The mental health battle among providers
A young 34-year-old nurse killed herself in Italy after testing positive for Covid-19 and was, according to reports, terrified at the prospect of infecting others. Her suicide may have been the first but almost certainly won’t be the last, and her story is perhaps a sober harbinger of things to come.
It reminds us, sadly, that if health care providers are subjected to high levels of stress and trauma – as their coping mechanisms are being taxed to the breaking point – tragic outcomes will abound. These issues should be of concern to us all.
Little formal research has been done to quantify the psychological outcomes of Covid-19 among healthcare providers. Last month, in the Journal of the American Medical Association (JAMA), a study reported on a cohort of nearly 1300 healthcare workers involved in the management of patients in 34 hospitals across China.
71% of respondents reported general psychological distress, and half endorsed symptoms of anxiety and depression. Difficulties were particularly likely to occur among front-line providers.
Appreciating all our heroes
In America, we honor Veterans and public servants like policemen and firefighters – selfless and courageous people who willingly put themselves in harm’s way out of a robust sense of duty.
Yet, we can sometimes overlook the fact that bravery is expressed in many occupations. Indeed, it is alive and well in the healthcare community, where healthcare providers are fighting or preparing to fight a unique kind of war. Their uniforms of personal protective equipment (PPE) offer scant protection against different sorts of concerns: anxiety over contracting a virus and leaving children as orphans, guilt over tasking subordinates with duties that could lead to their deaths, grief over the cruel and untimely passing of patients, colleagues, and so many others. Some have faced additional psychological fallout from losing a job over speaking out.
There are no easy solutions but we know where to begin
To start, we must mobilize mental health professionals and encourage them to contribute during this unique moment in history – these psychologists, psychiatrists, and therapists may not be managing ventilators at the bedside but they, too, have a critical, role to play.
Crucially, we must reduce barriers to mental health treatment by transforming existing paradigms of delivery that emphasize in-person encounters, not possible in our social-distancing era and not practical for those working exhaustive schedules.
We’re delighted to hear of so many of our colleagues working collaboratively to rapidly restructure the care delivery model of mental health services to include one-on-one tele-psychiatry and group peer-support psychotherapy options, among others. Finally, we must continually communicate to medical personnel that mental health difficulties are not signs of weakness and not sources of shame.
Although the mental health needs of healthcare workers have been highlighted in previous circumstances, it has taken the pandemic to remind us that healers are themselves, vulnerable, and that they must be heard from, supported, and cared for.
Prioritizing and attending to the mental health needs of our virtual “army” of providers is our clarion call in this moment and we must rise to the occasion – all of us will be better for it.
Dr. James Jackson is research professor in the Department of Medicine and the assistant director of the ICU Recovery Center at Vanderbilt. Dr. Jo Ellen Wilson is an assistant professor in the Department of Psychiatry at Vanderbilt.