Study Finds Doctors Seeking Mental Health Support During Pandemic

It's encouraging to know that doctors have sought mental health support during the COVID-19 pandemic.  Being on the front lines has its own challenges, and it's good that they are taking the time to care for themselves as well.

https://www.medpagetoday.com/psychiatry/anxietystress/96805

More Docs Turn to Mental Health Support During COVID

— Sharp uptick in outpatient mental health and substance use visits, Canadian study finds

by Kristen Monaco, Staff Writer, MedPage Today January 21, 2022

A "substantial increase" in physicians in Canada sought mental health support during the COVID-19 pandemic, a new study reported.

Looking at nearly 35,000 practicing physicians in Ontario, the overall annual number of outpatient mental health and substance use visits increased by 27% per 1,000 physicians -- from 816.8 pre-pandemic to 1,037.5 during the pandemic -- reported Daniel T. Myran, MD, MPH, of Ottawa Hospital Research Institute, and colleagues.

This equated to a 13% increase in the rate of mental health and substance use visits per physician during the pandemic (adjusted incident rate ratio [aIRR] 1.13, 95% CI 1.07-1.19), an increase that appeared driven by those who had no prior mental health or substance use history (aIRR 1.72, 95% CI 1.60-1.85), the group wrote in JAMA Network Open.

Overall, the absolute proportion of physicians with one or more mental health and substance use visits within a year increased from 12.3% before to 13.4% during the pandemic (adjusted odds ratio [aOR] 1.08, 95% CI 1.03-1.14).

Increases in mental health visits seemed to be across the board, and didn't differ by sex/gender, age, or urbanicity, the researchers said. Regarding specific types of physicians, psychiatrists saw the highest rate of annual mental health and substance use visits during the pandemic (3,441.5 per 1,000 physicians), whereas surgeons had the lowest rates (370.9 visits per 1,000 physicians).

The author of an accompanying commentary, however, said that despite this sharp uptick in COVID-related mental health visits for physicians, the findings should actually be "somewhat encouraging," since they show that physicians are actively seeking help, support, and the treatment they need.

"Creating additional avenues or opportunities for health care professionals to obtain mental health services will be paramount, while cognizant of the unique challenge surrounding reticence in seeking care within the profession," wrote Bernard P. Chang, MD, PhD, of Columbia University Irving Medical Center in New York.The findings also aren't much of a surprise, since it is known that the pandemic took a heavy toll on the mental health of healthcare workers, Chang added. He also pointed to the benefits of telehealth resources in particular, saying that these discrete and flexible platforms are ideally suited for practicing physicians.

Myran and co-authors agreed, noting that their findings "may also be explained by reduced barriers to access for health care and mental health services among physicians during the COVID-19 pandemic," and that "in response to the pandemic there was a large expansion of virtual care options in Ontario."

"It is possible that physicians with both physical and mental health concerns that predated the pandemic increased their health services use owing to this change (e.g., appointments are easier to schedule and less visible and thus less stigmatized)," the researchers wrote.

The population-based cohort study included 26,266 individual counts of outpatient mental health and substance-use related codes prior to the pandemic, which were compared with 31,936 codes during the first 12 months of the pandemic. This equated to a 22.6% change in codes. The biggest uptick in code type was for adjustment reaction, followed by the cluster code for "anxiety, somatoform, dysthymia, dissociative, or psychosomatic," the researchers reported.

"Future research should focus on longer term outcomes associated with the pandemic and explore associated risk and protective factors for physicians' mental health to better target interventions," the group concluded.

Psychological Fallout from the Pandemic and Its Impact on Behavioral Health

I found an interesting article on the psychological fallout from the pandemic.  It has affected people in many different ways, and they discuss what we know vs. what we don't yet know and the implications for behavioral health.  

https://behavioralhealthnews.org/psychological-fallout-of-the-pandemic-what-we-know-what-we-dont/

Psychological Fallout of the Pandemic: What We Know, What We Don’t

By: Michael B. Friedman, LMSW Calliope Holinque, MPH, PhD

January 1st, 2021

More and more studies confirm widespread psychological fallout from the pandemic. The studies also confirm intuitive expectations about which populations are most psychologically vulnerable—those directly experiencing illness and death, those with economic hardship, frontline health care and other essential workers, and more.

