Mental Health Support for COVID-19 Health Care Workers

Mental Health Support for COVID-19 Health Care Workers

[MUSIC PLAYING] JOSH SHARFSTEIN: Welcome
to Public Health On Call, a new podcast from the Johns
Hopkins Bloomberg School of Public Health. Our focus is the
novel coronavirus. I’m Josh Sharfstein, a faculty
member at Johns Hopkins, and also a former Secretary of
Maryland’s Health Department. Our goal with this podcast is
to bring evidence and experts to help you understand
today’s news about the novel coronavirus and what
it means for tomorrow. If you have questions,
you can email them to [email protected]. That’s
[email protected] for future podcast episodes. Today, I’m talking to Dr. Albert
Wu, an internist and professor at the Johns Hopkins Bloomberg
School of Public Health. He is Co-Director of the
RISE service at Johns Hopkins Medicine. RISE stands for Resilience
in Stressful Events. This service provides support
for health care workers. Let’s listen. Thank you, Dr. Wu,
for joining me. I understand you’ve
been studying the mental health of
caregivers for some time now. Could you tell me a
little bit about that? ALBERT WU: Sure. Well I’m an internist. I’m a general internist. But I’ve always been
interested in how in particular stressful
incidents in the hospital affect health care workers– doctors, nurses, and in fact,
all the other many people who work in the hospital. And we found that when
bad things happen, which happens quite frequently
when people are sick, and you’re trying very
hard to make them better, that those health
care workers are often traumatized by
the same incidents that cause patients harm. And they can become very
depressed, anxious, sometimes fearful, feel like
they’re not doing– they hadn’t done everything
that they could have. And this can
actually hamper them in their work, both in
their personal lives and in their ability to do
a really good job of taking care of patients. JOSH SHARFSTEIN: Wow, that’s– ALBERT WU: Sort of
a principle that– a principle we’ve worked on
is that health care workers need to be healthy, both
physically and mentally, in order to do their best
job taking care of patients. JOSH SHARFSTEIN: Which brings us
to the unprecedented situation we’re now facing
with the coronavirus. What do you think
the key issues are for health care workers and
their mental health right now? ALBERT WU: Well, they’re–
the key issues now are a few. First of all, as you
said, this is really an unfamiliar situation
for health care workers. They’re rarely in a position
where they themselves are at risk. There’s also just not
enough information. People just don’t
know what to expect. And they’re afraid. Health care workers are
worried about their patients who are desperately ill. And it’s frightening
to see people so ill. They also are afraid that they
themselves may become infected. If they do, they’re afraid
they may go off and infect their own family
members, or other people that they care for
outside of the hospital. And in many ways, they feel
frustrated because we’ve had a shortage of supplies. And they feel like they’re not
being given all the tools they need to do the job,
the very difficult job that they’ve been
charged with doing. All of this makes what is
already a very stressful work environment that much worse. JOSH SHARFSTEIN: And aside
from the obvious risk of actually getting
sick with coronavirus, what are the other consequences
of that kind of stress? ALBERT WU: Well, the
other kinds of stress are that people may
simply not be able to– people may have
trouble sleeping. They may be anxious. They may feel like
withdrawing, actually. And they may not
have as much reserve as they would normally have
for taking care of people, for giving the
kind of compassion and caring that patients
need so much when they’re sick in the hospital. JOSH SHARFSTEIN: So
is that just something we’re going to
have to deal with? Or are there things that
can be done to mitigate all those stresses and anxieties? ALBERT WU: Well, I think
that we can do two things. First of all, we need to
communicate effectively with health care workers. We need to let them know
exactly as much information as we have up to the
moment, because people, when they are so stressed,
need two kinds of support. They need information
support, and they need emotional support. One thing which we
think is very important is to really normalize
people’s feelings. That is to say it is natural
for you to be feeling this way. In fact, it would be odd if you
were not anxious and worried, at least a little bit. And we should encourage them
to express those feelings. And then there are support
resources that people have. And we should encourage people
to identify those resources that they have in
their own lives. What they usually do to
make themselves feel better, now some of those things
are not so available as we are under more
or less isolation. JOSH SHARFSTEIN:
Right, so people like to go to the movies. That may not be possible. ALBERT WU: But there is Netflix. We can also offer them
support sort of ahead of time, proactively, and
encourage them, get them to talk about their
feelings, be empathetic. In the hospital, I think that’s
another thing that’s important, is to have groups of
supporters who systematically provide this kind of support. And then we need to support
those supporters, giving them information about
how to do the kind of psychological first stage
that might be necessary, or crisis management. JOSH SHARFSTEIN: And I know this
is not a theoretical discussion for you. We’re talking early
in the morning in part because you have different
kind of responsibilities at Johns Hopkins. Could you just generally
explain the kinds of services that you’re making
available for caregivers? ALBERT WU: Well, we are trying
to coordinate the resources that we already have
in the hospital. And fortunately, we
have a lot of people who are concerned about the
well-being of our own staff. Again, we recognize
that for them to do their job
enthusiastically, and to be able to do the
extra hard work that they need to do now, they need to feel
well and fit and enthusiastic about doing their work. So we’re trying to maintain
that morale as much as possible. We’re not gonna succeed if
