Coping With Pre-COVID Mental Illness After Things Go Back to 'Normal'

black man looking stressed out

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Key Takeaways

  • Some people living with mental illness before the pandemic got left behind when care shifted to address the needs of people with COVID-related concerns.
  • Leaders and allies in the workplace, educational settings, and elsewhere should consider extending the care and flexibility they offered to those with COVID-related concerns to those who live with chronic and ongoing mental health challenges.

The pandemic led some people who had never experienced mental health concerns into new territory as they navigated encounters with a range of emotional challenges for the first time in their lives.

For some, those concerns are beginning to dissipate. Situational anxiety about catching the virus feels less intense for those who are vaccinated. Situational depression due to isolation might no longer be a concern for people who are excited to get back to their pre-COVID lifestyles.

But for those individuals who were already living with mental health concerns before the pandemic, ongoing support from mental health professionals and compassion from support networks must be sustained as the world re-opens. Many hope for change in our cultural norms to promote more acceptance and affirmation for people living with mental illness.

How COVID-19 Affected Pre-Existing Mental Health Conditions

Pixie Kirsch Nirenberg, LSW, is a therapist in private practice in the Philadelphia area. They say that the pandemic hit marginalized groups of people more intensely than those who have fewer barriers to support and care.

They explain that people who face social isolation—including older people, those who lack access to technology due to disability, poverty, or lifestyle, and those who were in recovery for substance abuse and dependency or coping with traumas—were especially impacted.

Jeffrey Cohen, PsyD, is a clinical psychologist with Columbia University Irving Medical Center. He says that "although access to care increased for some through telemedicine, others actually lost access to what they needed."

"People who encounter a greater number of symptoms and those requiring medical detox or residential programming benefit from the kinds of in-person care that was limited during the pandemic," Cohen explains.

Pixie adds that "structural oppression is a form of trauma and people who have marginalized identities and experiences continually endure that trauma. This negatively impacted their mental health before the pandemic, but because the pandemic highlighted disparities, many living with pre-existing concerns felt their symptoms exacerbated."

Jeffrey Cohen, PsyD

Although access to care increased for some through telemedicine, others actually lost access to what they needed.

— Jeffrey Cohen, PsyD

Pixie cites the struggles of trans people, especially youth, who often encountered serious and consistent barriers to wellness caused by their lack of support and resources.

When social distancing recommendations increased barriers for people to connect with "chosen" family, or non-biological community members who often live in different homes, some people lost access to their entire support networks and to professional help.

Finding Quality Care

Jonah, 33, a transmasculine and nonbinary person, sought support for major depressive disorder (MDD), ADHD, complex trauma disorder (C-PTSD), and autism before the pandemic. They were getting to know a new therapist who they decided wasn't a good fit, but because of the shortage of providers, they felt that there were no other options for help.

Before the pandemic, Jonah's biggest struggles were executive functioning and motivation as well as social anxiety and an auditory processing disorder. Because they were already working from home when COVID-19 showed up in their city, their workday didn't change much, but the idea of leaving their home for anything became much more debilitating.

Some days, work was the only task Jonah had the mental energy to pursue, and other days, they couldn't do that. Jonah says that some organizations and resources that claim to help people with mental health concerns can be exploitative or mismanaged. They withdrew from their support systems but recently found someone online support groups that have been helpful.

Pixie says that it’s important for practitioners to remind people that it’s okay to not be okay. The world beginning to re-open does not overshadow the pre-existing concerns people held before Covid-19 or the trauma people have endured during the pandemic.

Pixie explains that peer-led support group spaces are often the least expensive, most accessible, and most affirming settings because they're run by and for people who struggle with the same specific concerns or experiences. This can be an important addition to professional care or a solid option for temporary support before professional care becomes available.

Cultural Change Is Needed

Jonah hopes that because people have learned a lot about mental health during this time, the stigma surrounding mental health issues will decrease.

Before the pandemic, their mental health concerns and trans identity were reported to a leadership team and used against them—prompting a lengthy psychological evaluation. They underline the importance of ending stigmatization by looking out for any problematic vilification and jokes about mental health or marginalization.

Pixie Kirsch Nirenberg, LSW

My biggest hope is that people who might not have understood mental health or weren’t impacted by it before now see that the environments we’re in have drastic effects on mental health.

— Pixie Kirsch Nirenberg, LSW

"If we view mental health as a personal defect and ask people to pull themselves up by their bootstraps, we’re telling people they need to get fixed and that they should fix themselves. My biggest hope is that people who might not have understood mental health or weren’t impacted by it before now see that the environments we’re in have drastic effects on mental health," Pixie says.

Cohen adds that workplaces should normalize paid sick leave and the importance of taking mental health days. He adds, "A workplace with leaders who rarely take time off and never take mental health days can create a toxic environment where people are afraid to take time off and are therefore more likely to burn out." Leaders should continue to extend the same levels of flexibility, support, and understanding they did to those who struggled during the pandemic.

For neurodivergent people, workplace flexibility is key. Jonah says, "We've spent our entire lives with a very intimate knowledge of what we need to do to function in society. Trust that if we say we can do a job, we can do a job—even if we don't use the same, route, technique, or schedule they're used to seeing."

Systemic change can also be pursued at the legislative level. Pixie urges people to vote for representatives who prioritize mental health care as well as other topics which impact mental health—including insurance coverage and issues related to poverty and marginalization.

Cohen says that people sometimes receive care that doesn't actually help, adding, "We need laws which ensure people who seek mental health treatment are getting access to treatment that is evidence-based, which is treatment that is backed by scientific studies." He advocates for laws that promote measurement-based care, which evaluates symptoms to ensure that clients get better instead of worse, and higher insurance reimbursements for evidence-based practices.

Advocating for Yourself and Others

Jonah says that if new coping mechanisms or healthier aspects of routine emerged during lockdown, it supports mental health to keep those new habits and priorities in place. They say, "All of the major adjustments you made last year don't need to immediately disappear or change back to the way they were 'before.'"

Pixie reminds those who are struggling to seek support from allies. If you have a documented disability—including mental health struggles—schools and workplaces must make reasonable accommodations for you. Think about asking for shorter shifts or longer breaks to attend therapy appointments or support groups if needed. Pixie says, “Think creatively, because you’re allowed to ask for anything.”

Jonah explains that one of the hardest parts of sharing their mental health concerns is that friends and allies don't often know how to react. They urge people to avoid awkward and sympathetic sayings, offering words of encouragement, trying to relate to other people's experiences, or offering unsolicited advice. Instead, they highlight the importance of listening without judgment.

Pixie highlights that one of the most important things society can do to support mental health is to acknowledge that structural oppression is one of the leading factors that negatively impacts mental health.

They underline that those with chronic and pre-existing mental health concerns know how others can best support them--but it's up to allies to ask how to help. They say, "We took agency away from people when we created systems that don’t benefit everyone. The best thing we can do in that case is putting power back into the hands of the people who need it.”

What This Means For You

If you experienced mental health concerns before the pandemic, you might need continued or increased support as the world re-opens. Because a cultural shift in perception around mental health began during quarantine, your workplace, school, or support network may be more open-minded about granting flexibility and accommodating needs.

The information in this article is current as of the date listed, which means newer information may be available when you read this. For the most recent updates on COVID-19, visit our coronavirus news page.

By Lauren Rowello
Lauren Rowello is a writer focusing on mental health, parenting, and identity. Their work has been published in the New York Times, Washington Post, and more.