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It’s OK to Not Be OK

Contributed by Suzanne Jasberg, MD and Anastasia Ristau, PhD, LP

Well before COVID-19, there were already multiple crises facing our country’s healthcare sector—from high costs of care to hospital staff shortages. Now, nearly two years since the first COVID-19 case was reported in the United States, healthcare workers are exhausted, burned out, disheartened, disillusioned and unsure how much longer they can endure. And there doesn’t seem to be an end in sight. At PrairieCare—one of the nation’s fastest-growing psychiatric health systems—we are seeing an exacerbation of existing mental health struggles as well as the development of new illnesses among healthcare workers. For those we treat as well as our colleagues, this seems, in part, a result of what healthcare workers are facing each day on the front lines of this pandemic. This is especially concerning when considering the hesitancy among physicians to seek care or treatment for a mental health condition because of fear of medical license repercussions.1 To do their best work in taking care of others, doctors, nurses, and healthcare workers need to take care of themselves first, starting with their mental health.

Compassion fatigue at the forefront

When the pandemic began, healthcare workers were constantly discussing PPE shortages, ventilator settings and how to ration ICU beds. They were afraid—in a way that many have never experienced — that their career could harm their families if they brought the virus home. As a psychiatrist and psychologist, we watched our colleagues endure this, knowing that the psychiatric ramifications

Suzanne Jasberg, MD

would be next—from trauma responses and insomnia to anxiety and guilt. Healthcare workers are also challenged with fighting a constant stream of misinformation. Topics of vaccines and masks have become controversial and political. Some individuals are dismissing advice to get vaccinated or refusing to practice basic public safety measures, and down the line require care for something that is largely preventable. Some doctors are facing violent threats while trying their best to provide evidence-based medicine. And we’re all worried about protecting those who are vulnerable, including children under 12 who just recently became eligible for the vaccine. We’ve heard many doctors and nurses ask questions like, “I’m losing my faith in humanity, what do we do next?” Once the vaccine arrived, we had more hope, but our efforts are falling short and compassion fatigue has set in. These thoughts do not make us bad healthcare professionals, or bad people—we have been subjected to prolonged

Anastasia Ristau, PhD, LP

trauma and these feelings are valid, and they must be addressed with care and support.

Healthcare workers struggle with mental illness-related stigma, too

There’s still a stigma in this country associated with having mental illness symptoms, and an even more pervasive stigma exists for healthcare providers. We’ve heard firsthand the concerns healthcare providers have around getting mental health care, starting with fear that this could impact licensing status and ability to practice. For many years, Minnesota’s licensure application required physicians to disclose mental health conditions even if the individual is being appropriately treated and the condition does not impair their ability to practice medicine with reasonable skill and safety. Thankfully, this has recently been addressed by the Minnesota Board of Medical Practice. In September, the board unanimously

voted to change the language for initial and renewal applications for licensure.2 The question, thought to have been a barrier for physicians, nurses, and medical students to seek appropriate care, has been changed to: “Do you currently have any condition that is not being appropriately treated which is likely to impair or adversely affect your ability to practice medicine with reasonable skill and safety in a competent, ethical and professional manner?” This will take effect Jan. 1, 2022 and will mean better mental health for the medical community and, ultimately, better care for patients.

Real change must come

It’s one thing to talk about how we, as healthcare providers, need to take care of ourselves so we can take care of others, but it’s much more difficult to translate that into action. Systemic changes are needed. To keep expecting more and more of ourselves and each other as the pandemic continues is not only unrealistic, but also dangerous to doctors and patients alike. If society wants healthcare providers to be able and willing to seek mental health support, they must receive more acceptance, guidance, and free time. With the increase in teletherapy, mental health care is more convenient and accessible now than ever before, but it still requires that healthcare providers can take time out of their busy schedules. Healthcare workers shouldn’t just be able to access mental health care, they should be encouraged to seek it out. Changes like the board language update are a great step in the right direction. But efforts on a more micro-level have tremendous impact as well. Checking in with ourselves and our fellow healthcare providers regularly with a “How are you?” and then acknowledging that it’s OK if the answer is “not OK,” can go a long way.

Put on your own mask first before assisting others

Tending to our own personal mental and physical health provides us a critical buffer against the impact that our minds, bodies, and spirits take from caring for others day in and day out. One way to mitigate feelings of exhaustion, helplessness, and potentially disillusionment about work is to refocus your “why.” Why did you choose a career in health care, what drew you to this work in the first place, and why is it fulfilling right now? That fulfillment from helping others or solving problems can keep us inspired and motivated and help us be more intentional about the day—refocusing on the things that can be controlled and positively impacted, rather than on what seems impossible or like a losing battle. Small efforts, such as pausing for slow, deep, and restorative breaths before your next patient, or taking a few minutes before and after work to focus on something you are grateful for in your life, can make a world of difference in recharging your batteries, staying calm, and minimizing toxic feelings. The daily work we do matters and every person we care for matters. Know that every time you educate someone to get the vaccine and have that difficult conversation, you are making a huge difference. Healthcare providers are used to pushing beyond our limits, even before the pandemic, but the more we tend to our mental health needs, the more resilient we will remain. We’re more willing to talk about mental health and acknowledge those limits when we have a strong support system scaffolding us. Try seeking out a trusted colleague who you are comfortable with and look out for each other. Make daily efforts to check in on each other with intention and mutual support. Healthcare employers also have a responsibility to focus on the needs and wellbeing of their staff. At PrairieCare, we’ve been providing group listening sessions to support our clinicians during this time. And of course, healthcare workers deserve to seek out specialized mental health care if and when they need it. Call PrairieCare at 952-826-8475 for a no-cost mental health screening to determine next steps and access any needed services for mental health support. There’s also the Physician Support Line3 that was developed during the pandemic, offering free, confidential peer support from U.S. licensed psychiatrists to doctors and medical students navigating the many stresses of their personal and professional lives. It’s available from 8 a.m. to 1 a.m. ET, seven days a week, at 1-888-409-0141. While there’s no chance everyone will go to sleep tonight and wake up tomorrow in a COVID-free world, as healthcare workers, we can still wake up with the goal of taking care of ourselves and watching out for our healthcare colleagues.

Suzanne Jasberg, MD, adult interventional psychiatrist, director of the Center for Neurotherapeutics, PrairieCare.

Anastasia Ristau, PhD, LP, licensed psychologist, director of psychotherapeutics, PrairieCare.

References 1. Dyrbye LN, West CP, Sinsky CA, Goeders LE,

Satele DV, Shanafelt TD. Medical Licensure

Questions and Physician Reluctance to Seek

Care for Mental Health Conditions. Mayo Clin

Proc. 2017;92(10):1486-1493. doi:10.1016/j. mayocp.2017.06.020. 2. A Victory for Physician Mental Health–Twin

Cities Medical Society. Twin Cities Medical

Society. https://www.metrodoctors.com/tcmsblog/2021/9/11/a-victory-for-physician-mentalhealth. Published September 11, 2021. 3. Physician Support Line. https://www.physiciansupportline.com/.

Disclaimer: The contents of this article are for informational purposes only. The content is not intended to be a substitute for professional advice, diagnosis, or treatment. Always seek the advice of your mental health professional or other qualified health provider with any questions you may have regarding your condition. If you are in crisis or think you may have an emergency, call 911 immediately. If you’re having suicidal thoughts, call 1-800-273TALK (8255) to talk to a skilled, trained counselor at a crisis center in your area at any time (National Suicide Prevention Lifeline). If you are located outside the United States, call your local emergency line immediately.