Who helps the helpers? Why health care workers need ‘emotional PPE’
This story discusses suicide. If you or someone you know is at risk of suicide please call the U.S. National Suicide Prevention Lifeline at 800-273-8255, text TALK to 741741 or go to SpeakingOfSuicide.com/resources for additional resources.
As an emergency room nurse, Kristin Dorow thought she understood the complexities of her job. Each shift brought a different, and sometimes exciting, challenge but she felt adept at quickly assessing and treating a patient. When COVID-19 patients started flooding her Austin, Texas area hospital, work — and life — started getting tougher.
“It’s just this physical and mental exhaustion … (I'm) constantly going through in my mind, ‘Is that person sick? Am I at risk?’” Dorow, 39, told TODAY. “I’ve seen my co-workers and myself cry. It’s just overwhelming and it’s scary. You don’t really have an outlet."
Dorow is not alone.
In April, many were shocked by the story of Dr. Lorna Breen, an emergency room doctor in New York City, who died by suicide. Her family told Savannah Guthrie they believed she felt overwhelmed by those sick with COVID-19 who she just could not help.
"She said, 'People are just dying in the waiting room before they even get in. There aren't enough hookups for the oxygen to help them. They're not getting admitted fast enough. We can't keep up,'" Jennifer Feist, Breen’s sister said during the TODAY interview.
Breen had admitted that she struggled to even get up sometimes. The family believes that the culture in medicine prevented Breen from asking for help.
"She couldn't stop working, and she certainly couldn't tell anybody she was struggling," Feist said. "And that needs to be a conversation that changes. People need to be able to say they're suffering and to take a break."
Experts agree. People on the front lines of COVID-19 are facing increased stress and it’s taking a toll on their mental health. But for many, talking to a therapist or taking medication could impact their ability to practice and they worry what asking for help might mean.
“Stigma in mental health is high — especially among health care workers,” Dr. Cecilia Livesey, chief of integrated services in the department of psychiatry at the Perelman School of Medicine at the University of Pennsylvania in Philadelphia. “They have always been told they are the ones who are helping and caring for people. Caring for the care provider is a new idea.”
Related: "When all this is over, whenever that is, I'll have some serious healing to do," Krista Perry, an ICU nurse in Arizona, told TODAY.
The need is there
In late May, Livesey helped launch Cobalt, an online platform for immediate mental health support for Penn Medicine employees. To date, nearly 10,000 people have used the platform and there were 60 cases of suicidal thoughts. While this highlights the need in one hospital system, research from Italy, China and now New York City reinforces that those caring for coronavirus patients experience much strain.
“57% of health care workers experienced acute stress, nightmares, detachment, in this current pandemic. Forty-eight percent had depression, 33% had anxiety,” said Dr. Lori Plutchik, a New York City psychiatrist, citing numbers from a recent survey of New York City-based health care workers.
"These numbers are incredibly high," noted Plutchik, who is a co-founder of Caring for Caregivers, a program that offers psychotherapy to front-line physicians. Yet, those in health care are often reluctant to seek help, she told TODAY.
Dr. Daniel Saddawi-Konefka agreed.
“Health care workers don’t do a good job of taking care of themselves. We have higher rates of suicide. We have higher rates of depression and burnout in the general population,” Saddawi-Konefka, a critical care physician and anesthesiologist at the Massachusetts General Hospital in Boston. “For some reason, we just don’t seek help. So, you’ve got that as your baseline and then on top of that you put on all these other stressors. And it’s not a recipe for anything good.”
Helping the helpers
Saddawi-Konefka and Ariel Brown, Ph.D. and neuroscientist based in Arlington, Massachusetts, started the Emotional PPE Project, a directory that provides contact information of volunteer mental health practitioners to health care workers, at the beginning of the coronavirus epidemic.
“We want to be able to help people really protect themselves on the inside from the effects of COVID,” Brown told TODAY. “That’s where the emotional PPE came in because in a similar way seeking professional support will help to mitigate these effects of the virus on your emotions, your brain and your mental health."
Saddawi-Konefka saw firsthand how the pandemic impacted himself and others. Suddenly, what many thought they knew about medicine changed and tough decisions became even harder.
“Imagine that unfortunately it’s the end of life for one of your patients, and now the family is faced with the decision — because of visitation policies — of deciding which one of the children gets to say goodbye to their mother,” he said. “When you see grief and people hurting and, frankly, I think it is a little bit of primary trauma.”
Plutchik and her colleague, Marianna Strongin, a therapist, heard from health care workers that they felt overwhelmed and burned out from the pandemic. The founders of Caring for Caregivers asked their New York-based mental health peers to volunteer for therapy. When a health care employee contacts the group, they are matched with a therapist.
“This is really a grassroots effort,” Strongin told TODAY. “We offer free therapy to front-line doctors and nurses for up to three months. When those three months are over we obviously encourage our front-line doctors and nurses to work with their therapy and mental health.”
In North Carolina, clinical psychologist Stephanie Zerwas also observed many of her co-workers were suffering. She started Project Parachute to provide therapy to front-line employees both in her area and across the country. Project Parachute has therapists in 40 different states.
“I called it Project Parachute because I wanted to soften the emotional landing,” she told TODAY. “It can be really helpful to have a container for all these big thoughts and feelings that are separate from the workplace. Having a trained therapist who can really empathize and listen to what you’re talking about and reflect back what they are hearing … can help.”
All of the programs offer anonymous help, which makes it easier for health care workers to call without fearing repercussions.
Dorow, the Texas nurse, felt that asking for help meant she was weak. But as she experienced more stress and woke up frequently at night in a panic wondering if she made a mistake, she reached out to Emotional PPE.
“It helps,” she said. “I think deep down, we all know it’s normal to go through these times where you’re anxious or stressed or depressed about what’s going on in the world around us. But to hear someone else say that, someone who doesn’t know me personally … it really made me feel better.”