Counseling Practice During Phases of a Pandemic Virus. Mark A. Stebnicki

typically do not have the capacity to respond to the grief, loss, and extraordinary stressful and/or traumatic events associated with a pandemic virus because they are too internally focused on their severely unhealthy thoughts, feelings, and cognitions. Persons at Level 4 consistently struggle with balancing the reality of a pandemic disaster with other life responsibilities. They cannot move forward because of life circumstances related to their severe medical, physical, and mental health conditions. Persons at Level 4 also have academic, job, career, relational, financial, and other hardships that may be beyond their control. Their overall mental and physical well-being is severely compromised by their inability to cope with adversity. Persons at Level 4 find very little meaning in their existence and find it difficult to gain relief during phases of a pandemic disaster. Some individuals at Level 4 exhibit suicidal ideation. Adjustment and adaptation to the overall effects of a pandemic virus are poor because they do not recognize a path forward to achieve overall health and well-being. The mental, behavioral, psychosocial, and medical/physical health of the individual at Level 4 is demonstrated by the following.

Mental Health

      Person is at severe risk, with a poor degree of psychological adjustment when dealing with critical life events and major life stressors (e.g., job loss, the death of a family member, divorce, personal illness, injury, disease, disability). Person takes little therapeutic responsibility for any mental health symptoms and conditions. They demonstrate very little positive optimism and have a poor balance of mood, emotion, affect, and rational thinking. Person generally cannot handle daily life stressors and use coping and resiliency skills. Person transitions poorly through the phases of pandemic disaster and has very little ability to cultivate new meaning, personal growth, hardiness, and self-care.

Behavioral Health

      Person has severe problems maintaining good virus hygiene standards. They have very little awareness of the need for social distancing, stay-at-home orders, and other good virus hygiene habits. Person does not engage in regular exercise or recreational activities. Nutritional intake is poorly controlled because of financial inability and lack of knowledge in purchasing healthy food items. Person demonstrates unhealthy patterns of sleep and rest, has poor virus-related hygiene, and exhibits a severe inability to maintain overall daily functioning. Person is perceived by others to be poorly focused, motivated, and goal oriented. They are observed by others as not taking personal responsibility and struggle significantly more than Level 3 individuals. Person demonstrates extremely poor interpersonal communication skills and cannot sustain communication at adequate levels. Relationships are severely strained because of a lack of interpersonal communication skills. Person is not viewed by others as action oriented or a contributor. They have a narrowly defined environment in which they can exist or maintain a balance of medical, physical, mental, and behavioral health. Overall functioning in this area is considered poor.

      Psychosocial Health

      Person struggles considerably in a wide range of life areas, such as academics, job, career, and economic stability. Person exhibits poor social and familial connections. Person has a poor ability for self-motivation and does not engage in any organized activities such as social clubs, organizations, religious/spiritual life, and recreational activities. Person struggles considerably to maintain food, shelter, and clothing. This may be because of issues of systemic racism; low education; poor job skills; lack of ability to transfer skills to more highly skilled and better paying occupations; medical, physical, and/ or psychiatric disability; poor access to quality health care; inadequate or no transportation; or other sociocultural factors that hinder their ability to achieve optimal resiliency. A balance of home, work, academics, and social life is nonexistent. Person exhibits a severe level of risk to the adaptation and adjustment of a pandemic disaster. This is because of significant struggles personally, medically, physically, psychologically, behaviorally, financially, and occupationally. Person demonstrates severe adjustment difficulties in independent living, environmental functioning, and/or the overall ability to sustain any level of daily functioning.

      Medical/Physical Health

      Person goes through periods of exacerbation and remission due to medical, physical, and mental health conditions. Person is severely impaired in their ability to maintain personal responsibility for their medical, physical, behavioral, mental, and psychosocial health. This may be because of health disparities; poor access to quality health care; or other sociocultural factors that hinder their medical, physical, and mental health and overall wellness. They do not use support systems, resources, or technology to live life in optimal wellness. This is due in part to a lack of access to transportation, isolation in a rural geographic region, little or no health care benefits, and other issues related to health disparities.

Level 3 = Moderate Risk

      At Level 3, the person functions in the moderate range of mental, behavioral, and psychosocial health. The individual has very little recognition of and respect for the seriousness, lethality, and consequences of a pandemic virus. They are sometimes noncompliant with virus hygiene protocols such as wearing masks, washing hands, and keeping a safe social distance. They also do not endorse the use of vaccines. Individuals at Level 3 experience and exhibit moderate fear and anxiety in response to a pandemic disaster. However, this is directed solely toward their changing environment, which they only moderately understand, recognize, or feel they have control over. Individuals at Level 3 may or may not be triggered by specific events (e.g., media reporting of positive COVID-19 cases, COVID-related illnesses and deaths, school and workplace closures). They have a moderate lack of awareness of a pandemic disaster and how it could potentially adversely impact their present life. Clinically significant psychological/emotional symptoms and conditions are in the moderate range, and the person has chronic and persistent traits that create the exacerbation and remission of a mental health crisis on an occasional basis. The individual exhibits very few stress-hardy behaviors. The ability to bounce back from adversity is moderately impaired because of inadequate coping and resiliency skills. Individuals at Level 3 only somewhat endorse public health principles, practices, guidelines, and government mandates associated with a pandemic disaster. They view virus hygiene and adherence to public health guidelines in relation to the environment in which they live but generally view them as nonessential protection for themselves and others. Thus, persons at Level 3 take moderate virus hygiene risks in comparison to persons at Level 2. Individuals at Level 3 struggle with balance, adaptation, and adjustment in relation to their changing pandemic environment. They have little capacity to respond to the grief, loss, and extraordinary stressful and/or traumatic events associated with a pandemic virus because they are internally focused on their moderately unhealthy thoughts, feelings, and cognitions. Persons at Level 3 struggle moderately with balancing the reality of a pandemic disaster with other life responsibilities. They have moderate difficulties moving forward because of life circumstances related to their moderate medical, physical, and mental health conditions. Persons at Level 3 also have moderate difficulties in academic, job, career, relational, financial, and other essential life areas that may be beyond their control. Their overall mental and physical well-being is moderately compromised by their decreased ability to cope with adversity. Persons at Level 3 find very little meaning in their existence and find it difficult to gain relief during phases of a pandemic disaster. Some individuals at Level 3 exhibit suicidal ideation. Adjustment and adaptation to the overall effects of a pandemic virus are challenging because they have little awareness and recognition of the path forward to achieve overall health and well-being. The mental, behavioral, psychosocial, and medical/physical health of the individual at Level 3 is demonstrated by the following.

Mental Health

      Person is moderately impaired and has challenges with psychological adjustment when dealing with critical life events and major life stressors (e.g., job loss, the death of a family member, divorce, personal illness, injury, disease, disability). Person takes little therapeutic responsibility for their mental health symptoms and conditions. They demonstrate a decreased level of positive optimism and have challenges balancing mood, emotion, affect, and rational