By Heidi Godman, Contributor
ON A RECENT FRIDAY afternoon, while much of the Mount Sinai Health System staff was focusing on patients with COVID-19, the illness caused by the coronavirus, Dr. Dennis Charney was thinking about the mental health crisis threatening his colleagues. “Mount Sinai has been the epicenter of the epicenter. We know what the experience is like dealing with the this terrible virus and death and we’re hearing lots of stories of stress from our staff. We predict that the rate of post traumatic stress disorder could be very high, up to 25%,” says Charney, a psychiatrist and dean of Mount Sinai’s Icahn School of Medicine.
Similar concerns are gripping hospitals around the country and the world.
What They’re Facing
Even though health care workers are trained to perform under stress, nothing has prepared them for the waves of people with COVID-19. “Imagine working in the ICU during the peak and patients are coming in like a tsunami, very sick, and no visitors are allowed, so no family for support,” Charney says. “It’s you and the patient. You’re wearing protective gear that inhibits face-to-face support, patients are dying, you’re there and it’s happening multiple times a day. That’s the stress and you develop memories of that, and they stay with you.”
The effects radiate beyond hospitals, with some health care workers practicing additional germ prevention strategies or a self-imposed quarantine to improve their loved ones’ safety.
“Some ER doctors I work with strip in the garage when they get home and immediately shower. Other health care workers are not even going home at all, instead opting to stay in hotels for fear of infecting their families,” says psychologist Moe Gelbart, who provides counseling to health care workers at Torrance Memorial Medical Center in Torrance, California.
“Then there’s the anger and alienation at the general public, who are not taking this seriously enough, not wearing masks appropriately, which will ultimately prolong this and bring more people into hospitals, putting the health care providers’ lives further at risk,” says Dr. Paul Puri, a psychiatrist and assistant clinical professor at the UCLA department of psychiatry.
The overall result: “Anxiety, fear of the unknown, anger at the lack of supplies and support, feelings of lack of control and questioning of their competence,” Gelbart says.
Tips to Cope
To avoid a personal mental health crisis, consider the following steps.
- Breathe deeply. “Try to give yourself a quick break between patients to take three conscious breaths: Breathe deeply into your belly and slowly exhale. The simple act of taking a few conscious breaths like this can calm your sympathetic nervous system – that fight-or-flight response. Slow exhales also activate the vagus nerve, which can turn on parasympathetic activity, which is our rest and digest system,” says Laurie Santos, professor of psychology at Yale University who teaches the Science of Well Being.
- Get support from loved ones. “The frontliners are heroes, but a lot of times they don’t feel that way, especially if someone died under their care,” Charney says. “By sharing with friends and family, you get good feedback on how well you’re actually doing and saving lives instead of focusing on the negative.”
- Limit social media and news exposure. “We conducted a study in China that found that the more social media people consumed, the more stress they reported. We also found that when people had access to accurate information in small amounts, they had less depression and anxiety. So we recommend portion control of information and to use high-quality media sites,” advises Dr. Roger McIntyre, a psychiatrist and medical professor at the University of Toronto.
- Let some things go. “It is very unrealistic during the pandemic to assume that you’re going to ‘eat problems for breakfast’ in the way that you usually might. You’re going to have really hard days emotionally, and the key here is to give yourself grace and extend kindness,” says psychologist Jim Jackson, director of Psychological Services at the ICU Recovery Center at Vanderbilt University Medical Center.
- Make self-care a priority. “When not on the front lines, those who care for others, particularly during crises, often postpone caring for themselves, even though there is a greater need to engage in self-care practices during these times. Regular exercise, sleep hygiene, good nutrition, connecting with friends and family – each is vitally important,” says psychologist Diana Concannon, associate provost at Alliant International University in California.
- Pay attention to signs of coping difficulty. “These could be personality changes, worsening irritability, having problems with drive and motivation, drinking a little too much. These warning signs are a lot like check engine lights on your car dashboard: You ignore them at your peril, and the longer you wait to attend to them, the bigger the problems you’ve got,” Jackson says.
- Reframe what you’re doing. “Ultimately, you’re doing something that’s incredibly brave, something that’s really helping people. But it’s easy not to feel the positive emotions that come with that during the usual frantic day-to-day pace,” Santos says. “Taking a moment to experience the compassion that comes with helping can allow you to build up a little bit more resilience. Emotions like compassion can improve our self-regulation, the ability we have to do hard things.”
- Take time off, if possible. “Exhaustion will make things worse, and your ability to perform will be impaired,” Charney warns.
- Talk to your peers. Getting what’s called a “battle buddy” can give you strength. “If your peers are going through the same thing and you share that this is tough, it’s very helpful,” Charney says.
- Ward off burnout by practicing loving-kindness meditation. “You actually think about different people in your life and extend to them information about being happy and healthy,” Santos says. “Use a mantra of, ‘May you be happy. May you be healthy.’ The research suggests that the simple act of doing this – even temporarily – can allow you to feel compassion.”
Seek Professional Help
If your attempts to avoid a mental health crisis aren’t working, experts advise that you seek help. Many health care workers are.
At NYU Langone Health, for example, the number of telemedicine support groups for staff has gone from five to almost 40 in recent weeks. “Group leaders have aimed to provide ‘psychological first aid’ to promote a sense of safety and reduce distress, bolster calming and coping strategies, provide emotional support and psychoeducation, normalize and validate and connect front-line staff with appropriate services,” says Dr. Marra Ackerman, a psychiatrist and director of the NYU Langone Health House Staff Mental Health Program & Student Mental Health Services.
At Mount Sinai, Charney led the team launching the hospital’s Center for Stress, Resilience and Personal Growth, designed specifically for front-line health care workers.
“If you’re hurting badly and you’re at risk for PTSD or depression, we want to intervene right away and get care for you immediately,” Charney says. “We’ll provide free screening, referrals for care and resilience training.”
Help is crucial, Charney says, and not just to get staffers through the current situation. “We have to make sure the stress will not impair their function over the long term.”