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As COVID-19 continues to spread throughout the world, it is apparent that adverse mental health effects are also impacting our communities. J. Kevin Tucker, MD, assistant professor of medicine at Harvard Medical School, spoke with Christopher Palmer, MD, a practicing academic psychiatrist, about the mental health effects of the ongoing pandemic and how health care providers can help their patients navigate this challenging time.
There is No One-Size-Fits-All Solution
Psychiatrists and psychiatric experts are anticipating that a mental health crisis will result from the coronavirus pandemic. In addition to the innumerable lives lost, communities have experienced increased unemployment, which in itself often leads to increased rates of domestic violence, alcoholism, drug abuse and suicide.
While everyone is experiencing this pandemic differently, we are collectively facing an extraordinary level of stress. There is not a one-size-fits-all solution for those suffering from mental health effects as we navigate to ‘the new normal.’
Lost Routines in Isolation
While structure and routine sound trivial a lot of times, they are extremely important. People develop routines to accomplish necessary tasks. When upended, they create a very stressful environment. People struggle. They have to think about, ‘how am I going to get all of the stuff done that I need to get done?’ They don't have their same systems as before the coronavirus.
Meanwhile, as people try to navigate new routines, they are also doing it in seclusion. “Although it's clear that we need to [isolate] to fight the virus and fight this pandemic, forcing people to be away from other human beings is actually a really aversive thing to do. A lot of people are experiencing social distancing in the same way that they would probably experience solitary confinement,” said Palmer. “It is extraordinarily painful to most human beings.”
Hopelessness is not Helpful
While the past few months have been extremely challenging, as Palmer notes, it’s possible for people to do most anything for a couple of months. The real mental health crisis will appear when we reach our new normal and when economic supports dwindle. One of the biggest risks to mental health is the concept of ‘learned helplessness,’ which happens when people are exposed to stressful, toxic, possibly life-threatening circumstances repeatedly, and they learn that there is nothing they can do to control it. A state of learned helplessness leads to many health problems.
It’s important for providers to not give into a patient's hopelessness, says Palmer. If you have somebody telling you about how their life has been devastated, it's really easy to accept that hopelessness and say, ‘that's awful, it's devastating.’ Some clinicians actually become silent. They immediately become hopeless for the patient, which is not helpful.
Tips for Non-Mental Health Providers Treating Patients
There is a shortage of mental health providers, which means primary care physicians are in a unique place to offer mental health guidance to their patients. As Palmer explains, there are a few tips for dealing with mental health issues among patients:
1) Listen, Empathize and Support
Simply talking to patients is an important screening tool. Take 30 seconds to ask patients questions like: ‘how are you holding up? How are you doing financially as a family? How are the kids managing with remote learning?’
You may get a lot of really valuable information. In that case, Palmer recommends aligning with your patients around problems that they've identified. You can empathize: “As your doctor, I want to help you in your fight. I want to help you survive this.”
If you start hearing ‘I'm not sleeping, I'm not doing well,’ frame it around the reality of ‘the pandemic sucks.’ Validate their circumstances, frame the current problem and then discuss how self-care can help.
For example, try saying to patients ‘if we could get you some sleep, it might make you more resilient. It might help you find a job faster. You might be able to think more clearly. You'll feel better, if nothing else.’
2) Do Not Call it a “Mental Problem”
As Palmer explains, it’s important to recognize that nearly 50% of patients are having some type of struggle with stress, anxiety, depression or insomnia. Patients usually don't bring this up with their doctor. It’s also common for patients to think that because doctors can’t help with unemployment, food insecurity or housing problems, that the doctor’s support is not needed.
This is why it is also important for providers not to refer to the patients’ experiences as a “mental problem.” Especially for people who didn't have a pre-existing mental disorder, they don't think of their problems as mental. As far as they're concerned, they have life-and-death problems. Problems stemming from employment insecurities or financial difficulties. Their stress is coming for obvious reasons.
3) Be Non-Judgmental
If somebody comes in and says, ‘I'm pissed off— I'm so furious that the president or whoever did this,’ it's really easy to be judgmental. Especially as a health care professional, we recognize that millions of people could potentially die if we let the virus spread unchecked. It's important to give patients an opportunity to talk about why they're so angry. Maybe it's not as trivial as wanting to go to a restaurant. Maybe the patient lost their job and is worried about their livelihood.
Palmer also recommends avoiding comparing yourself and your stress with another person's stress. People who still have their jobs and some degree of wealth experience stress in a profoundly different way than someone who is trying to figure out how to pay their bills.
4) Reach out to Mental Health Professionals
Finally, if any clinicians are anticipating mental health needs, reach out to local therapists or mental health professionals and ask to refer patients. Ask for their help. Many mental health professionals, if they get a call from another clinician, they're probably going to think ‘I can help you out.’
If somebody is not doing well, sometimes a prescribed medication is appropriate. Sometimes a referral is helpful. Recognizing the problem is the first step to treatment.
- J. Kevin Tucker, MD, Assistant Professor of Medicine, Harvard Medical School, Chief of Nephrology Brigham and Women’s/Faulkner Hospital, Faculty Director, Accreditation and Maintenance of Certification, Harvard Medical School Postgraduate Medical Education (PGME).
- Christopher Palmer, MD, Assistant Professor of Psychiatry, Harvard Medical School, Director, Department of Postgraduate and Continuing Education, McLean Hospital.