Coping and Healing in a COVID Reality

What happens when it’s the helpers who are hurting?

The COVID-19 pandemic has taken an emotional toll on the entire nation, but no group has been affected more than healthcare workers. As we emerge from the acute phase of coronavirus and its effects, many experts say we are facing another crisis – an epidemic of mental health issues.

Provider Solutions & Development (PS&D) talked with Dr. Annelise Manns, PsyD, about what clinicians can do to heal and recover from the trauma of the pandemic and how to prioritize their mental health going forward.

Dr. Manns was a resident at Providence Medical Group (PMG) Clackamas for two years when she reached out to PS&D to help her secure a permanent position at the busy suburban clinic she had grown to love. She’s passionate about mental health, particularly for healthcare workers. Below, she shares how COVID has impacted her clinic and offers advice on how to cope, heal and even thrive in our new normal.

PS&D: How has your job been impacted by COVID-19?

Dr. Manns: I’ve seen a systemic anxiety on how to initially approach things. There was a lot of disorientation around logistics. I work at a bigger, primary care clinic, where we have case managers, dieticians, four medical teams and a pediatric specialty that rotates through. We treat all ages, from 0 to 95. We had to figure out quickly, were we going to be a sick clinic or a well clinic, or should we split our time? How were we going to provide care that is mindful of COVID? We have done so many iterations of that over the past four months. At first, we were routing all sick patients elsewhere, then we did well clinic in the morning and sick clinic in the afternoon, then we were just a well clinic. So the amount of change providers are having to adjust to at every level, the cost of that was such a high mental load. I would round with the providers because with the amount of emails, it was completely fatiguing to keep up with. It was, ‘What’s going on? How can we deal with this?’

Was there a low point that you remember?

In mid-March, everyone got the re-deployment email, which asked who would be willing to go and work in the Emergency Department. This was a really hard day for providers. There was fear, anxiety, concern for each other. There was a desire to meet patient needs but also a desire to protect themselves and their families. Some of them are immigrants, and they’ve gone through difficult experiences before, so this was very triggering for them and brought up all that past trauma, and they were emotionally flooded. It was also at this point that a lot of people began working from home, so they had to learn how to do Zoom visits with patients, which has its own challenges, and our providers were really worried about a lot of their patients. It was a very real emotional and mental load. One of our providers has the oldest patient panel in Oregon PMG region. So many of these patients were shut away in their rooms, and they were really not doing well. That was tough to witness for that particular physician.

How are clinicians being impacted by this pandemic?

Providers are feeling a lot of loss. And there’s grief that comes with that – the loss of being able to provide care the way they usually do. The loss of their own safety and the safety of their families. And then there’s pay cuts or job loss or furloughs. The loss that comes from being asked to do more for less pay.

"People may think, Oh, it’s just the doctor, it’s Mary. But Mary has three kids, and she has trauma history, yet she is still showing up for her patients because she wants them to feel seen. They continue to show up. They are so courageous."

How have you been able to help at your clinic?

Having caring interprofessional relationships is huge. A lot of our clinicians were having a hard time, and I just went around and talked to them and asked them how they were doing. It’s a simple thing that makes a big difference. I’ve directed some of them to therapists. We have a concierge service that provides behavioral health service from a nearby clinic, so just adding in those extra layers of support. I regularly try to share the burden of patient care, and if I can take something off their plate, I do that.

What are the top three pieces of advice you can give clinicians right now?

Set boundaries to make sure you don’t get depleted. There is a lot out there right now about taking care of yourself and practicing basic self-care, and I just don’t feel like that adequately captures or addresses what we are dealing with here. This is having a bio-psycho-social toll on providers, and that’s how we need to treat this. We need to address each bucket. Trauma affects us in each sphere. For spiritual people, it can challenge their world views, and that can feel really disorienting. Providers must protect space to meet their own needs. They need to schedule time to recharge and take care of themselves. Providers deeply care about their patients, so in this pandemic, it’s, ‘I’m going to meet their needs, and meet their needs,’ and then the well gets depleted. It’s important to remember the concept of pacing, and to understand that this is a marathon, not a sprint. Providers need to adjust their boundaries accordingly. This may mean sometimes saying no to asks, even if it would be helpful to patients, because they don’t have the bandwidth. That is hard.