we’re not able to do that. We do have a few resources. One is a program
that we call RISE, which stands for Resilience
in Stressful Events. And we have a very
multidisciplinary group of workers, nurses, doctors,
social workers, chaplains who are basically on-call
for health care staff. If they’re feeling badly, if
they feel overly stressed, they can call a
number, and someone will call back, and
then show up in person to listen, to do a little
psychological first aid, and to mostly provide
emotional support. We also have chaplains who are
in the hospital all the time. We have a call-in service, which
just about every hospital has. It’s just a staff
assistance program. And in fact there’s someone
who can answer the phone and perhaps talk someone down,
encourage them, or support them over the phone at any time. JOSH SHARFSTEIN: And
what about the staff that maybe people don’t
think about everyday, but who are really essential
to the COVID response? ALBERT WU: That’s
a great question. It’s not surprising
that the people in a– who are taking care
of COVID patients are gonna be
stressed and worried about their own
health in many ways. But there are people
you wouldn’t think of, people in laundry, or in
sanitation, or in food service. They are having
contact with patients or with materials that have
potentially been contaminated. They also don’t have as much
information in many ways as the doctors or nurses do. And when you don’t have
enough information, you tend to assume the worst. You tend to imagine the
worst possible situation. And rumors can
spread very quickly across a small group
based on that very– that information vacuum. JOSH SHARFSTEIN: Well,
you know, it definitely has crossed my mind
and the mind of others about the stress that
might be affecting people throughout the hospital. But what can you
do for people who have jobs that aren’t even
direct patient contact jobs in some cases, but
may be quite stressed because of what’s going on for
all the reasons that you said? ALBERT WU: Well, I’ve
got a couple of things. One is you can make sure
that they get information. These are people who
do not have the– who are not sort of up to
the minute with all the data that we have at the
very front line, or at the management
level of the hospital. So you can keep talking to them. You can– JOSH SHARFSTEIN:
Answer their questions. Yeah, answer their questions. ALBERT WU: Oh, absolutely
answer the questions. And they are likely
to have questions that might not have
occurred to you, but which, if you think
about it for a minute, are completely logical. So listening first, and
answering the questions. And the final thing which I
think cannot be emphasized enough is to thank them for
the job that they are doing. If people don’t feel like
they’re being recognized, or if they don’t feel like
they’re being appreciated, if they feel like the
people at the top are– know everything
and are in control, but they don’t know so much,
they feel out of control. That’s a terrible feeling. And they feel like
why am I doing this? And be inclined to
even call in sick. I think that in some places,
as the stresses mounted, more and more people have called
in sick for unclear reasons. And it may simply be
kind of logically. They’re afraid. They’re not sure
that they’re doing what they– they’re
doing anything that’s making a difference. I think they need to
be reminded that they are crucial to the functioning
of the institution. They’re kind of the backbone
of the whole system. And we all have to be
there and show up and do a good job for us to work–
for all of this to work. JOSH SHARFSTEIN: So there may
be health professionals who are listening to this podcast,
maybe going to and from work, hearing you talk. If you had a message for
them, what would it be? ALBERT WU: I would
say that it is– if you are a little bit
worried about yourself, about your patients,
about your family, I think that that is
completely normal. You should talk to other
people about those concerns. And if you have questions, you
should pass them up the line and get your managers
and leaders to give you the information you need. You should think
about your own life and identify the kinds
of support resources that you’ve always used,
and avail yourself of those, both at work and– and at home. It may be talking to people. It may be escaping a
little to watch a film or a movie or a cat video. It might be reading or going
for a walk, off by yourself. And you should make sure
that you make a little time for yourself, maybe for a
short personal meditation. If you’re someone
who has religion, for a religious observance. If you see that some of your
staff are anxious or need help, you should talk to them. And you should
offer them support. Something that’s
really important is to give yourself
a little credit. You should appreciate
the important work that you yourself are doing. And you should always give
gratitude to yourself. And thank your colleagues. I think that a little extra
kindness goes a long way. This is a very stressful
time for all of us. JOSH SHARFSTEIN: Great. Well, thank you so much, Dr. Wu,
for joining me, and walking us through these really critical
issues for health care workers, caregivers, and
really everyone who is involved in the
medical response to the coronavirus epidemic. ALBERT WU: Thank you
very much for the chance to talk about these issues. I think it’s very important. You’re doing an important
service for all of us. JOSH SHARFSTEIN: Thank you
for listening to Public Health On Call, a new podcast from the
Johns Hopkins Bloomberg School of Public Health. Please send questions to be
covered in future podcasts to [email protected]. That’s
[email protected]. This podcast is produced
by Josh Sharfstein Lindsey Smith-Rodgers, and
Namari Morales. Audio production by
Nile Owen McCusker, with support from Chick Hickey. Distribution by Nick Moran. Thank you for listening.

In the midst of a pandemic, resilience is key for health care workers. Dr. Albert Wu, co-director of RISE—Resilience In Stressful Events—an emotional peer support structure at Johns Hopkins Hospital, talks to Dr. Josh Sharfstein about the importance of supporting hospital staff and what can be done to mitigate anxiety and stress in this unprecedented situation. Learn more: jhsph.edu/covid-19