Experts question Utah report that says mental distress hasn’t significantly increased during the pandemic

Suicides and substance abuse have not increased, but mental health professionals say the numbers don’t provide the whole picture.

Editor’s note: If you or someone you know is experiencing suicidal thoughts, call the Suicide Prevention Lifeline at 1-800-273-8255 or the UNI CrisisLine at 801-587-3000.

Some experts are disputing the interpretation of a recent state report that said the COVID-19 pandemic and ensuing stay-at-home orders have not led to more emotional distress among Utahns.

”To say, ‘No, we’re totally fine, nothing to see here,’ is a little bit false,” said Michael Staley, who tracks and researches suicide within the Utah Department of Health. “There is some room for relief, to be sure. But we’re not out of this. I’m still holding my breath.”

Utah’s Department of Health last week released a report that indicated there was no preliminary evidence linking social distancing and stay-at-home orders to an increase in distress among Utah residents in 2020.

It pointed to no increase in suicides during the first three quarters of the year. Calls to the Suicide Prevention CrisisLine increased, but the growth was “similar” to that of past years. And there also was no significant jump in emergency room visits for drug overdoses and substance abuse.

Gov. Spencer Cox quickly labeled it “good news.” He said the data shows “how resilient the response of Utahns has been to this.”

But Staley and other mental health officials disagree.

Utah historically ranks among the worst states for mental health. While the state’s suicide rate has declined slightly in recent years (about 640 Utahns die from suicide annually), it remains too high — even without an obvious impact from the pandemic, Staley said. He and others also noted there are gaps in the data. And research shows reaction to trauma often is delayed.

“Just because somebody didn’t die by suicide doesn’t mean that they were not significantly impacted by the pandemic and their mental health didn’t suffer,” Rep. Steve Eliason, R-Sandy, said of the report. “So, in no way, shape or form would I want any of the data to be interpreted that things are good.”

What the report said

In the state’s report, health and human services officials said they had anticipated “negative impacts on behavioral health outcomes in Utah.” But they did not find a significant increase in people visiting emergency rooms or seeking help for serious mental distress.

[Read more: Here are Utah resources and advice for taking care of your mental health during the pandemic]

From March to August of 2019, about 13.5% of Utah adults surveyed by phone reported that they had experienced poor mental health for 14 days of the preceding month. That held steady at 13.4% for the same months in 2020. And prescriptions for anti-anxiety, anti-depression and anti-hypertension drugs were filled at a similar rate as a year ago.

Kimberly Myers, assistant director of the Utah Division of Substance Abuse and Mental Health, credited the state’s existing health structures and response systems.

“This data suggests that interventions and treatment during the pandemic have remained as effective as in previous years,” she said when the report was released, “even in the face of a sudden shift to primarily telehealth.”

Staley and Travis Mickelson, a psychiatrist for Intermountain Health Care, said it’s easy to look at the report and see a fairly rosy picture. And some of Utah’s advantages, they said, likely have helped support residents’ mental health.

The general good physical health of Utahns has contributed to fewer people dying from the virus than in other states, Mickelson said. And Staley noted that Utah hasn’t been hit as hard by unemployment as places like Hawaii, which helps.

He also pointed out that Intermountain hasn’t had to delay most elective surgeries, which has also been true of other providers. Having a medical problem, like needing a knee replacement, that causes pain and gets postponed can greatly add to someone’s stress or anxiety, he said.

And the recent introduction of vaccines might be bringing some new hope.

But Staley points out that the survey data on Utahns experiencing poor mental health only runs through August. He and Mickelson worry the state might be jumping to conclusions too quickly.

‘That wave hasn’t hit yet’

In 2020, Utahns endured not only a once-in-a-lifetime pandemic, the state’s report notes, but also a significant earthquake, a major windstorm, local and national protests and civil unrest.

With such community-level trauma, Staley said, there’s often an initial feeling of “we’re all in this together.” And that helps people through at first.

But when that camaraderie wanes, the emotional impact sets in. That delayed response happened with the 9/11 terrorist attacks and even outbreaks of Ebola, according to a study from Boston University.

Mickelson believes that could, at least partly, explain what’s happening in Utah. “We are expecting to see an increase in people reaching out and seeking out mental health services,” the psychiatrist said. “We just think that that wave hasn’t hit yet.”

The overall volume of calls to the state’s numerous hotlines combined — including the CrisisLine, the WarmLine and SafeUT — never reached the peak rate from 2019, the state report noted. Still, more people were calling as the year wore on.

The first case of COVID-19 was discovered in the United States a few weeks before Carter Crosland of Midvale found himself punching a wall and screaming in a “quiet” room at his workplace.

(Photo courtesy of Carter Crosland) Carter Crosland of Midvale gets cuddles from his 1-year-old daughter, Bonnie. Crosland experienced a panic attack in March that led to a diagnosis of depression and says he doesn't believe Utahns are not experiencing more stress as a result of COVID-19.

With a new baby and a new job in a new city, he felt plenty of stress. The arrival of the coronavirus added concerns about his job performance as a recruiter and about his health and that of his wife, both of whom are considered at high risk for complications from the virus.

”I was always able to manage and to deal with all the things that I was going through beforehand,” said Crosland, 36, “and then I just felt like the pandemic pushed me over the edge. … [It] tipped the scales where I couldn’t lift the weight anymore.”

After his panic attack, Crosland said, he was diagnosed with depression. “I don’t know anybody who hasn’t been affected [by the pandemic] in some way,” he said.

