For grocery store and pharmacy workers across the U.S., stocking shelves and checking out customers have become anxiety-inducing tasks. Each commute and customer interaction comes with the risk of exposure to the coronavirus. And returning home means a chance of transmitting a potentially deadly illness to a spouse or family member.
Thousands of grocery and retail workers have gotten sick from Covid-19. Some have died.
Major retailers, psychologists and the nation's top grocery worker union say they anticipate a greater need for mental health services, such as therapy, as people continue to work during the pandemic and later cope with its aftermath. Anxiety, depression and other mental health challenges may linger, even as coronavirus cases level out or decline — especially for those on the front lines.
Some retailers, such as Walgreens and Walmart, say they're encouraging workers to use company-provided benefits, such as teletherapy and referring them to digital tools that offer stress relief strategies, mediation exercises and peer support.
In some hard-hit parts of the country, government officials are urging the public to seek out mental health services, too. In New York, for example, Gov. Andrew Cuomo said thousands of mental health professionals have volunteered to provide free and confidential support through a new hotline and residents can use Headspace, a meditation and mindfulness app. New Jersey has launched a similar hotline.
"We cannot overlook the mental health impacts this pandemic is having on all of us," said New Jersey's health commissioner Judy Persichilli, at a news conference Thursday. She said some Americans are out of work, far from those they love and anxious as they risk exposure during essential work — which creates new worries.
"While we fight hard to protect your physical health, let's be sure to focus just as intently on our mental health and mental well-being," she said.
Vaile Wright, director of clinical research and quality for the American Psychological Association, said hourly retail jobs typically come with stresses like low wages, long hours on your feet and numerous customer interactions.
"Working these jobs is stressful under normal circumstances," she said. "Then, you add the current situation, which is they are knowingly putting themselves at risk of exposure and have been deemed an essential worker, but I imagine don't feel like they're being paid as an essential worker. So you have this almost disconnect, too, where you're being asked to do this extraordinary thing."
Wright said she hopes the pandemic inspires more employers to expand access to therapy by phone or video, which she said is "just as effective as face to face." She said the approach eliminates some of the barriers such as availability in rural areas, concerns about anonymity or problems getting child care or transportation to go to a session.
"Employers have a lot of power," Wright said. "They're negotiating huge, huge packages with these insurers and that's something they need to advocate for."
On a phone call Monday, grocery workers from across the country who belong to the United Food and Commercial Workers International Union shared their worries of catching the coronavirus or bringing it home to their families. The workers said those fears have been exacerbated by customers who don't wear masks, especially as they see their friends and co-workers get sick.
As of Monday, 30 people who belong to the union, which represents 1.3 million workers at grocery chains, meatpacking plants and more, have died from Covid-19. About 3,000 have been directly affected by the virus, such as through infection, hospitalization or quarantine because of symptoms.
That doesn't include deaths of employees at nonunion companies, such as Walmart and Amazon-owned Whole Foods. Two Walmart workers at a store in the Chicago area died, and the family of one of them has filed a wrongful death lawsuit.
Walmart said in a statement that it's "heartbroken" by the employees' deaths and "mourning along with their families." The retailer said it's added numerous safety measures, such as providing masks to employees and taking their temperatures.
Some grocery workers are already struggling, said Marc Perrone, president of the UFCW. He's spoken to employees who can't sleep. Others said they feel stressed or burned out.
Perrone said he's waking up in the middle of the night and having pandemic-related dreams, even without working at a store each day. He said that the union is considering whether to have a town hall to discuss mental health with workers and gauge whether workers have the resources and support that they need.
"It's going to be a combination of stress over time that's going to get to people," he said.
While doctors, nurses and other health-care workers face even more challenging circumstances as they care for sick and dying patients, grocery workers face unique hardships, he said. Many live in multigenerational households where the stakes of catching and spreading the coronavirus are higher. And the hourly workers do not have the training, higher pay and protective gear that usually comes with hazardous or life-or-death jobs, he said.
Unlike a nurse or doctor, he said hourly workers may not have the same level of awareness and may resist seeking help.
"There's a certain stigma that's sometimes attached that shouldn't be," he said. "That's a challenge, for sure."
Nearly 1 in 5 U.S. adults live with a mental illness, according to the National Institute of Mental Health. There are wide disparities in access to mental health care, however, and cost is the most commonly reported barrier, according to research by the Substance Abuse and Mental Health Services Administration.
Lack of health insurance or the cost of deductibles and copayments for those who do have insurance can dissuade lower-income families from seeking out the care. Use of the services is lower for blacks, Asians and Hispanics, too, and care can be out of reach for those who live in small towns or rural areas with few licensed professionals.
