Sometime last year — Lisa Hughes doesn’t remember exactly when — she sat on the landing of her stairs. Then, she laid down.
That day, she had spent hours in back-to-back therapy sessions and rushed to the hospital after one of her clients attempted suicide. As she rested on the floor, her phone blowing up with messages from even more people who needed her help, she wondered for one of the few times in her career whether she should quit.
Remembering this moment makes Hughes sad because she loves her job. But during the pandemic, Hughes — a clinical social worker and therapist in Frederick and Hagerstown — saw her caseload skyrocket from 50 clients to 80. She was spending six to nine hours in session per day and had started working on the weekends to accommodate the schedules of doctors and nurses. Her phone wouldn’t stop ringing with people requesting intake appointments. Sometimes, when a friend would ask how she was, she’d just start crying.
Laying on top of the stairs that night, Hughes felt so alone.
“I just, at that moment, felt like, ‘There is literally no way for me to carry this all,’” she remembered. “I just wanted to be like, ‘I’m done. I’m not doing it anymore.’”
Over the past year and a half, the occurrence of mental health issues in the U.S. has erupted, with young people, people of color and essential workers facing the brunt of the surge. This avalanche of need soon became obvious to Hughes and other Frederick social workers, counselors, psychologists and therapists, as they saw their call volumes balloon to levels they had never seen before. They were tasked with guiding their community through a fog of uncertainty that they themselves were struggling to navigate.
Even before the pandemic, mental health workers were strained. Demand for mental health services has increased in recent years even as the long-standing shortage of mental health providers nationwide persists. Last year, a survey of more than 2,000 North American psychiatrists found that 78 percent had scores suggestive of high levels of burnout, and 16 percent had symptoms of Major Depressive Disorder.
Now, with coronavirus cases dipping and the restrictions enforced during the pandemic lifted, the work is far from over for Hughes and her colleagues. Many are still juggling amplified demand for their services, and some are working through wait lists that are months deep. Moreover, as life gurgles back to a kind of normal, their clients are facing a new round of anxieties.
“There is no break. There is no wrap-up. There is no period to breathe,” Hughes said. “It’s just kind of on to the next wave of issues that came out of living this way for quite some time.”
Katie Frazee started Guiding Paths Counseling six years ago because she wanted to cut back on her hours to spend more time with her newborn son. For five years, it seemed like her plan was working — she was working about 25 hours per week.
Then the pandemic hit. Suddenly, she was working up to 45 hours a week. All the while, she was helping her son through virtual kindergarten and later first grade.
A couple of weeks ago, Frazee said she had to finally put her foot down and stop accepting new clients. She knew she was getting to a point where she could no longer be fully present with them. She estimates she has to refer about 20 people per day — a huge surge from the five people she turned down each day pre-pandemic. She recently spent an entire Saturday calling people back and trying to help them find therapists who could fit them into their schedules.
It’s been difficult, especially because many of the therapists she typically refers people to are also no longer accepting new clients. She advises people who reach out to her to get on a therapist’s wait list, even if it’s a month or two long. That way, if they’re not able to find someone else in that time period, at least they have an appointment lined up.
“It’s disheartening because typically people are reaching out at a point in their lives when they don’t know what else to do or who else to go to,” she said. “Now, we’re in a position where people have to wait a month and a half. And by the time a month and a half comes, maybe that initial problem has dissipated or they lost motivation.”
Monique Harris, a licensed professional counselor who runs Blu Haven Wellness Center on Urbana Pike, also saw a spike in requests for service during the pandemic. To keep up with the demand — and be able to see all of her former clients who needed help again — she hired a virtual assistant and two additional therapists.
In the early days of the pandemic especially, Harris dealt with feelings of loneliness. She was relatively new to the Frederick area — having recently moved from Montgomery County — and had yet to build a local network of therapists to lean on. But she deeply valued the bonds she built with her clients and feels grateful to have been able to contribute to her community in this way.
She recently joined a peer support group, where she learned a new way of ending counseling sessions.
