, has been delivering teletherapy to her patients during the coronavirus crisis.
With privacy laws, doctors must make sure the technology platform they are using comply with the Health Insurance Portability and Accountability Act (HIPAA) to avoid impermissible disclosures of protected patient health information. The U.S. Department of Health and Human Services (HHS) has relaxed some of the rules that govern which technology platforms comply with HIPAA.
Since it's a matter of getting health care or not getting services due to coronavirus limitations, the federal government has decided to lift some of the restrictions on which technology platforms can be used, Williams-Nickelson said.
The Office of Civil Rights (OCR) at HHS, which enforces certain provisions of HIPAA, said it will "exercise its enforcement discretion and will not impose penalties for noncompliance with the regulatory requirements under the HIPAA Rules against covered health care providers in connection with the good faith provision of telehealth during the COVID-19 nationwide public health emergency."
Health care providers are permitted to use applications that allow for video chats, including Apple FaceTime, Facebook Messenger video chat, Google Hangouts video, Zoom, or Skype, to provide telehealth without risk that OCR might seek to impose a penalty for noncompliance with HIPAA rules. However, Facebook Live, Twitch, TikTok, and similar video communication applications that are public facing should not be used for telehealth, the OCR said.
This list below includes vendors that provide HIPAA-compliant video communication products and plan to enter into HIPAA business associate agreements:
Skype for Business/Microsoft Teams
Zoom for Healthcare
Google G Suite Hangouts Meet
Cisco Webex Meetings / Webex Teams
In her teen group therapy sessions, Williams-Nickelson said she is using HIPAA-compliant platforms that allow everybody’s faces to be on the screen. Some platforms like Doxy.me have had shaky connections over the past two weeks, with so many people using them for online meetings, she said.
"It is an important time to take advantage of telepsychology and teletherapy," she said.
Atlantic Counseling Group - 703-621-7121 ext. 4
Fairfax-Falls Church Community Services Board - 703-573-5679
Alexandria Emergency Mental Health Services - 703-746-3401
Loudoun Mental Health Emergency - 703-777-0320
Prince William County Emergency Services Division - 703-792-7800 in Manassas and 703-792-4900 in Woodbridge
Rappahannock Area Community Services Board emergency therapist - 540-373-6876
PRS CrisisLink hotline - 1-800-273-TALK