But the published studies do not yet answer several critical questions. Do people having troubled emotional reactions to the pandemic have diagnosable mental disorders? Do increased rates of alcohol and drug use constitute a rise in the prevalence of diagnosable substance use disorders and addiction? How long lasting will emotional reactions to the pandemic be? Will they dissipate as the pandemic and the socio-economic conditions it has engendered come to an end? Will they last long beyond the pandemic itself, creating increased long-term need for behavioral health services?

What We Know

The studies confirm that some of the people experiencing emotional distress have pre-existing mental and/or substance use disorders that have recurred or been exacerbated during the pandemic. But they also make it clear that people, with and without diagnosable disorders, have experienced a broad range of emotional distress—including fears regarding illness and death, desperation regarding economic survival, isolation and loneliness, loss of a sense of control, hopelessness and profound sadness, moodiness, difficulties sleeping, family tensions, and grief.

The studies also indicate that reactions during the pandemic vary substantially. Some people are experiencing high levels of emotional distress; some very little. For some, emotional distress is relatively constant, for some it has declined and for some it has increased. For many people, emotional distress is “up and down.”

The Pulse survey done weekly by the Census Bureau initially showed a decline in emotional distress overall, suggesting some adaptation was taking place. Later, the survey indicated an increase in the number of people experiencing psychological distress, though this may also reflect political and racial tensions as well as the pandemic itself.

All of the studies show that some populations are experiencing more emotional distress than others, including:

• Those with direct experience of sickness or death due to COVID-19
• Those without adequate income, food, or housing
• Healthcare providers and other essential workers
• People of color
• People with pre-existing cognitive or behavioral disorders who are at risk for relapse or severe reactions
• Working parents with children at home
• Family caregivers.

The one finding that has been surprising to some people is that young adults are more at risk for emotional distress than older adults. But this should not be a surprise because, contrary to ageist perceptions, most older adults are not disabled and in need of help, and most have survived difficult times that have taught them to cope.

Nevertheless, many older adults experience significant emotional distress largely related to their vulnerability to illness and death and due to social isolation.

What We Do Not Know

The surveys unfortunately do not tell us whether reported emotional distress constitutes diagnosable mental or substance use disorders because diagnosing these conditions typically requires an interview or more in-depth questioning. The surveys are essentially screening tools rather than diagnostic instruments.

Whether or not they provide an adequate indication of diagnosable behavioral health conditions, they certainly do not answer the critical question of whether the psychological reactions to the pandemic will be long-lasting. After all, even some “serious” disorders, are transient, and some people will certainly experience adaptation and resilience over time.

In general, we do not know to what extent psychological reactions will diminish as the pandemic and its economic consequences diminish and to what extent there will be lingering emotional damage.

Implications for Behavioral Health Policy

Telehealth: Some behavioral health need is being met via tele-mental health. Unfortunately, many of the rule changes that support use of tele-health are temporary. They need to be made permanent. In addition, tele-health is not available to everyone due to lack of internet access, lack of needed hardware, and lack of technical skill. These issues need to be addressed.

Social Determinants: It is also essential to address the social determinants of emotional distress—economic hardship, persistent racial/ethnic inequities, the vitriolic political divide, and more. It is time for our society to face up to the social determinants of physical and behavioral health.

A Mental Health Tsunami? The claim made by some that there is a second pandemic coming—a tsunami of mental illness and substance abuse—is neither confirmed nor disconfirmed by existing studies. We do not know how long lasting and severe the lingering psychological effects of the pandemic will be.

