Virus hits medical workers’ mental health
The emotional toll of COVID-19 can overwhelm
In the Memphis area, medical professionals have spent weeks caring for an increasing number of COVID-19 patients in addition to patients with other severe illnesses and injuries. Some are working overtime, some have been redeployed and are learning new protocols and technologies, and others have been furloughed as hospitals continue to lose revenue due to canceled elective procedures.
All are worried about becoming sick and potentially bringing the virus home to their families on top of their concerns for their patients. And with many hospitals limiting or barring visitors, they’re standing in for loved ones who can’t be with sick or dying patients.
“Our doctors and nurses and janitors are having to step in and be that support system for people who are extremely sick. I think there’s a new emotional toll on our healthcare workers,” said Dr. Laura Shultz, director of Behavioral Health-ambulatory Care for Methodist Le Bonheur Healthcare.
Shultz has seen an increase in the number of medical personnel — doctors, nurses, medical assistants, hospital front desk staff, nursing home workers — seeking mental health help over the past two months, most of them experiencing symptoms of anxiety and depression.
She is already seeing an increase in alcohol and marijuana use, both in medical workers and the general public, and for some people, the pandemic has caused immense amounts of family stress. If substance use becomes substance dependency and prolonged familial divisions lead to estrangements or divorces, those could impact individuals and families long after life returns to normal — whatever that normal may look like.
A drastic reduction in elective procedures and other non-emergent medical care has caused financial difficulties for hospitals of all sizes. According to the Tennessee Hospital Association, the state’s 144 hospitals have collectively lost $1 billion in the last month, compared to $1.7 billion in revenue earned over the same period a year ago. Locally, Methodist and Saint Francis have enacted furloughs.
“There’s now financial stress and fear for those same people experiencing stress in other areas of their occupation,” Shultz said.
Memphis Medical Society CEO Clint Cummins said physician burnout was a huge issue before the pandemic and the current stresses associated with COVID-19 could exacerbate the issue.
“My biggest concerns are physicians having an appropriate outlet to seek help for that stress,” he said.
He’s worked for 18 months to raise funds and secure psychologists for an independent, confidential physician mental health hotline, which is set to launch imminently, Cummins said. Doctors can call, text or fill out a form online and will be matched with a psychologist. Cummins has raised enough funding to cover the expense of at least six visits for every person who uses the service, potentially many more depending on how many people call in.
Cummins said the hotline would be open to practicing physicians and residents.
Physicians can defer seeking mental health help for various reasons, including stigma, cost and concerns about medical license renewal. In some states, physicians are asked whether they have sought mental health help as part of the license renewal process.
Failure to seek help can be deadly for a population that already has double the risk of committing suicide than the overall American public, Cummins said.
“You have a high-risk population anyway and when people are living with mental illness... they live with a high risk of suicide,” said Dr. Shaili Jain, an expert on post-traumatic stress disorder with the Palo Alto VA and a Stanford University Medical School professor. “This has to be on our radar, and our efforts have to be on nipping it in the bud. Too often these things are not treated.”
In research for her book, “The Unspeakable Mind: Stories of Trauma and Healing from the Frontlines of PTSD Science,” Jain looked at frontline medical workers who lived through the 20142016 Ebola outbreak in West Africa.
That outbreak presented “unique” stressors for medical workers, she said, including seeing colleagues get sick and die, feeling the need to defer mental health issues to continue working and being physically isolated from their family and support system, to avoid spreading the virus.
Jain said all individuals exposed to trauma can struggle in the days and weeks afterward as their brain adjusts to what they have experienced, but the majority recover naturally over time. That held true with frontline workers in the Ebola outbreak.
However, she said a substantial minority of those workers did develop PTSD, and the same could happen with medical workers on the frontlines of the COVID-19 pandemic.
“The realist in me knows that a substantial minority are going to develop this and are going to develop it fullblown and that is going to have awful consequences the longer they wait to get help,” Jain said.
Treatments for PTSD have greatly improved over the past two decades but left untreated it can cause nightmares, flashbacks and sleep disruption. Reminders of the trauma can be everywhere and people who are experiencing PTSD can see severe emotional distress.
“They become really shut down and they don’t feel joy and love like they used to,” she said. “They live in this kind of mood state that really cuts them off from the people who love them… They’re sort of white-knuckling it through life but not really living life.”
The intensity of exposure to trauma can be a factor in whether an individual develops PTSD. Memphis’ outbreak has not been on the same scale as cities like New York, which could prove to be critical in whether and how many local medical workers develop PTSD.
Jain said people should seek help if they are still having trouble healing from a trauma more than a month later. However, that can be hard to measure in the current climate.
“What’s really disconcerting about this pandemic is, we don’t really know when this ends,” she said. “This is something to watch. There’s not just one trauma, there’s probably multiple.”
Shultz said she has not yet seen evidence of PTSD among medical workers in Memphis, but she has seen the pandemic begin to take a toll on her colleagues. About five weeks ago, she started a support group for Memphisarea mental health workers, to allow them to work through their own stresses and anxieties in a supportive environment.
Since its inception, more than 50 registered mental health providers from across the area have participated, including practitioners from psychiatric hospitals, the VA hospital, substance abuse facilities, Methodist, people in private practice and people from the school district.
“I started it out of a desire to make sure we were providing good support for one another, knowing that we were all about to get hit with a lot of heavy stuff,” Shultz said. “The fact that the majority of Americans, or worldwide, that folks are experiencing the same things at the same time ... it can be hard not to get overwhelmed and triggered by patients expressing the same things.”
For many practitioners, it’s the first time they’re experiencing the same things at the same time as the people they are treating, she said. It presents unique challenges but has also presented some benefits for mental health practitioners.
Instead of responding to people out of book knowledge, they can draw from personal experience, relate to their patients and respond with increased compassion, Shultz said.
“I think a lot of patients want to hear that they’re not crazy,” she said. “This is a human experience that everyone is going through.”