Addressing and supporting mental health concerns of medical staff during COVID-19

When licensed psychologist Marc Celentana, PhD, founder and principal, Propel + Excel LLC, looks at the COVID-19 pandemic and its effects on medical practices, it is “unlike anything” he’s experienced in his lifetime: “This is a crisis of isolation,” Celentana says.

Since mid-March, individuals have been told to stay in their homes, away from one another, and to fear other people. “The cost of isolation is really the standout risk factor from my perspective,” Celentana said during a recent webinar presentation, “COVID-19: Mental Health Considerations for Return to Work.”

“We do know that when an individual is isolated, he or she can develop mental health issues concerns; it can exacerbate pre-existing conditions. It could be related to poor sleep, poor functioning, problem-solving, planning and organization, and it can also be associated with suicidal thoughts,” he added. “I think it frames the entire crisis as we know it.”

In a recent NPR report, neuroscientist and social psychologist Julianne Holt-Lunstad of Brigham Young University notes, “isolation can affect your heart rate, your blood pressure, your stress levels, even your immune system. … People who are more socially connected have stronger immune responses and are more able to fight off a cold virus.”

The role of medical practice leaders

Celentana stressed that medical practice leaders have an important role in crafting return-to-work communications during the pandemic. “Workplaces can, in fact, be important sources of stability and navigating this crisis,” he said. “Work gets done because we've established really good processes and procedures that support the individual needs of individuals, from a behavioral perspective, an emotional perspective and a social perspective. And in doing that, you actually serve a very, very important role.”

Celentana invoked recent comments by Marcos Iglesias, MD, MMM, FAAFP, FACOEM, chief medical director of Travelers Insurance, about considering the social and emotional well-being of employees who return to post-COVID-19 workplaces. As Iglesias has said:

There are going to be employees who have a hard time readjusting to the workplace. And I think it's crucial that supervisors are trained in how to identify these employees that have, perhaps, some challenges. A simple way of doing that is asking, “Are you OK?” No one has the playbook. But clear, frequent and honest communication is going to win the game. Truly caring about your employees, about their physical well-being, their emotional well-being is paramount in this day and age.

Pointing to the resources available in the COVID-19 Mental Health Guide for Employers (PDF) from Thrive NYC, Celentana outlined five key areas to help address employees’ mental health and well-being:

1. Start with empathy and compassion toward yourself first. “Taking good care of yourself will only bolster your efforts with others,” he added.
2. Maintain a strengths-based approach by focusing on your organization’s ability to withstand the crisis you’re facing, while recognizing the severity of the situation.
3. Acknowledge that anxiety during the COVID-19 crisis is expected. “It’s a normal response,” he added.
4. Consider the widespread impact of the crisis and the ways it may affect your employees and also customers. “As much as you’re experiencing it, those who are working with you [and] patients who are coming to your facilities are also experiencing it, as well,” Celentana said.
5. Focus on the overarching strategies that support the mental health of your workforce.

The stress factor and action steps for practice managers

Underlying most of the mental health and well-being concerns for staff is stress, which manifests both as a cognitive challenge and a physiological challenge.

“Stress can be extremely problematic in environments that are unpredictable,” Celentana noted. “If you can make the unpredictable predictable,” you can decrease your stress and your staff’s stress.

To help mitigate stress, Celentana recommends these action steps to practice managers:

1. Increase awareness of available mental health services. “Being able to provide staff with accessible and up-to-date information is one of the most important things you can do,” he said.
   • Review commercial insurance plans and services and determine the availability of them to employees, as well as employee assistance program (EAP) offerings.
   • Consider using a self-screening test to understand your mental health concerns. Celentana recommended Mental Health America’s self-screening test online, which is free, confidential and well-respected in the industry.
   • Provide a listing of national support and resource hotlines to staff. “You don’t need to be an expert on this, but just being able to externalize [these resources] can be really beneficial,” he added.
     
2. Update and share workplace policies modified due to the pandemic. The stressful months of the COVID-19 crisis are an ideal time to review policies — such as sick leave, disability, family leave, work from home, bereavement, flexible scheduling, full-/part-time status — to ensure they’re consistent and in line with any changes in your area. “Understand that things are changing very rapidly,” he said, and that regular reviews of these policies throughout the pandemic might be necessary.
   
   
3. Demonstrate commitment to the mental health of everyone in the practice. Leaders can influence the behavior of staff, patients and other clients by encouraging healthy practices. This goes beyond the need to implement and ensure social distancing and cleaning policies are maintained. To combat anxiety, practice leaders can communicate to employees how often they can expect updates about the facility and ongoing efforts to ensure the safety of everyone. It also may require some one-on-one conversations with employees so they can share any concerns outside of a group environment. Signaling to employees that you are open to one-on-one conversations may help you learn about unknown issues in your practice. “You might be surprised by the responses you get,” Celentana said.

National support and resource hotlines

• National Suicide Prevention Lifeline: 1-800-273-8255
• Childhelp National Child Abuse Hotline: 1-800-4-A-CHILD (422-4453)
• The National Domestic Violence Hotline: 1-800-799-7233
• Aunt Bertha Resource Database
• SAMHSA National Helpline: 1-800-662-HELP (4357)
• Crisis Text Line (Text “HOME” to 741741 for free 24/7 crisis counseling)
• National Alliance on Mental Illness (NAMI) Helpline: 1-800-950-NAMI or text “NAMI” to 741741.