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The Crisis Inside the Crisis

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For the last nearly three months, I’ve scrolled the Instagram and Facebook pages of friends and family members who while on unemployment have spent their time baking banana bread, playing Animal Crossing, and coming up with an at-home workout.

I’ve maybe been a little jealous…

Okay, a lot jealous. Because while I know the uncertainty of life as we know it is stressful for everyone particularly those who no longer have jobs, there’s part of it that seems carefree and like an opportunity to recharge. Yet when I’ve talked to sober friends stuck at home suddenly without jobs, the fears are real. They’re afraid they won’t have work when life returns to whatever the hell normal is. They’re afraid of relapsing. They’re afraid of losing connections with their recovery communities. So the grass isn’t so green on the other side. From working in the very real and very intense current worlds of mental health and addiction this entire time, I know their worlds are not all baking and Tiger King. See while we’re watching the current COVID-19 crisis calm down, the ripple and fallout it’s caused in the recovery world is only beginning. 

For me, a person in long term recovery with a condo, Wi-Fi, and food in his refrigerator, not to mention access to any recovery ZOOM meeting in the world, this whole thing hasn’t been so bad. But for the people, we support at my job and the majority of folks struggling with substance use disorders all over, this virus is deadly on several levels. The first crack we saw in the system as places closed down and services became more and more limited was vulnerable populations immediately at higher risk for relapse. By the very nature of shutting down spaces where people had 12 step meetings, received MAT, group therapy, or spiritual support, a population that struggles under the best case scenarios had their lifelines cut off or at least harder to access. Also, we’ve always told people in recovery to reach out, to ask for help and that connection is the opposite of addiction but all of a sudden we were saying staying home and stay away from people. Sure, there’s online and digital support but that sort of support and social distancing, in general, is soaked in privilege. Around 75% of the people I supported at a busy hospital here in Portland, Oregon were homeless. They didn’t have phones or iPads, they didn’t even have somewhere to sleep.  So these meeting spaces and clinics weren’t just vital to their recovery but to their survival for things like snacks, warmth, and human interaction. The fallout from all of this from what I’ve seen begins with people falling off the radar. Now as a program manager, the mentors I supervise have lamented that people who they once saw weekly and who they could support at appointments, were now left to go at it alone. People struggling with mental health and addiction need the connection and haven’t always been able to get it over the last few months. 

Unsurprisingly, relapse is also on the rise. The people my team support who were struggling before the pandemic were suddenly at a higher risk. Add to this a huge amount of stress, loss, grief, and financial uncertainty and you’ve got the perfect recipe for relapse. For example one of our mentors who work in a hospital is usually given access to hospital rooms to build connections with folks with substance use disorders. This work is vital and it works to help get them connected to recovery resources outside of the hospital walls. She’s now forced to do this work over the phone and as you can imagine, it ain’t the same. The opportunity for a face-to-face to perhaps disrupt a pattern of use is now nonexistent. It’s a leap of faith that some connection can be made over the phone. Despite the limitations, she’s been able to get people into treatment and deliver much needed basic needs items like food boxes and phones. But the undertaking is monumental and the deck is stacked against recovery mentors with limited access and forever dwindling resources. She’s seen twice as many patients return to using as she has got into treatment. Again, this is difficult work even when a pandemic isn’t happening but now it’s blossomed into a crisis of its own.

I work for an agency that provides peer support and one of the things I love about the field is that we meet people where they’re at. If they want to get sober, terrific we help with that. If they’re interested in MAT, we help connect them to various clinics around town, and if they want to keep suing we talk about keeping them safe and harm reduction. Yet now actually meeting where they’re at is a challenge. We can’t pick them up and take them to the DHS office. We can’t take them to a recovery group. We can’t even meet them for a much-needed cup of coffee. Our magic trick of meeting people where they’re at is now made harder as we don’t know where many of our homeless people are and we couldn’t be near them even if we did know.

The final fallout from all of this is the worst and most final of all: suicide. I happen to live by one of those historic bridges you always see in photos of Portland, Oregon. About two weeks ago, a neighbor of mine ran through our courtyard frantic and told me to call 911. Someone had jumped off the bridge near my house and into the Willamette River. It shook me to the core obviously because it was right in my backyard but also because it illustrated what must be happening right now in communities around the country. The Washington Post recently ran an article outlining how America’s treatment centers and mental health facilities were ill-equipped for what was about to happen. Writer Brene Brown described it as “the crisis inside of the crisis” which is completely accurate. But for those of us working inside of that crisis, it feels more like a tidal wave after an earthquake. You see it coming but there’s very little you can do to get out of the way. 

Sean Paul Mahoney is the author of the new collection of essays Now That You’ve Stopped Dying and the co-host of the LGBTQ recovery podcast Queer Mental Condition. He also works as a recovery mentor and peer support specialist in Portland, Oregon.

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