“Even folks who hadn’t experienced anxiety will likely be experiencing it, and folks who have it, it’s likely to get compounded considerably.”

The COVID-19 outbreak has been rough on the minds and wallets of mental health patients, according to the people who treat them. The stresses of isolation can be especially harmful to people struggling with their mental health.

“It’s like Pompei,” Brookline psychologist Dr. Susan Schnur said in an interview. “You know, when you see the lava and the people are stuck in the position they were in? It feels like that.”

Despite the heightened anxiety, many can’t afford care because they have lost their jobs or because the health insurance they have doesn’t cover remote treatment. Reached for comment, Greater Boston mental health care professionals said that while the majority of health insurance companies have accommodated them and their patients, there are still some who are falling through the cracks.

Governor Charlie Baker has ordered that commercial carriers cover remote treatment. But some mental health patients are still struggling to pay their bills; in some cases, their health insurance plans are with companies based outside the state, while in others, many employer-funded plans don’t cover telehealth, according to area psychologists. The Baker administration did not respond to a request for comment for this article.

“Some clients are opting to pay out-of-pocket fees for temporary plans,” Dr. Ericka Bohnel, a psychologist who coordinates telehealth treatment for group practice Commonwealth Psychology, said.

Like other local mental health professionals, Bohnel has had to navigate a patchwork of individual plans to keep clients in treatment. “We’ve provided reduced rates for some clients. We can only do so much of that, but we’re really trying to accommodate and to provide as much support as for our clients as we can.”

Cambridge psychologist Dr. Lissa Dutra said her small group practice has been financially spread thin covering the extra costs of patients who can no longer afford treatment. 

“In some cases, they can’t pay anything,” Dutra said. “So we’re starting to have to make decisions about who we’re going to terminate with or not.”

Dutra’s private practice has taken the unusual step of setting up a GoFundMe page—a temporary measure for during the crisis—in an attempt to maintain its clients and handle an influx of new patients dealing with the anxieties of living in the time of COVID-19.

“It’s not going to be sustainable longer-term,” Dutra said. “What we like to say is, ‘We’ll go down with the ship.’ We’ll keep doing it as long as we can.”

The stresses of the outbreak have caused a spike in the number of people seeking treatment, adding another layer of difficulty to the situation. Doctors expect those numbers to keep rising, even after the worst of the pandemic has passed.

“I think we will most definitely see a lot of PTSD,” Bohnell said. “ When folks have been in [acute distress] for a long time, it increases their sympathetic nervous system reaction. Even folks who hadn’t experienced anxiety will likely be experiencing it, and folks who have it, it’s likely to get compounded considerably.”

Dutra said she worries about PTSD developing among medical workers dealing with the virus’s fallout, comparing them to “the functional equivalent of military medics right now in the making.”

“They’re afraid,” Dutra said. “And they should be, right? They’re going to have to decide who lives and dies.”

The main challenge in treating many patients is minimizing their anxieties and keeping people grounded in the moment.

“The client I have whose wife may be dying, the question is, how do we get through this minute and the next minute?” Schnur said. “So we really work to try to get into states of flow, so that time just passes.”

Caitlyn Schwager, a spokesperson for the Commonwealth Psychology Associates, said that while the practice had transitioned its roughly 3,000 clients to telehealth relatively easily, isolation posed a new challenge to the group’s staff.

“Isolation can often slip into depression,” Schwager said. “Things like 9/11, or the Boston Marathon Bombing, we had our traditional support systems around us where you could talk with your friends and family, and you could meet up and go out for dinner. This physical distance from people is something that we really haven’t dealt with before.”

This article is syndicated by the Boston Institute for Nonprofit  Journalism’s Pandemic Democracy Project. Contact [email protected] for more information.

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