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How Clinicians Can Heal from the Mental Health Effects of COVID-19
What happens when it’s the helpers who are hurting?
The COVID-19 pandemic has taken an emotional toll on the entire nation, but no group has been affected more than health care workers. As we emerge from the acute phase of coronavirus and its effects, many experts say we are facing another crisis – an epidemic of mental health issues.
Provider Solutions & Development (PS&D) talked with Dr. Annelise Manns, PsyD, about what clinicians can do to heal and recover from the trauma of the pandemic and how to prioritize their mental health going forward.
PS&D: How has your job been impacted by COVID-19?
Dr. Manns: I’ve seen a systemic anxiety on how to initially approach things. There was a lot of disorientation across the board. I work at a bigger, primary care clinic, where we have case managers, dieticians, four medical teams and a pediatric specialty that rotates through. We treat all ages, from 0 to 95. We had to figure out quickly, were we going to be a sick clinic or a well clinic, or should we split our time? How were we going to provide care that is mindful of COVID? We have done so many iterations of that over the past four months. So the amount of change providers are having to adjust to at every level was fatiguing to keep up with.
Was there a low point that you remember?
In mid-March, providers got the re-deployment email, which asked who would be willing to go and work in the Emergency Department and support COVID patients if needed. This was a hard day for providers. There was fear, anxiety and concern for each other. There was a desire to meet patient needs but also a desire to protect themselves and their families. Many of them have gone through difficult experiences in their personal lives before, so this was very triggering for them and brought up all that past trauma. They were emotionally flooded. It was also at this point that a lot of people began working from home, so they had to learn how to do Zoom visits with patients, which has its own challenges. Our internal medicine physicians were especially concerned, as many of their patients in assisted living facilities were shut away in their rooms, isolated and struggling to access care. It was an overwhelming and disorienting time for many folks.
How are clinicians being impacted by this pandemic?
From what I have observed, providers are feeling a lot of loss. And there’s grief that comes with that – the loss of being able to provide care the way they usually do. The loss of their own safety and the safety of their families. And then there’s pay cuts or job loss or furloughs. That’s a loss as well.
What are the top three pieces of advice you can give clinicians right now?
Set boundaries to make sure you don’t get depleted. There is a lot out there right now about taking care of yourself and practicing basic self-care, and I just don’t feel like that adequately captures or addresses what we are dealing with. This is having a bio-psycho-social toll on providers, and that’s how we need to treat it. Trauma affects us in each sphere. For spiritual people, it can challenge their world views, and that can feel really disorienting. Providers need to schedule time to recharge and take care of themselves. They care so deeply about their patients, so in this pandemic, it’s, ‘I’m going to meet their needs, and meet their needs,’ and then the well gets depleted. It’s important to remember the concept of pacing, and to understand that this is a marathon, not a sprint.
Second, I would say providers need to check in on their emotional needs. You can’t pour from an empty cup. This is not about taking a bubble bath to relax. Providers need to pay attention to how they’re doing in the world and notice their needs as valuable. From research, we know that social connectedness is so important, so clinicians need to engage in whatever that looks like for them, and it needs to be outside of the work environment. Within the work environment, lean into support from your smaller ecosystem, from your colleagues you connect with. Some health systems offer structured support, like peer support groups. Sit in the lunchroom at work, message your colleagues, make sure you’re checking in with each other. Pay attention, and touch base when someone seems like they’re having a hard time. Health care is fast-paced and productivity-oriented, and it takes a higher level of intentionality to do this.
Lastly, from a bio-perspective, make sure you’re taking care of your body. Take breaks, get seven or more hours of sleep – know that you can only go as long as your body can go. In places like New York and other hard-hit areas, providers are dealing with long, draining shifts, so remember that there are basic things your body needs for it to continue serving others. Exercise is medicine, so even if you don’t feel like doing it or don’t enjoy doing it, remember that it’s like medicine for your body. Exercise is also a way to release the emotional energy pent up inside. Providers are taking on and holding so much stress for people, and they need ways to release it. A good run or a class from an app on your phone can provide that release.
What stands out to you, from a mental health perspective, about how clinicians have been affected by this pandemic?
The thing that’s most significant to me is this concept that physicians are so often seen as their role, but they’re complex humans doing a role. Doctors and nurses’ humanity has really been brought out. They’re grieving their patients with COVID; their own trauma has been triggered; they feel a threat to their safety. People may think, Oh, it’s just the doctor, it’s Mary. But Mary has three kids, and she has trauma history, yet she is still showing up for her patients because she wants them to feel seen. Our health care workers continue to show up. They are so courageous.
What are some mental health resources clinicians can tap into?
I’d encourage clinicians to seek out the behavioral health services in their system. PsychologyToday.com is a great way to find a therapist. Better Help offers online therapy. The American Psychological Association has a lot of resources on its website. The government also has some great resources on its U.S. Department of Health & Human Services website. You can try telehealth or download mental health apps that are cognitive-therapy based. These will teach you how to reframe your thoughts. You can pick up a book on what you’re struggling with, whether it’s depression, anxiety or post-traumatic stress disorder. It’s so hard for helpers to ask for help. I would be remiss if I didn’t mention that there have been some providers who have had suicidal thoughts, and I want people to know that this is not a normal distress response. If this is happening, please reach out for help right away. The National Suicide Hotline is 800-273-TALK (8255).
What are the signs that a clinician needs to seek out help?
Biologically, it’s you’re not sleeping well, there’s changes in your appetite, you have increased headaches or stomach aches. Psychologically, you’re experiencing increased irritability or you’re cynical about everything – that’s a huge sign of burnout. Socially, you’re withdrawing and self-isolating. The big key is, you should ask yourself, How much is this impacting my functioning? Is your day-to-day functioning impacted? Have you been dealing with insomnia for a month? Reach out for help.
What would you say to clinicians who have been working in areas hard-hit by COVID?
These providers have been in a constant state of stress – which is that fight, flight or freeze state. For some, that will just be a period of time, but for some, it won’t go away. When we’re in an elevated state, we have to be that much more intentional to come down from that state. From a biological perspective, the level of cortisol you’re releasing is so high that you may need support to regulate it again. Exercise is the biggest reset. Deep breathing activates the parasympathetic system and helps us regulate. Mindfulness work is really helpful, and there are free apps on that. Talking about it and processing it is huge. Allowing yourself to delve into the emotional experience. Front line providers have been pushing that aside, but it will become really valuable for them to tell their own story about COVID-19, instead of being in a constant state of crisis. Journal, talk with friends or a spiritual mentor or try therapy.
What else do clinicians need to know?
I want to end with a message of hope! It’s important for us to maintain perspective on COVID. It’s a trying and painful season, and as with all things, seasons change. With that, there’s hope for a future where things return to a new kind of normal. That is really important for us to all remember. This is a chapter in our lives and in our history. Allow space for hope after COVID.
About Provider Solutions & Development
Provider Solutions & Development is a community of experts founded within Providence, a purpose-driven, 51-hospital health system, over 20 years ago out of a clear need to change recruitment. Today we support dozens of hospital systems and serve physicians and advanced practice clinicians with heart, from residency to retirement, so they can do the same for their patients. With exclusive access to hundreds of positions across the nation, Provider Solutions & Development offers holistic, personal career coaching and placement that puts physicians and advanced practice clinician’s needs first.
More information about Provider Solutions & Development can be accessed at psdconnect.org.
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