Lori Walsh: As America faces the coronavirus pandemic, many also warn of a mental health pandemic of sorts as South Dakotans face the intense disruption of their lives. They also face isolation and anxiety. Dr. Matt Stanley is a psychiatrist with Avera Health. He's the clinical vice president of the behavioral health services line. He's joining us today to talk about how people with ongoing needs are still engaged in mental health care and services and how people seeking help for the first time are also being served. Dr. Stanley, welcome back to In The Moment. Thanks for being here.
Dr. Matt Stanley: Yeah, as always, thanks for having me. Great to speak to you and appreciate the opportunity to reach out to others.
Lori Walsh: I think it is an important time to stop and say for many people, before this even happened, were in crisis for a variety of reasons, through depression or anxiety or PTSD or addiction, or their lives were already upended and then this happened. I want to start with you, if we could. How have those services for people who were already in need... Have they been interrupted? How has that transition sort of keep employees and healthcare providers and patients safe but also continuing to get the care that they need? How has that gone?
Dr. Matt Stanley: Well, you bring up a tremendous challenge, one of many challenges we've faced with this unprecedented pandemic. But I think, as you're implying, the other illnesses, the other issues that we've all been dealing with, and as a health system, we're here to take care of, didn't go on pause as we had to try to learn how to deal with the coronavirus. We have had to balance between keeping people safe and limiting exposure, but still providing services to those that have ongoing needs, whether it's, as you said, life-threatening diseases like depression and suicide or all the other mental illnesses we deal with. Certainly in any time of uncertainty, our anxiety disorders escalate as well as things like depression and even things like substance abuse and some of the psychotic disorders. We are still out there serving the community and addressing what's always been our primary focus in healthcare.
Lori Walsh: This is an organization as well that had recently had some disruption and innovative solutions after a tornado came through the town and impacted services a little bit. Tell me, have you noticed the fact that staff had already had to think outside that box, had already had to very recently respond to something that they really hadn't imagined before? Did that help at all in the, "Okay, here's the next thing that we have to figure out"?
Dr. Matt Stanley: It's interesting you would ask that question, and I think it's a brilliant question, because honestly I don't think most people would see that aspect of it, but I think you're absolutely correct. We see this, I think, in our community, and maybe nationally and maybe across the entire world. Challenges sometimes tend to bring us together. They certainly often challenge us to arise to a level we weren't aware we could achieve or weren't prepared to try for. I do think that our staff, first of all, showed an amazing resilience through the tornado.
I think they're brilliant people going far over and above what they probably realized they could do. I do think, oddly, it's probably not a normal expectation that we would come out of these kinds of challenges stronger, but I think we have. I'll tell you I would say it's hard to say there's a silver lining in something that's as traumatic and taking lives like this illness is, but there are some amazing changes, advances that are being propelled by this pandemic, such as... I think telemedicine is just going to be advanced dramatically through this crisis and the responses we've been forced to implement.
Lori Walsh: Even as we go through this, we are, I think, in our individual lives and then in the institutions or the employers we work for or with, we're learning these little things that say, "That's a glimmer of, 'Now that I'm forced to do it, it's a little bit of a better way to do it,' or there's at least a potential to look forward," which I don't think minimizes the suffering that we're experiencing now. But it does kind of get to this idea that the normal that some people are hoping for... Maybe normal isn't the right word. Maybe just next is the right word or looking forward instead of looking back, "How do we return to what we were doing?" versus, "How do we move forward knowing what we know now?" I want to talk to you, Dr. Stanley, a little bit about people who are suffering in new ways, people who have lost their jobs, people who are desperate, anxious, hurting, lonely, isolated in ways they've really never experienced before. What's your message to people about getting help, how to get help, and why it's okay to get help?
Dr. Matt Stanley: Yeah. Well, those are some pretty weighty questions right there. Absolutely, as you said, it's normal now, and I think one of the things we see in psychiatry and behavioral health is that sometimes just to normalize responses, to be anxious, to be worried, to be, maybe even to a degree, distraught is not abnormal right now. I think the biggest concern we have is exactly what you're implying, that you would lock yourself away and think that something's wrong with you and be embarrassed or afraid to ask for help. When we go through times like we're going through, it is normal for people to need and hopefully to seek help. I think you mentioned a lot of the stressors, loss of job, isolation, anxiety that... and people that probably have never or possibly have never experienced this kind of anxiety before, but the resources are there.
We're aware that things are very stressful for, I would say, most of America, maybe most of the world. People I work with, behavioral health professionals, our stress level is up. We are all dealing with things that we weren't necessarily prepared for or expecting. Let me mention a couple of resources. Avera Health has teamed with the helpline, so that's 211, for people that are struggling during this time. I think one of the beauties of teaming with the helpline is the helpline has always been excellent at directing people toward community resources, whether it's volunteer work or, in this case, maybe help with housing or emergency resources. We've teamed with them so that if people call in and they need those kinds of things that 211 normally deals, 211 will kind of take and manage that call or direct that call.
