COVID-19 & MENTAL HEALTH Diane Whitney MD, FRCPC, BCETS NOSM Program Director Psychiatry Residency Program Assistant Professor NOSM & University of Toronto, Adjunct Professor Western University
Teaching Objectives : • Understand the impact of COVID-19 & social isolation on mental health • Highlight findings from the scientific literature with regards to the impact of COVID-19 crisis on our health care providers • Identify how to provide support patients, medical colleagues & yourself
Impact of COVID-19 & Social Isolation on Mental Health
Anxiety & Uncertainty • This infectious disease outbreaks cause significant anxiety & uncertainty • General population • Anxious / depressed, psychotic patients & other vulnerable patients • Health care / mental health providers can play an important role in supporting well being of patients, families, health care providers & general public
Educate about Common Adverse Responses • Common responses include anxiety, insomnia, fear of illness, desire to increase drug & alcohol use • Children may experience regression, acting out & social isolation • Educate regarding reduction of overall stress • Inform patients & family where & when to get help
Managing COVID19 Anxiety • Acknowledge that some fear & anxiety is normal • Switch off technology & do some enjoyable i.e. reading, exercise • Limit your news intake including from social media • Get news from reliable sources-WHO, Health Canada • Show compassion & check on your neighbour / those at risk • Show respect- don’t buy excessively – Hoarding behaviours are common in times of uncertainty. Recognize it as your brain engaging in the fight or flight response and try not to feed into it.
Remember the Children • Children need to be reassured at age appropriate level • Acknowledge fears • Explain the risk & what is being done to keep the family safe • Reassure while being realistic • Discuss questions • Limit TV & Social Media time • Help adolescents understand social distancing – Not to share drinks, make up – Avoid smoking, vaping
At Risk Mental Health Populations People with Serious Mental Illness compromise 3-5% of pop – Homelessness & grp living increase risk of infection & spread – Coexisting medical problems – Inpatient admission may increase risk – Physical isolation increases depression and SI People with Addictions – Support groups limited & only on line, – Limited access to technology – Closure of stores for access may lead to withdrawal – Risk of relapse with unstructured time, loss of supports, recreational activities
At Risk Mental Health Populations Persons in Violent Living Situation Domestic Violence, child abuse, dependent adult abuse • Social isolation increases victimization • Program often not operating • Home bound victims less likely to be identified • Many children, youth & adults may be victimized during COVID-19
Suicide Mortality & COVID-19 Consequences of social distancing may increase risk of suicide: • Economic stress • Social isolation versus physical distancing • Barriers to Mental Health Treatment • Decreased Access to Community & Religious Support • National Anxiety • Elevated suicide rates among medical professionals
Recommend Health Promoting Behaviour • Eat a healthy & balanced diet • Reduce / eliminate alcohol, cigarettes, recreational drug use • Practice good hygiene • Good sleep hygiene • Establish daily routine • Exercise few times per week / Yoga • Engage in a sense of meaning/purpose or accomplishment
When we are in a place of uncertainty, the most effective way to decrease worry and anxiety is to be fully present in the moment
Pleasurable and Mastery Events • Bring us into the moment rather than focusing on the anticipation of what the future may look like • Pleasurable Events – things you do for the sake of bringing you joy • Mastery Events – things you do to gain a sense of accomplishment • Make your lists and try to ensure there is a combination of both pleasure and mastery in your week
COVID Friendly Pleasurable and Mastery Activities Family workouts, walking, biking • Baking • Playing board games, cards • Spring cleaning/Yard work • Try new recipes • Learn something new, i.e. language • Read books/listen to audiobooks • Write (emails, letters, autobiography, book, etc.) • Video games • Skype, Facetime, etc. • Take an online photography class • Research a topic of interest • Redecorate your room • Volunteer for a cause you support online • Do a jigsaw puzzle • Donate old clothes or items to charity • Lay in the sun •
Guide to living with worry and anxiety amidst global uncertainty https://www.psychologytools.com/ass ets/covid- 19/guide_to_living_with_worry_and_a nxiety_amidst_global_uncertainty_en- gb.pdf Walley, M., & Kaur, H. (2020). Living with worry and anxiety amidst global uncertainty. PsychologyTools.