Perrone said some companies have acknowledged the importance of their workers or referred to them as "heroes" to express appreciation or retain the workforce during a surge in demand. But he said he wonders how that will be weeks or months from now, when there are "serious conversations about what people are going to need going forward."
He said the needs will be greater, if there's a second round of the coronavirus in the fall or winter.
"People are pretty resilient as long as they see a light at the end of the tunnel," he said. "If they can't see a light at the end of the tunnel, that's when I think that people kind of break a little bit."
The APA's Wright said everyone deals with stress, such as when they take a test or interview for a job. With the pandemic, however, some hourly workers have faced stressful or frightening situations day after day. That not only can cause mental health problems, such as depression. It can also lead to physical ailments, such as high blood pressure, muscle tension and cardiovascular disease.
"It's this buildup of chronic stress over time that's problematic," she said.
Over the past few years, Walgreens has championed mental health because of its role as a community pharmacy and the number of related prescriptions it dispenses, said Kristin Oliver, chief human resources officer at Walgreens.
The retailer began offering Mental Health First Aid, which was developed by the National Council for Behavioral Health. The mental health literacy program has taught hundreds of its pharmacists and human resources employees to recognize risk factors and warning signs, so they can guide others toward help.
"It's one of those areas that gets less attention than other areas of concern," Oliver said. "We saw an opportunity to raise awareness and champion this in a more unique way than a lot of other pharmacies were."
Oliver said employees get five free hours of counseling and can access teletherapy with a licensed therapist. During the pandemic, the company has encouraged employees to try a new tool, too: Sanvello, a clinically based mental health app.
Walmart provides three free counseling sessions to its part-time and full-time employees through its employee assistance program, said Adam Stavisky, Walmart's senior vice president of U.S. benefits. It also offers Doctor On Demand, a telehealth provider to those who have benefits through Walmart.
"The telehealth utilization is going up stratospherically," he said. Within that, it's seen a "tremendous upsurge" in use of counseling, he said, adding that the company is pleased to see employees "avail themselves of the resources we have."
During the pandemic, the retailer has waived its $4 copay for telehealth visits, including those for behavioral health, he said. It also has digital tools that encourage resiliency and provide peer support.
"Our goal is to continue to support our associates as best we can," he said. "They are literally stocking the shelves for America."
Supportiv provides anonymous, peer-support services through a website to help people cope with common stressors. The San Francisco Bay Area-based start-up has seen an up to 400% increase of its web-based peer support chats, co-founder and CEO Helena Plater-Zyberk said.
Most customers sign up on their own, but the company also has contracts with large employers, including Walmart. In early March, Supportiv began offering free service to health-care workers.
Users answer the question: "What's your struggle?" and the service matches them with live chats centered around a related topic. In the chat, a moderator with a background in mental health guides the conversation and shares links to resources, such as articles, podcasts or meditations that may be helpful.
Prior to the pandemic, Plater-Zyberk said the start-up had a 22% month-over-month growth rate. Starting the last week of February, she said it saw a huge jump in use. Each day, she said about 9,000 people use the website versus the approximately 1,500 who used it before the pandemic. She said Supportiv is seeing people who used to visit three times a month now use the website three times per day.
Relationship troubles, loneliness and depression were the top reasons why people turned to Supportiv before the pandemic, she said. Now, Plater-Zyberk said anxiety is the No. 1 concern, followed by loneliness and stress caused by finances, family challenges or health concerns.
Supportiv has seen more people turn to the website to sort through major life decisions, such as satisfaction with jobs or marriages, Plater-Zyberk said. She said people are asking themselves: "Do I need to make substantial changes in my life choices when we get out of this?"
Plater-Zyberk said it offered additional training for moderators on grief, added new resources for parents who feel stressed and revamped recommendations to make them appropriate during the pandemic, such as suggesting activities or coping strategies that can be done indoors or without company of others.
She said she anticipates that need to continue, and even grow, as people try to return to their old lives and old offices.
"The last vestiges of stigma around asking for help are going to dissipate," she said. "This is now a universal experience to have felt anxiety."
But, Plater-Zyberk said, it will challenge a mental health system that already had a shortage of trained clinicians and lead to new approaches.
Instead of using licensed clinicians, it uses psychology graduate and undergraduate students to facilitate the chats and charges fees of $9.99 an hour or $19.99 per month. She said the website-based approach is a lower price point — aiming to make care more readily available for people who may not have the means or the time for therapy.
"These aren't folks who typically raise their hand," she said. "They have very legitimate mental health challenges, but the health-care system isn't welcoming to them."