Throughout my long career as a psychologist, issues of emotional and mental health always have taken a back seat to medical issues until it is impossible to ignore them. For example, in my work with NFL players with possible chronic traumatic encephalopathy (CTE) stemming from repeated concussions, the focus was on cognitive issues, i.e. concentration, memory, learning, etc. However, the hidden problems most often were in the areas of emotional and mental health. So many of the players suffered from anxiety and depression along with other challenges. Now we continue in the era of the COVID-19 pandemic. Many front line medical staff daily face herculean challenges in performing their work while being concerned about their own health and that of their families. In a recent article in the Los Angeles Times dated 2/3/21 titled “Health Workers Anguish” by Soumya Carlamangla, the author reviewed the increasing psychological distress experienced by frontline medical workers. She noted the rise of the new ritual born of the pandemic: death by Face Time. In this ritual, families are allowed access mostly by Zoom to seeing their dying relative as they are not allowed into the room. I myself went through this ritual three weeks ago as our niece’s 63 year-old beloved husband expired from COVID-19 as 15 of us were on the Zoom call offering words of remembrance and comfort to one another and to her. Medical workers are going through this on a daily basis. The Times author noted various stories of the emotional trauma, exhaustion, and despair experienced by the medical workers. There are indications of likely higher rates of burnout in these workers as well as ongoing anxiety, depression, and post traumatic stress disorder. As was noted in the article, experts in trauma have stated that we have no way currently of estimating the incidence of these traumatic emotional effects as most models of disaster assume a much shorter time line than is occurring in this pandemic. As stated, burnout always has been a risk for frontline medical workers but likely will be seen more often now and in the future. Symptoms of burnout include:
Sense of failure and self-doubt.
Feeling helpless, trapped, and defeated.
Detachment, feeling alone in the world.
Loss of motivation.
Increasingly cynical and negative outlook.
Decreased satisfaction and sense of accomplishment.
Activities you used to enjoy are no fun any more.
It is known that supporting workers with mental health services is not only an ethical obligation for employers, it’s also a bottom-line issue. More than 60% of workers say their mental health affects their productivity, according to a survey by Mind Share Partners, a nonprofit that works with companies to improve mental health resources. Also, in 2019 the World Health Organization estimated that depression and anxiety cost the global economy $1 trillion per year in lost productivity. Given the emotional toll of the pandemic, that price likely will be much higher this year.
Front line medical staff are suffering from mental health issues. How do we know this? Some information we have comes from studies of the medical staff in China, who already have gone through such challenges. In one survey of 1,257 physicians and nurses during the height of the COVID-19 pandemic in China, it was found that about 50 percent of respondents reported symptoms of depression, 44 percent reported symptoms of anxiety and 34 percent reported insomnia. Medical professionals are already at risk for many of these conditions at baseline—medical occupations have among the highest rates of suicide—yet it has been noted that physicians typically are unlikely to seek help.. Most are just so busy that they do not have the time or flexibility to go see a therapist. However, there also remains a stigma still attached to psychological problems leading many to defer or decline psychological treatment.
Given these problems, what can be done to structure more responsive interventions and means of assistance to frontline medical staff? This was a challenge faced by the Second Xiangya Hospital, a facility in Wuhan, China last year. They too found that medical staff were reluctant to access group and individual psychological interventions. In fact, it was observed that individual nurses showed excitability, irritability, unwillingness to rest, and signs of psychological distress, but refused any psychological help stating that they did not have any problems. Rather, many staff worried more about families, difficult patients, and lack of protective equipment and their own feelings of incapability when faced with critically ill patients. Many staff mentioned that they did not need a psychologist, but needed more rest without interruption and enough protective supplies. Finally, they suggested training on psychological skills to deal with patients' anxiety, panic, and other emotional problems and, if possible, for mental health staff to be on hand to directly help these patients. Therefore, different interventions were offered. These included the hospital providing a place for rest where staff could temporarily isolate themselves from their family. This strategy is being used now in some hospitals in the United States. The hospital also guaranteed food and daily living supplies, and helped staff to video record their routines in the hospital to share with their families and alleviate family members' concerns. Second, training was arranged to address identification of and responses to psychological problems in patients with COVID-19. Third, the hospital developed detailed rules on the use and management of protective equipment to reduce worry. Fourth, leisure activities and training on how to relax were properly arranged to help staff reduce stress. Finally, psychological counselors regularly visited the rest area to listen to difficulties or stories encountered by staff at work, and provide support accordingly. They found that these interventions were well received and staff reported lessened worry and stress. It is worth noting that in the earlier referenced Times article that at Harbor-UCLA Medical Center a psychologist has been offering therapy sessions to medical providers to process their grief and feelings of distress.
To support health care workers, experts need to intervene to help protect their mental health, not just their physical health. This was done in China as we have seen above and we should follow their lead. Some universities, like University of North Carolina Chapel Hill and the University of California, San Francisco, have been leaders in this effort, deploying their psychiatric workforce as volunteers. As has been noted, that appears to be occurring in more medical settings now in this country. What is needed are approaches that are comprehensive and multifaceted. There is a need for preventive measures (stress reduction, mindfulness, and educational materials), in-the-moment measures (hotlines, crisis support), and treatment (telepsychiatry for therapy, and medication if needed). For additional information about stress, please see our book (I Can’t Take It Anymore: How to Manage Stress so It Doesn’t Manage You; Paul G. Longobardi, Ph.D., and Janice B. Longobardi, R.N., B.S.N., P.H.N.), available on Amazon at https://www.amazon.com/dp/1542458056. For additional information about the book, authors and stress, please see our website at www.manageyourhealthandstress.com. Such interventions acknowledge that mental health treatment is not just something that happens urgently or in crisis, but rather is something that needs to continue and be available long into the future. When all the cheering of frontline medical staff diminishes, there likely will be an increase in mental health conditions to include anxiety, depression, and post traumatic stress disorder. This is our professional and societal challenge.
Good luck to all on our collective journey to wellness.
Dr. Paul Longobardi
For information about these and related topics, please see my website at www.successandmindset.com