Face Covid by Russ Harris • https://www.baps.org.uk/content /uploads/2020/03/FACE-COVID- by-Russ-Harris-pdf-pdf.pdf
Encourage Provider Self-Care • Risk of severely stressing the providers along with the system • Highlight basic needs including Sleep, eating, hydrating & regular breaks • Adequate PPE supply • Providing support, finding constructive solutions & staying connected to friends & family
Challenges for Health Care Providers
Difficult COVID Situations • Triage of Patients – Who gets the last ventilator or who gets taken off a ventilator? • You are asked to be a medical physician rather than a psychiatrist • Intubation, prescribing antibiotics • Colleagues are in isolation so the call schedule is a “no go” • Risk to you, your family – going & coming from hospital to home etc.
Supporting the Health Care Workforce during COVID-19 Global Pandemic- Adams & Wall , JAMA Mar 12, 2020 Pressures on Health Care Workforce 1. Potentially overwhelming burden of illness stressing a health care system already at capacity 2. Adverse effect on health care workers including infection 3. High risk clinical settings – Precautions for respiratory illness & crowding – Fear /anxiety
China Health Care Workers • 3300 health care workers infected • At least 22 died • Access to PPE & adequate cleaning major concerns • In China mental health needs have been apparently poorly handled – Planning is not adequate – Community & mental health institutions decoupled – Shortage of various professionals – Mental health professionals are considered non essential
Mental Health Impact on Health Care Workers Lai et al. JAMA 2020;3(3) • 1257 health care workers in 34 hospitals Jan 29 to Feb 3, 2020 in China – Participation rate 68.7% – 64.7% aged 20 to 40 years – 76.7% women – 60.8% nurses & 39.2% physicians • PHQ-9, GAD -7, Insomnia severity index-7, 22 item Impact of Event Scale-revised
Results – Health Care Workers • Those working in Wuhan, China had more severe degrees on all measures • Especially nurses, women • Frontline health care workers engaged in direct diagnosis, treatment and care of patients were associated with higher risk of symptoms: • Depression OR 1.52 • Anxiety OR 1.57 • Insomnia OR 2.97 • Distress OR1.60
https://covid19therapists.co m ONTARIO COVID-19 MENTAL HEALTH NETWORK -FREE
Preventing & Addressing Mental Health Concerns
Mitigating Psychological Effect on health care workers SARS Outbreak CMAJ Wu et al April 15, 2020 • Clear & rapid hospital communication • Frequent communication • Transparent leadership at multiple levels • Direction about hospital processes & appropriate supplies & equipment • Psychological support informally then telephone lines & drop in centres
Health Care Workers in Isolation / Quarantine • Workers self-isolation report symptoms of PTSD, depression, stigmatization & fear of $ loss • Strong social support network offsets feelings of isolation • Video calls / virtual meeting • Support & altruism i.e. medical students delivering groceries
Identifying & Addressing Mental Health Concerns • Educate people to understand normal reactions to stress & how to manage stress so individuals are more resilient Goals • Improve short term performance & long term mental health outcomes • Reduce barriers to care
Road to Mental Readiness Program (R2MR) LOAD THE APP!
Monitoring Behaviour
Some supportive and crisis resources for you or clients Health Sciences North Crisis Intervention Services 1- • 800-841-1101 Thunder Bay Crisis Response 807-346-8282 • 24 hour Crisis Line North Bay 705-474-1031 • Kids Help Phone 1-800-668-6868 • Transgender Crisis Line 1-877-330-6366 • Crisis Services Canada 1-833-456-4566 • First Nations and Inuit Hope for Wellness Help Line • 1-855-242-3310 1-855-892-9992 A Friendly Voice for Seniors • Stacey E. Roles & Associates Psychotherapy Services • Inc. 705-929-1612 or staceyrolestherapy.com
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