Medical Workers Fighting COVID-19 Are Facing a Mental Health Crisis

s a critical care doctor in New York City, Monica is used to dealing with high-octane situations and treating severely ill patients. But she says the COVID-19 outbreak is unlike anything she’s seen before. Over the past few weeks, operating rooms have been transformed into ICUs, physicians of all backgrounds have been drafted into emergency room work, and two of her colleagues became ICU patients. While Monica is proud of her coworkers for rising to the challenge, she says it’s been hard for them to fight a prolonged battle against a deadly, highly contagious illness with no known cure.

To make matters worse, Monica recently tested positive for COVID-19, and she believes she brought the virus home to her husband. Both have gotten sick and are improving, but he had a much harder time with the disease than she did. Monica says that, while she’s used the inherent risk of her job, she feels her hospital failed to protect her and her family — and she blames herself, in part, for her husband’s illness. “There’s this sinking feeling that you have,” says Monica, who requested anonymity because she feared professional repercussions for speaking candidly, “not only, like, the hospital let you down, and that the system let us down as doctors and didn’t protect us, but then I didn’t protect my own family.”

It will be years before the mental health toll of the COVID-19 pandemic is fully understood, but some early data already paints a bleak picture. A study published March 23 in the medical journal JAMA found that, among 1,257 healthcare workers working with COVID-19 patients in China, 50.4% reported symptoms of depression, 44.6% symptoms of anxiety, 34% insomnia, and 71.5% reported distress. Nurses and other frontline workers were among those with the most severe symptoms.

In interviews with TIME, several doctors and nurses said that fighting COVID-19 is making them feel more dedicated to their profession, and determined to push through and help their patients. However, many also admitted to harboring darker feelings. They’re afraid of spreading the disease to their families, frustrated about a lack of adequate protective gear and a sense they can’t do enough for their patients, exhausted as hours have stretched longer without a clear end in sight, and, most of all, deeply sad for their dying patients, many of whom are slipping away without their loved ones at their side.

It’s those lonely deaths that have hit the hardest for some. Natalie Jones, an ICU-registered nurse at Robert Wood Johnson University Hospital Hamilton in New Jersey, says it’s been agonizing to have to turn away people who want to visit their loved ones one last time. She’s trying to find ways to be compassionate where she can — last week, she passed on a message from a patient’s wife just before he died: “That they love him, and it’s O.K. to go.” But even simply carrying a message of such emotional weight can take a toll.

“We carry that burden for the families, too,” says Jones, who’s having difficultly sleeping without nightmares. “And we understand it’s so difficult that they can’t be there. And that hurts us too. As nurses, we’re healers, and we’re compassionate. It hits very close to home for us as well.”

“We’re all affected,” adds Jones, whose already hectic schedule has gotten even more intense amid the outbreak, costing her the sleep that might otherwise help her cope with what she’s experiencing. “To say that we’re not would be a lie.”

“We didn’t have the resources before this that we needed, and this has completely strapped them beyond anything feasible,” says Katz. “It’s so sad. I really feel for these nursing homes and the staff of these nursing homes, because I truly believe that they’re trying to do the right thing. But I really don’t feel like they’re being protected the way that we need to protect them.”

Finding ways to support medical workers’ mental health could be a key component in the fight against COVID-19. Dr. Albert Wu, professor of health policy and management and medicine at the Johns Hopkins Bloomberg School of Public Health, says that evidence from the 2003 SARS outbreak suggests that failing to support healthcare workers in a crisis, including by not providing enough protective gear, can erode their “wellbeing and resilience,” ultimately leading to chronic burnout. Some healthcare workers could leave the profession, be absent more often from work, or develop PTSD, and any preexisting mental health conditions could be exacerbated. Furthermore, healthcare workers are human like the rest of us, and under extreme stress, they could be prone to making mistakes — which could lead to worse outcomes for patients, and further erode doctors’ and nurses’ mental health. “We can’t get away from our physiology,” says Wu.

If healthcare workers can’t provide the care they typically believe is medically necessary for their patients, they may experience a phenomenon known as “moral injury,” says Dr. Wendy Dean, a psychiatrist and the co-founder of the nonprofit Fix Moral Injury. Dean says that American healthcare providers are used to doing anything and everything to help their patients, but inadequate protective gear and triage procedures will force them to make “exquisitely painful” decisions, such as choosing whether or not to risk infecting themselves, their family and other patients in order to help everyone in their care.

Still, Dean says the scope of the mental health crisis among healthcare workers won’t come into focus until the more immediate problem has ebbed.

“When I think the real challenge is going to come is when the pandemic eases up and people start having time to process,” she says. “All that they’ve seen, all that they’ve done, all that they’ve felt and pushed away.”

