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Social services director sees importance of mental health services during pandemic

Northeast Mississippi Daily Journal - 5/27/2021

May 27—Editor's Note: The Human Impact is an ongoing series about marginalized people in our communities and the disproportionate impact of COVID-19 upon them.

NEW ALBANY —Nakimia Agnew was still shaping the relatively new behavioral health program for North Mississippi Primary Health Care (NMPHC) when COVID-19 changed the way her work looked on a day to day basis.

As a licensed social worker, Agnew specializes in mindfulness. She counsels clients of all ages through trauma and grief, and as her clients experienced increased social isolation, anxiety and uncertainty brought on by the pandemic, she witnessed a collective trauma response that showed her just how needed mental health care is.

"COVID provided the perfect storm for people with mental illness because it took away their community, for a lot of them, and we know that community is a big support," Agnew said. "This is something the world has never seen before, we've never seen before, so people just didn't have the skills to deal with it."

A pandemic and the stigma of mental health

Originally from Baldwyn, Agnew has been a licensed social worker since 2007. She's been the director of social services at New Albany Health Care Associates for two years, and within her role, she provides mental health services, psychotherapy and clinical case management across the North Mississippi Primary Health Care, Inc coverage area, including New Albany, Oxford, Ripley, Ashland, Walnut, Corinth, Booneville, Tishomingo.

Agnew was tasked with starting NMPHC's behavioral health program thanks to previous experience starting programs and providing psychotherapy.

"It was just a good opportunity because we're in rural Mississippi,' she said. "There are not a lot of mental health care services available in the area, and so we just provide the opportunity for more people to receive more services. We're trying to break the stigma of mental health and mental health care and encouraging people if there's a problem or if they have an issue, it's OK to seek out mental health services."

When the pandemic began, Agnew had huge concerns about an increase in anxiety, domestic violence and social isolation. Her younger patients came back from spring break to a new world. Schools moving to virtual learning took away a lot of coping skills for children. For some kids, school is a time to socialize or escape from bad home environments, so missing school was a "very traumatic time for kids." Many, such as seniors, had to deal with missing big moments.

"That's a big milestone for them, and it changed," Agnew said. "They graduated, but they didn't get to walk the stage, they didn't get to have those last days with their peers, which caused some depression for some of them and some anxiety for some of them (about) what is life going to look like for me from now on?"

She saw similar worries play out among her adult clients. For clients who deal with depression and social anxiety, having to quarantine made it easy to revert to unhealthy habits where they did not want to be around people. Some people didn't feel safe outside, while other clients feared losing their jobs.

Agnew saw a rise in suicide because people didn't have the skills to deal with the challenges brought on by the COVID-19 pandemic, and clients who once saw their therapist weekly now struggled to manage their mental health on top of seeing COVID-19 dominate the news every day.

Collective trauma and teletherapy

As a mental health care professional, she also recognized collective trauma. The toilet paper shortage was one example; the scarcity driven by people buying in bulk increased anxiety. However, Agnew also recognized hoarding toilet paper and products as trauma responses.

"COVID was a traumatic situation for everybody, and when people are suffering from trauma and a traumatic situation, then they do whatever they can to try to find some type of control," Agnew said. "To be able to have a closet full of toilet paper was some form of control for some people."

Her goal was to help her clients know and understand community trauma so they could find the skills needed to deal with their anxiety in healthier ways. Offering mental health care during the pandemic was a big adjustment. Before, she met with clients face-to-face for interviews, but she moved to virtual sessions during the pandemic.

NMPHC already had a telehealth program where they contract with University Medical to provide psychiatric services and potentially get care to people who lacked the funds for or access to in person care, but telehealth was still new for Agnew.

"We are so used to being hands on and just being in the room with somebody," Agnew said. "We had to find, create ways to provide that same level of care for patients over the screen. We wanted them to feel like we were in the room together."

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At times, it was challenging to connect via a screen. Some clients weren't as open when talking virtually, and Agnew had to emphasize the importance of sharing their full symptoms. She helped patients learn the importance of the Health Insurance Portability and Accountability Act (HIPAA) and maintaining confidentiality.

Each session, Agnew would asked her client if they were in a safe place to talk, and she'd assure clients that she was in the room alone and that sessions weren't recorded as a way to encourage them to open up. Even now that she sees some clients in person, masks make reading compassion and body language difficult.

"I've had clients even say, 'I've seen you for almost a year, and I have no idea what you look like,'" Agnew said. "It's been an adjustment for us as clinicians, patients."

However, teletherapy also opened doors for some who wouldn't otherwise make it to the clinic. She learned to be creative and effective with on-screen activities. One example was making adjustments to how to perform deep breathing exercises under the mask. Since some of her clients are rural or older, there were occasionally challenges with reception or technology, so she also did phone calls when teletherapy didn't work.

There were moments when Agnew used the challenges to adapt her methods. When a client had to sit outside during a session for better reception, she used it as an opportunity to do mindfulness outside.

"We use that as an opportunity to be able to teach them how to use those skills in their own environment," Agnew said.

'People are going to need support'

While taking care of others, Agnew had to remember to manage her own feelings and emotions to care for others. NMPHC mental health providers checked in on the mental health of their front-line doctors and practitioners.

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"We did things like morning meditations to help them throughout the day," Agnew said. "We had an open door policy, so if somebody was struggling with how they felt about what was going in, then they could come in and talk to one of the therapists. We just made sure that we were taking care of our people who take care of people every day."

Now that vaccinations are available and some of the initial concerns around COVID-19 are receding, she's anticipating a rise in those needing mental health services.

"Sometimes you don't know it has affected you until you kind of step into something different," Agnew said. "I definitely can see where there's probably going to be a need for children being back in school, people entering back into the workforce, even going to the mall or going out is going to be different now because it's something that we feared before and now that's becoming normal to us again ... People are going to need support in doing it."

Those who lost loved ones during COVID-19 didn't get to have a traditional funeral, which can be part of the grieving and healing process. For those who contracted COVID-19, she's also preparing for lingering mental effects. Agnew contracted COVID-19 in October, and while she was blessed to have a very mild case, she knows recovery can be mentally taxing.

"Some will have the survivor's remorse: 'I made it through, why didn't my brother or my sister make it through? I was OK and I can return to normal, but they may still be having some effects from it.' (They'll be) dealing with those thoughts," Agnew said.

Even among her current clients, she knows some who are fearful of the vaccine or who are struggling to adjust to loosening restrictions. Agnew chose to be vaccinated in order to feel confident in returning to serving clients in person. As a practitioner, she tries to respect her clients' choices on whether to be vaccinated or not and encourages giving people the information to make the best decision for themselves.

Agnew's hope for the future is that more resources will come out of this and that people will take advantage of the resources and utilize them. Seeking mental health services doesn't mean something's wrong, she said; it should be as common and accepted as going to the doctor for a cold.

"It's OK that you feel how you feel about what's happened, and there are people out there for you to talk to about it," she said. "It's OK for you to need to talk to someone."

danny.mcarthur@djournal.com

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