>>’Stigma About Mental Health’ Hitting Front Line Heroes

SANTA MONICA, CA — Health care heroes in Santa Monica and across the West Coast experience the vicious impacts of the coronavirus pandemic and work hard to put others first.

Sometimes they’re afraid to seek help, facing a stigma or fear around asking for support—but even the helpers need help.

Throughout the pandemic, Providence has offered a free mental health program so care teams can celebrate victories, mourn painful losses and discuss the stress that goes into keeping their families safe. As they grieve changes and challenges, a group of health care professionals is there to help support the caregivers with virtual visits. They help people cope with caring for COVID-19 patients, along with the other stresses and experiences of a volatile year — school closures, a tense election and the upcoming holidays have added to some already stressful elements.

More than 4,000 people have used virtual mental health services so far, Patrick Lee, one of the Providence team members, told Patch.

The main problems that people share during this time include stress, anxiety, depression and family problems, Lee said.

“Those are kind of the four that make up 80 plus percent of the issues that we see and many of them are COVID-related or have been impacted by COVID, so seeing a big increase,” Lee told Patch.

“There’s such a big stigma about mental health and people just don’t want to get help,” Arpan Waghray told Patch.

Many health workers said they would not have known where to go if not for the service, he added.

“People wait until things are in a full-blown crisis before they get help,” Waghray said.

The group understands that pandemic fatigue is real and works closely with health care workers. They see how stress doesn’t just impact the workers, but also their families.

“A part of what we did, in addition to some of the well-being things we did, was recognizing the fact that it can take a toll on the mental health and well-being of everyone,” Waghray told Patch.

“Any of the employees or their children were given access to a stress meter,” Waghray said. “It helps them measure the level of how stressed or distraught they are.”

They work with families, including children, to talk through problems and share solutions.

“Daddy guilt is real, too,” Waghray said.

He recommends creating routines, establishing boundaries and balance.

“Get up, take a shower and get ready, get to your work area,” Waghray said. “Just because you can work 24 hours a day doesn’t mean you should work 24 hours a day.”

The team of mental health experts looked to the past to help navigate the future.

“One of the things we started doing was to learn from other natural disasters,” he said.

They looked at how the situations evolved.

“When you’re hit with something like his, unlike other major disasters that other people have lived through, there’s an endpoint but for us, this is continuing,” Waghray said.

Nothing compares.

“The adrenaline rush—everyone coming together as one team—that dips,” Waghray told Patch. “Then people start realizing everything that’s going on, the mismatch between resources, and what’s going on. You’re witnessing harm and you’re helplessly watching on the sidelines and you’re not able to do anything.”

“I would say that health care workers have been through a lot,” Waghray told Patch.

He expects that many more health care workers or people in emergency services do need help. And this service is available for those who seek it.

How do we deal with pandemic fatigue?

“This may be a chance to reset a little bit about our expectations,” Josh Cutler told Patch.

Health care provider burnout was a concern before the pandemic, but the group identified that people needed help, Cutler said.

“Insomnia is a big issue and headaches are a problem,” Cutler said. “People are looking at blue light a lot.”

He recommends people practice good sleep hygiene, shut screens off at night, and relax.

Cutler’s personal experience has shifted the dynamics in his home. And like many families, things are not the same as they were before the pandemic—both personally and culturally.

“We started early and ended late, and we were stretched to the max,” Cutler said. “And now, looking at how our lifestyle has evolved, I wouldn’t want to go back there.”

He recommended coming up with activities with families or kids to keep people motivated and moving. He and his daughter do a Fitbit steps competition and work on getting their steps in together.

“If you’re able to take advantage of that and have that be time for family connection or exercise,” Cutler said.

There’s also a push to step back.

“I think that as a working culture we tend to expect a lot from ourselves,” Kathlyn Fraguela told Patch.

People tell her ‘I’m noticing that I’m skipping lunch,’ or ‘I’m not doing breakfast.’ Some environmental factors have shifted, work friends might not be prompting you to take a lunch break, she described. This is happening to people who are working at home, while teaching, or caregivers who are on the front lines.

“I think a lot of people are making it work, so they’re just doing it out of a chair at a dining room table,” Fraguela said. “Oftentimes we forget that in order to do our best work that we have to take care of ourselves.”

“The emails will keep coming. so it’s important to set boundaries, take breaks for 30 minutes and enjoy a lunch break,” Fraguela said. “We feel so rushed through our days.”

Walks, stepping back or taking a breath, can go a long way.

And with the holidays approaching, it might be the time to consider alternatives and look for new rituals.

How do you navigate the holidays during a pandemic?

It’s good to consider the traditions that your family does each year, Fraguela said.

Families can design something that looks similar, so you can join in together, but in a distant way. She suggested making a recipe together with family or hosting a cookie decorating event via Zoom.

