Crisis counselors, the ‘paramedics of mental health,’ wage a wrenching battle on the coronavirus front lines

Missouri crisis counselor Lauren Ochs was just starting her overnight shift one night last month when a man called from a distant state hard-hit by Covid-19. With slurred, incoherent words — and a heavy Upper Midwest accent she could barely make out — he told Ochs he had tried to kill himself earlier in the evening.

She knew she had to act fast, so put the man on hold while she Googled the town where he said he lived. She could not find it. Staving off her own anxiety, she called emergency services in his state and pronounced the name of the place just as the man had. Fifteen minutes later, the dispatcher told Ochs that her team had located the caller and was taking him to the hospital.

The most iconic images of the coronavirus pandemic are, by now, familiar: the exhausted doctors peering from behind a 3D-printed face protector; the nurses covered in garbage bags; the brave first responders who arrive, sirens blaring, to help yet another person who is gasping for air. But there is a much less visible group of professionals, people like Ochs, who are on the front lines of a mental health crisis every bit as wrenching as medical battles waged every day in hospitals.

In ordinary times after an adrenaline-charged call with someone so distraught, Ochs would have been able to take a breath and turn to her colleagues in nearby cubicles at the basement offices of Provident Behavioral Health in downtown St. Louis. But like most people in America, she’s working from home — specifically in her 4-year-old daughter’s basement playroom.

When the crisis center shuttered its doors in April, Ochs had no time to set up the ideally ergonomic home office. She plugged her old-style black console phone into a dedicated phone line that forwards calls from all over the country, and she pulled a couch behind the hanging ice-blue sheets of the TV fort she, her husband, and daughter had created for movie nights.

The 26-year-old St. Louis woman, who was issued a provisional counselor’s license in November, is among the thousands of counselors taking calls from fearful Americans trying to cope with the Covid-19 pandemic. And Ochs, like her colleagues around the country, is doing it at a breakneck pace.

The St. Louis hotline, which provides backup service to several other crisis lines including the National Suicide Prevention Lifeline, has seen its call volume rise from 557 calls in February to 2,150 in March, a 285% increase. It reflects a national trend: Frances Gonzalez, a spokeswoman for Vibrant Emotional Health, a behavioral health nonprofit that administers the federally funded Disaster Distress Helpline, said that there has been a 338% increase in call volume between February and when the nationwide lockdown began in March.

In the last three weeks of March, the St. Louis hotline recorded 396 callers with suicidal thoughts, of which 65, or 16%, mentioned Covid-19, said Amanda Galloway, a spokeswoman for the center. In April, the number of suicidal callers who were distraught over the coronavirus quintupled. Of 1,018 suicidal callers, 346, or 34%, named the virus as their main reason for calling.

The overwhelming majority of callers are struggling to contain their anxiety, said Jessie Vance, a licensed counselor who is Ochs’ supervisor. Often, it is the first time they have asked for help with their mental health (only a small fraction, 15%, of U.S. adults received mental health care in 2018, according to federal data).

Some are worried about their jobs, or going to the grocery story. Others are concerned about their substance use. Many are health care providers or workers who are fearful for their own health, and the safety of their families. Others call out of grief for loved ones who died from the virus, sorrow often deepened by being unable to attend funeral services.

“You never know who’s going to be on the other end of the line,” said Vance. “Crisis counselors are the paramedics of the mental health world.”

Yet they tend to get a lot less attention than other emergency responders, said Jessi Gold, an assistant professor of psychiatry at Washington University in St. Louis. “They are the unsung heroes in a lot of ways, especially now,” she said. “We refer to them a lot — yet we don’t even know who they are, or how they got into this field.”

Some, like Ochs, came from a family that has dealt with alcohol and gambling addiction. She has lost friends to suicide and overdoses, and felt a calling to the field of crisis counseling. “The adrenaline rush suits me,” she said.

This crisis is even more overwhelming than the opioid addiction epidemic, and not just because of the volume of calls. Ochs and other crisis counselors are experiencing the same worries and difficulties of social distancing, isolation, and juggling work with child care as their callers. They are helping others navigate the pandemic at the same time they themselves are.

That produces some challenges.

“When I’ve had suicidal callers before, I’ve always been able to check in with my co-workers. Then I could decompress on the drive home,” said Ochs. “But now everything is blurred together. There’s no transition. After taking 30 or 35 calls in a shift, I step over my daughter’s ‘Frozen’ Jenga game and go upstairs to the kitchen for a bowl of cereal.”

Often, Ochs feels many of the same emotions as her callers. “They’re tired of being home, and we’re tired of being home. Behind the scenes, we’re having a lot of the same reactions as our callers,” she said. “Our job is to be empathic, to listen and be strong. I can’t show weakness at work.”

“But it’s a lot all at once, and this pandemic is sucking a lot of energy out of us,” Ochs said.

Meanwhile, her normal coping mechanisms have disappeared, too. She’s a regular weight lifter, but her gym is closed. For now, she brings her dog, a pug, to sit next to her during her shift — and hopes she doesn’t snore. She puts ocean-scented wax melts in a warmer next to her to help her remain calm. “Little things can add up,” she said.

Licensed counselor Nicole Meier, Ochs’s colleague, makes a point of taking walks during breaks from her work station at home, and tends to her yard work. The time helps her remain focused.

“It’s a lot of pacing ourselves,” Meier said. “We’re so busy, once we hang up the phone, it rings again right away. And if we get burned out, we can’t help other people.”

She can spot the exhaustion in her callers. One, for example, told her about becoming enraged after losing a place in line at the gas station. “‘OK, so you didn’t get the gas pump you wanted, so you started screaming,'” Meier said. Her questions often shift to remind people to add structure to their disordered routines. “I ask, ‘Are you eating regularly? Are you drinking enough water? Are you exercising? If not, then get up and stretch, and go get some fresh air. Your mental health is severely impacted by your physical health.’”

Meier, 32, is perhaps more prepared than most to discuss the existential fears the pandemic is creating. She has cystic fibrosis, a genetic disease that affects the respiratory and digestive systems, and can often shorten life spans. Her illness has required hypervigilance about germs her whole life, and she has always carried antiseptic wipes and hand sanitizer.

“I’ve had to deal with death my entire life, knowing I was going to die early,” she said. “It’s my reality. It doesn’t scare me.”

The mental health repercussions of Covid-19, experts say, will likely be felt for years to come. “This is traumatic to the nation, it’s traumatic to callers, and there’s vicarious trauma for the counselors who are hearing these calls day in and day out,” said Matt Kudish, executive director of the New York office of the National Alliance on Mental Illness. “They’re trained to deal with it, but it’s important that they process what it is they’re hearing.”

At the St. Louis office, Vance is making sure they do, in regular checkins. Ochs, for her part, makes a point of calling friends and family, and is in frequent contact with her colleagues.

“Oh, yes,” she said during a recent FaceTime call. “You can’t let it build up like the pressure inside a bottle of soda, or you’ll explode. And if you explode, there’ll be a sticky, sticky mess.”

If you or someone you know is considering suicide, contact the National Suicide Prevention Lifeline at 1-800-273-8255 (Español: 1-888-628-9454; deaf and hard of hearing: 1-800-799-4889) or the Crisis Text Line by texting HOME to 741741.