Several healthcare workers said that, amid all the uncertainty and horrors, they have found some relief in drawing upon support from their families, communities, and one another. Monica, for one, says her friends brought food to her and her husband after they got sick, and she deeply appreciated the support. She’s also proud of the way her colleagues have come together as a team to fight the virus. “There has been a real feeling of, everybody’s in the trenches together,” she says. “What I’ve been most amazed about is people have really risen to that call.”

Please send tips, leads, and stories from the frontlines to virus@time.com.

By Tara Law

April 10, 2020

Source: Medical Workers Fighting COVID-19 Are Facing a Mental Health Crisis

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Mental health crisis in teens is being magnified by demise of creative subjects in school

After the recent report by The Children’s Society that a quarter of 14-year-old girls have self-harmed, many campaigners have called for the root causes of the adolescent mental health crisis to be tackled – rather than just firefighting the symptoms.

Resilience lessons, peer mentoring, awareness campaigns and provision of early intervention may be valuable initiatives. But they do little to challenge the main causes of mental health issues – which are likely to be integral characteristics of a neoliberal economy, including austerity, global uncertainty and a highly pressured education system.

The British Psychological Society’s recently published Power Threat Meaning Framework also supports this viewpoint. It sees mental distress less as an individual medical issue, and more as an intelligible response to the social, material and cultural pressures acting on people.

Much of my experience is as a storyteller and community artist, and I coordinate the Things As They Are network for young artists with experience of mental ill health. I have found that young people with mental health conditions often have a keen perception of how the media, economy and society contribute to their problems. These large-scale issues are often beyond the scope of schools to address, but with a change of focus, the educational environment could move beyond firefighting problems to play a more fundamental role.

More time for play

A vital first step would be measures to reverse the shrinkage of what might be called the “youth public sphere”. By this I mean the space and time that is allowed for dialogue, self-expression, playfulness, exploration, development of personal initiative, and just plain chatting, between young people and caring adults.

These opportunities enable young people to understand the world around them and thrive despite adversity. But they have been dangerously eroded by closely specified curricula, performance-focused education systems and the decimation of the youth service.

Less than one in 20 pupils took music GCSE in 2017. Shutterstock

The Pupil Referral Units to which ever increasing numbers of young people are being sent – because they cannot cope within mainstream schools – make an interesting contrast. These units are frequently criticised, but they do allow space for dialogue and responsiveness to young people’s needs and interests.

I have witnessed conversations between young people too anxious to attend school sharing tips on how to get referred to a unit – because “they treat you like a human being there”, unlike in mainstream school.

Space to grow

At the risk of sounding bitter, I could also cite my own frustrating attempt to establish a lunchtime storytelling club with a group of keen, and vulnerable, young people in a local secondary school. The teachers were supportive – we wanted to establish a space where different “tribes” of young people could make friends and collaborate creatively outside the constraints of the curriculum, which allowed little space for creative writing or group work.

Yet with lunch breaks cut to 35 minutes to maximise lesson time and manage behaviour, and further shortened by frequent detentions, it proved impossible to build up a stable group, and teachers lacked the time to support the ideas for performances and projects from pupils.

Schools are cutting time spent on PE lessons because of exam pressure. Shutterstock

It is widely agreed that education systems centred on exams place stress on young people, yet there is less understanding of their more insidious effect. That is, their tendency to reshape every exchange between teachers and pupils into something directed at an assessment goal.

They also squeeze out of the school day anything that does not contribute to this. Arts and sports activities dwindle away from the curriculum, and teachers find themselves less often in the informal, supportive roles of mentor, facilitator, and guide.

Meanwhile, outside schools, austerity has led to open access youth clubs being gradually replaced by targeted provision to improve “outcomes” for school refusers, teenage parents, or young people in care – and even these are being cut in most areas. Mental health and well-being are also effectively being converted into goals which young people must individually achieve through learning strategies.

Beyond league tables

To thrive emotionally, young people need their own time and space, that is not explicitly directed at particular outcomes. This should be an arena in which diverse groups of young people can form their identities and agendas – perhaps with the non-coercive oversight of sympathetic adults. The arts provide some of the key forums for this – I gratefully remember the music teacher that helped me and my friends set up our band in the lunch break.

To try and tackle the challenge young people are facing, the government could start by mandating time and space in schools for exploratory, informal, and pupil directed activity. This could be done by reinstating leisurely lunch breaks and allowing for extracurricular activities within them. Arts and sports lessons also must be restored where they have been reduced within the curriculum.

The education sector should pay attention to solutions to the mental health crisis which arise from young people themselves – I’m thinking of the group of GCSE students whose protest on London’s tube trains proclaimed the human cost of pupil exclusions in a system focused on exam results rather than compassion and support.

As mental health campaigner Natasha Devon points out, self-harm is frequently a way of being heard. Perhaps then, if we help young people find other, more creative outlets, we might find it easier to hear what they’re trying to tell us.

By: Postdoctoral researcher and arts practitioner, York St John University

 

Source: Mental health crisis in teens is being magnified by demise of creative subjects in school

 

 

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