March 24, 2020

Anxiety doesn’t always look the way we think it will, forcing deep breaths, having a rapid heart rate or crying. It’s not just something in our heads.

Anxiety can cause physical illness, affecting people’s sight, hearing and stomachs. Some people feel chest pain and shortness of breath. For others anxiety presents like a flu, causing muscle pain, temperature changes, dizziness and headaches.

Curling up with a good book is one way to redirect anxious thoughts during home isolation.

“Everyone manages stress and anxiety in their own way, and we want to remind everyone that those reactions are normal,” said Ebony Clarke, director of the Multnomah County Health Department’s Behavioral Health Division. “With COVID-19 spreading, and people physically isolating, it makes sense that people would feel overwhelmed, fearful or sad.”

Multnomah County has modified most behavioral health services to prioritize the health and safety of the public and staff. Although many offices are physically closed to the public, staff are still available by phone and email. 

“We know that mental health is crucial. We’re leveraging technology to find alternatives to support people. Much of what we are doing is through video conferencing and telehealth,” Clarke said. “For the handful of individuals we do need to see in person, we’re finding ways to follow physical distancing requirements and keep our consumers and staff safer.”

[Check out this list of updated services and resources]

‘The piece that keeps me going’

Most people feel some level of fear or depression right now, with residents ordered to stay home and avoid physical contact with anyone outside their household. For some that means being physically alone. For others it means unemployment.

Many are also feeling anxiety right now. Officials can’t tell us how long we’ll be isolated or what this will do to our economy; health experts can’t say how many people will get sick and how many will die.

Clarke is among thousands of Oregonians who must stay home, so she focuses on the silver lining where she can. She normally works long hours outside her home so she’s choosing to be grateful for the time she’s now spending working alongside her husband and two sons.

“I’ve been able to enjoy that and reconnect,” she said. “That’s the piece that keeps me going.”

Clarke connects with her mother, Helen, through video chatting and sends her little gifts to lift her spirits. On a recent Saturday night, that meant ordering her mother a Domino's pizza and a liter of Sprite. And as an active member of her church, Clarke logs onto weekly video services.

“When I don’t connect or talk to anyone at church, I start to get anxious, fearful and worried,” she said. “My faith grounds me. It helps bring a sense of peace.”

Experts say there are things we can do, every day, to ease anxiety and depression. Try a few:

Keeping a journal is one way to work through fears and anxieties that might overwhelm us.

Support your mental health

  • Stay in touch with the people you love

  • Show affection to your pets

  • Pause: Take some deep breaths. Pray. Explore mindfulness

  • Make a gratitude list​​

Protect your physical health

  • Get up and go to sleep at a consistent time

  • Eat well. Eat produce.

  • Move. Talk a walk. Practice yoga. Garden.

Feed your creative self

  • Make art

  • Take photos

  • Play music

  • Read books

  • Write a story. Keep a journal

Gratitude and guilty pleasures 

Lynn Smith-Stott, supervisor for the Office of Consumer Engagement at the Behavioral Health Division, has been at home for more than a week. She says she’s had moments of overwhelming anxiety.

Not only is Smith-Stott personally at higher risk of complications from COVID-19, she also has family living in high-risk areas of Washington state.

But she’s employing her training with the county and skills acquired in long-term recovery from addiction and mental illness to keep her spirits up. Here are a few:

Keep a gratitude list: “I have been counting each day the things I am grateful for. I’m grateful I have a job and I can do meaningful work. I’m grateful that I’m well. I’m grateful for my family and friends,” she said. “What I try to do is catch those moments throughout the day. I’m grateful right now that I’m looking out on my gardens. My wife planted flowers this weekend.”

Indulge: “I find a guilty pleasure to indulge in everyday. Not something harmful, but something simple and pleasurable. For me, that’s watching Grey’s Anatomy.”

Anxiety vault: “If I feel anxiety amping up, I let myself go for about 15 minutes. I really let myself be anxious about all of it. And at the end of 15 minutes, I take a breath and say, ‘OK, that’s enough.’ I put it in my imaginary anxiety vault, and I shift my focus to the present moment.”

Practice grace: “I just try to have a little grace and mercy for people, and I hope people do that with me. This is going to bring out the best and worst in all of us.”

Mindfulness and burpees

Before isolating at home as part of the state order on physical distancing, Dr. Nimisha Gokaldas, medical director for Behavioral Health, traveled to Houston to bury her father. 

His death prompted her to see how vulnerable the rest of her family was to COVID-19. Her sister is a family doctor, and she’s also pregnant. Her mother is older and at higher risk of complications from the virus.

“A lot of people are worried about family right now,” she said. “I think that’s very normal.”

Enjoy quality time with family in your house.

While she works from home, Gokaldas has tried to focus her energy on the things she can control, and that includes her own health.

Take breaks: “I don’t like working from home. I have a standing desk at work and a balance board that I don’t have here. I find it's harder to work here. So I find time to go out and take a break. Taking the time to move, for me, is really important.”

Eat veggies: “Fresh produce is what we should be eating. And there’s lots of it in the grocery stores. People are buying canned food. But fresh fruits and vegetables are great. If you don’t like a lot of prep work, buy precut or frozen produce.

Limit news: “I limit my media to a small portion of the day and one point in the day. I get up. I read the New York Times headlines. And that’s the only time I read the news. The rest of my day is not spent checking the headlines.”

Read a book: “I do a lot of fiction reading. Nothing doomsday or dystopian.” Right now she’s reading the young adult fantasy novel, The Hero and the Crown.

Exercise: “It’s silly, but I get up every morning and do burpees. It makes me wish I wasn’t doing them, and it makes me feel incredibly accomplished in five minutes.”

Mindfulness: “Just try a quick two-minute breathing exercise. Inhale for four seconds and exhale for four seconds. Having to count helps you focus on something else. Mindfulness, meditation, prayer. It’s all the same thing. It’s like gratitude practice, flipping my fear to my gratitude. Those feelings of fear are normal, but you don’t want to allow yourself to sit in it.”

New connections: “Asking for help and being of service both support our own mental health. Someone in my neighborhood started a Facebook page, in case people need help. So we find that opportunity to make new relationships and new ways of communication. It’s going to shift.”

Mental health services during COVID-19

Although many County offices are physically closed to the public, staff are still available by phone and email. Most services have been modified to prioritize the health and safety of both the public and Multnomah County staff. Many services are still being offered online, via telephone or via virtual venues. 

Urgent and 24-hour mental health support during COVID-19

Multnomah County Mental Health Call Center

Don’t wait for a crisis to reach out for support. Multnomah County’s mental health call center staff are here to talk, every day of the week, every hour of the day. If you are in crisis, if you want help finding a mental health provider, or if you just need to talk, now is the time to call.

  • Dial: 503-988-4888 

  • Toll-free: 800-716-9769

  • Hearing-impaired: 7-1-1

Urgent Walk-in Clinic

For immediate care during a mental health crisis, to speak with a psychiatrist or mental health nurse practitioner, or for help with medication and treatment, visit the urgent walk-in clinic, open daily from 9 a.m. to 9 p.m. at 4212 SE Division St., Portland, or dial 503-963-2575.

Mental health services in MultCo during COVID-19

Other COVID-19 mental health resources