Staff members at an Israeli emotional support hotline, which around two weeks ago began operating a dedicated service for issues relating to the coronavirus pandemic, have reported a steep rise in calls and text-based requests.
ERAN (a Hebrew acronym for "Emotional First Aid"), which operates the hotline, attributes the rise in calls to the rising number of confirmed cases in Israel, fear of unemployment, loneliness and a sense of uncertainty regarding how long the stringent Health Ministry measures preventing the virus' spread will remain in place.
“On a normal day we respond to around 530 calls. In the ‘anxiety in the time of corona’ period, we began with around 600, rose to 800, and over the past 24 hours we had more than 1,200 calls,” said Dr. Shiri Daniels, national professional director for ERAN.
Daniels says she feels as if staff members have been called up for military reserve duty. “We work around the clock to increase our scope and accessibility,” she said. “We’ve doubled the number of active stations for each shift to 200 at any given time, and we’re training new support staff, including in foreign languages. We’re also preparing to move the service’s ‘center of gravity’ from the offices to supporters’ homes,” in keeping with Health Ministry work-from-home directives.
Saying goodbye to grandchildren
The rise in calls spans Israelis across genders and ages. Sixty percent of requests come from women, 40 percent from men. ERAN's statistics show that 38 percent of requests come from those over the age of 65, and 22 percent from the elderly. Nearly 60 percent of callers report anxiety and a sense of crisis, with about one-fourth suffering from loneliness and interpersonal issues (26 percent), and fifteen percent experiencing severe emotional distress.
“We get a lot of calls from adults who feel anxiety, people who need information and relaxation techniques and consult with us about children, parents and family members – often with special needs,” Daniels says. She adds that many young adults say they have trouble controlling their consumption of information.
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“Control of information brings with it control of anxiety, and at the moment it seems the information is managing us, not the reverse,” she says, adding: “Limiting information – content, frequency and scope – significantly improves the sense of well-being.”
Daniels says the hotline handles large numbers of calls from people who are 65 and older who clearly are putting a lot of effort into reassuring their children and other younger people. In addition, she reports, “The over-85s question whether they’ll die if they are infected, and ask if they should say goodbye to their grandchildren. It breaks your heart,” Daniels says.
"There's also a sense that people are speaking 'over the heads' of the elderly rather than to them," she added, "and at times, that can be irritating."
Dr. Zvi Fishel, the chairman of the Israel Psychiatric Association, reports a rise in the number of people going to the emergency room with physical symptoms of anxiety, which can include chest pressure and difficulty breathing. Often, he says, they don’t realize that what they’re experiencing is an anxiety attack. "Anyone who identifies the source [of the anxiety] or fears going out calls the emotional support hotlines," he adds.
In terms of mental health, Fishel says the current crisis is different from the scenarios Israelis have grown accustomed to. “The anxiety that appears in situations such as war, rocket fire or terrorist attacks contains an element of anger, which has a slight ameliorating effect. There’s an object to be angry with. Here it’s different – we’re talking about a virus. That has an effect,” Fishel says.
Changing the psychological community
The latest Health Ministry directives don’t prohibit face-to-face therapy sessions, but the recommendation is to use remote means of communication when feasible to reduce the number of patients passing through the clinic.
“I experience great ambivalence regarding asking for help,” says Refael Yonatan Leus, a clinical psychologist. “On one hand, people need a supportive meeting, but a face-to-face meeting isn’t possible and not everyone is willing to settle for a remote meeting by telephone or a video call.” He says the entire psychological community is experiencing a change.
“Before now, I didn’t agree to therapy by phone or video, and now I move every patient I can to video,” Yonatan-Leus says. “For now, the conclusions are in both directions: One one hand, the therapeutic capabilities in this format are limited, but it’s still possible to help this way. One the other hand, it’s really not the same.”
Yonatan-Leus says that stress in times of crisis is a natural occurrence. "There are many factors effecting our emotional state these days, not just loneliness, but being shut in with your family contributes to pressure, people need breaks from each other." He adds that when "there's a fear of poverty or economic uncertainty in the background, health-related fear and a very present fear of death, it feels like the end of the world."
Surprisingly, the situation has had positive effects on those who tend to suffer from loneliness and anxiety in general. "Now, suddenly, everyone's going through a crisis, like fear of germs or fear to leave the house," Yonatan-Leus said. There's a sense of relief for those with anxiety in their daily lives "from the fact that the catastrophe that they're experiencing isn't just a figment of their internal world."
The bigger challenge is yet to come
The Health Ministry’s mental health division is working on being able to meet the growing need for emotional support. “Our big challenge lies ahead,” says Bella Ben Gershon, who is in charge of emergency preparedness at the division. “If and when there is a full lockdown, we will definitely be called upon to give maximum support to the population.”
She says the division is working on “expanding the response capacity to medical teams, opening support hotlines for the general public, drafting and distributing directives dealing with increasing the emotional resilience of medical teams, hospital directors, people who work with the elderly and people in isolation. In addition, we're putting great effort into disseminating information and producing videos,” Ben Gershon says.
She says the mental health division is based on a “practical model” that encourages action and commitment while recognizing that helplessness is the greatest enemy in situations like these. “There is impressive organization within the community and I keep seeing new responses – in the education system, in the health maintenance organizations and organizations in the nonprofit sector. This event will eventually end, but we want to reach the peak when we are as ready as possible, and I think that we can be optimistic.”