AUGUSTA, Ga. (WJBF) – The COVID-19 pandemic has impacted nearly every aspect of our lives, and our mental health is no exception. During the last 12 to 13 months, there is been a lot of isolation and other factors that can impact our mental health. How can people deal with that? And what about suicide rates? Has the pandemic affected them and how can we make sure those rates and behaviors are properly addressed? The Means Report tackles all of those questions, first with Dr. Vaughn McCall, the chair of the Department of Psychiatry and Health Behavior at the Medical College of Georgia, and then with Dr. Dale Peeples, a child psychiatrist at the Medical College of Georgia.

Brad Means: Dr. Vaughn McCall is up first. He chairs the Department of Psychiatry and Health Behavior at Augusta university. He is a means report veteran and we sure do appreciate you joining us today Dr. McCall

Dr. Vaughn McCall: Pleasure Brad, thank you for having me.

Brad Means: Dr. McCall, we’ll start with general questions and then we’ll certainly get more specific as our segment goes on, but just in a general sense, what are some of the primary issues or factors that contribute to mental health problems during the pandemic?

Dr. Vaughn McCall: Well, no surprise isolation has been a significant part of this from the very beginning. And that’s combined with financial factors such as a job loss or reduction in hours, also patients and… Or rather workers being sent home to work. I think we’ve discovered that working from home is not all that it’s cracked up to be at least for some people and the combination of financial pressures, isolation and then coping with restrictions in the workplace have created problems of all sorts for most people.

Brad Means: You know, depending on what statistics you read, suicide rates are either up or down. I know the CDC recently came out with a report that says despite common presumptions that the suicide rate during the pandemic is down, what are you seeing locally? I had heard one time that there were as many suicide attempt patients in the hospital as coronavirus patients. Are we seeing anything in Georgia and South Carolina to help you answer that question?

Dr. Vaughn McCall: No, I don’t have any specific numbers, but my sense is that while psychological distress is unequivocally increased, we have some statistics for that, and it’s certainly plausible that on the other hand suicide rates may go down. I saw the same report that you were mentioning and explanation which was plausible is that in times of a huge national challenge and the example that they gave was wartime, that folks that are under psychological distress, nevertheless managed to steal themselves in such a way as to still be functional. In other words, they may be miserable but still functional and not necessarily prone to commit suicide. So, we’re left with the paradox. The paradox with people that are not feeling well, and yet at a time when suicide rates may be temporarily reduced. I do think this is temporary.

Brad Means: What does isolation do to you? What feelings does it present that, you know, feelings to which a person can succumb and need help?

Dr. Vaughn McCall: Sure, so, as a primate, as an animal we are dependent to a large degree on human physical contact and that releases a very specific chemicals in the brain which are essential for our wellbeing. There’s a chemical called oxytocin which Dr. Peeples and I were hearing about this earlier today on our departmental grand rounds, and oxytocin is a chemical, which is released on the effects of physical bonding. And in the absence of oxytocin, we just don’t function like we’re supposed to. But apart from the direct biological effects, an area that I’ve been keen to understand what happens to people’s daily schedules when they no longer have to have a place they have to be in the morning and they’re left somewhat unmoored, ungrounded by virtue of either unemployment or being sent home to work. And the nature of our biology is such that we need to have schedules and being isolated and left at home isn’t good for us.

Brad Means: You know, we’ve seen so many work arounds to that isolation issue during the pandemic FaceTime calls, regular phone calls, visits through a window. Is that kind of connection not as intimate though it may be Dr. McCall, enough to help overcome some of the feelings you just described?

Dr. Vaughn McCall: I think it is a partial solution. It’s not a substitute for human touch and the other thing too of course is that hopefully folks are not left doing Webex or Zoom meetings from sunrise to sunset, typically what happens is, your day may be peppered here and there with specific things you have to do at specific times, but otherwise a person’s schedule could be left very loose so that they’re not really compelled to feel like they need to go bed at a certain hour. They’re not compelled to get up at a certain hour. And on top of that, the vacancies in the middle of the day, the downtime can lead to behaviors that they may regret later such as drinking alcohol more than they normally would or at times that are perhaps not just socially normative, so I think not being in a common area, in a public area where we hold each other accountable, can leave us a little bit vulnerable to laxity in our schedules and sometimes a laxity in our consumption patterns.

