The Crisis Center of Tampa Bay’s Clara Reynolds reflects on the biggest mental health challenge of modern time

It didn’t take Clara Reynolds long to realize the dramatic impact Covid-19 would have on the community’s mental health. The proof was right there in the numbers.

At The Crisis Center of Tampa Bay, where Reynolds serves as president and CEO, calls to the 2-1-1 emergency line started trickling in at the end of February from people concerned about the virus. That week, there were 14. Two weeks later, the trickle had turned into a flood with more than 400 people calling in. They spoke of financial concerns over lost jobs. Fear for the health of their families. Feelings of despair and hopelessness. 

The pandemic, Reynolds said, is “absolutely, unequivocally” the biggest mental health challenge of modern time, and she anticipates its effects will linger for many years to come. As part of the Catalyst series The New Normal: Six Months Under Covid, Reynolds shared what it’s been like to work with people in crisis in 2020, the things she’s learned and what she expects to see in the future.

The Catalyst: What have the numbers looked like in terms of how many people have reached out to the Crisis Center?

Clara Reynolds

CR: At one point, we had a 100 percent increase in call volume compared to the same point last year. That was during the height of things in April, that first month when people started losing their jobs and didn’t have money coming in. One significant increase we’ve seen when comparing last year to this year is the number of suicide calls we’re getting. In tracking from June to August, we saw a 17 percent increase in call volume. And it’s not just the pandemic – there’s social unrest, we’re in an election year that has been challenging, there are weather systems across the country – there’s just a sense that this is never going to end and that lack of predictability is weighing on us. None of us expected that we’d be six months in, and while things have gotten better in Florida, we all know the threat is still out there. 

You quickly saw the impact of Covid in the number of calls coming into the Crisis Center, but when did it really hit home for you?

Well, hindsight is 2020. I was like, “oh, this Covid thing,” and then the week of March 14, which was significant for me because it was my 50th birthday, we saw this explosion of calls. I’d been planning to go on vacation with my kid, and then we had to come back early because we were having to pivot on a dime. We had to figure out different ways of doing business and even though we had policies and procedures in place, none of it really addressed a global pandemic. We were making changes on the fly. I’m a firm believer we can all be as flexible as we need to be when we have to be. Our staff has shown that and our clients have shown that.

When people call in distress, what are the most common themes they are sharing?

Most of the time folks will call us, they’ll call with symptoms. With Covid-19, the symptom has been the need for financial assistance, but calls that used to take us seven minutes to get through are now taking 15-20 minutes because while the financial assistance is the symptom, it’s the emotional stress that’s the real problem. People are feeling so overwhelmed and so anxious, and for those already struggling with behavioral health issues, certainly the pandemic has exacerbated them, but then we are seeing those who have never experienced behavioral health issues. They’re seeing it for the first time and they don’t know what to do. Not only do they not know what to do, but if they’ve lost their job and no longer have access to an employee assistance program or insurance, they don’t think they have any mechanism to get treatment. That’s what we’ve been trying to stress to our callers. “We’re going to help you, we’re going to figure that financial assistance piece, but we want to know how you are feeling.” We want them to be able to voice all that emotion and stress and anxiety so we can not only help them financially but also assist them in dealing with their emotional issues that they’re struggling with. Sometimes just asking the simple question of “how are you feeling?” gets lost in the survival mode than many folks are in. They’re trying to keep a roof over their head, they’re trying to educate their children, they’re trying to feed their family – all of those things. A lot of people will just focus on asking them “what are you going to do about a job?” What we need to do is deal with the feelings and allow them the opportunity to voice those feelings because once you can do that and take a breath, then you can start problem solving.  

How is your staff holding up with having to take so many more complicated crisis calls?