Bruce Gentry, a 22-year-old from Provo, said it’s gotten more difficult to cope the longer the pandemic has persisted.

He feels lucky to have been getting help for his depression. But doing counseling over a Zoom call, he said, hasn’t been as effective. He struggles to find a private place in his house where he can talk. And he doesn’t feel the same connection when he’s not face-to-face with his therapist.

The things he used to like to do have largely stopped. His singing group called off practices, and his opportunities to attend services at The Church of Jesus Christ of Latter-day Saints and participate in temple ceremonies have been limited due to safety restrictions.

“It just leaves you rather isolated. … I just wish I could give someone a hug,” Gentry said. “And like the things you need most like that, you can’t have right now. I don’t know when I’ll get them back.”

Did Utahns stop seeking help?

To avoid contracting COVID-19, people might not be going to emergency rooms or visiting doctors for their mental health — which would make those numbers artificially low, both Staley and Mickelson said.

And fewer Utahns sought help from public mental health treatment services in the spring and the first half of summer in 2020, the state report noted. Compared to March through July 2019, the number of people contacting such services dropped by 33.4%. Those checking in for substance abuse treatment decreased by 44.3%.

The same trend holds for emergency room visits for all illnesses and injuries, too. Visits for chest pain and strokes are down about 30% across the state.

Mickelson noted that he saw a sizable two-week dip in his schedule of patient appointments right after then-Gov. Gary Herbert’s call for Utahns to stay home in late March. His appointments quickly returned to normal, spurred by the launch of telehealth video visits.

But other specialists have continued to see a lag, he said, which in itself could be an indicator of a mental health problem.

“We definitely haven’t seen a decrease in mental health visits like the cardiologists have seen a decrease in their cardiology visits,” Mickelson said. “The fact that our numbers have stayed the same, someone could argue that maybe that actually represents the increased need of the community.”

Mickelson said more people have begun seeking treatment for mental health issues from their primary care doctors rather than specialists, which also may not have been reflected in the state data. Staley said he believes people were more likely to stay home to avoid the virus, or lost jobs and couldn’t afford help. The report is likely also missing people who don’t have a support system or a network of family or friends to catch warning signs, Staley said

The longer isolation continues, mental health experts believe, the worse a person’s condition can get. Eventually, it can make them even less likely to reach out. And delaying care can be dangerous, Staley added.

“I’m concerned,” he said. “How long can these people wait it out before it gets ugly?”

Families with children may be facing similar reticence or barriers. Mickelson, who specializes in treating children and who has a teenage daughter, said anecdotally the pandemic seems to be weighing on kids the most. But when he asks for crisis reports from places like Children’s Primary Hospital, he said, they show little fluctuation.

Residents under 18 were not included in the mental health surveys. The one spot in the state report that specifically discussed youth noted only a slight “deterioration” in the mental health condition for those in therapy.

‘We should not be complacent’

One place where data is clear: Calls for help from domestic violence victims have increased during the pandemic, a trend described in the state report.

The Utah Domestic Violence Coalition hotline received 1,712 calls in 2019. With data through just September for 2020, there were 2,273 calls, said Liz Sollis, who oversees public awareness for the coalition.

Sollis believes the number of cases could actually be even higher than their call volume indicates. If a victim is stuck at home with a perpetrator closely watching them, for instance, they may not be able to call for help.

Still, she added, there has been an overall 25% to 50% increase in the use of their services, depending on the location.

Washington and Duchesne counties have experienced the highest increases, she said, and she believes that’s due to more unemployment caused by the pandemic in those areas — such as in the hospitality industry in St. George, Washington County’s popular tourist destination.

Loss of jobs, she said, has been a significant contributor to increased abuse, causing extra tension in close quarters when people are stuck at home together. It has also lengthened the stay of most victims at the coalition’s shelters statewide.

The beds throughout the state have been consistently at capacity; the organization has expanded into renting some hotel rooms, too, in part to keep victims safely spaced and avoid spreading the virus. They often can’t afford to go elsewhere.

Police departments have noted more aggravated cases, said Unified Police Department Sgt. Melody Cutler. “On our watch logs, it seemed like every day it was domestic violence, domestic violence, domestic violence,” she said.

In the last few months of 2020, calls escalated, she added. There were 1,407 cases of aggravated domestic violence between September and December. In the same time period in 2019, there were 1,181. That’s a 20% increase, and mirrors the delayed impact that Staley mentioned with mental health.

Eliason, who has been advocating for increased resources for both mental health services and domestic violence prevention since he first took office in 2011, said he is looking for ways to help this legislative session.

(Rick Egan | The Salt Lake Tribune) Rep. Steve Eliason introduces a bill in a committee meeting on Monday, Feb. 1, 2021.

He is supporting funding through HB35, which would create a roving Assertive Community Team to treat mental health issues on the streets. Its funding was cut from the budget during a special legislative session called because of the pandemic in June.

Eliason has also asked for increased funds for the Utah Crisis Line and mental health research.

Staley said he appreciates those efforts. “We should not be complacent,” he said. “One of the biggest threats to suicide prevention right now is complacency.”

People should be aware, he added, that hospitals and emergency rooms are taking precautions against the virus, and no one should not get help out of fear of contagion.

Another good step, Mickelson said, is creating a more accepting environment around mental health issues. So much stigma is attached to them, he said, that many people may be saying “everything is fine” when it is not.

— Tribune reporter Bryan Schott contributed to this report.