August 31, 2021 – Looking for Light in an Unbelievable Time
When I sat down to write this post, one of the phrases I started with but didn’t necessarily plan to keep was “family physicians are stressed beyond belief.” I thought those last two words, “beyond belief,” might sound exaggerated or dramatic.
Now I think that’s exactly where we are: beyond belief.
I can’t believe this country has logged 38.4 million cases of COVID-19. I can’t believe this virus has killed more than 630,000 Americans. I can’t believe that, a season past when there seemed to be light at the end of the tunnel for our strained practices and our colleagues and our families and our patients, the delta variant and the politicization of prevention and vaccination have for now eclipsed our hopes.
I can’t believe that, in the very same week the FDA announced its full approval of the Pfizer-BioNTech COVID-19 vaccine for all patients 16 and older, the United States just repeated a cruel milestone: We’re back up to 100,000 hospitalizations for the first time since the start of 2021.
Honestly, it’s not just stressful. It’s exhausting.
It’s exhausting to see how many Americans don’t believe the evidence-based science of the COVID-19 vaccines, even when they’re hearing it patiently but urgently explained by their family physicians. It’s exhausting to see how many people have steered themselves toward misinformation or demagoguery about masks, endangering themselves and their families and imperiling their communities. And it’s incomprehensible — it’s devastating — to know how many people who could have prevented their infections or lessened the impact of the illness have gone from beyond believing us to beyond rescue.
All of these elements are taxing the capacity of the health care system — including us — beyond its limits. Again.
5 Podcasts to Reset Your Mind
You, our family physicians, have faced an especially challenging time as frontline workers seeing first-hand the impacts of COVID-19.
Prioritizing mental health as we enter the winter months has always been key, but with the continuing pandemic as an added stressor, checking in on your mental health will be even more necessary.
To help with this, we’ve compiled a list of five, must-listen podcasts to help reset your state of mind going into the new year.
Mental Health During the Pandemic (by Jonathan Temte, MD/PhD)
It’s happened to me three times so far. I get a text message from the US Census Bureau requesting, “Please answer survey on COVID19 crisis.” Although my mind initially said, “scam,” I connected using the hot link to find that there is an ongoing assessment of the American population. Among the questions related to employment, changes in income, health care utilization, and food security, I immediately recognized four from the PHQ-2 and GAD-2; these are validated screening instruments for depression and anxiety, respectively, in primary care.
Upon tracking down the Census results, I found that almost 30% of responding adults reported feeling anxious or nervous and 23% reported not being able to stop or control worrying more than half the days or nearly every day in the preceding week. Moreover, 19% reported feeling down and 21% reported having little interest or pleasure in doing things more than half the days or nearly every day during the previous week. Anxiety and depression are following in COVID-19’s wake.
A recent research letter compares the rates of serious psychological distress in early April 2020, using data from a reliable survey platform representing the US adult population, and in 2018, using data from the National Health Interview Survey (NHIS) and yields similar results. Between 2018 and 2020, the estimated prevalence of serious psychological distress increased by 3.5 fold, from 3.9% to 13.6%. The groups with the highest current rates are young adults (age 18—29 years: 24%), those with household incomes of <$35,000 per year (19%) and Hispanic adults (18%). The lowest levels were for individuals aged ≥55 years (7%) and with household incomes ≥$75,000/year (8%). In addition, one in seven respondents reported that they always or often feel lonely, increasing from one in nine in 2018.
The Mental Health Association of Maryland has a website dedicated to healthcare workers. Resources to help healthcare workers address burnout, while taking care of their mental health can be found here.
Maryland Department of Health offers mental health support to frontline workers during COVID-19 pandemic
The Maryland Department of Health (MDH) is proactively supporting frontline workers during the COVID-19 outbreak by sharing widespread mental health resources, joining forces with experts throughout the state, offering discussion groups and weekly webinars for behavioral health providers, and providing virtual training and recovery resources.
Health professionals across Maryland are uniting to share resources, build partnerships and raise awareness of much needed mental health support, particularly for the frontline workers facing COVID-19 every day.
“As important as our physical health and wellness is right now, we must also emphasize mental health,” said MDH Secretary Robert R. Neall. “From people who are cut off from loved ones or living in difficult situations, to those working on the frontlines in stores or in healthcare settings, support is available to those who need it.”
Maryland’s helpline for mental health and substance use has experienced an increase in calls. Data collected by MDH’s Behavioral Health Administration (BHA) shows calls to “211, Press 1” increased from 1,619 in February to 2,345 in March.
