Young Arkansans reported higher rates of depression last year, according to data released Thursday by the nationwide Crisis Text Line, with an average of almost 40% of text line users experiencing depression and sadness, and the majority of users being 24 or younger.
"As we mature, as we grow up and experience life, we build these resiliency posts," said Tyler West, the communications chairperson for the American Foundation for Suicide Prevention.
West is also in charge of Arkansas public relations and public policy for the national nonprofit.
"Young people haven't had the life experiences to gain those resiliency life skills," West said. "Trauma has lasting effects, and how you process it is key to recovery. We're all in recovery from 2020 and the mental roller coaster we've all been on."
The crisis line's data is the latest point underscoring what mental health experts began reporting last year -- the pandemic had a negative impact on the mental health of many.
Crisis Text Line, established in 2014, is a free, around-the-clock, text-based mental health support system. Interim CEO Dena Trujillo described it as a "mental health emergency room" that determines which texters are in the greatest need of help and answering messages in order of severity.
In 2020, 6,833 Arkansans used the text line, and 64% of them were first-time users, according to the report. The text line had 10,527 conversations with Arkansans last year.
Crisis Text Line had 1.4 million conversations with 843,982 texters nationwide in 2020.
"Between lockdowns, rising death tolls, street protests in cities from coast to coast, political conflict and rampant misinformation, it is no wonder so many Americans reached out to Crisis Text Line for help at unprecedented levels all year, resulting in a 19% increase in total conversations from 2019," the report states.
Mentions of depression and suicide decreased from 2019 to 2020. Shairi Turner, a physician and Crisis Text Line's chief transformation officer, said in the report that this is "typical of human behavior during emergencies that pose external threats to our safety" such as the covid-19 pandemic.
The Crisis Text Line national average of depression and sadness was greater than 35% but less than 40%, according to the data. Arkansans also felt slightly more isolated but had lower rates of anxiety and stress than the national average.
The average state and national rates of suicidal ideation were the same, around 22%.
The report did not show large differences between the Arkansas and national averages for other, less pervasive mental health issues, including grief, emotional abuse, substance abuse and body image.
West said the Crisis Text Line data paints a clearer picture than previously known of the rates of depression and suicidal tendencies in Arkansas. The state implemented telehealth care last year, but it only goes so far on its own, he said.
"If they don't have adequate internet connection or don't know [telehealth] is there, it's not doing a lot of good," he said.
The Arkansas Lifeline Call Center, which answers calls made from Arkansas to the National Suicide Prevention Lifeline, received 10,690 calls between March 1, 2020, and April 1, 2021, and 815 of those callers were concerned about covid-19, said Danyelle McNeill, a public information officer with the Arkansas Department of Health.
REACHING PEOPLE
The Crisis Text Line currently has about 4,000 conversations per day, Trujillo said. Users can text CRISIS to 741741, and the team works to match texters with trained volunteers within 5 minutes. Licensed clinicians monitor all of the conversations.
In 2020, Crisis Text Line volunteers de-escalated 59 situations in Arkansas in which a texter was considering suicide. In the 1% of cases where de-escalation is not enough and someone appears at risk of harming themselves or others, Crisis Text Line will enlist local mergency services to intervene. There were 148 of these "active rescues" in Arkansas in 2020.
The text line collects demographic data on its users through a voluntary post-conversation survey. The data indicates that the largest age group nationwide is teenagers and young adults. About 50% of texters in Arkansas in 2020 were 17 or younger, and more than 20% were 18-24 years old.
Trujillo and Turner said the service's users are frequently younger because texting is a normal and natural mode of communication for younger people.
"Texting is a teen modality [and] a primary mode of communication," Turner said. "They're also very engaged with social media. They're going to be seeing and viewing and re-viewing what's on the news cycle many times."
Younger people are also more likely to experience the long-term affects of trauma. Turner and West said it will be necessary to monitor how more than a year of isolation affects children's and teens' development.
"It's important that we as parents, we as communities look after our kids, and acknowledge and grieve what was lost and work really hard to reassure them that things are stabilizing and we're going to move forward together," West said.
West and Tammy Alexander, the assistant director of behavioral health at the Arkansas Department of Human Services, agreed that the rural nature of Arkansas could lead to increased feelings of isolation and therefore depression.
"People in larger cities that have better connectivity have been able to maintain that social support, but many [rural] residents just don't have good internet access, or any access," Alexander said. "So for them, isolation has really hit hard."
The state had to come up with "creative ways to reach people" last year, Alexander said, such as including mental health resource pamphlets in utility bills and bank statements. The public health department in Texarkana helped the Department of Human Services reach about 40,000 people in rural southern Arkansas via utility bills and another 25,000 via bank statements, Alexander said.
People have been more reluctant to reach out for behavioral help throughout the pandemic, she said, so the department has tried to raise awareness of different coping skills and let people know they are having "normal reactions to abnormal events."
"We tried to normalize it so they weren't hard on themselves if they were experiencing depression," Alexander said.
West said one possible reason Arkansans experienced less anxiety than Crisis Text Line's national average could be that life became "simpler and much smaller" when the pandemic restricted activity. Spending more time with family could either eliminate or create stress, he said.
"It can be a protective factor if you have that close-knit family support within the home, but if you don't, that obviously can be a major stressor as well," West said.
WHAT'S NEXT?
The nationwide spike in texts to the Crisis Text Line could be a combination of more people needing help and more people being willing to ask for it, Turner said.
"It certainly says that the country is in a space of need, and that either more people know about us or more people are actually in need," she said. "It's hard for us to parse those two things apart."
Behavioral health centers in Arkansas are getting more calls and walk-ins recently, Alexander said, at a time when covid-19 vaccines are available to most citizens and activity is returning to pre-pandemic levels.
"I think that kind of shows where we are in this disaster," she said. "Early on it's like being in shock survival mode, and people are coming out of that and realizing there's a lot going on with them."
The Department of Human Services anticipates Arkansans will need more mental health aid and support in the coming years as the long-term affects of the pandemic become increasingly apparent, Alexander said.
Crisis Text Line hopes to use federal covid-19 relief funds to create "mobile crisis units" so trained mental health professionals can travel to underserved areas throughout the U.S.
Greater availability of licensed professionals reduces the burden on police, who do not have the training, to respond to mental health emergencies, Trujillo said.
All mental health advocates agreed that a vital means of protecting mental health is to check in with others, especially if they have indicated they are struggling.
"We need to be super vigilant and hyper-aware of the people we care about and the people we interact with in our lives," West said. "We're hardwired as humans to interact with one another, and we can sense when something is wrong."