Brad Means: Alright, so I get the human contact needs that you’ve described, but let’s take the work from home issue if we can. My question is if someone is working at home, no they don’t have the office environment, they don’t have the water cooler conversations, but if you bury yourself in your work and for your normal shift, if you stay just immersed in it, can’t that help you power through the day?

Dr. Vaughn McCall: I think it’s… Yes, I would say at least partially. In other words, having deadlines during the day, have a certain amount of work that you need to complete, has got to be good on several fronts. First, keeping you up and engaged and not maybe down on the couch is always a good and the feelings of accomplishment that come with completing tasks is always good. The risk of course is monotony on the one hand, and then also just failing to get outside and ever breathe fresh air if you don’t make yourself do it during the middle of the day, I think can be a problem.

Brad Means: Yeah, I was gonna ask you about some of the solutions if you are feeling blue, if you are feeling disconnected, is exercise your best bad and what else might we be able to do to sort of distract ourselves from what the past year’s been like?

Dr. Vaughn McCall: Well, exercise is always good and what’s nice is that it doesn’t have to be complicated. So, the amount of exercise that’s generally good for your mental health and good for your sleep patterns is exactly the same as the sort of exercise that’s good for your cardiovascular health. So for example, getting 25 to 30 minutes of exercise per day at 85% of your maximum heart rate is a terrific way to stay healthy all the way around with the one caveat that you don’t do it too close to bedtime which of course can negatively impact your sleep. So, exercise is a good thing, I think breaking the monotony and getting out of the chair, going outside at least for brief periods of time is good, and I think we all now appreciate that when we can’t hug the ones that we love, that at least having a video conference call with our family is maybe a second best substitute. So, having that from time to time is very helpful.

Brad Means: Well, when do we know when it’s time to seek professional help? And will you even see us right now? What our visit with you have to be through our iPad or phone?

Dr. Vaughn McCall: Well, we always need to get help when we begin to neglect ourselves. And I’ve seen patients in the last year that by virtue of COVID their scheduled became somewhat unraveled and next thing you know, they’re not bathing or putting on fresh clothes or brushing their teeth and any sort of self neglect is a worrisome sign and it should be pursued in the medical venue. Feelings of suicide or hopelessness or worthlessness I think are critical signs and when you allow you to consumption of alcohol and certainly illicit drugs, when those get out of control, then you need to go see somebody before you really hit a dead end. As far as how people can get help, you know mental health services are intimately suitable for this sort of exchange that you and I are having now. You can do it by telehealth and our department and with my colleague Dr. Peeples who’s gonna be right behind me on your segment today. Dr. Peeples has been a leader in our department, getting us all well-schooled and how to do telehealth, and as a virtue of that, our department is a leader at Augusta University health system in providing telehealth services presently just about 50% of all our outpatient encounters at the Medical College of Georgia and psychiatry are performed by telehealth. And we’re happy with that. We think the 50/50 split between telehealth and in-person is a reasonable split and within some limits we’ll try to accommodate the patient’s preferences. Some patients feel very strongly, that they wanna see the doctor in person and if an infectious disease circumstances will permit it, then we’ll try to see the patient in person. Other patients are adamant they want to be seen on tele-health. Well, we’ll try to accommodate that too. So, but then minor limits. We’ll try to accommodate to the patient’s wishes.

Brad Means: Well, you make some good points and I mean, for the viewers at home watching, just think about how clearly you can hear Dr. McCall, how he looks on your television screen, that’s what a telehealth visit would look like, and you can determine whether it would help you or not. I’ve loved listening to your answers today. And I just have one more quick question for you in the few seconds we have left, is do you think any of these issues, the anxiety, the loneliness, the self neglect, might remain after the pandemic is over or once we get some sort of green light to re-enter society, will those feelings and symptoms fade?

