Consumer demand for mental and behavioral health services reached a fever pitch in 2020.  From prolonged social distancing and financial strains, to the burnout of extra caretaking, grief over tremendous loss, and the monotony of working from home, the effects of the pandemic drove many people to seek professional help.

Even with the end in sight, many people are struggling to recover from the toll this crisis imposed. As people contemplate the transition to more in-person contact, mental and behavioral health professionals will need to be vigilant about the aftershocks and long-term impacts the public will experience in the upcoming months and years.

I’m optimistic about our emergence from the pandemic, but the road ahead is a long one. The need for mental health services will only continue to grow as people cope with everything that has happened through COVID-19 and begin to reemerge into more interpersonal contact. As a mental health provider, I’m concerned about three particular side effects in the near term. Left unresolved, these isolating behaviors could develop into more serious health concerns in the long term.

Limited socialization

Studies show that spending time with friends and loved ones supports our health. Socialization wards off loneliness, which can pose health risks like heart disease and depression, particularly in people of older generations. In fact, one study suggests that the effects of  social isolation and loneliness are twice as harmful on our physical and mental health as obesity.

Beyond the requisite human contact, social interaction also improves our cognitive skills and our overall sense of well-being, making us sharper, happier people. And happier people live longer.

Technology gave us a much-needed alternative to connect through the pandemic—for work, school, exercise, religion, health care, and interactions with family and friends. Yet, it will be important to return to real, in-person contact. Working, socializing, and connecting through exclusively remote means can further contribute to this country’s loneliness epidemic. New research that looked at the mental health impact of remote work found a spike in depressive symptoms and large decreases in happiness and social satisfaction following the onset of the pandemic.

Still, remote work will persist through this year and possibly indefinitely for many people, taking with it many small opportunities for casual workplace socialization. This is likely to spur additional mental health needs down the road. Providers will need to stay cognizant of the symptoms of loneliness and intervene with those patients who continue to face isolation in their work and personal lives.

Avoidance, the secret sauce of anxiety

Beyond health reasons or just circumstantial factors, however, people may also choose to continue to isolate out of avoidance. Avoiding stressors, even out of necessity, can strengthen anxiety. For many, the prospect of returning to more socially demanding circumstances (e.g., meeting new people, going new places, being observed by others, etc.) is a stressful prospect.

As mental health providers know, avoiding challenging circumstances makes anxiety stronger. Yet in the context of the pandemic, we know our home “bubble” is relatively safe.   Out of necessity, many of us have avoided interpersonally demanding situations (e.g., social situations, work events, performances, etc.) to protect our health.  A byproduct of this prudent behavior, however, may be an increased anxiety response as we again face social demands.

Life has become more uncertain than ever before, so it’s easy to understand fears around returning to normal life. But avoiding that return – after a year that many spent in near solitude – won’t help the problem. Avoidance may feel good in the short term, but in reality, it just exacerbates stress long-term, which in turn will only reinforce unhealthy isolating behaviors.

What to watch out for? Adults refusing to go back to work. Kids refusing to go back to school. People not re-engaging in the activities they participated in, and enjoyed, pre-pandemic. These avoidant behaviors are indicative of a larger health issue – anxiety.

Anxiety disorders are the most common mental health disorders in the U.S., impacting more than 40 million people, yet less than 40 percent of the population suffering from them are currently seeking treatment. Without intervention, this problem will only become more severe over time. As providers, we need to re-familiarize ourselves and be aware of avoidant patterns before that behavior turns into something far worse for our patients in the future.

A normalization of bad behavior

For many people, the last year involved copious amounts of indulgent eating, drinking, overspending, and a general lack of true self-care. Last March, Nielsen reported a 54 percent spike in alcohol sales compared to the same time in 2019, and the following month online alcohol sales rose nearly 500 percent.

Concern comes not from the fact that people engaged in these behaviors, but rather if these behaviors are still ongoing a year later, and more importantly, why. It’s when people are still eating, drinking, or spending in an attempt to cope with negative emotions that is the true cause for concern. Untreated, the compounding effects of these behaviors, in excess and over the long term, could result in credit card debt, weight gain, liver damage, and other long-term health consequences.

As a mental health care provider, I hope to make swift interventions with our patients who show signs of these at-risk behaviors. That said, I also recognize that identifying and treating these issues at scale with many people outside the mental health care fold will be difficult. There’s still a lot of work that needs to be done in this country on the mental health front – better access, more funding. I could go on, but for now, I offer my compassion to all the psychologists, psychiatrists, therapists, behavioral health coaches, and everyone in the mental and behavioral health field who will be tasked with helping to alleviate the mental and emotional burden this pandemic has placed on our society. The work you are undertaking is profound.

Sara Smucker Barnwell is a licensed clinical psychologist and clinical director of behavioral health, 98point6. She can be reached on LinkedIn and at her self-titled site, Sara Smucker Barnwell PhD.

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