With the advent of COVID-19 and the need for social distancing, constant sanitizing and mask-wearing, many Americans have experienced increased feelings of isolation, anxiety and depression. We spoke to two Atlanta practitioners who shared their insights about treating mental health issues that have been brought on or exacerbated during the pandemic.
“Probably everyone in healthcare has some experience with being present and helping people who are suffering. This is the fundamental thing that bonds us,” said Jennifer Whaley, MD, a psychiatrist practicing adult, child and adolescent and addiction psychiatry, who serves as Associate Medical Director of Care Experience for The Southeast Permanente Medical Group. “Most of the time, when we’re helping someone through what they’re experiencing, we are not experiencing it ourselves. What makes this pandemic situation feel different, perhaps, is that we are simultaneously experiencing some of the same trauma. And if it’s not us personally experiencing it, it’s a family member or friend.”
Whaley says that, although challenging, it’s crucial for physicians and healthcare workers to try to protect their own mental and emotional health.
“Since we are going through something of a shared trauma with our patients right now, it’s even more important that we pay attention to how we take care of ourselves,” she said.
There are many different ways in which healthcare workers can practice self-care, many of them the same as their patients. Exercise, meditation, eating well, and getting enough rest are examples of the basics. But Whaley says it’s especially important that they pay attention to their mental and emotional needs, too.
“In our patients of all ages, we are seeing more depression, more anxiety and more addiction. These are being triggered and exacerbated by many stressors — financial strain, job loss, housing and food insecurity, social isolation, illness and death — circumstances that are occurring far more often and more intensely than in the past. We, healthcare practitioners, are not immune to those things ourselves,” she warns. “As best we can, we want to avoid falling into the trap of neglecting our own mental health as we try to help others. We should not be afraid to get help from friends, family members, other clinicians, or even mental health professionals if we need it.”
An additional burden caused by the pandemic is that many physicians may find themselves confronted with patient symptoms that are beyond their area of expertise to treat. Whaley advises devising a plan and a go-to list of resources for this purpose.
“It’s good to have a ‘toolbox’ of other people and programs to whom we can make referrals. For example, the Georgia Department of Behavioral Health & Developmental Disabilities operates a 24-hour crisis line that can help doctors with issues like figuring out the patient’s level of risk or matching patients who don’t have insurance with resources,” she said. “Take a moment to think through your plan. It can help make the conversations with your patients more fruitful.”
Therapists See Huge Uptick in Patients Use Telehealth to Connect
Seri Gohde, LCSW, BC-TMH, says that being able to teleconference with clients has actually allowed her to make good progress with them during the pandemic.
“I was in a good position when COVID hit because I already had my certificate in telehealth and had seen some patients that way for several years,” she said. “I think most therapists are using telehealth now, and overall it’s been very successful.”
She acknowledges there are some pluses and minuses in the use of teleconferencing to see patients.
“At first I wasn’t sure what to expect. A lot of the people I see have significant dissociative and personality disorders as well as traumatic injuries. I wasn’t sure how they would respond to teleconferencing,” she said. “I’ve learned that I’m less able to read their body language through a screen. But at the same time, it allows me to better read micro-movements in their faces. I feel that I’m able to do some good work through telehealth.”
The telehealth option has come in handy with an explosion of people seeking therapy during the pandemic. A lot of individuals and families are experiencing job loss, health issues, and financial and marital problems…many of which are magnified by anxiety over COVID.
Gohde adds that the pandemic has affected some permanent changes in her field, including telehealth.
“I feel that telehealth is here to stay. There will be some clients who’ll want to come back in person when they can, even those who drive a long way, but there are also people who now prefer to use telehealth,” she said. “They will seek out qualified practitioners who offer it.”
With the advent of COVID, Gohde says that therapists, universally, have been seeing a significant rise in people wanting their services.
“There is considerably more anxiety among the general public and a corresponding uptick in referrals to therapists from other practitioners,” she said. “My practice was already full to the brim in March, and I have remained full through the pandemic. My voicemail and email are always full, and I still have a lot of referrals coming in.”
She adds that healthcare workers are not impervious to their own mental and emotional difficulties.
