For COVID-19 Workers: Therapy = Support + Advocacy

Why are workers depressed? Neglect, abandonment, abuse, and moral distress.

It's not over.

That's the message from public health experts, researchers, health setting staff members, and epidemiologists who study the progression of pandemics. COVID-19 will likely be with us for some time, albeit with some ups and downs. The pandemic is still here, and so are the problems that many workers in healthcare settings have been facing: Lots of very sick, contagious patients; lack of the protective equipment that their lives depend on; lack of recognition by workplace administrators; silencing; and now, layoffs. Mental health experts can only genuinely help with workers' depression and anxiety if we acknowledge the reality of the conditions that are causing it.

Stunning flyovers by the Blue Angels, 7 PM public music and cheers, the designation of "hero," and accolades and heartfelt thanks by patients and family members notwithstanding, many members of our communities who work in healthcare settings—nurses, food service employees, physical therapists, social workers, maintenance staff, emergency medical workers and first responders, to name a few—have been neglected in several ways. Some have been wrongly told they did not really need essential protective gear; some have been attacked for speaking out about suboptimal conditions; and some—over 1000—have died as a result of the terrible conditions of their work during the pandemic.

Like many military veterans, surviving healthcare workers may be reluctant to seek mental health support because they worry about stigma—they may not want to be labeled—and because they may know that the origin of their mental, psychological, and emotional crises are not in their distant past, but in the conditions they have been, and still are, facing. And like veterans, some have taken their own lives, overwhelmed by exhaustion, trauma, and so much death. Some have been reprimanded for speaking out about the problems they and their colleagues have faced. And now, as hospitals face revenue shortfalls following the suspension of elective treatments and surgeries, some workers are being laid off.

When we see people who are depressed, anxious, have insomnia, and are experiencing deep distress, psychologists and other mental health professionals are trained to look for personal vulnerabilities. We look for possible family history of mental illness, for childhood trauma, for personal loss or disappointment, for physical or emotional illness.

But if we do this with those who have worked in healthcare settings during the pandemic, we are most likely looking for causes of distress in the wrong places. We cannot be satisfied with simply acknowledging current conditions as "triggers," while tending to assume that past personal difficulties explain why any individual reacted with depression, anxiety, insomnia, distress to a current condition. That pattern was what drove Vietnam veterans to protest and, ultimately, to the creation of the new categories of traumatic reaction and syndromes.

Veterans often suffer moral distress as they become disillusioned—they thought they were fighting to protect their loved ones, only to find they were unprotected and their efforts were being used to support corporations or politicians. They may begin to feel that they participated in—or sent others to participate in—conditions they can no longer justify. Their distress is immense—so immense they can hardly stand it. Some of them give up. Many desperately need to talk about the outrages they have witnessed, and, sometimes, participated in. And many need encouragement to work for change.

The same is possibly true for community members who work in healthcare settings. Disillusioned at the negligence that leaves them unprotected and nevertheless risking their lives for patients, workers find the hospitals can, and do, lay off their peers based on reductions in profit, while hospital administrators make no financial sacrifices. Most do not need to explore their pasts or deal with diagnoses indicating internal pathology, at least not now. What they need from us now is support, encouragement, and advocacy.

They also may need to have someone available, on an as-needed basis, to talk to: a genuine human, trained to listen and help them find their equilibrium, after being witness to impossibly painful circumstances. Various organizations have set up support lines for those who work in health care settings.

In California, the Alameda County Psychological Association, in partnership with the Crisis Support Services of Alameda County has established a support line for anyone who works in health care settings, called Staying Strong Against COVID 19. Californians who work in health care settings can reach the line by calling 510-420-3222. Anyone can learn about the line by going to www.stayingstrongagainstcovid19.org.