The pandemic has taken a toll on Americans’ mental health—and service providers have had to scramble to keep up.

Across the country, providers have seen an increased need for mental health services, and telehealth providers have seen their user numbers soar. Locally, the picture has been more varied, with some providers seeing a drop in patient contacts, while others found themselves overwhelmed by requests.

All, however, have seen symptoms of depression and anxiety increase among their patients. Providing care for those patients despite restrictions on in-person meetings, though, has required a significant change in protocol among therapists—and caused a shift toward providing virtual services that is likely to have a lasting impact.

Fear and isolation have worsened patients’ mental health

“Those of our clients who had depression or depressive symptomatology felt a little bit more isolated; those with anxiety had increased anxiety,” said Audrey Fisher-Price, a licensed clinical social worker and the vice president of integrated behavioral health at Crittenton, a nonprofit contracted to provide government and school-linked mental health services in LA County.

The economic reopening and decrease in coronavirus infections have done little to alleviate the fear many of Crittenton’s patients experience, Fisher-Price said. “With the uptick of the delta variant, people got fearful again. Uncertainty breeds anxiety.”

There have been numerous studies examining the impact the pandemic has had on mental health, all of which have confirmed what Fisher-Price and other providers are reporting: The level of depression and anxiety experienced among the general population has increased significantly.

A study by the Pew Research Center found that one year into the pandemic, in spring of this year, a fifth of U.S. adults reported high levels of psychological distress, with troubled sleep, anxiety and depression ranking among the top concerns.

Virtual therapy has presented challenges, opportunities

Providing care for those patients, however, has been challenging at times.

Some patients have been hesitant to allow staff into their homes or meet in person, which has created a barrier to providing care for the children and families Crittenton serves, staff noted. “People are concerned about what comes into their home,” Fisher-Price said. Add to that the already simmering fears of contracting the virus at work, and virtual therapy became inevitable.

“Staff had to learn different ways to provide interventions that would work for our clients when they weren’t in the room with them,” Fisher-Price remembers. “That was a challenge for everybody, for clients and for staff.”

But 20 months into the global health crisis, mental health care providers like Crittenton have also come to recognize the benefits of providing virtual care.

A county-wide agency, Crittenton serves patients from Long Beach to Lancaster, spanning several hours worth of driving between patients. In an emergency, being able to offer virtual meetings with providers can help “quickly alleviate the crisis situation,” Fisher-Price pointed out.

For some patients, virtual therapy can serve as a way to build trust before meeting with a provider in person, she added. “In the future, should we have a client that really, really struggles with trust and the ability to welcome people into their home, if they begin with telehealth […] maybe this is a different avenue that can work on a long-term basis.”

For staff at Prospect Therapy, a Long Beach-based office focused on serving the LGBTQ community, virtual therapy proved crucial in maintaining the level of care they provide as well as their relationships with patients.

To date, all of Prospect’s therapists remain exclusively remote, and it’s not clear yet when in-person therapy will resume—but owner Sara Stanizai said they’re likely to wait until indoor mask mandates have been rescinded.

“I would much rather see my client’s face, even if it’s just on a screen,” Stanizai said.

Prospect has offered teletherapy options throughout its four-year existence and will continue to do so, she noted. As such, she currently works with patients across the state and as far as Nevada.

Patient demand overall, Stanizai said, has increased significantly during the pandemic—last month, her office had to turn away at least 50 patients, referring them to other providers. With things as they stand and uncertainty abound, Stanizai said she’s not expecting that to change anytime soon.

“I don’t think the demand is going anywhere,” she said.