BHA administrators have been urging Marylanders — especially those on the frontlines — to seek help before they reach a crisis point. BHA has created extensive resources to help healthcare workers and the general public access mental health support, including:
- New public service announcements targeting people in extreme stress situations
- Virtual recovery and wellness resources
- Suicide prevention guidance
- Mental Health FAQs for healthcare workers, parents and other audiences
- Discussion groups and weekly webinars for behavioral health providers
“It is vital that we are proactive about addressing mental health concerns,” said Dr. Aliya Jones, Deputy Secretary for BHA. “Even after the critical data points have gone in the right direction, due to the nature of the pandemic, this crisis has the potential to have a long-term impact on all of us. Disasters are known to be followed by increases in PTSD, depression, substance use, suicidal thoughts and attempts, domestic violence and child abuse. However, that doesn’t have to be the case. We can minimize increases in these after effects by taking advantage of available emotional support and treatment resources.”
BHA has created a Telehealth Resource Guide and an interactive Telehealth Map to help new patients access care. The map includes known behavioral health providers now offering telehealth services across the state.
Another new resource from BHA is Operation Roll Call, a program that offers veterans regular check-in calls and a chance to talk to someone who can offer support. An emergency contact is called if a veteran cannot be reached. Inspired in part by the Department of Aging’s Senior Call Check-in, this new resource will continue for veterans after the COVID-19 pandemic subsides.
BHA is sharing resources from healthcare professionals with its network of stakeholders, including:
- Virtual trainings and support for behavioral health professionals
- Information guides on websites and other resources for individuals and families
- Resources from the federal, state and local level to help address heightened levels of stress, anxiety, fear and depression
Other collaborative projects include:
- Sharing mental health resources with COVIDConnect, the state’s new website for Marylanders who have recovered from COVID-19
- Partnering with the National Alliance on Mental Illness (NAMI) Marylandto disseminate messages of support and create a Mental Health Awareness Month social media toolkit
- Organizing webinars for the Maryland Primary Care Program (MDPCP) for ambulatory care providers to help support the mental resilience of frontline physician providers
- Supporting Children’s Mental Health Matters, a campaign from Maryland Coalition of Families and the Mental Health Association of Maryland to raise awareness of children’s mental health
- Promoting Behavioral Health Integration in Pediatric Primary Care (BHIPP), a program that improves access to quality mental health for children and adolescents
- Supporting Mind Resilience, a program that helps educators and organizers understand self care, well-being and a resilient mindset
BHA also is working on a new initiative to provide targeted mental health support to personnel working in skilled nursing and other long-term care facilities impacted by COVID-19.
“Nursing home staff are facing especially difficult situations, given the impact of COVID-19 on the elderly and physically vulnerable. They often work for years with residents who become like family,” said Jones. “Many of these frontline healthcare workers need mental health support now, and we cannot ask them to wait in line to get help.”
Like several other initiatives developed in reaction to COVID-19, Jones hopes to expand this resource beyond nursing homes and the current pandemic. BHA is calling on volunteers to help build support systems that will last into the future.
Those interested in donating time, sharing resources or ideas for collaboration should email email@example.com.
For COVID-19 guidance specific to behavioral health professionals, visit bha.health.maryland.gov/Pages/bha-covid-19.aspx.
Physician Health First
The AAFP Physician Health First initiative is devoted to improving the wellbeing and professional satisfaction of family physicians by addressing the causes of physician burnout, including the broken U.S. health care system, the organizations employing physicians, the practice environment, individual wellbeing, and a physician culture of self-sacrifice over self-care. Learn more
Check out great resources available to help you practice self care, including opportunities for CME credit!
Apps for Mindfulness & Wellbeing
Family Physicians are working tirelessly to provide critical support to patients and families in their communities during this time and the added challenges you’re facing during the pandemic add a lot of additional stress. There are several recommended apps available to support the wellbeing of healthcare providers:
Calm (free options, can pay for additional features)
- Variety of meditation exercises and relaxing soundtracks organized by topic (e.g. stress, anxiety, sleep, focus, etc.)
CBT-i Coach (free)
- VA resource with Cognitive Behavioral Therapy for insomnia strategies, free guided relaxation activities, and sleep logs to help keep your sleep on track
Happify (free options, can pay for additional features)
- Science-based activities and games to overcome worries and stress
- Techniques were developed by experts who study evidence-based interventions in the fields of positive psychology, mindfulness, and Cognitive Behavioral Therapy
Headspace (free for providers for the rest of the year with verification by NPI; otherwise 2 week free trial for non-providers)
- Sets of guided meditations aimed at tackling problems related to stress, anxiety, sleeplessness, and relationships
Healthy Minds (free)
- Translating pioneering neuroscience into tools for everyday life using mindfulness practices and podcast style lessons.
