Illustration: Aïda Amer/Axios

As COVID-19 continues to strain health systems around the country, local leaders are trying to address the mental health needs of people in their communities.

Why it matters: Unlike the physical maladies the pandemic causes, its psychological toll is often invisible, and stress tends to have a cumulative effect that may not be apparent until months after the trauma of this period.

Between the lines: Stress becomes traumatic when people face uncontrollable and unpredictable events that are continually changing and require constant adaptation.

  • Ironically, the very mandates that officials are making to protect communities from COVID-19, such as continued social distancing, are creating new challenges and sources of stress.
  • Our physiological responses range from anger and frustration to feelings of hopelessness and loneliness — and, for some, worsening depression and anxiety.
"When people experience stress, we naturally want to escape it, usually by finding something that feels familiar, comforting, and routine. COVID-19 is unique because it is not only adding stress to our lives, but has also taken away predictable outlets for dealing with that stress."
— Madison, Wisconsin, Mayor Satya Rhodes-Conway in a recent blog post

What's happening: Mayors and local public health officials have launched initiatives to support their communities' most vulnerable residents — and are openly talking about their own struggles.

In Coral Springs, Florida, Mayor Scott Brook launched the nonprofit Mental Wellness Networking Alliance in the wake of the Parkland school shooting. It started with monthly in-person meetings where licensed counselors lead sessions on anxiety, depression and post-traumatic stress disorder. When the coronavirus pandemic kept people at home, Brook shifted to weekly virtual meetings held via Zoom and Facebook Live.

  • "It's a very free-flowing, safe dialogue," said Brook, who lost his mother to suicide when he was 23 years old. "It's important to help people to have a resource and a human connection, and to see the faces of a lot of other people who are in the same boat in their community."
  • Typically about 75 residents join the live conversations, with another 600 watching on Facebook. Students as young as 11 years old have joined the calls, he said.
  • The recent conversations have included tips for dealing with the stress of COVID-19 as well as coping strategies for grief and isolation.

In Lincoln, Nebraska, during daily press briefings, Mayor Leirion Gaylor Baird shares her own family's experience with the added strain, as well her own self-care routine, including daily runs, per the Lincoln Journal Star.

In Topeka, Kansas, Mayor Michelle De La Isla instituted a "warmline" system (as opposed to a hotline) to connect volunteers with lonely residents who need to talk to someone. She's read books to children via Facebook.

  • "People are hungry for that human touch. I’m trying to make sure that personally I’m modeling what I’m asking people to do," she told Axios in March.

The big picture: Local leaders should use their pulpits to share emotional connections with residents and create a sense of belonging, said Melissa Whitson, associate professor of psychology at the University of New Haven, who specializes in community psychology and trauma.

  • "Not only will people trust that leader more, it also normalizes it for people," Whitson said.
  • "We do a lot of social comparisons. The more we see people say they have everything under control, the more we feel like there's something wrong with us for feeling overwhelmed. People need to hear they're not alone."

What to watch: The extent of mental health problems is still unknown, but early surveys lead researchers to expect increases in child abuse, domestic violence and substance abuse as family stress mounts.

  • Large scale studies are underway. For example, health measurement firm Evidation just announced a nationwide study with New York City Department of Health and Mental Hygiene and Mount Sinai's Icahn School of Medicine to understand the mental health impact of the pandemic.
  • It will track the daily symptoms and experiences of participants — it already has more than 25,000 — over five months, per Ernesto Ramirez, design lead for research analytics and learning at Evidation.
  • "This is typically a hidden burden for most people," he said. "The waterfall of that burden doesn't come until much later, especially now that people have less access to mental health services they usually access."

Go deeper: Parents' stress levels spike as pandemic drags on

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