“After every session, you just kind of put your hand over your heart, and you just send love to that client,” she said. “And you close out by just leaving the session there. So not taking it with you to your other room or not taking it with you anywhere — just leaving your session there but also sending it off with love.”
Jess Albright was overcome with emotion when she walked into her office a few weeks ago for the first time since the pandemic began.
“I sat there and cried for a few minutes,” said Albright, who runs Counseling with Jess in Frederick. “Because it has been a year, you know?”
During the pandemic, Albright missed the safe space her office provided for her and her clients. Working from a nightstand in her bedroom, it was hard to maintain clean boundaries between her job as a counselor and her job as mom to two kids — a 3-year-old and a soon-to-be second grader, who she homeschooled last year.
The transition to telehealth was trying. Staring at a screen all day was exhausting, she said, and she found herself leaning forward in her chair more and making more dramatic facial expressions to show her clients she was listening. Now, she has the frown lines and crick in her back to prove it, she said with a chuckle.
It was hard to avoid burnout, but Albright developed some strategies. She did a lot of walking, watched mindless TV shows and sometimes just sat and stared at the wall — a coping method that might have not been the most effective, she acknowledged, laughing.
She also turned to an analogy she often shares with her friends. We’re all juggling a lot of balls, she tells them, some rubber and others glass. If you drop the rubber ones, they’ll bounce, and you can pick them up later, when you’re ready, she says. But if you drop the glass balls, they’ll shatter. The trick, Albright said, is figuring out that distinction for yourself: What in your life is a glass ball, and what is a rubber ball?
For Albright, her relationship with her kids and her husband is a glass ball. When her daughter remembers 2020 and the first half of 2021, she said, she doesn’t want her to think of it as the time when mommy was a monster and they argued over silly things to do with school.
Instead, she wants her to remember it as the time “we laughed and we made play dough,” she said. “And we played in the creek because the pool wasn’t open, and we went to drive-thru restaurants and ate it in the back of the car — we called it a ‘car picnic.’ And [we tried] to chase joy because joy was so sparse.”
During the pandemic, the Frederick County Health Department’s six-person team that provides mental health services to people in the county who use Medicaid and Medicare experienced many of the same challenges experienced by private providers.
With about 400 clients already on their clinic caseload, Joyce May — a clinical social worker specialist for the county health department — said she and her colleagues found themselves making more and more referrals. Similar to Albright, May found it hard to neatly compartmentalize her home and work life while working from her family room.
But in a recent interview, May concentrated more on the silver linings of what has been a pretty grim year and a half. During the pandemic, Medicare and Medicaid began offering more flexibility in covering teletherapy than it did before. Without the added burden of finding transportation to the office, clients also began making their appointments more regularly, May said. And since many were tuning into sessions from spaces where they felt comfortable, May and her colleagues noticed many of their clients were sharing more than they previously had. Many made strides in their healing journeys because of the new setting, May said.
Alicia Dacey, a licensed clinical marriage and family therapist who runs the Frederick Center for Marriage and Family Therapy, noticed similar benefits to teletherapy. The transition online and uptick in demand for counseling caused business at Dacey’s center to double. She hired more staff and now sees clients from every region of Maryland, including areas that don’t have marriage therapists.
“I have clients with young children who would not have been able to get a babysitter during the pandemic,” she said. “I have clients with disabilities who are in too much pain and are physically unable to leave their homes. I have clients who are working from home who are able to take a quick one-hour break during their work day to receive mental health services.”
And Hughes? She didn’t give in to the thoughts of quitting, even after that night when her feelings of isolation became impossible to ignore. She hates seeing people suffering and doesn’t think she would have been able to walk away. The relationships she has with the people she works with are “near and dear” to her.
Still, it sometimes feels like mental health workers are a “lost group,” Hughes said. Although she has seen so many of her colleagues work tirelessly to meet the needs of others — sometimes to the detriment of their own mental health — she wonders if the broader community just assumes they’re always OK.
Nobody looks out for therapists’ mental health because, well, that’s their job, Hughes said.
“If you know one, if you are friends with one, if you have a family member that’s one, just ask them how this year has treated them. Ask them how they are — check in with them.”