10 minute read
The Growing Toll on Mental Health
COVID -19, Surge Two:
The Growing Toll on Mental Health
By Lauren English Britton, LPC
Many of us had active social lives before Covid-19 arrived on the scene. We dined out at restaurants. We attended large gatherings with family and friends without a care. I remember exactly where I was when the first Arkansas case was reported. I was attending a work conference in a large event space. Word spread quickly about that first case, and the energy in the room shifted almost instantly from carefree to tense. Many of us became painfully aware of any person who coughed or sneezed.
The presence of COVID-19 launched a series of stressful life adjustments for many: Leave home only for essential reasons, like going to work or picking up grocery orders (perhaps placed online). Set up a home office space to accommodate daily Zoom meetings or online learning for students. Limit social gatherings to tiny groups and meet outdoors. Learn the public health practices of social distancing, sanitizing, and mask wearing.
As for health care professionals, many of us found ourselves continually garbed in PPE, caring for patients receiving oxygen or on ventilators. We tested people for the virus. We cared for each other at work. We became stand-in families for too many patients separated from their loved ones while hospitalized. And we were devastated when so many patients didn’t survive.
Today, the Delta variant is attacking full-force. Restrictions that began easing just three months ago are necessary once again. The toll on our mental health deepens. It sometimes seems like more than we can bear.
THE WHIPSAW EFFECT
A few months ago, as vaccines became available and case numbers dropped, it felt as if we were approaching some sort of “normal.” People vacationed for the first time in a long time. They felt comfortable scaling back a bit on maskwearing. Health care professionals took the opportunity to breathe and hope for less daunting days.
But, by June, virus variants had gained a foothold in the United States. In July, daily case numbers in Arkansas began reaching 3,000 or more for multiple consecutive days. Emergency departments became overcrowded with frightened – and often younger – patients seeking help, and our hospitals reported more patients requiring ventilator care than in past waves. Fear of the worst settled in even deeper, especially for already-exhausted frontline health care workers.
As another school year begins, hospitals in Arkansas are overfilled with COVID-19 patients stricken with the highly contagious Delta variant, yet the rate of fully vaccinated individuals aged 12 and over in Arkansas stands near the nation's lowest at 50.8%. Arkansas Governor Asa Hutchinson makes frequent announcements about the dangerously limited number of ICU beds available in the state, and, in August, virus-related hospitalizations reached their highest point since the pandemic began.
The nation’s mental health – the world’s mental health – is affected every day. And those at the front lines of the medical community are suffering greatly. Their daily workload is physically, mentally, and emotionally taxing, and then they go home to the common concerns affecting the mental health of nearly every person living today.
A SEVERE TOLL ON MENTAL HEALTH
Grief from loss of loved ones, extended isolation, financial insecurity, and job loss are continuing common psychosocial stressors faced by Americans during the COVID-19 pandemic.
While many wrestled – during the first wave and lockdown – with mounting stress and anxiety, the current wave, caused by the Delta variant, brings new questions about healthy survival.
Stressors include: • Questions about being vaccinated. • Worry about family members’ vulnerability. • Concerns about others’ vaccination choices. • Dismay at the behavior of others.
By now, most of us personally know individuals who have been hospitalized with the virus or its complications, have been placed on ventilators, or perhaps have even died of COVID-19.
Scientists, learning from past pandemics, tell us that a disaster’s adverse mental health effects impact more people – and last much longer – than do its physical health effects.
I’m a licensed professional counselor. It’s probably no surprise that those in our profession see an increase of symptoms and heightened levels of anxiety in clients as the pandemic wears on. Requests for appointments with mental health therapists are dramatically rising; many people must wait months for their first appointment due to heightened demand.
We’re all working desperately to meet people’s mental health needs. We know the need for mental health care is growing exponentially and will continue growing long after the infectious outbreak resolves.
ALL AGE GROUPS AFFECTED
A report published recently by the CDC found that ER trips due to suicidal ideations in teen girls (ages 12-17) has risen by 50.7% (3.7% in teen boys) since the start of the pandemic.1 According to a metaanalysis published August 9, 2021 in the Journal of JAMA Pediatrics, one in four youth experiences symptoms of depression, and one in five experiences symptoms of anxiety, highlighting a startling truth: These mental health symptoms for young people around the world may have doubled since the COVID-19 pandemic began.2
The stresses associated with variant strains leave many people – parents, children, senior citizens, teachers, frontline workers, health care professionals, others – more anxious than ever.
Arkansans who are vaccinated say they are now less concerned about being hospitalized if they get a breakthrough case of the virus, but that the high number of unvaccinated Arkansans is worrying. They’re concerned about contracting the virus and possibly spreading it to someone who is unable to be vaccinated at this time, such as children 11 and under.
As a mother to a one-year-old son who is still too young to be vaccinated, I live with anxiety and fear every day, as many do, that I may unknowingly do something to expose my child to COVID-19. Parents of school-age children worry about health safety in classrooms.
Nearly two years into the pandemic, constant debates still take place on social media, within families, and among friend groups about whether or not COVID-19 is a real threat. I marvel that becoming vaccinated and wearing a mask have become dividing lines in our society. Emotionally loaded discussions, disagreements, frustrations, even feelings of helplessness are affecting mental health in negative ways.
COMPASSION FATIGUE AND COVID-19
As a health care professional, do you at times feel like health care’s fight against COVID-19 is the most challenging group project in which you’ve ever participated? Are you frustrated when people refuse to take advantage of the tools designed to help us win that fight?