But if someone calls in with a need for some counseling, some anxiety issues or depression issues, then that call moves over to our 24/7 counselors who are prepared to work with people on the phone and both counsel them in the moment, but also direct them to other resources and direct them to the right level of care. I also want to point out, although we're trying to limit people going into clinics at this point in time, our clinics are trying to move over to all install telemedicine visits. That is, as you can imagine, a tremendous challenge within a week two to move from face-to-face appointments to telemedicine. But there are apps that can be downloaded, AveraNow is an app we're using so that you can actually do a visit on your smartphone. But emergency resources, you can still walk into our behavioral health facility for an assessment.
Resources are still available. If you don't feel like you've quite gotten to that level, where you need to maybe see help of professional nature, I think there are a few things that we are learning in a broader sense, sometimes just that we're inundated with the information about the coronavirus right now. It dominates our lives, and understandably so. I think if you find your anxiety escalating, you should learn to limit maybe your exposure to those sources. Certainly only stick to credible sources. I think the other thing that's going on is this is a new event for us in many ways, both the nature of the disease and our response to it. I think you need to stick to trusted sources if you do need information. It certainly is important to be informed. I'm not suggesting that you lock yourself away from that.
But you mentioned the isolation as well. I think it's a wonderful time to reach out and reconnect with people, especially people that have been supportive in the past, family members. I find myself doing more of that now. Again, maybe one of those silver linings, where I see more families out in their yards, engaging in activities I haven't seen for maybe years. Some of the positives, that ability to reach out, to reconnect. Obviously we need to maintain social distancing. We need to maintain our hand washing and our cleanliness, but there are some opportunities for support and strengthening here.
Lori Walsh: Talk a little bit, if you will, about the impact of chronic stress, just the physiological stress, because that's... One of the things in this job that we struggle with is that we're in that sort of information soup every day, and we're pushing for questions to things as things are not set in stone and, "What's the next question to move the conversation forward, to help people know what they need to know?" You can feel that physically. You can feel it, and different people are feeling it in different ways in their body, whether it's a headache or a stomachache or a tightening of your throat or somebody else's hands might be shaking.
We all have a physical response. Talk a little bit about how important it is to address that physical response and find a place of physical calm, as well as sort of walking away from the information that might be causing it, but getting to that physical space where at least you feel like a normal human being again, and how... If you don't do that, what can it do? I remember the other day, we were getting ready for something, and my heart was just racing. I was like, "You have to calm that down now because I don't know where that ends if you don't." That could be a real health risk for people.
Dr. Matt Stanley: Not to get too deep into the physiology of the anxiety, but when you stay at an elevated level of anxiety, it does affect hormones, particularly cortisol, which then triggers other events in your body. We're all familiar with that concept of fight or flight. To have your body always in a heightened state of awareness, a heightened reactionary state does wear on you and can create prolonged mental and physical effects and changes. You're absolutely correct. It's in your health interest to control that. I think one of the things to remember about anxiety is anxiety so often is really based on just being unsure or out of control. You can't control the situation, or you can't control what's occurring. The counter to that at times is action or to have a plan.
I think we talked about some of the things you can do to maybe limit sources, but I think physically one of the things that I think many people are struggling with is they're laid off from work, so the actual structure of their life is lost. Some of the simplest things, and of course we apply this to many areas of health, is stay on structure, get a good night's sleep, go to bed at the same time, get up at the same time, exercise when you can, eat well. But I think when you're talking about that anxiety, you were feeling that, that heart rate, flushing, whatever it may be, very simply, deep breathing can often be one way to calm them down. You used, actually, self-talk. You said, "Come on. You got to calm down. Get this under control." That can also be a powerful method.
I think in deep breathing, people underestimate it. It sounds so simple, but it's actually very powerful. I think one of the concepts of deep breathing is you exhale more slowly than you inhale. It's both kind of a subconscious and a conscious way to regain control, but also, that idea that exhaling, you're kind of blowing out, releasing the problem that is pent up within you. I think this is a wonderful time, if some of us have more time on our hands, to explore some of the apps that are out there to help us relax, or even to contemplate meditation. The benefits of meditation have been pretty well documented as well. I think there are some tools we can employ. I'm a strong believer in the deep breathing, and the physical component of your health is critical. Again, something as simple as stretching, very valuable in times like this when our body is maintaining a level of tenseness or anxiety that we're... Sometimes it gets to be so normal we're not aware how tense we are.
Lori Walsh: Yeah. For people who aren't finding themselves with extra time right now because you're in healthcare or you work at a grocery store or you're... That breathing, it can take a minute. In one minute or three minutes, you can really... It really is a short period of time for some pretty big results that can keep you safe from doing something dangerous as well if you're getting in your car or what have you. Dr Matt Stanley, thank you so much. We really appreciate your time, and we hope to talk to you again. Be well.
Dr. Matt Stanley: You as well. Thank you very much.