Roy Rochlin/Getty Images

With Fewer Resources Than Ever, Young People Are Pivoting To Online Therapy

'Their entire structure and framework of daily life has fundamentally shifted'

By Jessica Suriano

30-year-old Milagro Jones arrived in Los Angeles from Milwaukee, Wisconsin, with $40 and his then-3-year-old daughter about two years ago. They experienced homelessness, spending time in hotels and Skid Row sporadically. In June 2019, Jones became a digital media student at Los Angeles Trade Technical College and was beginning to find his routine with the assistance of his school’s Extended Opportunity Programs and Services, which helps refer students to nearby mental health care providers at no cost. That is, until the school closed last month as a result of the novel coronavirus pandemic.

He was just about to start meeting with the therapist he found through this program, but their first appointment was tentatively postponed until May 1. For now, Jones is keeping in touch with the campus liaison who helped him via Zoom calls. He doesn’t have any money to invest in mental health care right now, so he’s also been embracing some of the free COVID-19 coping resources listed by the Los Angeles County Department of Mental Health. He plans to release his own music later this month using Amuse, a free music distribution service, because a creative outlet is another way for him to “not break down with everything that’s going on around me.”

Across the world, college campuses have closed, therapists’ offices have shuttered, and job losses have boomed due to the coronavirus pandemic, and for many, prioritizing mental health care has taken a backseat to securing basic needs like food and housing. Still, some students and young workers like Jones are trying to find new ways to manage their mental health with fewer resources than ever available to them.

Public health experts are expecting to see significant “widespread emotional distress” and the need for more mental health care due to fears of “looming severe shortages of resources,” “large and growing financial losses,” and “conflicting messages from authorities,” among other stressors. In a study of over 1,200 hospital health care workers in China, the workers “reported high rates of symptoms of depression, anxiety, insomnia, and distress,” and the majority of these workers were between 26–40 years old. Aside from the psychological burdens these workers are coping with every day, everyone staying at home in quarantine or self-isolation is susceptible to substantial and possibly long-lasting mental health impacts, too, another study found.

“Personally, being a single parent was already tough enough, but then I went through a pretty tough breakup with another student, and usually my support system would actually be on campus, and to talk with other students,” Jones told MTV News. “Since I don’t have that, I’m using these resources to stay positive and to not get too depressed or sad.”

Even before this pandemic, roughly 1.5 million young adults 18–25 in the United States responded in a national survey that they needed mental health services but did not receive them. Over 600,000 of this group said that cost and insurance barriers were the primary reasons they lacked access to treatment. Over 500,000 of the respondents said they were concerned they would experience discrimination from employers, friends, or family for seeking mental health services. Even when young people are covered by an insurance plan, the U.S. Department of Health and Human Services concedes that “the amount of mental health services they can receive is often limited.” To work around these obstacles, college students increasingly rely on their campus counseling and psychological services, according to a study by the Center for Collegiate Mental Health. In a five-year time span, the study found, the number of students visiting their campus counseling centers increased by about 30 percent. The schools are struggling to meet this demand, however. The average university employs one clinical staff member per every 1,737 students, failing to meet the International Accreditation of Counseling Services’s recommendation of a minimum one staff member per every 1,000 to 1,500 students. Another study concluded that people ages 10–25 are likely to turn to their peers on social media platforms when they’re seeking information and support regarding mental health.

Peer support is not a new idea by any measure, and experts believe it can increase young adults’ sense of “hope, control, and ability to effect changes in their lives.” Healthy peer support in any available forum “is extremely important right now,” Tanya Lalwani, engagement coordinator for the New York City branch of the National Alliance on Mental Illness, told MTV News in an email.

“With the elimination of school, college, [and] social activities to create organic environments for support and interaction, students are strapped for essential support from their own peers, instead spending the majority of their time in isolation or with family members, amongst whom it can be harder to communicate as openly and comfortably,” Lalwani said. “Finding some form of safe space to be able to vent, and share your thoughts and feelings is essential and young people should be encouraged to talk with peers they trust about their concerns and how they are feeling.”.