- App designed by UW Center for Healthy Minds
Insight Timer (free)
- Guided meditation app with a variety of mindfulness and meditation practices targeting stress, anxiety, insomnia, etc.
Recovery Path (free)
- Personalized evidence-based prevention and intervention strategies for people struggling with or recovering from substance or alcohol addiction
- Incorporates aspects of Motivational Therapy, Cognitive Behavioral Therapy, and Community Reinforcement to boost your treatment and recovery plan.
Ten Percent Happier (free options, can pay for additional features)
- Large selection of guided meditations and mindfulness practices
- Great for beginners as well as those already well-versed in mindfulness
- Includes free Coronavirus Sanity Guide
Sanvello (free premium during COVID-19 crisis; additional features available with qualifying insurance)
- Clinically-validated evidence-based mobile application for anxiety, stress and depression
- Based on Cognitive Behavioral Therapy, currently used by over 3 million people
Stop, Breathe & Think (free options, can pay for additional features; free kids version)
- Guided meditation and mindfulness
- Includes theme “Calm Coronavirus Anxiety”
- Option to check in with your emotions and pick exercises based on how you feel
- 2017 People’s choice award for best health app
- Personalized web-robot who delivers Cognitive Behavioral Therapy skills to foster insight into unhelpful thoughts and behaviors and reduce stress
Wysa: Mental Health Support (free options, 20% off subscription cost right now)
- Research-backed app that utilizes Cognitive Behavioral Therapy, Dialectical Behavioral Therapy, yoga, and mindfulness to support people with mental health and wellness needs
- Access to a real mental health professional who coaches you through new skills and coping behaviors (with subscription)
1] Support for Healthcare Providers Coping with the Pandemic
The COVID-19 pandemic is taxing the human, material and financial resources of individuals, communities and countries around the world. This unprecedented public health crisis is impacting every aspect of daily life, but the toll on healthcare professionals in particular is immense.
There are many tips and resources to help caregivers find information they need to continue supporting each other and caring for themselves during this extremely difficult time on The Schwartz Center for Compassionate Healthcare website.
The Schwartz Center’s mission to put compassion at the heart of healthcare holds true no matter how extraordinary or difficult the circumstances.
2] COVID-19: Stress and Coping (CDC)
– Acknowledge that secondary traumatic stress can impact anyone helping families after a traumatic event.
– Learn the symptoms including physical (fatigue, illness) and mental (fear, withdrawal, guilt).
– Allow time for you and your family to recover from responding to the pandemic.
– Create a menu of personal self-care activities that you enjoy, such as spending time with friends and family, exercising, or reading a book.
– Take a break from media coverage of COVID-19.
– Ask for help if you feel overwhelmed or concerned that COVID-19 is affecting your ability to care for your family and patients as you did before the outbreak.
– Seek additional information about stress management for first responders from the Disaster Technical Assistance Center(SAMHSA)
Be sure to check out AAFP’s Focus on Well Being page dedicated to family physicians. This site is full of content and includes inspiring stories from fellow family physicians, blogs, AAFP news coverage and tools.
Deep breaths are like little love notes to your body.
1] Mental Health of Healthcare Workers Podcast
In this podcast, The Happiness Lab host, Dr. Laurie Santos of Yale, talks to doctors on how they cope with isolation and lack of self-compassion. They explore doctor’s mental space as they explore advocacy in crisis, meditation, courage and more. See how here.
2] Physicians Support Line
Support line service made up of 600+ volunteer psychiatrists, joined together in the determined hope to provide peer support for our physician colleagues as we all navigate the COVID-19 pandemic.
During this time it’s emotionally difficult for everyone and physicians are not exempt. Mental Health First Aid has a website full of articles available that are specific to COVID-19 and mental health; relevant for anyone including physicians, family & friends and patients.
Another source for now and anytime you may want to consider is an app to help routinely practice mindfulness and medication. Check out Headspace, an app that teaches you how to meditate. Headspace is offering free access to Headspace Plus for all US. healthcare professionals working in public health settings during the crisis.
Be gentile with yourself. You’re doing the best you can.
Four principles for handling stress during a crisis
In times of crisis, such as the COVID-19 public health emergency, stress can be heightened by a number of factors. AAFP offers advice for physicians to address their stressors and support their own well-being in the midst of a pandemic in this week’s AAFP FPM Journal blog: https://www.aafp.org/journals/fpm/blogs/inpractice/entry/stress_crisis_tips.html?cmpid=em_FPM_20200422
“Self-care means giving yourself permission to pause.”