Six months. For some, this pandemic has meant six months of feeling isolated, lacking regular human contact, riding the roller coaster of emotions.


It has taken a toll.


A new Centers for Disease Control and Prevention study conducted in June found that 10.7% of adults were seriously considering suicide, about twice as many as the year before. Of the respondents, 40.9% said they had at least one mental or behavioral health condition in the past three months, and 13.3% reported increased substance abuse to cope with the stress or emotions of COVID-19.


The Disaster Distress Helpline, part of the National Suicide Prevention Lifeline, experienced an 890% increase in call volume in April from April 2019.


These numbers come as we as a country already were struggling with mental health. The rates of suicide in the United States have increased from 10 per 100,000 in 1999 to 14 per 100,000 in 2017, the last year these statistics were available.


"This toll the pandemic has seen is exacerbating everything," says Allison Chase, regional managing clinical director of Eating Recovery Center and the newly renamed Pathlight Mood & Anxiety Center in Austin. "Too many are remaining so isolated. Are they getting help or seeking help?"


Chase is seeing more people seeking care and more people on the waiting list to get care. She’s also seeing more patients coming for care who are now sicker than they might have been when they sought care in the past.


National Alliance for Mental Illness Central Texas also has seen more people reaching out for mental health care since the pandemic began. It switched to virtual programming, but as the suicide numbers suggest, the mental health crisis began before the pandemic, and the pandemic has just added to it.


Karen Ranus, the executive director of NAMI Central Texas, cites recent studies on the impact of loneliness on depressive symptoms and suicidal thoughts.


"Even before the pandemic hit, we were dealing with the silent epidemic of loneliness," Ranus says.


She points to testimony to the U.S. Senate in 2017 by Julianne Holt-Lunstad, a professor of psychology and neuroscience at Brigham Young University, that loneliness has the same impact on our health as 15 cigarettes a day.


While this isolation is impacting all of us, "folks that were already vulnerable, now there is an added layer of concern," she says.


"Everyone in one way or another is experiencing this pandemic," Chase says. We are missing that physical contact of hugging family members or friends or just being in one another’s presence.


Ranus wants to change the language around social distancing to physical distancing. It’s not that we need to be isolated socially, just not physically close together.


That means getting creative on how to stay connected, both virtually through Zoom calls, texts, emails or phone calls, and in-person by doing things like gathering outside, 6 feet apart or more.


Right now it’s important to reach out to people who might be vulnerable, such as people who are living alone and people you haven’t heard from in a while. Ranus says she recently called a friend who was grieving the loss of her daughter. That phone call gave her friend a reason to get out of bed that day. She put a note on her calendar to call that friend again the following week.


A friend can make a really big difference. Quevarra Moten knows what it feels like to have thoughts of suicide. She is now NAMI Central Texas’ deputy executive director, but in 2008, after facing a divorce and dealing with her mother’s mental health crisis, she had her own dark thoughts. At that moment, a friend called and simply asked, "Hey, are you OK?"


Her friend talked to her and prayed with her. Her call, Moten says, reminded her that "you don’t have to have all the answers. ... People think you really have it together. With everything I was juggling, the load was too heavy."


The next day, she signed up for therapy.


"It’s OK to ask for help," Moten says, and if you can’t, come up with a code word you can use with friends to let them know you are not OK, she says.


The warning signs that someone needs help are essentially the same as before the pandemic, although things like hygiene, sleep and eating habits are not as much of a red flag and have changed for all of us.


If you are seeing signs of hopelessness, more depression or anxiety; if they are giving away possessions, saying goodbye; if they have stopped participating in group activities such as Zoom calls; or you haven’t heard from them in a while, those are signs of concern, Chase says.


Ranus encourages people to listen to their gut. While the NAMI Central Texas site has a checklist of suicide risks, if someone you know just doesn’t seem right, trust your instincts. Sometimes the checklist is not enough, Ranus says.


When you call a person you’re concerned about or you see them in person, express your concern by using "you" language, Ranus says. Suggested conversation includes: "Do you know how much I love you? I’m just so concerned. I know it’s hard to be vulnerable, but it’s OK to be vulnerable with me."


NAMI Central Texas has a PDF with tips for having that conversation. If you say, "How are you doing?" they might just answer, "I’m good." She suggests saying, "How are you, really?" instead.


Right now, Chase says, we’re having to "dig a little deeper" to find out what’s going on with friends and family members because we’re not necessarily seeing someone every day. One thing we can do is talk about what’s going on with us to our friends to try to lessen the stigma around mental health.


"This is really hard now," Chase says. "Put that out there and you’ll be able to support others."


Normalize that you are also struggling. "None of us has to pretend like this is OK," Ranus says.


You can ask them if they have been thinking of harming themselves or have had suicidal thoughts and if they have a plan. It’s a myth that asking these questions can increase suicidal thoughts, Chase says, and those questions can help someone feel relieved to be getting help and support.


You can help someone you’re concerned about by assisting them with scheduling a telemedicine appointment for therapy and helping them log onto the call. You can call local mental health authorities based in your county or city and talk to a trained professional about next steps.


You also can call the National Suicide Prevention Lifeline or text the National Crisis Text Line.


If they are showing intent, then you need to get them somewhere safe and make sure they do not have access to things they can use to inflict self-harm.


If someone is in imminent danger, you can take them to a local emergency room. Dell Seton Medical Center and Dell Children’s Medical Center have emergency psychiatric care, but the closest emergency room works, too. You can also call 91- and let them know you are having a psychiatric emergency.


Ranus worries that the wave has not yet hit. "People will grip themselves for a while and say, ‘I’m OK, I’m OK,’" she says. She believes that six months from now, when we are one year into physical isolation, we won’t be able to continue to say, "I’m OK, I’m OK."