“Many of my clients are doctors, nurses, psychiatrists and psychotherapists. They already have to deal with a level of feeling inadequate simply by being in a ‘helping profession,’ and often find themselves in situations where they can’t help. COVID has intensified this,” she said. “There is a lot of re-traumatization in my entire client base due to a feeling of helplessness. Feeling helpless — people are hurting, people are dying, people are stuck — is a triggering feeling.”
While recent months have seemed “dark,” with shelter in place orders, mask-wearing and social distancing, Gohde says she sees light at the end of the tunnel.
“The advent of the COVID vaccine has generated hope,” she said. “I’m seeing my patients exhibit optimism and confidence in a positive change for our nation.”
A Dangerous Toll On the Mental Health of Frontline Healthcare Workers
The pandemic is taking a dangerous toll on the mental health of frontline healthcare workers, according to a new survey conducted by Mental Health America (MHA) with funding from the Johnson & Johnson Foundation.
“Health care workers have been thrust onto the front lines, exposed to a deadly virus daily,” said Paul Gionfriddo, president and CEO of MHA. “With the skyrocketing number of COVID-19 cases, it is getting worse by the day and healthcare workers aren’t getting a reprieve. They are frustrated, anxious, overwhelmed, burned out and worried about exposing their loved ones, nurses in particular. We need to make sure that we are taking care of healthcare workers so they can take care of us.”
The study showed that healthcare workers are:
- 93% of health care workers were experiencing stress, 86% reported experiencing anxiety, 77% reported frustration, 76% reported exhaustion and burnout, and 75% said they were overwhelmed.
- 76% of healthcare workers reported that they were worried about exposing their child to COVID-19, nearly half were worried about exposing their spouse or partner and 47% were worried about exposing their older adult family member(s).
- Emotional exhaustion was the most common answer for how healthcare workers were feeling (82%), followed by trouble with sleep (70%), physical exhaustion (68%) and work-related dread (63%). Over half selected change in appetite (57%), physical symptoms like headaches or stomachaches (56%), questioning their career path (55%), compassion fatigue (52%) and heightened awareness or attention to being exposed to COVID-19 (52%). Nurses reported having a higher exposure to COVID-19 (41%) and they were more likely to feel too tired (67%) compared to other healthcare workers (61%).
- • Not getting enough emotional support: 39% of healthcare workers said that they did not feel like they had adequate emotional support. Nurses were even less likely to have emotional support (45%).
- • Struggling with parenting: Among people with children, half reported they are lacking quality time or are unable to support children or be a present parent.
MHA says stress if left untreated can lead to more severe mental health conditions such as depression, anxiety, psychosis and even thoughts of suicide or self-harm, or Stage 4. MHA says that the best way to avoid a mental health crisis – referred to as “Before Stage 4”– is to prevent it altogether. To do this, MHA says it is critical to identify signs of anxiety and depression early on and intervene quickly.
MHA teamed up with the Johnson & Johnson Center for Health Worker Innovation to listen to the needs of healthcare workers and developed a library of resources for healthcare workers, which can be accessed at MHAnational.org/frontline. The library includes webinars, resources for getting sleep, coping with fear, finding emotional support, dealing with burnout and overwhelm, and coping with contracting COVID-19.
Across the board, MHA has seen alarming increases in reports of depression and anxiety nationwide. A report released in October 2020 showed that more than 1.5 million people who took a screening at MHAscreening.org reported signs of anxiety and/or depression, with Sept. reporting the highest rate of severity since the start of the pandemic. Anxiety screenings were up by 634% from January and depression screenings were up 873%.
The Georgia Department of Behavioral Health & Development Disabilities operates state hospitals and provides for community-based services across the state through contracted providers. The department serves people living with mental health challenges, substance use disorders, intellectual and developmental disabilities, or any combination of these. As Georgia’s public safety net, the agency’s primary responsibility is to serve people who are uninsured. It also serves individuals on Medicaid and others with few resources or options.
Visit dbhdd.georgia.gov for more information. For access to services and immediate crisis help, call the Georgia Crisis & Access Line (GCAL) at 1-800-715-4225, available 24/7.