The Jerusalem Post - The Jerusalem Post Magazine
Mentally coping with corona • By ALAN ROSENBAUM
Making life more bearable in this unusual, taxing time
‘These days, anyone who is not feeling anxious, overwhelmed or triggered easily by things, would be categorized as having an abnormal response,” says Hindy Ross, clinical case manager at Amudim Israel, an organization that helps English speakers in Israel navigate the mental health system and find appropriate treatment. Ross is speaking about the emotional stress experienced by people living under the threat of COVID-19.
While close to 18,000 Israelis have become infected with coronavirus out of a total population of almost nine million people, the percentage of people that have been affected by the mental stress caused by the pandemic is far higher. Everyone has been affected.
In response to the mental health stresses caused by the corona crisis, Amudim, the parent organization, which is based in New York, opened a 24-hour anonymous support line, staffed by mental health professionals who answer hundreds of calls each day.
“By and large,” says Ross, “they are people who are calling because of anxiety. They are overwhelmed and they are not sure what to do.”
Many times, she adds, calls to the support line come from people who just need to vent, and want to know that their reactions to the crisis are normal. Amudim Israel has also been fielding calls from Europe, Australia and South Africa.
Andy Ifergane, director of the Social Work Division, Department of Psychiatry, Soroka University Medical Center in Beersheba, psychotherapist and sexologist, says that depression and anxiety are at much higher levels, and marital and family conflicts have increased.
“I do couples therapy,” says Ifergane, “and every one of my couples are in a worse state than they were before.”
Before corona, she explains, everyone had their own coping strategy for dealing with stress, whether it was going for a run, or having a cup of coffee with a friend. The restrictions put in place by the government stymied many of these activities and added to the stress. Ifergane adds that conflicts about sex are not uncommon during periods of stress.
“For some people, having sex helps them cope with anxiety, but there are people who are the opposite. If there is a crisis, or if their level of anxiety is high, they don’t want any kind of contact.”
Ross, a certified school psychologist by training, notes that cases of child sexual abuse have come to light during this time, due to people living in close quarters during the crisis.
“Things that might not have been discovered before have now been discovered because of these close quarters. There have also been cases of domestic violence that have come up.”
High levels of stress can be felt in families where a family member has a chronic illness or condition that places them at a higher risk for becoming seriously ill with the coronavirus, says Ifergane. As a result, the entire family may be at a higher stress level, because family members fear that contracting the illness may infect the high-risk member of the family. She notes that many who have fallen ill from the coronavirus feel a sense of guilt.
“I treat the medical staff and when someone from the medical staff tests positive, there is a lot of guilt, because they may have potentially harmed patients and their family members.”
Grandparents, says Ifergane – even those who communicate with their grandchildren on Zoom and Skype – are unhappy and stressed, because they can’t kiss and hug their grandchildren. And, she adds, it’s difficult for grandchildren as well, not to experience hugs from their grandparents.
Self-care is most important: ‘Try being kind to yourself’
Beyond the family dynamics, a major source of anxiety has been the economic fallout caused by the crisis. Businesses have closed, people are struggling with less income, and workers have been laid off.
“We know that a lack of money is always a major issue in families,” says Ifergane.
Family strife, money worries and health concerns – together they can add up to stress-filled lives for families and individuals. What strategies can be employed to make life more bearable during the pandemic?
IFERGANE SUGGESTS that people should examine the coping strategies that have helped them in the past, pre-corona, and try to apply them in the present, whenever possible.
“Each of us should know his normal coping strategies. Do you regularly pray or run, or read a book, or imagine, or do meditation or yoga or relaxing stress techniques – what helps you on a regular basis? If you can’t meet friends in person, arrange to speak to friends on Zoom. If you can’t pray in the synagogue, pray at home.”
She adds that practicing relaxation techniques, such as deep breathing, muscle relaxation, or guided imagination, in which positive mental images are visualized to influence how we feel, can be beneficial.
She recommends that couples try to improve their communication skills with each other.
“Instead of saying to your spouse, ‘You are not doing that,’ try talking about how what he or she does makes you feel.”
Ifergane says that it for those who are not working, it is important to maintain a daily routine, eat normally and sleep normally.
Another way to reduce stress, says Ifergane, is avoid overuse of smartphones.
“There is a lot of information provided on cellphones about Corona, from different sources, and it is very confusing. If you are anxious to begin with, that makes you more anxious, and you don’t know what to do.”
Ross says that self-care is most important.
“Try being kind to yourself,” she says.
If parents are working from home, it is important to create ground rules and structure for the entire family. Adults need to give themselves “alone time” from kids and must ensure that mental health remains a priority. If a family is experiencing a budget crunch, she adds, expenses for maintaining mental health, such as therapy costs, should not be cut.
In Ross’s view, it is important to remove the stigma from the need to manage one’s mental health.
“The COVID-19 crisis is a global traumatic incident, but on a positive note, the mental health stigma will go down, because there has been so much more discussion about mental health.”
Interestingly, Ifergane suggests that society tends to view mental stress as more legitimate for women than for men.
“That doesn’t mean that men don’t have any stress or depression,” she says, “but that’s why we have more women patients than men.”
