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The isolation, economic instability, and general dread that has accompanied COVID-19's arrival in the Pacific Northwest has begun to take a mental toll on Portlanders.

During a Tuesday press conference, Portland Police Chief Jami Resch told reporters that in the days following March 12—the day Portland declared a state of emergency due to COVID-19—the number of 911 calls related to suicide skyrocketed. Specifically, 911 calls involving suicide attempts or suicide threats were up 41 percent from the same time period in 2019, and up 23 percent from the 10-day period prior to March 12.

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These statistics don't come as a surprise to longtime mental health experts.

"Personally, that's my greatest worry about the whole thing," said Dr. Micheal Freeman, a professor of forensic epidemiology and psychiatry at Oregon Health & Science University (OHSU). "Folks who are already living paycheck to paycheck, who get laid off, and then are being told this thing is huge and out of control and there's no end in sight."

People are often drawn to suicide when they're feeling a lack of control over their lives, Freeman said. Hearing that loss of control being echoed by public health experts, global leaders, and media outlets could make matters worse.

"Helplessness is a bad thing for someone who has no control over their lives other than the ability to leave it," he said.

It doesn't help that Oregon Gov. Kate Brown and local elected officials' direction for people to stay home, while necessary to slow the spread of COVID-19, is also likely distancing vulnerable people from family, friends, and other social interactions.

"If you isolate someone and they're only consuming media outlets or websites that are giving them really concerning, hopeless information... without any external stimulus... that raises potential for that person to take action," said Freeman.

The United States has seen a considerate increase in firearm sales since the coronavirus began spreading across the country. First-time gun owners have said they're concerned about looting and break-ins at their businesses and homes, and want to be prepared for the uncertain future. To Freeman, those numbers mean more people are able to access a weapon that could end their life.

"The person buying the gun might just want it to protect themself and their family," he said. "But for another person who lives in their household, it means increased access to take action. It could be a co-factor."

Portland's uptick in suicide-related 911 calls has begun to be reflected in calls to local mental health crisis lines.

"My clinicians are telling me that on almost every call somebody mentions COVID-19," said Greg Border, the crisis line director for Lines for Life, a nonprofit that operates several phone lines for people in mental health crises across the Portland metro region. "It’s at least in the background of what's going on, if not the core reason they're in crisis."

Border, who oversees Lines for Life's 115 operators, says it's not unusual for calls to increase—especially from people who don't normally have mental health issues—during an economic downturn. But what makes this current uptick stand out is the breadth of stressors the COVID-19 pandemic has unleashed.

"There’s so many unknown questions right now," Border said. "The calls are coming from people who are worried about their health, worried about being isolated, worried about [their] financial situation, worried about their own employment, worried about their retirement. It spans everything you can think of."

Those worries also exist within Border's own office. Usually, Lines for Life staff are taking calls from a central office, where clinicians can support each other in person during and after challenging calls. Now, the majority of operators are working remotely from their homes.

"That means we have to be creative to keep that team mentality going," said Border. "We need to work harder to know when a clinician is on tough crisis call, so we can have someone check in on them."

But the crisis has not impacted their ability to keep the 24/7 crisis line running, nor has it forced them to reduce staff size. Border said that while he's "certain" that his clinicians' call volume will increase, it won't impact Lines for Life's ability to serve the public.

"If you’re feeling isolated, we want you to call us," he said. "If you’re somebody who’s not feeling isolated, go through the contacts on your phone and reach out to people who might be. It could save their life."

The region's other crisis call center, run by Multnomah County, says it's hard to tell how COVID-19 is impacting their call load. That's because it's common for the crisis line to already be overloaded with calls this time of year. Leticia Sainz, interim deputy director for the county's behavioral health division, says the call center has been receiving an average of 200 calls per day for a few weeks.

"For whatever reason, springtime has always been a pretty tough time for folks with mental health challenges, so we are already are getting an average of 200 calls a day," said Sainz.

Sainz said she's prepared for the calls to increase in the weeks to come.

"It seems like years since this crisis began, but it’s really only been maybe two weeks," she said. "There’s still so much to come with this specific incident. I think with [Gov. Brown's] stay-at-home order, we're going to see people needing more and more support from us."

Portland mental health providers are hoping to address their patients' increased instability before it turns into an emergency. At Cascadia Behavioral Healthcare, a nonprofit that offers mental health services and addiction recovery support for low-income populations, staff have been directed to reach out to clients whose mental health may be critically worsened by the COVID-19 crisis.

"We're tying to be proactive about this, rather than just waiting for them to reach out to us or emergency services when they're in crisis," said Dr. Jeffrey Eisen, Cascadia's chief medical officer. Like other clinicians, Eisen is concerned how increased isolation will hurt clients with depression, anxiety, or mental illnesses.

While Cascadia's emergency mental health walk-in clinic remains open, Eisen said all medical facilities are leaning more on video or telephone appointments with clients, so as to prevent the potential spread of the coronavirus. But not everyone has reliable access to wifi or a phone.

"We are concerned about individuals who don't have the technology to connect... especially those who don’t have homes," said Eisen. He said Cascadia's street and housing outreach teams have been visiting houseless camps and low-income housing units to check in on folks in person, at a safe distance.

"These are the most vulnerable in our community right now," said Eisen. "We have to make sure they're not forgotten."

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Are you or someone you know in crisis or just in need of extra support during this time? Rely on these excellent local resources:

Call Multnomah County Crisis Line: (503) 988-4888
Call Lines for Life: (800) 273-8255
Don't want to call? Chat online with a counselor with the National Suicide Prevention Lifeline.
Check out Multnomah County's resources for coping with anxiety during COVID-19.
Set up an appointment with Cascadia Behavioral Health: (503) 674-7777
Visit Cascadia's Emergency Walk-In Clinic at 4212 SE Division, Suite 100. Currently open 7 days a week from 9 am to 9 pm.