“I think there’s a lot of opportunity to do things that still feel like you’re joining,” Fraguela told Patch. “It’s really about connection. That’s what we’re struggling with the most. Everybody is feeling so burdened by what’s going on.”

Waghray recommends explaining to kids how it’s time to stay safe and help other people.

How do you talk to kids or teens about the pandemic?

“When they’re a part of a solution and they actually feel like they’re doing something they value that,” Waghray said.

Reminding children that they help to stop the spread of an infection that might hurt other people, especially family members who might be more vulnerable, is a good way to start, he said.

“I’ve been having a lot of conversations with teens and who had to move home,” Fraguela said. “A lot of what we’re feeling is grief and nobody’s really talking to teens about grief.”

People are adjusting to new realities—that change is difficult. Kids might be struggling in school, back in their childhood home with rules and online learning.

“It’s being able to talk through what’s going on and listening,” Fraguela said. “Let kids grieve the friendships they can’t have.”

Kids at college are not going to have an Animal House college experience, Cutler said. “It’s not exactly turning out that way. But it may be an opportunity to be closer connected to their parents and other people and engage in some things at home that they wouldn’t have had an opportunity to do if they were hungover at campus.”

“People need to acknowledge it’s hard and painful,” he said.

Talking it out helps, and creating a comfortable space to talk about what’s going on can help people recognize and explore what they feel, he added.

Each person goes through something different, Fragela said.

“We really have to individualize our treatment because that’s how we find we can help our caregivers,” Fraguela said. “With young adults, it might be talking about relationships, how to improve them, and be positive.”

Not much is the same for most teens and kids. And that’s OK, she said.

“In challenges, there’s usually some growth,” Fraguela said. “When we think about going back, do we really want to be in reverse all the time? We want to think about going forward. Tomorrow’s not going to look like yesterday did, it’s not supposed to. We gain flexibility in pain.”

There is no predictable future.

“When people think about going back, it’s about what was, because we don’t know what’s going to be,” Fraguela said.

And one of the biggest obstacles so far continues to be dating—something people already struggled with before the pandemic.

“I hear from a lot of caregivers around dating, ‘How do you date in a pandemic?'” Fraguela said.

Creativity is key. And yes, the dating part is hard, she added.

Fraguela described how she sent a handwritten note and care package to her niece to wish her well. It’s the little things, small gestures to show care.

What are some of the positives amid the pandemic?

Kintsugi is a Japanese ritual that focuses on imperfection and repairing areas that are broken, Waghray described, comparing it to our uncertain reality today. It’s one way to look at the present and work to improve it, using their experiences, imperfections, fears or doubts.

“If a piece of pottery is broken you accentuate them and recognize that there is brokenness in us,” Waghray said.

Today, health care professionals are experiencing what he calls post-traumatic growth, a result of this pandemic era.

“We’re not going to bounce back to when it’s normal but it’s the next normal, especially with telehealth,” he said.

This version of life might look or feel much different than in the past.

“There are a lot of positives, too, here,” Waghray told Patch. “I used to travel a lot for work. My six-year-old loves this whole phase.”

“We will come to a new normal that will make sense to all of us,” Waghray said.

How are people grieving in the pandemic?

Hospitals had little warning before the pandemic. They faced protective gear shortages as a surge of patients with baffling, very serious symptoms filled ICUs. The toll on doctors, nurses and all those who care for patients is intense, particularly as cases begin to surge again.

The Providence team feels inspired to keep supporting the front line workers and their families. Cutler described how the stages of grief can come into play when people experience a prolonged state of emergency.

“When people have some of these strong feelings and emotions coming up it’s not just sadness,” Cutler said. “It’s a bit more complicated. This is very complex grief. It’s a loss that’s sort of never-ending and we keep losing certain parts of our lives that we can’t have access to. I think recognizing that, psychological flexibility, really helping people to learn some practices that help them be more resilient.”

Building resilience can help, he said.

“Grief is not a new phenomenon,” Cutler said. “Death is not a new phenomenon. Death is a new experience.”

“This has been some of the most meaningful work of my career, to provide emotional support to nurses, doctors, caregivers,” Cutler said.

“Doctors are often the last people with COVID patients and they are struggling with watching patients die,” Cutler said. “It’s become a part of their day and it’s not that they hadn’t been with a patient who hadn’t died before but just the intensity of it.”

Many health care workers worry when they return home to their families at the end of a shift.

“They’re worried they could get them sick,” Cutler said.

“I find this work extremely rewarding, so in a way, it fuels me in a different way,” Fraguela said. “It can be draining but at the same time knowing that I can be there for somebody who might not have had anybody else is really awarding.”

The Providence Telebehavioral Health Concierge provides same-day or next-day access to licensed mental health professionals to help employees address burnout and other mental health concerns. The service is now available to 119,000 employees and tens of thousands of their family members across the Providence system.