Mental health care needed for frontline workers
A study of health-care professionals working with coronavirus patients in China found more than 50% had symptoms of depression
Like those who served in military combat, the doctors, nurses and paramedics fighting to saves lives in the COVID-19 pandemic are at war. They aren’t staring down enemy bullets, rockets and bombs but they’re fighting an enemy just as deadly. In the past three months, more Americans have died from this disease than during the Vietnam War, which spanned 13 years of U.S. involvement.
Each of their wars has taken a profound toll. Just as many veterans have permanent physical and psychological wounds, those on the coronavirus front line will invariably emerge with their own scars from working long hours and witnessing traumas and horrible deaths. Lacking effective therapeutics or vaccines, they often feel powerless. And they have too limited time to decompress from the daily tragedy before going back the next day.
Having worked with populations prone to PTSD, such as veterans, mass shooting survivors and 9/11 first responders, we know that if not identified early and treated comprehensively, the mental health challenges these medical professionals are facing will become chronic and life altering.
Consider that, just as the suicide rate among veterans is about twice as high as the general population, so is the rate among medical professionals. In the first national study of its size, researchers at the University of California-San Diego confirmed recently that nurses have a significantly higher risk of suicide than the average individual.
Fighting COVID-19 is exacerbating this risk. A study in the Journal of the American Medical Association found that among 1,250 health-care professionals working with coronavirus patients in China more than 50% of these professionals reported symptoms of depression; nearly 45% noted symptoms of anxiety; and more than 70% reported distress.
In the United States, the picture is equally alarming. In April, the National Crisis Text Line handled about 6,000 conversations, double its usual volume, with an increasing number from paramedics and nurses. Some 84% of those who reached out identified as essential workers.
Our country has a responsibility to provide them with immediate mental health care as well as ensure the long-term mobilization of resources to buffer or mitigate PTSD, anxiety, depression and suicide risk among them. Unfortunately, the National Institutes of Health spends more money on treating West Nile virus, which kills only 137 people in America annually, than on suicide prevention.
So we are calling for a fullyfunded effort that brings together university researchers; public health experts from the CDC and NIH; psychologists and psychiatrists; and authorities in wellness, nutrition and fitness, and tasks them with studying and providing ongoing care to COVID-19 first responders. This new body must also include the Veterans Administration’s participation, as it has unique expertise in dealing with PTSD and grief.
Each of us can also make a difference. Asking each other direct questions about difficult thoughts and feelings gives us all permission to be human and heal from stress and trauma together. One significant barrier is the lack of screening for suicidal thoughts.
To remedy this, we must screen for risk and monitor like we do for blood pressure, hearing or vision. Resources such as The Columbia Protocol, a simple tool that anyone can be trained to use, are already available. With wider implementation, we can identify suicide risk among healthcare communities and reach those before they are in crisis.
There is hope. “Post-traumatic growth” is a term in our field to understand how individuals “come out on the other side” of trauma stronger than when it started. As humans we can learn how to grow, reach out for help when we need it most, and support one another through these experiences. This will carry us — both medical professionals and the general population — now and on the long road to a brighter future.
Dr. Keita Franklin, former director of suicide prevention for the Department of Defense and VA, is chief clinical officer at Psych Hub. Dr. Kelly Posner Gerstenhaber, recipient of the highest civilian medal given by the Defense Department, is director and founder of the Columbia Lighthouse Project.