We Must Address the Mental Health Crisis Among Medical Professionals
Even as they battle a virus that has claimed more than 90,000 lives in the U.S., hospitals are scrambling to address another onslaught: a mental-health crisis in their ranks.
As the Covid-19 pandemic grinds on into its third month, many doctors and nurses on the front lines say they are physically and emotionally drained. The psychological burdens are felt across the spectrum of hospital staff, from specialists being rerouted to Covid-19 care, to emergency-medicine workers dealing with low stocks of protective gear and the recurring loss of patients who are forced to die alone.
Hospitals across the U.S. have launched extra efforts to support their workers. In New York, the Northwell Health system has set up a 24-hour “emotional support resource call center” for employees seeking help. It has also posted tents outside its hospitals where doctors, nurses and other staff can stop and talk to people trained in psychological first aid, or, if they prefer, scan a QR code that provides links to a variety of mental-health resources. A number of health-care systems, including UCSF and Kaiser Permanente, have rolled out a suite of apps intended to reduce stress and improve sleep for their workers. Some nurses and doctors are convening in Zoom support groups as well.
“Emergency physicians are drawn to the field because they like looking after really sick people,” says Michael Myers, a psychiatry professor at the SUNY Downstate Medical Center who facilitates support groups for doctors at the University Hospital of Brooklyn. “But they are very vocal about the fact that they’re just not used to so much death.”
Others have also found it difficult. A 39-year-old nurse at Mount Sinai South Nassau in Oceanside, N.Y., Nicholas DeLuca usually works in the operating room, but has been redeployed to an intensive-care unit with Covid-19 patients. On occasion, he says, he has seen as many as three or four patients die on a shift—something that is particularly heartbreaking, he says, because they are passing away alone, as their families, connected through mediums like FaceTime, strain to understand what is happening to them.
“It’s like when I used to talk to my grandfather about World War II, all the vivid memories that are hard to get out of your mind, and you’re never going to get over it. It’s something that sticks with you,” says Mr. DeLuca, who at home tries not to talk about what he is seeing at work to avoid upsetting his wife.
Mr. DeLuca was a first responder during 9/11 in New York before he became a nurse in 2006. Covid-19 is a different kind of challenge, he says: a day-in, day-out roller coaster.
Mount Sinai Health System, where he works, is launching a new center for researching and addressing the impact of Covid-19 on the mental health of its front-line health workers. Dennis Charney, Mount Sinai’s president for academic affairs, estimates that 25% to 40% of first responders and health-care workers in the U.S. will experience some form of stress or post-traumatic stress disorder as the result of the pandemic.
Even those used to dealing with emergency medicine say the situation has challenged traditional coping mechanisms. Before the coronavirus, Luis Quintero, a critical-pulmonary-care specialist at Northwell Health, says he was able to leave work behind each time he went home. But now, the New York-based doctor says he worries about getting his wife and baby son sick, and about being exposed to coronavirus in the community. For the first time in his career, he says, he worries about his own mortality.
“I have to be cognizant of everything around me,” Dr. Quintero says. “It’s exhausting, because it seems like we’re always thinking about Covid-19 all the time.”
Given the likelihood that communities across the U.S. will continue to see spikes in cases, the need for mental-health care is even more urgent, says Alison Holman, an associate professor at the University of California, Irvine, specializing in trauma research. Holman’s research has found that “anticipatory anxiety” can be profoundly difficult for people to deal with—and can make trauma worse once a difficult event does occur.
“Human beings don’t like uncertainty,” she says, adding that it’s important for health-care systems to provide mental-health resources even if their local communities haven’t yet been badly hit.
For physicians like 33-year-old Erik Blutinger, an emergency-room doctor at Mount Sinai Queens, the disconnect between what they see at work and the more-relaxed public attitudes they encounter elsewhere has been especially frustrating. “I’d come home emotionally spent and turn on the TV and see reports of people questioning the validity of health experts like Dr. [Anthony] Fauci, and playing down the importance of really staying inside,” Dr. Blutinger says of his experience at the height of the crisis in New York.
Meanwhile, the emergency room where he works, treating hundreds of Covid-19 patients, “felt like a movie, a horror film,” he says.
Though the crisis has been taxing on the mental health of Americans generally, health-care workers are especially vulnerable, says Curtis Reisinger, who heads Northwell Health’s employee-assistance program. The field is already subject to heavy rates of burnout, he says, and the coronavirus “is layering on something of catastrophic proportions, exacerbating fatigue.”
Surveys of health-care workers in China earlier this year found high rates of symptoms of depression (50%) and anxiety (45%), with nurses reporting more severe symptoms than physicians.
Once the immediate crisis recedes, the emotional toll will continue to unfold as more health-care workers have time to reflect on what they’re experiencing, says Edward M. Ellison, executive medical director of the Southern California Permanente Medical Group: “We do expect almost a PTSD [post-traumatic stress syndrome] or second wave of mental-health issues and anxiety to address,” Dr. Ellison says.
Some doctors and nurses say they are only now beginning to process the events that have upended their professional lives.