By Dr. Marcy Adelman. This article originally appeared in the San Francisco Bay Times.

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The COVID-19 crisis, and with it the need to shelter in place, have exposed gaps in San Francisco’s services for seniors and LGBTQ seniors in particular.

The city has long established partnerships with community nonprofits with whom they have a successful track record for delivering in-person health and wellness services and programs and peer support groups that reduce social isolation and increase opportunities for program participants to engage, connect, and volunteer in their communities. For people who are not comfortable with in-person experiences, the Institute on Aging provides a phone service for older adults who need someone to listen to their concerns. All of these programs create a robust and effective safety net of services for San Francisco’s older adults.

But one important piece is missing: one-on-one counseling programs for seniors experiencing severe levels of distress.

A typical scenario goes as follows: After a care manager refers a senior for counseling, the senior’s name is typically placed on a waiting list, sometimes with as much as a two- or three-months wait. At times, the senior is lucky, and is referred to a counselor who may not understand their history or their culture. And other times, the senior in crisis does not trust working with someone outside of their network of providers.

A San Francisco Department of Disability and Aging Needs Assessment report (2018) noted that Japanese, Korean and LGBTQ seniors identified mental health services as an unmet need. Jesus Guillen, founder of HIV LONG TERM SURVIVORS, the largest national HIV long term survivor (LTS) network, wrote in a pre-crisis email, “My biggest concern is mental health. In communities with many members who experience PTSD, anxiety, and depression, like the HIV LONG TERM SURVIVORS group, there is a great need for mental health services. There is so much pain and nowhere to turn to for help. Many HIV LTS are isolated. They rarely leave their home and experience extreme fatigue and physical pain, as I do myself. One of the solutions to keep people alive and connected could be telemedicine.”

In the time of the pandemic, city services were quickly shifted from in-person to phone and internet services.

A large percentage of San Francisco’s older adult population live alone. Seniors who live alone are at greater risk for isolation and increased risk of depression and physical health problems. The majority of LGBTQ seniors who participate in city services (61%) live alone compared to 39% in the overall senior client population, and 69% percent of LGBT adults with disabilities (age 18–59) live alone, compared to 53%.

Calls to the suicide prevention hot line have dramatically increased. As senior centers, senior programs, and congregate food sites shut down in response to shelter in place, senior serving organizations pivoted to proactively reaching out to program participants to see if they were ok and what they might need. Concerns about not having enough food and groceries quickly emerged as the number one concern.

Seniors die earlier than they should because of isolation. It doesn’t have to be that way. Congregate meal sites are an important part of reducing isolation for these seniors. Toby Short of Curry Senior Center wrote, “Curry’s dining room is Project Open Hand’s largest congregate meal site, and pre-COVID-19, served hot breakfast and lunch every day of the year. It gives older adults a place to socialize. Many of our clients are homeless or live in SROs and most of them don’t have a way to store food. The staff at Curry are making between 500 and 600 calls each week to connect with and check in on our seniors, but there are still many without a phone or internet. Some of the seniors we speak to are saying they are scared, lonely, and worried. This pandemic has shined a spotlight on food insecurity in the older adult population and the trauma they’re experiencing is manifesting deeply problematic mental health concerns.”

Karyn Skultety, the Executive Director of Openhouse, which serves 3200 LGBTQ seniors citywide, reported, “In the first two weeks of shelter in place we proactively made over 1000 calls and have continued our staff focus on providing ongoing telephone support. In the first two weeks, most community members were requesting calls weekly or less often, but as the weeks have gone on people are requesting more frequent calls, sometimes daily check-ins. Our staff is hearing a lot about loneliness/isolation, increased overall anxiety and fear, and, for those with a previous history of depression, they are finding it difficult to use the coping skills they have used in the past. We are also working closely with the community and have volunteers and staff delivering groceries or connecting people to Meals on Wheels and other food providers. We have started offering and will be expanding virtual programming, but we know that people will continue to feel isolated and may not be able to access programs that require access to technology.”

Guillen echoed many of Skultety’s concerns.

“According to a correspondence from the San Francisco Department of Public Health, there are 2711 persons diagnosed with HIV/AIDS before 1996 who are alive and reside in San Francisco, he shared. “The triggers that many of the HIV LONG TERM SURVIVORS are experiencing right now are very intense and extremely difficult from the physical distancing, lockdown, and people not even wanting to breathe in the same room, as it happened in our past, where people didn’t even use the same bathrooms, not only if they knew we were HIV positive, but even if we were suspected to be gay. Society does not want to touch us for fear of becoming ill, so many now fear they will die in this epidemic. For others, it feels that we went through a training for the apocalypse, that we were some kind of ‘advance guard’ receiving important lessons in plague survival which now can be shared.”

In these extraordinary times, an increased feeling of distress is a normal reaction to a world challenged by a pandemic with as yet no cure and an imposed social isolation with an uncertain end date. Studies have found that a mild psychological response to the pandemic can include blue moods, sadness, irritability, and insomnia. But seniors with pre-COVID-19 crisis histories of anxiety, depression, and post-traumatic stress disorder find themselves having a harder time managing imposed isolation and more severe responses to the pandemic.

But where can we refer San Francisco’s diverse population of seniors who are in need of counseling? Where can LGBTQ seniors, LGBTQ adults with disabilities, and HIV long term survivors find counseling in the time of the pandemic? Now is the time to close the gap on mental health services by providing culturally competent counseling for all seniors.

Dr. Marcy Adelman, a psychologist and LGBTQ+ longevity advocate and policy adviser, oversees the Aging in Community column. She serves on the California Commission on Aging, the Governor’s Alzheimer’s Prevention and Preparedness Task Force, the Board of the Alzheimer’s Association of Northern California, and the San Francisco Dignity Fund Oversight and Advisory Committee. She is the Co-Founder of Openhouse, the only San Francisco nonprofit exclusively focused on the health and well-being of LGBTQ+ older adults.

The opinions expressed in this article are those of the author and do not necessarily reflect those of the Diverse Elders Coalition.