About 60% of calls to Colorado’s crisis hotline this month had the same theme: the new coronavirus.

Callers are isolated and anxious. Some are stressed because the pandemic cost them their jobs or reduced their income. Others are overwhelmed by spending whole days with their families and helping kids with online school. And some are worried that they are more likely to die of the virus because of other health conditions.

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One way or another, the pandemic is coming up in conversations between callers and the clinicians and peer counselors who answer the phones. And those conversations are lasting two to four minutes longer than usual — closer to 15 minutes per call, according to the state Office of Behavioral Health.

The Colorado Crisis Services line — where callers are routed either to a hotline for urgent issues or to a “warm line” to talk through their situation with a peer counselor — handled about 20,000 calls in March, up 47% from 13,600 last March. Callers have kept up a similar pace so far in April.

But while calls, especially to the “warm line,” are up, visits to Colorado Crisis Services’ network of walk-in mental health centers are down in March and April as people are urged to stay in their homes and social distance during the coronavirus outbreak. State officials believe more Coloradans are relying on the crisis line because it feels safer during the pandemic than asking for help in person.

“We actually started seeing a spike in calls as soon as the state went on lockdown,” said Camille Harding, the state’s division director for Community Behavioral Health. “We have gradually continued to have growth week over week.”

So far this month, the warm line is receiving about 170 calls per day, on average. The hotline is getting between 360 and 390 calls each day.

The crisis line’s 100 therapists and peer counselors, who have personal experience with mental health problems or substance abuse, are now mostly answering the crisis line from their homes instead of their office building off Colorado Boulevard in Denver. The state Office of Behavioral Health worked to set up employees with computers, headsets and other equipment to work from home during the pandemic. The system is integrated so that a peer counselor, if needed, can tag a clinician to join a call with a person in crisis.

Colorado Crisis Line: A statewide hotline. 1-844-493-8255, or text TALK to 38255.

Crisis line staff also can dispatch mobile mental health teams when necessary.

At walk-in clinics, there are temperature checks, social distancing and other precautions aimed at protecting people from the coronavirus.

State behavioral health officials do not yet have detailed statistics on why Coloradans call the crisis line, but deeper data is coming within the next few weeks. The system was recently enhanced so that staff can note whether calls were about depression, anxiety, thoughts of suicide, concerns about teen pregnancy or financial stress. For now, staff report that 60% of calls are related to the pandemic but that data is not captured in the system.

And because of COVID-19, workers asked if the system could also include a “natural disaster” or community incident category in the system’s drop-down menu. They plan to select it when callers say they’re worried about the pandemic, but also will use it in the future when there is widespread concern about disasters such as floods or mass shootings, Harding said.

She expects another spike in coronavirus-related mental health issues after social-distancing measures are lifted and people attempt to return to normal life.

“We see this during the holidays — people grit their teeth and power through and then you see a spike in the spring,” Harding said. “As they come out of their homes, they are going to realize, ‘I’m overwhelmed with this and I need to reach out for support.’”

Workers on the front lines of the pandemic, including those who work in hospitals and nursing homes, could face a “secondary trauma” as they are able to slow down and attempt to process what they went through, Harding said.

Higher rates of suicide predicted but it’s too soon to tell

Mental health experts are concerned that anxiety and depression brought on by the pandemic and so many weeks of isolation could lead to higher rates of suicide. It’s too early to tell, in part because the pandemic is likely to affect mental health for months to come. There is also a lag between deaths and the state health department’s release of statewide suicide data.

The Colorado Sun requested suicide data from March and so far in April from several county coroner’s offices, and based on a preliminary review, it does not appear that the number of suicides is significantly higher than in prior months or the same period last year.

In Mesa County, for example, 13 people people died by suicide in March and April. That compares with 13 deaths during the same time period last year.

The ages of those who died by suicide in the past month and a half ranged from 25 to 81, according to Mesa County Coroner Victor Yahn.

And in El Paso County, 21 people died by suicide from March 16 to April 22. Three of those suicides occurred because of a “coronavirus stressor,” in addition to “other personal stressors,” according to Dr. Emily Russell, deputy chief medical examiner.

That information came from interviews with family and friends of the deceased, who are asked about the person’s relationships, financial issues and what they talked about before they took their lives. The interviews are done a day or two following the suicide, “after the family and friends have had some time to calm down and re-evaluate,” Russell said.

El Paso County has closely kept track of suicides during the pandemic in part because of false rumors in the community that multiple young people had taken their lives because of the coronavirus. That’s not true, Russell said. “I think it’s too soon to know if it has had a statistically significant impact,” she said. But “we wanted to keep track of it so we always had a pulse on it.”

The 21 deaths are nearly on par with the 20 suicide deaths during the same time period in 2019.

Safe2Tell tips have dropped since schools were closed

Meanwhile, as calls to the state crisis line are up, tips to the state’s school violence and intervention program — Safe2Tell — have dropped off.

The anonymous, peer-reporting system created in the aftermath of the mass shooting at Columbine High School in 1999 was having a huge year, with a 20% increase in tips this school year compared with last. Safe2Tell received 2,348 tips in February, including 399 about threats of suicide.

But then in March, when schools closed to in-person learning halfway through the month because of the pandemic, tips dropped off significantly. Tips were down 13%, with a total of 1,768 for the month. Still, suicide-related tips — at 377 — made up the highest category, more than school threats or drugs.

The current numbers look more like summer, when kids are out of school and less likely to report concerns, said Attorney General Phil Weiser, whose office is in charge of the program. It’s concerning, he said, that young people are isolated and less likely to know if their peers are struggling with depression or thoughts of suicide.

“Our overall message particularly to young people is that you are not alone,” he said. “Whether it’s with your parents, whether it’s with a professional or whether it’s with a friend, please share your struggle.”

Weiser’s office is working to improve coordination between Safe2Tell and the statewide crisis line after mental health experts noted the shortfalls of having hundreds of suicide-related tips going to the school-safety tip line instead of the statewide crisis line. As of March, calls to Safe2Tell from young people who are in the middle of a mental health crisis are being forwarded — with the caller’s consent — to the crisis line.

A bill introduced at the Capitol this year was aimed at enhancing the relationship between Safe2Tell and the crisis line, as well as providing funds for additional staff. But with the legislature shut down for a month because of the pandemic, it’s unclear whether the legislation will stay on course.

The attorney general noted that suicide is the leading cause of death for those ages 12 to 24 in Colorado. “That is a clear and scary statistic,” he said. “Now that we are in a public health crisis, … these things could get overlooked or not get as much attention.”

Updated at 10:30 a.m. April 29 to clarify the number of calls per day versus per week.

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