Even before 2020 began, many Americans of all ages had mental health conditions and alcohol or drug issues that weren't getting the attention and care that they deserved.

Now, six months into the COVID-19 pandemic, three months into a major social justice movement, two months away from a national election and with school starting, hurricanes blowing, wildfires burning and the economy slumping, it's a fair bet that many more people are struggling with mental health concerns.

That's why Michigan Medicine assembled a panel of experts for a recent webinar to offer concrete steps that might help, and links to further resources for helping to manage overall well-being.

This recording has a wealth of tips, from breathing exercises to family activities to advice about the kinds of healthy lifestyle choices that can bolster mental health and keep alcohol use in check. The U-M Department of Psychiatry also offers a wide range of resources and helpful links in its COVID-19 Toolkit.

Expert tips for managing mental health and substance abuse concerns? 

• If you're feeling overly stressed, depressed, anxious or concerned about your alcohol use – or someone close to you is showing such signs – you don't have to start with a specialist. In fact, primary care providers such as family doctors, general internists, pediatricians and primary care nurse practitioners, are trained to handle many mental health symptoms, says Jill Schneiderhan, M.D., a U-M family medicine doctor and mental wellness specialist.
  
  So just as you would start by contacting them for a new physical symptom, don't be afraid to contact them about changes to your mental health and substance use. That includes a persistent low mood, finding things less enjoyable, and anxious thoughts that intrude on your everyday life.

• Several of the experts focused on the things you can do to improve your mental state, including more regular bed times and wake times, cutting out screen use in bed, keeping up social connections even if it's via video chat or phone calls, eating a healthy diet, getting regular physical activity, engaging in a hobby, spending time outside, and engaging with art and music.

• Elizabeth Duval, Ph.D., a clinical psychologist in the U-M Department of Psychiatry, offers some specific breathing exercises and mindfulness activities that anyone of any age can do, almost anywhere.

For example, try these simple breathing exercises and mindfulness activities: 

• Box breathing: Breathe in for a few seconds, hold for a few seconds, breathe out for a few seconds, and hold for a few seconds before breathing in again.

• Try the 54321 exercise: Sitting or standing wherever you are, take a moment to notice and name out loud or to yourself five things you can see right now, four things you can touch, three things you can hear, two things you can smell and one thing you can taste.

• When talking with someone, say what you are feeling inside. Just speaking it out loud can actually help defuse the feeling itself

If you're a parent, keep in mind that your children are noticing and reacting to the way you're handling these times, says Polly Gipson, Ph.D., a clinical psychologist who heads U-M's Trauma and Grief Clinic. That's especially true if your family has lost someone to COVID-19, or you belong to a group or live in an area that's being especially affected by current events.

But you can be a model to them by engaging in healthy mental wellbeing self-care – and finding ways to focus on positive memories, things to be grateful for, family togetherness because of the lack of scheduled activities, and more. She recommends the CALM method: Communicate with the child to share information, find out what they know and validate their feelings; help them stay Active and creative; Learn how children in general, or your child in particular, show distress; and Model self-care by using positive strategies and sharing them with children.

Children's future mental health depends in part on how they're affected by adverse experiences now, both their own and those that their larger community is going through. If you notice troubling behavior in the children in your life, speaking up to get help can make a major difference.

Alcohol and cannabis sales have shot up during the past six months, and jokes about drinking or using marijuana-derived products to cope with these times are rampant on social media. This is typical during stressful times, says Mark Ilgen, Ph.D., the addiction psychologist who directs the U-M Addiction Treatment Services. But he warns that as time goes on, what was once a short-term coping mechanism could develop into a substance-use problem.

Fortunately, he says, support groups, twelve-step groups and addiction care specialists have pivoted to offer online help. And newer medications can help people who have developed a dependence on alcohol, opioids and more. If you're not sure you need this level of help, he notes that many people can cut back on their substance use on their own, by setting targets for themselves including limits on daily or weekly alcohol or cannabis intake. If you find you can't stay within these self-imposed limits, that's a time to seek help. Find more information on the U-M Addiction Treatment Services' COVID-19 Addiction & Recovery Resources page.

Above all else, the experts note, if you or someone you're in contact with have been feeling hopeless or even suicidal, it's crucial to get help. Don't shy away from discussing the topic, and get in touch with a primary care provider if it's not an urgent situation. For urgent or life-threatening situations, contact the National Suicide Prevention hotline at 800-273-8255 or call 911.