Second, I would say providers need to check in on their emotional needs, and those look different for everyone. You can’t pour from an empty cup. This is not about taking a bubble bath. Providers need to pay attention to how they’re doing in the world and notice their needs as valuable. From research, we know that social connectedness is so important, so clinicians need to engage in whatever that looks like for them, and it needs to be outside of the work environment. Staying connected and recharging your relationships is really key in times like this. Within the work environment, lean into support from your smaller ecosystem, from your colleagues that you connect with. Some health systems offer structured support, like peer support groups. Personally, I round with the teams, I sit in lunchroom at work, I message providers, I make sure we’re checking in with each other. Pay attention, and check in when someone seems like they’re having a hard time. Health care is so fast-paced and productivity-oriented, it takes a higher level of intentionality to do this.

Lastly, from a bio-perspective, make sure you’re taking care of your body. Take breaks, get seven or more hours of sleep – know that you can only go as long as your body can go. You can burnout physically too. In places like New York and other hard-hit areas, providers are dealing with long, draining shifts, so remember that there are basic things your body needs for it to continue serving others. Exercise is medicine, so even if you don’t feel like doing it or don’t enjoy doing it, remember that it’s like medicine for your body. Exercise is also a way to release all the emotional energy pent up inside. Providers are taking on and holding so much stress for people, and we need ways to release it. A good run or a class from an App on your phone can provide that release.

What stands out to you, from a mental health perspective, about how clinicians have been affected by this pandemic?

The thing that’s most significant to me is this concept that physicians are so often seen as their role, but they’re complex humans doing a role. Doctors and nurses’ humanity has really been brought out. They’re grieving their patients with COVID; their own trauma has been triggered; they feel a threat to their safety. It’s been impactful to me to see the full picture of these clinicians’ humanity and witness their journeys as they’re trying to provide support, whether that’s in a hospital, a clinic or from their homes. People may think, Oh, it’s just the doctor, it’s Mary. But Mary has three kids, and she has trauma history, yet she is still showing up for her patients because she wants them to feel seen. They continue to show up. They are so courageous.

What are some mental health resources clinicians can tap into?

If they’re needing therapy, they can go online to PsychologyToday.com and find a therapist. Better Help offers online therapy. The American Psychological Association has a lot of supportive resources on its website. I’d encourage clinicians to talk to the behavioral health services in their system. The government also has some great resources on its U.S. Department of Health & Human Services website.

What are the signs that a clinician needs to seek out help?

Biologically, it’s you’re not sleeping well, there’s changes in your appetite, you have increased headaches or stomach aches. Psychologically, you’re experiencing increased irritability, you’re cynical about everything – that’s a huge sign of burnout. Socially, you’re withdrawing and self-isolating. The big key is, you should ask yourself, How much is this impacting my functioning? If your day-to-day functioning is impacted? If you’ve had a month of insomnia? Reach out for help.

You can try telehealth, you can download mental health apps that are cognitive-therapy based. These will teach you how to reframe your thoughts. You can pick up a book on what you’re struggling with, whether it’s depression, anxiety or post-traumatic stress disorder.

What would you say to clinicians who have been working in areas hard-hit by COVID?

These providers have been in constant state of stress – which is that fight, flight or freeze state. For some, that will just be a period of time, but for some, it won’t go away. When we’re in an elevated state, we have to be that much more intentional to come down from that state. From a biological perspective, the level of cortisol you’re releasing is so high, that you may need support to regulate it again. Exercise is the biggest reset. Deep breathing activates the parasympathetic system and helps us regulate. Mindfulness work is really helpful, and there are free apps on that. Talking about it and processing it is huge. Allowing yourself to delve into the emotional experience. Front line providers have been pushing that aside, but it will become really valuable for them to tell their own story about COVID-19, instead of being in a constant state of crisis. You can journal, talk with friends or a spiritual mentor or go to therapy. There’s lots of impactful ways to get help.

What else do clinicians need to know?

It’s so hard for helpers to ask for help. There have been some providers who have had suicidal thoughts. That is not a normal distress response. The National Suicide Hotline is 800-273-TALK (8255).

I also want to end with a message of hope! It’s important for us to maintain perspective on COVID. It’s a trying and painful season, and as with all things, seasons change. With that, there’s hope for a future where things return to a new kind of normal. That is really important for us to all remember. This is a chapter in our lives and in our history. Allow space for hope after COVID.