Dr. Vaughn McCall: I think it’s gonna take a little time and this has gone on long enough that just resuming the normal niceties like shaking hands, hugging people, interacting without masks, I think will require a little bit of practice as strange as that may seem. People are for the most part very hungry for it, but we have many of us have adopted the infectious disease control recommendations so much that to totally give those up. We’ll take a little bit of doing. I of course and I bet you too. I know a few people that have told me that they not sure they’re ever gonna completely give up wearing masks, especially maybe during the winter flu season. So, I think we’ll get through this for the most part from a mental health perspective but it’s gonna be a slower process than we might anticipate.

Brad Means: Yeah. I think masks and fist bumps may stick around for a while. Dr. Vaughn McCall, thank you for what you do. Pandemic or not, you help people lead healthier lives and I appreciate your time today.

Dr. Vaughn McCall: Thank you for having me Brad, thank you very much.

Brad Means: Absolutely, and as Dr. McCall mentioned, our next segment is with Dr. Dale Peeples What about the pandemic and its impact on children? How can we address those issues help our kids stay strong? Next.

Part 2

Brad Means: Welcome back to “The Means Report” continuing to tackle the issue of mental health as it relates to the pandemic. We talked about general signs and symptoms and treatments in segment one. Now, let’s look at our children and how these tough times may impact them. Dr. Dale Peeples is a child and adolescent psychiatrist and MCG at AU. He did his internship, residency and fellowship in those areas. He is an expert on it for sure. And that’s why it’s about the 100th time you’ve been on “The Means Report,” right Dr. Peeples?

Dr. Dale Peeples: It’s always a pleasure to be here. Thanks for having

Brad Means: We appreciate you. What about this crazy pandemic? Can it impact children of all ages or you seeing just a certain age group that is the most impacted?

Dr. Dale Peeples: Definitely can have an impact across all age ranges. Now, the effects you’re gonna see do look a little bit different in various age groups. You know, so younger children, we’re gonna see them a little bit more clingy, a little bit more fearful. Older children, we’re seeing more academic troubles, more trouble with concentration, focus and we can see a little bit of irritability and sleep problems in almost all of these kids.

Brad Means: When we look at our young people, what is the primary factor that may make them anxious? Interruption of the routine, you think about a young person, they thrive on routines, right?

Dr. Dale Peeples: Oh, absolutely yeah. I think you’ve really nailed it. You know it’s this drastic shift in routine. And kids really benefit from structure and school and trying to adjust to, are we doing remote learning this week? Are we doing in class this week? It’s been a real challenge for a lot of families.

Brad Means: You know, why do kids not like not knowing how they’re gonna learn remotely or in person? I would think the absence of a requirement to go to school would be celebrated among young people and I’m not trying to be silly. I mean, you think of a child and tell them, “You don’t have to go to school anymore, just open your laptop.” Why can’t that be a good thing?

Dr. Dale Peeples: Yeah, I think that was the initial general sense among kids that, you know, we we’ve lucked out here. but when kids were actually faced with the reality, you know, they weren’t getting to socialize the way they used to. They weren’t really able to have the direct feedback from teachers to really help them learn and understand, I think you started to see a lot of this frustration with the current system really coming out.

Brad Means: Alright, so let’s stop where we are right now. We’ve established that the frustration and the anxiety can impact our young children and our older children. Is there an approach that mom and dad or caregivers can take at home that might help them? Is it more hugs, more conversation?

Dr. Dale Peeples: Yeah, conversation is important and always checking in seeing how the kids are doing, what are the stressors they’re dealing with throughout the week. I mean, that’s just a great way parents can be supportive even after the pandemic. It might be on parents a little bit more to keep a closer eye on school and academics, to make sure that they’re helping kids understand some of these difficult concepts that the teacher might not be able to help with as much this year, so that could also reduce stress for some of our kids.

Brad Means: Dr. Peeples it’s tough sometimes to remember what it was like to be young. And so I’ll just ask you, ’cause you see the young people in your office, or via telehealth, when they miss life events, graduations and such, how heavy does that weigh on them? For us it might just mean a missed two hour commitment on a Friday night at the James Brown Arena, what’s it mean to them?

Dr. Dale Peeples: Yeah, that’s a great point too. You know, childhood is filled with these milestones that the kids are anticipating and looking forward to, and it might just seem like another year to me. There’s nothing big going on but with our kids, typically there is some big life of them. Whether it’s sports related or academics, first prom, graduation, that is a loss. And I think the families of these kids, we need to be mindful of that and understanding that they are experiencing these additional losses. And again just listening and hearing what they have to say so then we can offer support.