Like Jones, Jill Yassay, a 20-year-old nursing major at the University of Michigan, has found a mental health support system among other students rather than exclusively through licensed professionals. She is one of the roughly 400 students at the University of Michigan who participate in the Wolverine Support Network, a student-led organization that manages about 30 free weekly group meetings for students to discuss stress, fears, or any other topic related to mental health. Before the university closed last month, she met with her assigned peer group every Monday. In March, those meetings moved online using Zoom.

“It was, honestly, consistently the highlight of my week,” she told MTV News. “Just going there and being surrounded by other people that very obviously cared about their mental health and the mental health of other people was an extremely supportive environment.”

Each peer group also includes a few student leaders who have received training in facilitation techniques, mental health research, and information on local resources outside of campus, according to Hannah Connors, executive director of the Wolverine Support Network studying public policy.

“It’s not therapy, but it’s therapeutic,” she told MTV News. “We’re not trained counselors, and for some people, seeing a professional might also be part of their mental health care plan.”

She said offering these meetings virtually is better than the alternative of not offering them at all, and students lately have been discussing challenges specific to the changes brought by COVID-19. These challenges include an overconsumption of news media, anxieties related to fear of the future, and creating healthy boundaries and relationships with roommates — who might also be parents for students who unexpectedly had to move home.

For Connors, these challenges include navigating the grief of losing her college graduation ceremony and the potential delay of her post-graduate plans. She was supposed to begin in the Peace Corps after graduation, but that future seems uncertain now. Still, she’s grateful students have been able to find any form of solace in the Wolverine Support Network.

“At a university, especially a competitive university, that can fall to the wayside in favor of other markers of success like good grades and getting a good job, but by taking this one hour a week for you, you’re saying that my mental and emotional health are also important,” she told MTV News.

The New York City branch of the National Alliance on Mental Illness has seen an increase in call volume to its helpline, Lalwani told MTV News, and a “large proportion of those callers are reaching out to seek support for increased depression and anxiety.” Young people and college students, already at a higher risk of developing anxiety, are facing many challenges as “their entire structure and framework of daily life has fundamentally shifted,” Lalwani added.

Everyone is facing an unprecedented amount of uncertainty right now, and Lalwani said young people and students’ “patterns of decreased motivation, poor sleeping and eating patterns, and increased loneliness and stress will be natural and may hit many students hard,” hampering their abilities to manage or access care remotely. Still, it’s important for them to know they are “definitely not alone” in their anxieties, and that “it’s completely expected and appropriate to experience fear during situations like these.”

While online therapy seems to be even more in demand because of the pandemic, therapists could be struggling more with adapting to clients in remote-only settings, such as college students who had to move back home to an out-of-state residence. Some licensing laws prohibit therapists from practicing care with a client who is living in another state if they don’t have the required credentials, complicating how accessible virtual mental health care is for many.

Some, but not all, states have relaxed licensing laws for this reason, Mei Kwong, executive director of Center for Connected Health Policy, told MTV News. In addition to treatment regulations, the practice of online prescribing has also adapted due to our public health emergency. Therapists operating online usually can’t prescribe controlled substances without an in-person exam under a 2008 federal regulation, but in March, the Drug Enforcement Administration temporarily lifted this restriction in response to COVID-19. State and federal laws for online prescribing can still conflict with each other, however, and regulations for telehealth prescriptions vary from state to state for non-controlled substances too, Kwong added. While states or regions in the country that already established efficient telehealth practices were more prepared for a public health emergency, those not as familiar with it are “finding it difficult” to meet the demand of people inquiring about remote treatment.

“We have these technical advances, but they haven’t been instituted everywhere, and not everybody has access to it,” Kwong said.

