The emails and phone calls that come into therapist Jonathan Caspi's practice in Montclair and Hazlet are often from families on the brink of combustion, largely propelled by the COVID-19 pandemic now closing in on two weary years.
And all Caspi can do at this point is politely decline to take them on. His practice has been at capacity for months.
"I used to refer them to other therapists, but they’re all full, too," he said.
New Jersey's mental health system has been stretched so thin over the course of the pandemic that getting help is a months-long wait for many.
For almost two years, most mental health counselors have been inundated with increased caseloads by people suffering from depression, anxiety and a host of other ailments brought on or exacerbated by the pandemic.
Now the new, highly contagious omicron variant is causing further problems. As has been seen in other health care settings, omicron has begun to deplete some mental health professionals who were still giving in-person counseling.
Those seeking help in New Jersey are seeing a 30- to 60-day wait for a private practice counselor — if they can get in at all — and a three- to five-month wait to see an agency therapist, said Jennifer Thompson, executive director of the National Association of Social Workers' New Jersey chapter.
"Everywhere you turn, everyone is at capacity," she said. "We're in a crisis situation. There are a lot of people seeking help who can't get it when they need it the most."
Unlike so many other providers, an addiction center in Camden County has seen its roster of clients decrease during the pandemic for many reasons — including one no counselor wants to see.
"We're seeing a lot of relapse, and those people aren't coming in anymore," said Ashley Roselli, director of substance abuse at Delaware Valley Medical in Pennsauken. "We’re fighting an epidemic in a pandemic."
Statistics are still being compiled for November and December, but New Jersey was on track to record 3,200 overdose deaths last year — the most since the state started keeping track in 2012, despite having a lower rate than other states.
Throughout much of the pandemic, the staff at Delaware Valley Medical has maintained in-person counseling at about 80%. Their patients run the socioeconomic gamut, but many are poor or homeless and do not have regular access to a phone or computer.
While the center has been able to keep its staff protected for much of the pandemic, the highly contagious omicron variant has changed that.
The center, with a staff of 40, is seeing seven to 10 employees out each week, Roselli said. Staff members are out for a minimum of five days if they are asymptomatic, based on new guidelines issued late last month from the federal Centers for Disease Control and Prevention.
Counselors are filling in for their infected co-workers and working extra hours, but it's taking a toll.
"It adds another layer of chaos that we have to deal with," Roselli said. "The thing that gives us hope is seeing our clients working so hard to maintain their recovery. That keeps our spirits up."
Omicron has also ensured that remote treatment through videoconferences is not going away — a drawback for many seeking help.
"Every time we think of going back to in-person, we have these surges," said Nancy Graham, a social worker and executive at the Renfrew Center, an eating disorder clinic with locations in several states.
Renfrew's Paramus clinic has been doing only virtual treatment since the pandemic began. There are some benefits such as giving access to people who don't live near a provider and a decrease in absenteeism. A survey by Renfrew showed high levels of satisfaction among its patients for virtual counseling.
But there are limitations.
Video counseling makes it difficult to assess non-verbal cues such as body language. Group therapy can also be challenging because it can be hard to maintain everyone's attention with tiles on a screen as opposed to sitting in the same room together. In the case of eating disorders, a lot of counseling is done during mealtimes, when in-person supervision is important.
And then there is the worst-case scenario. Renfrew has checks in place if someone appears to be suicidal during a remote session, but it is a much easier situation to deal with when a if the patient is sitting in front of a therapist.
"When they are with us, and we think they’re suicidal or want to do self-harm, we can get them help immediately," Graham said. "That can be tricky now. If they disappear from the screen, and we think they’re suicidal, we have to have someone nearby that we can call to make sure they’re safe."
Another problem has been getting new social workers and counselors licensed, which has helped cause a significant delay for those seeking help.
Normally it would take the State Board of Social Work Examiners three months to approve a "perfect" application, which includes criminal background checks, college transcripts, examinations and more.
That ballooned to a six-month to nearly two-year wait during the worst of the pandemic, said Thompson, head of the 7,000-member social workers group.
"We still have people waiting from early in the pandemic," she said.
Most state workers have been forced to work from home for more than a year, including those with the Division of Consumer Affairs' licensing boards who evaluate applications. Phones were rarely answered and emails went unanswered, Thompson said.
Gema de las Heras, a spokeswoman for the division, said steps such as upgrading online application systems and reassigning staff to process applications resulted in 2,250 licenses issued in 2021, the most ever in one year, although she did not say how many were still awaiting a decision. The board has issued temporary emergency licenses to 3,400 out-of-state social workers to help bolster the state's mental health capabilities, de las Heras said.
Although the slow return to the office has helped with some of the backlog, Thompson said, New Jersey is still much slower than other states, which are issuing licenses in 30 days.
"They are processing some in three months, but those with issues are taking up to 12 to 18 months," Thompson said. "One thing that’s a challenge is that people who are reaching out for help get one piece of an answer and no follow-up, so they sit in limbo for months or until they show up at a board meeting and speak in public."
Caspi has never seen the demand for his services so high.
An author and longtime professor of family and child studies at Montclair State University, Caspi has maintained a small private practice focusing on family, couples and singles therapy. But he hasn't taken on a new patient in months.
“Sometimes the phone calls or emails are heartbreaking,” he said. “I don’t want to take them if I can’t devote the time needed to help them.”
He has made one exception: taking on former patients who requested his help during the pandemic.
Job stress and overall anxiety are cascading from adults to children, he said. Bickering that was once occasional and annoying has become frequent and intolerable. More people are retreating to their smartphones and other devices in lieu of real human contact. Feelings of intense isolation are strong among older singles — especially widows and divorcees.
The duration of the pandemic and its roller-coaster ways — a decline in COVID numbers followed by dispiriting surges — has added to the problems.
“They get hopeful that it’s going to get good, and then the rug is pulled out and there is anger,” Caspi said. “It’s sapping people's endurance.”
There are mental health providers and specialists throughout New Jersey. Here are some statewide resources and hotlines.
General mental health and emotional support