FIQ (Fédération Interprofessionnelle de la santé du Québec)

COVID-19 and mental health

Healthcare professionals will likely have to manage some challenging behaviours as part of the COVID-19 pandemic. The Association paritaire pour la santé et la sécurité du travail du secteur des affaires sociales (ASSTSAS) has prepared two documents that may be useful

Taking care of healthcare professionals’ mental health

The anxiety and stress that the difficulty in providing care in a context of a pandemic such as the coronavirus (COVID-19) entails, requires paying attention to the healthcare professionals’ need for emotional support. Looking after oneself and encouraging others to take care of themselves also maintains the ability to take care of patients.

The following information was loosely translated into French and adapted from “Cuidando la salud mental del personal sanitorio” of the Spanish Psychiatric Society (Sociedad española de psiquiatría) with their permission. Then, it was translated into English. Some additions were made based on the reality of healthcare professionals in Québec. The content in no way binds the Spanish Psychiatric Society.

Challenges facing healthcare professionals during the coronavirus crisis

  1. Overflow in requests for help

While many people are seeking health care, healthcare professionals themselves, or their loved ones, may become ill. Especially in circumstances like those of COVID-19, healthcare professionals may be contaminated and have to be quarantined or need health care. Moreover, healthcare professionals are often the reference person in their circle for support and information on health.

  1. Constant risk of contamination

The risk of contracting this dreaded illness and transmitting it to family members, friends and colleagues is higher.

  1. Insufficient and awkward equipment

Equipment may be lacking, a little awkward, limiting movements and communication, and the safety it provides may be uncertain. Moreover, all the messages about a limited quantity of equipment may contribute greatly to the healthcare professionals’ uncertainty.

  1. Facing greater needs of support

At the same time as needs and frequency are greater, it may be increasingly difficult for healthcare professionals to manage the anxiety of patients and their families.

  1. Major stress in areas of direct care for infected patients

Helping people in need may be gratifying, but also difficult, and professionals experience fear, sadness, and frustration, a feeling of guilt, exhaustion and insomnia. These are expected reactions in situations of this importance and uncertainty. Knowing all these reactions are normal in an abnormal situation may be comforting.

  1. Exposure to families’ distress

The COVID-19 crisis exposes healthcare professionals to the intense suffering felt by inconsolable families who cannot be with their loved ones in isolation.

  1. Ethical and moral dilemmas

The lack of means, excessive workload, as well as the uncertain patient outcomes, ensure that at times healthcare professionals are obliged to take complex decisions in a short space of time, which causes profound moral dilemmas and feelings of guilt. It is difficult to be in a situation that confronts both our personal and professional values.

Possible reactions in a situation of profound stress

Emotional:

  • Anxiety
  • Exhaustion
  • Frustration
  • Fear
  • Guilt
  • Irritability
  • Sadness
  • Desensitization

Cognitive:

  • Confusion or contradictory thoughts
  • Difficulties in concentration, thinking clearly or taking decisions
  • Memory problems
  • Obsessive thoughts and doubts
  • Nightmares
  • Intrusive thoughts
  • Compassionate exhaustion
  • Denial
  • Sense of unreality

Behavioural:

  • Hyperactivity
  • Isolation
  • Avoiding situations, people or conflicts
  • Excessive verbosity
  • Uncontrolled crying
  • Difficulty looking after oneself and resting/disconnecting from work

Physical:

  • Breathing difficulties: chest pressure, hyperventilation…
  • Excessive sweating
  • Trembling
  • Headaches
  • Nausea
  • Gastro-intestinal problems
  • Muscle cramps
  • Tachycardia
  • Paralysis (numbness, tingling)
  • Physical fatigue
  • Insomnia
  • Changes in appetite

Strategies for taking care of oneself during the coronavirus crisis

  1. Look after essential needs

Healthcare professionals are accustomed to thinking that they have to be available for others and their own needs are secondary, while not eating or resting causes exhaustion. Be sure to eat, drink and sleep regularly. Not doing so jeopardizes mental and physical health and in the end, it compromises the capacity to care for patients.

  1. Take a break

When possible, take part in activities that are comforting, fun or relaxing for you. Listening to music, reading a book or talking to a friend may help. Some people may feel guilty not working all the time or if they take the time to relax when so many are suffering. However, taking a break will also help in giving better care to patients.

  1. Plan a routine outside of work

Try to maintain habits that are allowed given the restriction measures. Since the change in habits is drastic, explore creative ways for other options at home: daily exercise routines, personal care, reading, call or videoconference with loved ones.

  1. Talk with work colleagues

Talk with your work colleagues and support each other. Isolation due to the pandemic may produce fear and anxiety. Talk about your experience and listen to that of others.

  1. Respect differences

Some people need to talk while others need to be alone. Recognize and respect these differences for yourself, your patients and work colleagues.

  1. Share constructive information

Talk to your colleagues clearly and encourage them. Identify errors and failures constructively in order to be able to correct them. They all complement each other: praise can be a powerful motivator and stress reducing. Share your frustrations and solutions. Problem solving is a professional aptitude that provides a feeling of accomplishment even for little incidents.

  1. Talk with family and loved ones

Talk with loved ones, if possible. They are your support outside the health network. They may be able to give you more support if you share with them. Furthermore, they will embrace your vulnerability. Feeling useful to each other is a protection factor.

  1. Keep your skills up to date

Rely on trusted sources of knowledge. Participate in meetings to keep informed of the situation, planning and events. However, don’t stop taking part in activities not related to the pandemic (reading, board games, movies, physical activities, as much as possible).

  1. Limit exposure to means of communication

Explicit images and disturbing messages will increase your stress and may lower your efficiency and general well-being. Protect yourself psychologically setting limits on the demands that can come from social media and other digital means asking for personal information or advice, in order to maintain your rest time and capacity to get through this endurance race. If possible, reduce your exposure to the COVID-19 media and social media.

  1. Allow yourself to ask for help

Recognizing our signs of stress, asking for help and learning to stop and take care is an internal regulation mechanism that fosters stability in a situation of enduring stress. Your employee assistance program may be a good source of support in the current context.

  1. Vent your feelings

Professional competence and strength are not inconsistent with feelings: confusion, concerns, feeling of a loss of control, fear, guilt, exhaustion, sadness, irritability, desensitization, instability… are precisely the emotions that make us human. Sharing one’s feelings with someone who inspires safety and trust helps us tolerate these feelings better and resolve them.

  1. Self-observation of feelings and perceptions

Feeling unpleasant emotions is not a threat as it is our mind’s normal defence mechanism when faced with danger. However, be watchful that symptoms of depression, professional burnout and anxiety do not develop: lingering sadness, difficulty sleeping, fatigue, loss of motivation, vivid memories, despair, fear, irritability. Talk with your colleagues, superior, or seek professional help if necessary.

  1. Apply recognized emotional management strategies

Breathing, awareness techniques, physical exercise, among other things, may be useful in defusing negative thoughts, emotions and physical symptoms.

  1. Remember that just because it’s possible doesn’t mean it is bound to happen

Healthcare professionals are constantly exposed to the darker side of this dramatic pandemic. This creates an emotional charge that translates into obsessive thoughts where we always think the worst. It is important not to lose hope and remember that many people suffering from this virus exhibit mild forms of the illness.

  1. Acknowledge your team

Remember that despite the obstacles and frustrations, you are on a great mission: providing care to those in need. Recognize your colleagues, formally and informally. Remember that all those who work in care settings in these circumstances are doing their best and are the real heroes for the population.