You balance your work caring for others with genuine concerns for your own family and loved ones. The long work hours and increased demands are causing health care professionals to suffer overwork, exhaustion, and in some cases, burnout and compassion fatigue.
Compassion fatigue is a state of chronic physical and mental distress and exhaustion. People with this fatigue often describe a negative shift in their world view; they seem to absorb the stresses of their traumatized patients. Compassion fatigue creates its own physical and mental stressors and can lead to burnout, affecting a caregiver’s ability to be effective in their job and relate to their loved ones and friends. Health care workers experience stresses distinct from those in other professions. The pandemic only heightens this: They take care of patients making heart-wrenching phone calls to family members before going on life support. They educate patients about the COVID-19 vaccine, then deal with disappointment and frustration when many still refuse to take it.
Many health care professionals report feeling less respected and supported than in the pandemic’s early days. Today there is little cheering from the parking lots or signs saying, “We Love Our Health Care Heroes!” We wonder: Are we really “all in this together,” as we heard so often in 2020?
PRIORITY ONE – TAKING CARE OF YOU
Health care workers are so used to caring for others that we often put ourselves last; the thought of caring first for ourselves seems almost foreign. Flight attendants remind us, ”In case of emergency, put on your own oxygen mask before helping those next to you.” This logical concept applies to everyone, perhaps even more to health care professionals in the midst of a pandemic.
In today’s pandemic world, health care professionals can benefit from these practices: • Make self-care a priority: Despite your workload, do your best to make your health a priority. Focus on staying hydrated, sleeping as much as possible, eating nutritious meals, and getting exercise when you can.
• Boost your emotional resilience: Deep breathing, meditation, focusing on gratitude, and allowing yourself downtime to relax will allow you to better handle stress, setbacks, and crises. • Lean on social support: Connecting with supportive loved ones, friends, and colleagues can be a calming influence and shift your perspective on what you are dealing with every day. • Take pride in your profession: Your work is not only important, it’s a calling. You are caring for people during this ever-changing pandemic while giving them hope and strength. • Seek professional help: If you are experiencing distress and/ or symptoms of burnout for more than two weeks, help is always available at 1-800-273-TALK or by scheduling an outpatient appointment with a mental health professional.3
In addition to these self-care steps, health systems and hospitals should proactively ask doctors and nurses about their well-being, make the time and space to actively listen, and offer appropriate supports as needed for each staffer. Mental health care is as vital for health care professionals as are facemasks and other PPE.
Support is needed to allow doctors, nurses, and other staff members the time and space to reflect and discuss the emotional toll of working through this pandemic and toward a post-COVID era. A promising sign: some hospitals provide support groups led by psychiatrists to help health care professionals manage symptoms caused by anxiety, depression, and PTSD.
One lesson learned during the pandemic takes precedence: Take mental health seriously. Mental health is an aspect of overall health. The more we make the time to breathe and actively care for ourselves as caregivers, the more we will be able to help normalize an increased focus on mental health care. This moves society forward and helps us sincerely “all be in this together.”
Endnotes
1Yard E, Radhakrishnan L, Ballesteros MF, et al. Emergency Department Visits for Suspected Suicide Attempts Among Persons Aged 12–25 Years Before and During the COVID-19 Pandemic — United States, January 2019–May 2021. MMWR Morb Mortal Wkly Rep 2021;70:888–894. DOI: http:// dx.doi.org/10.15585/mmwr.mm7024e1. 2Nicole Racine, PhD, RPsych; Brae Anne McArthur, PhD, RPsych; et al. “Global Prevalence of Depressive and Anxiety Symptoms in Children and Adolescents During COVID-19, A Metaanalysis.” JAMA Pediat. August 9, 2021. http://doi.10.1001/jamapediatrics.2021.2482. 3Varun Choudhary, MD. “Compassion Fatigue and COVID-19.” Magellan Health Insights. https:// magellanhealthinsights.com/2020/03/17/compassion-fatigue-and-covid-19/.
Lauren English Britton, LPC, is a Licensed Professional Counselor and Business Development Representative working with Pinnacle Pointe Behavioral Healthcare System. She earned her Master of Science degree in Clinical Mental Health Counseling at Henderson State University, and her Bachelor of Arts degree in Mass Communications at Ouachita Baptist University. She has clinical experience working with children, adolescents, teens, adults, and families. You may recognize her from appearances on KATV Channel 7’s “Therapeutic Thursdays.”
SELF-CARE TIPS FOR CAREGIVERS
THE 4–7–8 BREATHING TECHNIQUE FOR RELAXATION
1. Sit quietly, relax, and close your eyes. Place the tip of your tongue against the ridge on the roof of your mouth just behind your top front teeth. Your tongue should remain in this position throughout the exercise. 2. Exhale completely through your mouth, making a whooshing sound. It may help to purse your lips. 3. Close your mouth, and inhale quietly through your nose for a count of four. 4. Now hold your breath for a count of seven. 5. Exhale completely through your mouth, making a whooshing sound to a count of eight. 6. Repeat steps 2–5 three times, for a total of four breaths.
In this technique, exhalation should take twice as long as inhalation. This ratio is the important part; the exact amount of time you spend on each phase is not important.
PROGRESSIVE MUSCLE RELAXATION
1. Get into a comfortable position. 2. Choose a muscle group (e.g., muscles in your feet or lower legs). 3. Breathe in and tighten the muscles in the group for 5 to 10 seconds. 4. Breathe out and release the muscles suddenly. Relax for at least 10 seconds. 5. Repeat the process with another muscle group. It often helps to progress from head to toe or vice versa.