Brad Means: Do you think that kids ever feel like their safety or security is threatened that they are so unfamiliar with what a pandemic even is? We’re all learning as we go I know, but do you think they ever feel scared in those regards?

Dr. Dale Peeples: Yeah, I think particularly for your younger kids, they might have a lot more fears about their own personal safety, but a lot of times when you’re looking at your teenagers, they’re not as concerned about themselves and their own welfare, as they are worried about their family members who are out there in the world interacting with people could potentially get COVID. So, fear is definitely a part of it. And again, it might be for a child’s own safety or for the family’s

Brad Means: I know you may have heard Dr. McCall talk about warning signs and I was picturing grownups when he talked about those warning signs. What about in kids? When should we say, “Oh this is more than just my child being stressed out. This is something that I need to go see the doctor.”

Dr. Dale Peeples: So, when we think about how depression presents in kids versus adults, one of the big differences in kids is that you can see a lot of anger and irritability. So, that would be an additional sign for families to pay attention and be on the lookout for. Additionally, everything Dr. McCall brought up in terms of sleep disturbance, thoughts about not wanting to live, you know, loss of energy, loss of appetite, those can all be serious symptoms of depression too. So, if we’re seeing those kinds of things build up and week after week, it’s not getting better, that’s really the time to kind of turn to someone and ask for a little bit of help.

Brad Means: Dr. Peeples kids love their smartphones, their mobile devices, do you do a lot of telehealth with them on those things?

Dr. Dale Peeples: Yeah, absolutely. So, with the new setup with telehealth, it can be done on a patient’s phone, tablet or desktop computer. So, it’s really a lot of flexibility on their end. It’s whatever device is most comfortable for them. You know, so you got a lot of kids who really kinda take to the technology and are able to use it just as well as their parents.

Brad Means: Has this changed the way you practice medicine forever? You think you’ll try to do more of the at home approach when this is over?

Dr. Dale Peeples: Yeah, so I’ve done telemedicine for 20 years actually now but this is the first time where I’ve done it in the patient’s home. Previously it would be… I’d connect to like a rural hospital in Georgia. See a patient there but nowadays we have the ability to connect directly to the patient in their home, and a remarkable ease of use for the patient. I think this is here to stay.

Brad Means: Can you pick up on mannerisms expressions, things like that that normally you would see in a clinical setting? Can you pick up on that through the screen to know what the feelings are behind their words?

Dr. Dale Peeples: It’s fairly good. I wouldn’t consider it a complete replacement for actually being in the same room and space with an individual. But of course right now, if we do that we’ve gotta be masked. So, we lose some of that right now during COVID anyways. And there are some patients who you know, the technology is just not for them that, they really do have trouble with communication over the screen whether it’s from a sensory issue they don’t hear or see quite as well or a kid with ADHD that I might see and doesn’t wanna sit still in front of the screen, you know. So it doesn’t work for everyone but it works for the majority of people.

Brad Means: What kind of treatments are you using to help our kids get back on the right track? What are you saying to them or telling them to do?

Dr. Dale Peeples: Well, you know, we wanna acknowledge the reality of the situation and that they are experiencing significant loss and you know, validating their feelings I think is a great place to start. Then we wanna work on structure. You know, let’s try to make life as normal as we can. you know, can we think about ways to perhaps socialize that are gonna be reasonably safe. Outdoor activities with a little bit of distance from friends, and then trying to think about, well, if academics has become a stress, are there things we can do to support and help you out there? We also wanna think about sleep and making sure you’re getting a good night’s rest, and then sometimes we are talking about medications too if it looks like issues with depression or anxiety have gotten to that level.

Brad Means: We love our children so much. And Dr. Peeples thank you for loving them too and for caring for them and getting us all through this tough time. We appreciate you being with us today so much.

Dr. Dale Peeples: Always a pleasure. Thanks for having me.

Brad Means: Absolutely we’ll see you real soon. Dr. Dale Peeples MCG at AU.