It’s been an opportunity for us as a leadership team to figure out how to work in the new normal. Very similar to many other jobs, we had to send people home to work. Before, home would be a sanctuary space, and now they’ve having to bring all this trauma into that space. We had to really be very thoughtful about what supervision looks like for our staff. We used to do weekly check-ins. Now those are daily and multiple times a day. We’ll ask them how they’re doing, how they’re coping, if they’re using self-care, what their plans are for taking care of themselves. It’s like when you get on a plane, they tell you to put your oxygen mask on first before helping others, and that’s what we have to do with our staff. We have to make sure they’re able to be present and be in the moment and be empathetic.  We’ve also learned a lot about the hiring process. We’ve learned to ask additional questions to make sure the people we’re hiring have the skills to be able to overcome the vicarious trauma many of our staff experience on the phone lines. 

I’ve seen you refer to the mental health impacts of the pandemic as an “impending tsunami.” When do you think it will hit?

If you think about PTSD, symptoms really start to show about six months after the incident occurs. We’re expecting to start seeing extreme behavioral health challenges in September, October, November and into the holidays, and that’s just from the pandemic and not also from the other stressors I mentioned earlier. We’re all preparing for something we’ve never seen before. While September 11 impacted all of us in the U.S., it was from a distance for most of us. I didn’t know anyone in the World Trade Center. I didn’t know anyone who passed. I could empathize but I had no personal experience. Covid, on the other hand, has impacted every single human being in the country in one way or another, if only for the fact that you couldn’t go sit down and have a meal in a restaurant. That’s what makes this so different and why the behavioral health impact is going to be so significant.

What forms will that impact take? 

Certainly, we’ll see more calls for services from people who haven’t called before. We expect more calls from young people who have been extremely disrupted during the pandemic and more calls for individuals who need to be Baker or Marchman Acted for being a danger to themselves or others, for either behavioral health or substance abuse issues. And I’m certain we’ll see more attempted deaths of despair and overdoses. We’re all worried all of these things are certainly possible. Given that more people will need help than ever before and there are going to be fewer fewer resources available, it’s going to be incumbent on the behavioral health community and our regulatory agencies to allow us to be able to treat people in ways we’ve haven’t been able to do before, with teletherapy being a big one. 

If we want to talk about something positive to come out of this, it’s that federal, state and local authorities are working very closely with the medical and behavioral health community to serve people in the best way possible. We’ve busted through myths and provided innovative ways of working with people. Now people can go to AA and NA meetings over Zoom, and that’s never happened before. Group therapy that had to be done in an office setting is being done in people’s yards. All of those things are working. People are telling us that it works and evidence is showing that people are getting wonderful treatment in a variety of ways. We must be able to continue to not only serve the incredible population that may be coming but also to do it safely. Folks are going to continue to need help, and the ways we used to do it aren’t going to work anymore. 

How can we support our friends and family during this time?

Learn about the signs and symptoms of suicide if you’ve got a feeling in your gut that something isn’t right. Maybe a friend or family member told you they bought a gun, and they’ve never been interested in guns before, or you’ve noticed more prescription bottles behind them during a Zoom call. It’s important to feel comfortable asking if they’re suicidal, if they’re thinking of taking their own life and if they’re OK, and then giving them the chance to answer. Whatever their feelings are, validate them, no matter what age they are. Don’t discount them. That’s one of the worst things you can possibly do. Even if you might not understand someone else’s feelings, learn how to say “it sounds like it’s really tough to be you right now” and let them continue to talk. Finally, don’t wait for someone else to reach out to you. Be the one to reach out to someone else. We’re all struggling in this together. We’re all feeling isolated and like no one else understands how we feel. When someone else reaches out, not only are you making the other person feel better, you’ll be amazed at how much better you feel yourself. 

What lessons have you learned from this experience that you can apply in the future?

My crystal ball is so cloudy. I honestly don’t know what the next six months holds. I had a vision for 2020; this was certainly not the vision. I’m going to say that we’re all going to have learned that the most important thing we can do is take care of each other. The things we thought we needed, the vacations we thought we needed to take – we really don’t. It’s taught us the value of family and friends, and how important it is just being together. It’s my hope that if we focus on those things, the behavioral health tsunami that is coming is going to be lessened, because we’ll all know we have to be there for each other.