COVID Curve 1.5: A Brewing Crisis of Clinician Mental Health

by Carter Toni

This year, after weeks of socially isolating and following stay-at-home orders, many of us have a renewed appreciation for psychological well-being. In the last week, it seems like even the most resilient families are starting to voice the strain.

May is mental health month and this year it could have additional resonance. We all are chafing to get back to life as we knew it. But life is never going to be quite the same after this experience, and neither are we. There are none for whom that will be more true than for healthcare workers.

The conditions in hotspot hospitals have been widely publicized for being exceptionally challenging. Layering those struggles on top of a baseline of distress (almost half of doctors reported some level of burnout in 2019) sets conditions for a brittle relationship with leadership, and potentially a more difficult psychological course. Preparing adequately for psychological recovery may be the first step in repairing relationships between clinicians and administrators. A piece in STATNews outlined some strategies for organizations to take in addressing the aftermath and psychological recovery.

Unfortunately, relying wholly on administrators to orchestrate recovery may not be realistic; they are also trying to ensure the financial survival of their organizations. The compassionate, responsible action from hospitals is to put in place robust plans for supporting their workforce: true crisis teams that can respond to immediate needs; an ongoing, structured psychological crisis response akin to the responses of schools and communities to school shootings; expanded employee assistance programs to anticipate increased need; memoranda of understanding with local organizations to accept overflow or ongoing care; and expanded support programs besides talking sessions, where teams or individuals can come together to process their experience differently. But it also will be important for clinicians to have some strategies of their own, and for communities to help take care of those who take care of them. Below are frameworks for structuring individual coping and for friends, loved ones and mental health professionals to support clinicians on this journey. This framework may even be helpful if you are not in healthcare.

In the immediate context of the crisis, and the inevitable low-level continuation of it, a few simple practices, tailored to what works best for you, will strengthen your ability to withstand the stressors.

Center. This is a process of gathering strength and calm within yourself, ready for an unpredictable challenge. In the sport of fencing, when stepping to the en guard line during a bout, the goal is to be poised to act in an instant, but deeply calm, pushing away extraneous doubts and nagging distractions to respond to the opponent, not react. Fencers achieve that state through various methods–meditation, mindfulness, visualization, a playlist or explosive activity. Find your path to your strong, calm “center”. The more you walk it, the smoother it will be.

Connect. This is obvious, but sometimes we take the obvious for granted. Check in with friends and family. Use their support and offer yours to them. Those are self-strengthening circles we all need, especially now.

Create. Find time every day, even for a second or two, to let your creative side express your experience or your gratitude. Sketch, paint, sculpt, sew, cook, carve, weld, smith, or simply take a photo of some found beauty.

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As we start emerging from the first wave of the pandemic, and clinicians have the time and the perspective to start processing what they have seen and done and felt, there will be many ways to get to recovery. There is no one proscribed program or timeline to follow. Having an experienced guide in the process—a therapist or clergy—can be very helpful, but their guidance supports an individual process, respectful of each person’s unique background and recent history. We do not all process grief or trauma the same way, and some of the other approaches outlined below may be useful.

Make. Nonverbal expression is a side door into our psychological experience. In committing to memorialize an event, we have the opportunity to spend time during the making, contemplating our experience, considering it from many perspectives, and wresting some necessary distance from it. In the end, the process allows us to understand the context of the experience, and to rework its place in our life story.

Break. Sometimes, the messiness of trauma and grief demands a less controlled response. There are times when pure, hot rage needs an outlet. Finding acceptable ways to unleash the power of those emotions can be cathartic and allow progression. Smashing bottles into glass recycling bins, winging mudballs at a tree trunk or a back fence, splitting stacks of wood, or pounding handfuls of nails into a scrap of 2 x 4 can all be satisfyingly, yet acceptably, destructive.

Sweat. Research shows that activity boosts divergent thinking and has benefit in shaping responses to trauma. Movement can serve as background activity that allows the mind to wander with it, such as going for a walk. Alternatively, attending to more complex and unpredictable activities (riding horses, for example) can be completely distracting—a sort of immersive mindfulness practice.

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Speak. This is obvious, but it bears saying, especially for clinicians: it may be very helpful to find someone who can offer support during this process. A therapist, clergy, a support group or some combination can make it easier to do this sometimes challenging work.

Courage is being afraid and doing something anyway. Clinicians chose careers in healthcare knowing they would be hard. We knew we would face inordinate risk. But that does not mean we became immune to the horrors we see. It just means we think taking care of patients is worth that exposure, and we trust our courage will be returned with support as we cope with its impact.

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