More people have been using therapy apps because of the effects of coronavirus, too. Although they’re not a replacement for human-to-human counseling, they can offer a stop-gap measure for people looking for free help. Jessica Wing, a social prescribing link worker based in the United Kingdom, has been using the Woebot app for one week. The Woebot app is an interactive chat-bot that claims to use cognitive behavior therapy (CBT), a method of care meant to target patterns of negative thinking. Several studies have concluded that “internet-delivered” cognitive behavioral therapy for anxiety and depression is “effective, acceptable and practical health care.”  One found that people using online therapy retained positive improvements after one year of treatment, and another reported that people participating in therapy over the phone experienced similar levels of satisfaction and comfort in their sessions as people who were participating in-person. Still, there are important differences between the two. While an online session is one of the only options right now, it’s also not recommended to treat certain conditions, might be inaccessible to people without high-speed internet at home, and makes it easier to miss body language cues during a session.

Just like in-person therapy, “you need to [motivate] yourself to implement the tips and engage with the support,” Wing said, but she believes apps and digital resources can be a viable mental health care option for some people. She has participated in therapy before the pandemic, but she’s facing new challenges with its arrival and devastation. In particular, she felt “very helpless” when her mother tested positive for COVID-19.

“I wasn’t allowed to visit,” she said. “All I wanted was to give her a hug and look after her. There are feelings of guilt that come along with that.”

Her mother is in recovery now, but adjusting to working from home has also added to her stress. Part of Wing’s job now is to ensure patients she works with have access to food, medications, and some form of social interaction.

“Making those calls brings up all those concerns we have in the back of our minds, and I don’t have an answer for myself,” she said. “How can I reassure someone else? We’re all isolated, trying to process this thing that doesn’t feel real; we’ve got different working situations; we need to rely on others more.”

The rapid closures of retail stores, restaurants, hotels, and other businesses deemed “non-essential” have left nearly 10 million workers in the U.S. filing for unemployment benefits, crashing state websites and phone lines in the process. Among these workers was Anika Pasilis, a journalism student at The University of Arizona who was furloughed from her part-time job at a clothing store, and her mother, who was working as a server. For the first few days after losing her retail job, Pasilis couldn’t eat much or get out of bed. There’s not a developed “safety net,” she said, for so many people experiencing the same feelings of loss. Throughout this whirlwind of change, she has considered seeking outside mental health care to help cope with stress, but there is still a stigma around therapy and she’s struggling to find options that wouldn’t cost money or require health insurance to bring costs down. Counseling and Psych Services at the University of Arizona is still fulfilling appointments over the phone or video calls, but the well-known, frustratingly long waiting periods to book an appointment have also deterred Pasilis to consider it a realistic option.

“After all of this is over, I don’t know if I’m going to have a job to go back to, which is really, really scary,” Pasilis said. “I never thought that I would have to apply for unemployment at 20 years old.”

To cope with these new daily sources of stress, Lalwani told MTV News that people should define what self-care looks like to them and practice it as much as it’s needed. For those who were already working with a therapist or treatment regimen, they should discuss the best remote options for your space and schedule together. For those seeking a new care option, Lalwani suggests trying different remote options to see what method of treatment is the best fit.

“We’re literally building the plane as we’re flying it, so as we find solutions, new problems are bound to arise,” Lalwani said. “I think it’s so important to remember that it’s okay to not be the same student or person doing the same things, and achieving the same amount, as we were even just a month ago. Your concerns are real, your struggles are valid, and these times are incredibly difficult.”

Jones shares Pasilis’s dissatisfaction for a health care system that fails to provide efficient, affordable mental health services in times of crisis. He said it’s difficult for him to “try to wrap my head around” why more money and resources haven’t been allocated to mental health, especially right now. Most of the free resources he is using in Los Angeles to cope have resulted from self-initiated research and dedication to finding what works for him — a task requiring more time and energy than many others can spare right now.

“That is something that this pandemic sheds light on — is the fact that we didn’t have a social safety net in place that we should’ve had,” Jones said. “People like me have known this.”

The National Alliance on Mental Illness Helpline: 1-800-950-NAMI (6264) or visit https://www.nami.org/home.