As hospitals and medical centers geared up to manage incoming waves—or floods—of patients infected by the coronavirus, their departments of psychiatry deployed their own expertise to support their colleagues through what often became an unrelentingly stressful ordeal.
“We had a virus coming to an aging population with no immunity and with no specific treatments,” said Ed Pontius, M.D., a semi-retired consultant and legislative affairs chair for the Maine Association of Psychiatric Physicians.
“We can only hope that the frontline people can keep up with the numbers of people who get sick, and so we’re crucially dependent on the health of those frontline people,” Pontius told Psychiatric News. “Only a single moment of loss of concentration can result in transmission of the virus and illness.”
To help those frontline health care workers cope with that stress, some sites extended existing employee assistance programs, others developed similar models on the fly, while still others wheeled into place the results of longstanding thinking about the particular stressors that accompany the advance of contagion.
Beginning April 1, Maine Medical Center launched two weekly virtual support groups for physicians and nurses.
“The goal of these groups is to offer a confidential time and place to come together with colleagues who are facing the same challenges and find support through honest sharing and reflecting on our experiences,” said Daniel Price, M.D., residency training director for psychiatry. The sessions are not overtly therapeutic. Instead, they’re intended to allow participants to process their worries and how they’re coping with the stresses they’re experiencing.
“There is no curriculum for this group other than creating a place that encourages sharing our experiences,” continued Price. “This is a place to tell our stories, both external—what we’re doing or witnessing—and internal—what we’re experiencing, thinking, and feeling.”
The pandemic arose with unexpected intensity.
“None of us was prepared for this,” said consultation-liaison psychiatrist George Nasra, M.D., chief of collaborative care and wellness at the University of Rochester. “When the pandemic began, we saw an increase in referrals from employees—but not the usual request for mental health or psychiatric care. Rather, people just needed support and someone to talk to.”
Eventually, Rochester created an emotional support helpline, available from 7 a.m. to 8 p.m. available 7 days per week for all of the university’s 40,000 employees and their families, said Nasra. The helpline is staffed by about 15 university workers displaced by the pandemic from their regular jobs in the medical center. They transfer callers to a list of over 80 faculty and staff in the psychiatry and psychology departments, who seek to normalize the experience of callers, avoid pathologizing, encourage self-care, and offer a list of resources for those who need more help.
Unexpected Education for Residents
One group that required some extra attention were psychiatry residents, said Nasra. Like their peers around the country, many stepped forward to volunteer as the pandemic struck their training sites. Rochester already had in place a once-a-week coaching program for residents. When the pandemic arrived, the focus shifted to COVID-19, discussing and processing cases.
“Residents have less experience with patients and are still in training mode,” said Nasra. “They feel less equipped and need more support. They have to juggle the clinical needs of patients with their program requirements.”
In Washington, D.C., residents and fellows at George Washington University (GWU) also volunteered to help, aware that their formal education was disrupted. The pandemic was not only a crisis but an opportunity, they soon learned.
“The COVID crisis is not getting in the way of your education,” James Griffith, M.D., the Leon M. Yochelson Professor and chair of the Department of Psychiatry and Behavioral Sciences at GWU, reassured them. “This is your education, and you’ll be better physicians for it.”
Griffith also led grand rounds on resilience at the invitation of colleagues across medical specialties. He couched his lectures in terms familiar to each audience. To neurologists, for instance, he spoke about brain networks and how to protect executive function. He emphasized building relationships and adopting assertive coping as an approach to the stresses of caring for patients rather than withdrawal.
“Fear is not a problem; panic is,” said Griffith. “The pandemic is characterized by intensity and uniqueness. No place seems safe, and there is great anxiety and self-blame about carrying the virus out of the hospital to family members or friends.”
In a proposal to the dean of the medical school, Griffith suggested three levels of response to COVID-19 stressors among hospital staff. The first level emphasizes that individuals can show symptoms like insomnia or lack of concentration that are normal responses to stress. Support for this group includes psychoeducation and referral to web-based wellness resources. A clinician who requests help for emotional distress or is encouraged by colleagues to do so is considered to be at Level II. Those individuals are referred to peer support groups or the Physician Support Line. Level III covers those who have overt symptoms of depression, anxiety, or posttraumatic stress; they are invited to seek more intensive help from the GWU psychiatry faculty.
The Physician Support Line sprang up soon after the pandemic reached this country, said co-founder Smita Gautam, M.D., a child and adolescent psychiatrist at the Family Institute at Northwestern University in Chicago. Gautam and four colleagues around the country put together a group of hundreds of volunteer psychiatrists to provide telephone support. The group, now numbering about 500, includes a mixture of clinicians ranging from PGY-4s to retirees.
“We’re offering peer support but not doctor/patient therapy or medication, although we do provide referrals as needed,” said Gautam in an interview. “So far, people are telling us they’re experiencing anxiety, grief, loneliness, insomnia, relationship issues, and fear of loved ones dying, among other problems.”
Immediate Deployment of Help Advised
In New York City, the hardest hit area in the United States, frontline physicians, nurses, technicians, and others quickly reached the emotional brink because of the sheer volume of patients and subsequent mortality, said Vicente Liz, M.D., vice chair of psychiatry at BronxCare Health System and president-elect of the New York County Psychiatric Society. “There was a sense of frustration. People felt, ‘We gave our best efforts, and it didn’t work.’”
One night, 15 people died, Liz recounted in an interview.
“The next day we came in, and we knew we had to check on our people,” he said. “Our team went floor by floor, engaging nurses and patient care technicians. We just asked how they were doing, how they were holding up. There was a sense of impotence because they weren’t getting positive outcomes. But each interaction can be therapeutic. It doesn’t need to be a formal encounter. The important thing is to be able to deploy quickly, right in the hospital.”
The only constant about COVID-19 is the continued uncertainty surrounding its clinical and epidemiological course. That only underscores the continued need to support those who care for patients.
“This is not just a test of skill and endurance for frontline people,” said Maine’s Pontius. “The surge we anticipated this month in Maine has not struck us as hard as we’d feared it might, but we’ve had losses, and it seems likely that we will lose more during an eventual second wave.”
The phone number of the Physician Support Line is (888) 409-0141, and this is the link to its website.