Death. Dying. Pain. Stress. Fatigue. Facing all this daily and doing so with a smile on their face is the task expected of our Nation’s healthcare providers. >How can they do it? Are our healthcare providers mentally healthy? The additional stress associated with the COVID-19 pandemic has put a spotlight on this issue.
Are Our Healthcare Providers Mentally Healthy? Generally, yes.
However, with the recent additional pressures placed on them, there is serious concern that our healthcare workers will be at high risk for developing increasing serious mental health issues in the months and years to come.
Mental health is an increasing problem worldwide. Whether it is actually an increase in the issue or an increase in identifying the issue, diagnosed mental health issues are increasing annually. Some studies indicate that healthcare workers face a higher than average level of mental health risk than non-workers by virtue of their hours, type of work performed and chronic staffing shortages. The COVID-19 pandemic is merely adding fuel to an already exiting fire.
Increased Mental Health Issues
Experts, including members of the AMA and the psychiatric field, anticipate an avalanche of increased mental health issues among healthcare providers in the months and years to come, based on the novel Coronavirus and the associated COVID-19 pandemic.
The American Psychological Association defines anxiety as “an emotion characterized by feelings of tension, worried thoughts and physical changes like increased blood pressure”. Anxiety is frequently produced when an individual is faced with uncertainty and feelings of lack of control.
We are all facing these concerns and, no doubt you can feel the increased anxiety within yourself. Healthcare providers face even higher levels of uncertainty.
Due to their immediate potential proximity to the ill, there are high levels of concern for transmission to their own families. Some have gone so far as to quarantine themselves away from family. This leads to increased anxiety about how those family members are faring.
Additionally, it eliminates one of the primary coping mechanisms most individuals use, the love and support of family members.
True depression is a lot more than “just the blues”. Depression is a clinical diagnosis based on clear and identifiable symptoms. Some of the biggest risk factors for the development of depression include major life changes, trauma and stress.
According to the National Institute of Mental Health (NIMH), symptoms of depression include the following:
- Feelings of hopelessness, or pessimism
- Decreased energy or fatigue
- Difficult concentrating or making decisions
- Difficulty sleeping or changes in sleep patterns
- Feelings of restlessness
Depression is treatable with therapies and, in some cases, medications. Untreated, depression can easily worsen and lead to damaging coping behaviors and even suicide.
Moral injury is a term used when an individual does something that goes against their personal moral code or belief system.
The conflict between moral code and behavioral requirements could be illustrated by the ICU nurse, who is trained to take all steps to preserve human life. Now, facing a lack of sufficient resources, must help decide where those resources are to be allocated and what patients to recommend to hospice care.
Some hospitals have gone so far as to make the decision that, based on symptoms, certain patients may not be afforded ventilator support, in spite of their family’s preference.
Trauma and PTSD
Most of us think of blood, organs and bones when considering trauma and associated PTSD. However, trauma can occur whenever familiar expectations of the world and our role in it are violated. This violation sends the individual into a state of extreme “confusion and uncertainty”.
There is concern that the prolong uncertainty afforded by the Covid-19 breakout may lead to extreme trauma and ultimately PTSD in healthcare providers.
Ways to Help
There are things that healthcare providers can do to help with their own situation. There are also ways that society, in general, can help and finally, there are ways that the healthcare industry can help.
Self-care for managing mental health is something we can all do, whether we are healthcare providers or not. We are all facing increased risk of mental health issues, so having coping mechanisms benefits each of us. Here are a few recommended by the American Medical Association (AMA).
Feel your feelings. Healthcare professionals often push their feelings to the side in order to deal with the next emergency. As wave after wave of emergencies continue, those feelings can get pushed down and eventually fester. This leads to depression, anxiety and increased trauma. Take a moment to acknowledge or “feel your feelings”.
Take breaks from news and social media. This is something we could all benefit from. Our personal world is constantly being bombarded by negativity, strife and conflict. No where is this more evident than on your daily news and social media accounts.
This constant negativity overload leads us to feel overwhelmed and unable to cope. We feel like we have no control over what is happening. Again, that leads directly to increased levels of stress, anxiety, depression and trauma.
Intentionally use coping strategies. Be aware of the risk to your mental health and make intentional use your existing coping strategies. Meditate, listen to music, exercise, whatever calms your mind and soul is your best bet.
Some people are particularly susceptible to using negative coping mechanisms like alcohol or drugs to avoid the emotional barrage. Avoid these choices. If you find yourself slipping into one of these unhealthy coping mechanisms, please seek help.
As a society, we can support our healthcare providers, and one another, through this mental health challenge.
Kindness. Sounds simple, but amazing how effective it is. Treat one another with kindness at every opportunity. Give a smile to your neighbor as they head to the hospital for their shift. Thank your cousin who is a CNA and caring for a vulnerable population.
Simple kindness makes us all feel more inter-related and less alone. The feeling of connectedness and appreciation is a balm for a wounded soul.
Emotional Support. Sometimes we all just need someone to listen, and professional healthcare workers are no different. We are bound by certain laws that limit the personal details, but we need to be able to vent about the conditions we see daily. Having an ear to listen, uncritically and compassionately, is a true help to our mental health status.
The healthcare industry and the organizations within it can also help address the coming mental health crisis.
Training. Improve the training for healthcare workers both relative to their own mental health, as well as the training relative to managing this pandemic.
Improved training makes workers feel empowered and more in control of their own situation. By knowing “what to do”, the sense of helplessness and overwhelming loss of control can be reduced. This single step reduces stress, anxiety and depression.
Tools. Give workers the tools they need to do their job effectively. There should NEVER be a shortage of basic supplies like PPE, medications, gloves or simple masks.
There is no excuse. Organizations must find the means within their budget to keep adequate stock on hand.
Information. Workers need immediate information when protocols and best-practice guidelines change. Throwing a paper printout in their mailbox and hoping they see it “sometime” is not adequate. Organizations owe a duty of care to their staff to provide them with timely information on the best ways to protect themselves and their patients.
Reduce shift hours. This has been discussed for decades. 12-hour shifts are dangerous. They exhaust staff, they increase risk of error or mistake, they put patients at risk. The fatigue caused by working extraordinary shifts contributes directly to feelings of depression, anxiety and stress within each healthcare worker.
The COVID-19 pandemic has unburied serious failures within the healthcare industry and our society, as a whole. These failures give rise to a significantly increased risk of the development of mental health issues by the very people who are charged with caring for us.
However, we also have the opportunity to revolutionize our healthcare system. By identifying these failures and drawing upon them to find solutions, we can improve both the quality of our health, as well as the quality of our healthcare workers lives.
That’s a solution worth finding.