Disaster Mental Health Practice in a Public Health Emergency
Posted on: April 30, 2020
By James Halpern
COVID-19 will impact and kill more Americans and last longer than any disaster in our history. It is unnerving and frightening. We can’t see it and don’t know if we have it and could pass it on to others or if others are a danger to us. Although New York Governor Cuomo has warned of the mental health consequences of COVID-19 and referenced “cabin fever,” this pandemic will cause a wide range of more serious mental health problems including acute stress, grief, prolonged grief, depression, substance abuse, and domestic abuse. Although the health and economic consequences of this catastrophe have most of our attention and rightly so, the mental health impact should not be underestimated and will become more apparent over time.
My recent textbook Disaster Mental Health Case Studies (co-edited with Amy Nitza and Karla Vermeulen) covers 17 disasters, but none were as big, bad or long as COVID-19. Still, there is a lot we can learn from these experiences. In this article, I share three key lessons that will help Mental Health Professionals (MHPs) navigate the unique challenges of this global pandemic.
Increased Risk of Trauma for Healthcare Workers
Healthcare professionals are exceptionally at risk and we can expect that many will need short and long-term trauma focused psychotherapy. MHPs should understand and appreciate that some stressors are due to an overwhelmed healthcare system, where healthcare staff are often asked to take on unfamiliar roles. They have grave concerns about their own health, the health of their colleagues and their families. Many are caught between feeling responsible to colleagues, patients and the profession vs taking care of themselves and their families. Hospital procedures and protocols change rapidly, sometimes hourly, leading to uncertainty and anxiety. Healthcare workers have also been regularly exposed to injury, death and dying – significant risk factors in the development of PTSD. MHPs should keep in mind that in spite of these significant risk factors, healthcare professionals are dedicated to their patients, their colleagues, their mission and their oaths that all promote resilience and strength. They are a tough group, but no one is immune to extreme traumatic events.
New Challenges for Mental Health Professionals
This pandemic is changing mental health practice. MHPs cannot counsel face to face so they will have to rely more on Telemental health – phone, Zoom, Facetime, Skype and the like. Research on the effectiveness of Telepsychology is promising but as always it depends on who and how it is being used. Fortunately, the NYS Office of Mental Health, SAMHSA and professional organizations like the APA offer Telemental health guidance and training for practitioners.
Another new challenge for MHPs is that they are experiencing many of the same problems as their clients. This “shared trauma reality” is common in the Middle East, where therapists and clients share the same fears. When a siren sounds warning of a missile attack, a therapist and client both dive under the therapist’s desk. In the US it is rare for MHPs to be impacted by the same fire, flood, tornado or school shooting as their clients. Not so in this current pandemic. MHPs are worried about their own health, the health of their family and friends and may also be worried about financial problems. MHPs might be helped by speaking to one another about coping with the same issues as their clients. Let’s encourage our policy makers leaders to ensure that not only our health care providers, but also MHPs get the training, supervision and support they need.
Partner with Spiritual Care Workers for Increased Support
One of the central lessons learned from our most recent textbook was that expert MHP authors/practitioners regularly acknowledged the contribution of Chaplains. Chaplains were fully available to survivors who were suffering. MHPs and Spiritual Care Workers treated clients and helped one another using their own unique skills and training. When our assumptions about ourselves, other people and the world are shattered by a pandemic or plague, for many clients there is a religious or spiritual reaction and sometimes even a crisis. MHPs can partner with spiritual care workers to assist those who may be reassessing everything in their lives. Clients who have a relationship with a house of worship or spiritual provider should be encouraged to access that support. Clergy are also beginning to use Telechaplaincy. When there is a catastrophe of this magnitude, those who suffer can benefit from either or both mental health and spiritual support. As MHPs let’s utilize that partnership if it helps in the healing process.