Ross concurs, saying, “Women have been (prior to COVID) and still are now, more likely to call. Men need much more of a push, and usually call only when the crisis is already advanced.”
WHILE THE tips suggested by Ross and Ifergane are practical and can be beneficial, there are times and circumstances when people will need to seek professional help to maintain their sense of equilibrium. Where can people turn when they need assistance?
Tanya Prochko is the founder and director of Get Help Israel, an organization that attempts to bridge the mental health care gap for English speakers in Israel, and which, in her words, “is a one-stop shop for all of their mental health needs.” A psychotherapist specializing in trauma and relationships, Prochko made aliyah in 2012, and established Get Help Israel, whose website lists 250 therapist members, subsidized therapy options, listings of support groups, information about anonymous group meetings such as overeaters anonymous, help hotlines and general information on navigating the mental health care system in Israel.
“You can get therapy through your Kupat Holim (health organization), but they don’t speak your mother tongue, or if they do, they are not fully fluent. This can become hard in space of a therapy session, when you are most vulnerable disclosing painful things. You want the therapist to fully understand you and understand you culturally,” she says.
In addition to its extensive website, Get Help Israel publishes a book called The Mental Health Resource Guide. The organization also has established the Israel Association of Mental Health professionals, a cohesive community of English-speaking mental health professionals in the field. Prochko says that therapy is not regulated in Israel, and their association has established a list of qualifications and requirements for its members.
Prochko says that therapists in her organization work with many English-speaking seminaries and yeshivot in treating students, as well as offering a special program for lone soldiers, and offers a secure and encrypted video platform enabling therapists to conduct long-distance therapy with their patients.
ANOTHER ORGANIZATION (mentioned above) that assists English speakers in Israel with mental health needs is Amudim Israel, the Israeli branch of Amudim, which was created in New York six years ago to address addiction and sexual abuse in communities. Amudim has gradually widened its focus and now addresses general areas of mental health. Amudim Israel opened three years ago, to help the large population of American students in Israel with mental health care needs, and other English speakers who couldn’t participate in mental health services in Hebrew.
“We deal with olim who have been here for 40 years,” says Ross. “Their native language is English, and they’ve never been able to acclimate to the system here, which is technically difficult, and dealing with mental health in their native language is much more effective.”
Ross explains that Amudim provides clinical case management, referring people to specific individualized referrals, and following up with therapists to track their clients’ progress.
“We check in with therapists very often, making sure that the therapy is appropriate.”
THE THIRD and least expensive option for mental health treatment is receiving treatment from therapists and psychiatrists from Israel’s kupot holim (health funds). Kupot holim have a list of English-speaking therapists online. Ross explains that individuals seeing therapy through the revacha (social welfare system) do not always have a choice as to which therapist will be assigned to them. Members of kupot holim who seek psychiatric care, she says, can choose their therapist, and she adds that many English-speaking psychiatrists work with the kupot holim on a reimbursement scale, receiving a reimbursement of between 60% and 80% of costs.
Ifergane notes that Kupat Holim Clalit maintains a hotline staffed by social workers and psychologists that provides help for people who are feeling stressed or depressed. The hotline is available in Russian, Arabic and English.
The coronavirus has not left any country unscathed, but Ifergane feels that Israel has managed better than most, because it is used to dealing with emergencies. She says that social workers and psychiatrists at Soroka Hospital are experienced in dealing with crisis intervention and were able to adapt to the situation quickly.
Ross thinks that the fact that Israel is used to military involvement has helped in its approach to dealing with the virus, and with regards to the public’s approach to obeying rules and regulations. “There was more unity,” she says.
While many of the rules and regulations put in place by the government have gradually been relaxed, the government is still encouraging citizens to maintain social distance, wear masks and maintain hygiene. After three months, many Israelis are finding it difficult to maintain some of these practices. Ifergane explains that it is difficult to live our lives without physical touch.
“From birth, we are connected to each other and that’s how we live. Israelis are a hugging community.”
Ross adds that people need to balance health precautions, mental health and sanity.
“Some people need more socialization than others, for their sanity. If you see someone practicing something that you are uncomfortable with, take it with a grain of salt that people’s emotional and mental health needs are part of that consideration.”
She adds that technology has allowed people to function far more effectively than the Spanish Flu pandemic of 1918, both in terms of daily activities and in the area of mental health.
“Technology affords us a wonderful thing in that we can sharing so many techniques. We can work from home and have school from home. That’s a huge thing. A hundred years ago, they had no access to anything, and now you can get access to all mental health. There is tele-health, different meetings – for addicts, it has been a huge thing and it is a literal lifeline. The fact that these resources are available online is huge. People should not underestimate the value of those resources.”
What lasting effects will the Coronavirus have on mental health in society? Ross says that there will be an uptake in trends of suicidal ideation globally, as well as addiction. Amudim is preparing for an uptake in domestic abuse, child sexual abuse and divorce.
“Having the humility to see what needs to be done and then responding accordingly is the only thing that we can do. We’re just trying to do our best,” she says.
While it is difficult to consider an upside to the effects of the corona pandemic, at the very least, it has legitimized an understanding and appreciation among the general population of the need to maintain mental health, manage stress and think positively.