Unmet Need: Whether or not there is a behavioral health tsunami, we know that our nation’s capacity to respond to behavioral health needs is woefully inadequate. We know that there are, and will continue to be, fault lines in American society that will continue to contribute to mental and substance use disorders if they are not addressed more effectively.

The pandemic has highlighted long-standing failures to meet America’s behavioral health challenges. It is long past time to act.

Michael B. Friedman taught at Columbia University School of Social Work before he retired. He is currently volunteer Chair, AARP Maryland Brain and Behavioral Health Advocacy Team. Calliope Holinque, MPH, PhD, is a postdoctoral research fellow at Kennedy Krieger Institute and the Johns Hopkins Bloomberg School of Public Health.

Art Therapist Brings Creative Ways for Frontline Workers to Cope with Stress from COVID-19

It is refreshing to find a story that highlights the use of art therapy with front line workers who have been dealing with the unprecedented stress of dealing with COVID-19.  Thanks to Spectrum News for featuring this, and to art therapist Zulay Romero for using our practice to help those in need as they work tirelessly to help others.

Frontline Workers Use Art Therapy to Cope With Stress

By Jenna Rae Gaertner Craven County

PUBLISHED 11:37 AM ET Feb. 08, 2021

What You Need To Know

• Frontline workers have dealt with a lot of stress over the past year, but some are turning to art therapy to help relieve stress.
• Zulay Romero, an art therapist, is offering some free art therapy sessions for frontline workers at CarolinaEast Medical Center.
• Art therapy is found in many major cities across the state, but it is not utilized in many rural areas and smaller cities.

CRAVEN COUNTY, N.C. — Many frontline workers have dealt with a lot of pressure and anxiety caused by the unprecedented year of 2020. 

“It's been very stressful,” Jennifer Lewis, laboratory director at CarolinaEast Medical Center, says. “We are responsible for the implementation of the new test for the COVID virus, especially. And worrying about our staff staying safe, worrying about our own self, worrying about our families. So, it's been very stressful this whole year.” 

More people are finding that creativity is a good outlet to help manage this stress, and some frontline workers are turning to art therapy to release built-up tension.

Zulay Romero is an art therapist who experienced the challenges of COVID-19 first hand when she and her family caught the virus last year. Ever since then she has had an even bigger heart for these frontline workers.

“One day in the mail they just announced, 'hey we're struggling. We need prayers; we need support.' And so, I immediately was like 'I gotta do something,'” Romero says. 

Romero decided to offer free art therapy sessions to employees at CarolinaEast Medical Center to specifically address COVID-related stress.

“Art therapy allows that exploration of what I'm feeling, when I'm feeling it, and how I'm feeling it,” she says.

Romero added it's often hard for people to put their frustrations into words, but art gives people a new way to communicate emotion.

“I'll tell them like, you don't have to talk to me. Lets just release everything, and as soon as they release, they're like 'this is what I released.' Because a lot of times we do hold onto that. And when we hold onto things mentally and emotionally, it becomes very physical,” she says.

Art therapists use a lot of different mediums from clay to watercolor, but Romero's personal favorite is collage, because it doesn't require perfection.

“A lot of times I do use collage interventions and call it release artwork, where they can choose images that relate to how they're feeling, thoughts that they've had that they just want to put on paper and leave on paper,” she says.

Art therapists can be found in many major cities in North Carolina, including Raleigh, Durham, and Asheville. However, Romero decided to return to her hometown in New Bern when she realized that many smaller cities have not yet taken advantage of the benefits art therapy offers. The American Art Therapy Association has more information about where art therapists are located and what kind of resources they provide.

Romero has one last piece of advice for those who are interested in art therapy: “Be as authentic as you possibly can. Like I said earlier, it's your story. It's no one else's, so whatever you create, don't think of it as is it good or is it bad. Think of it as I need this in this moment, and that's OK.” 

The Impact of the COVID19 Pandemic on Aspects of Mental Health

I saw some relevant news from MedPage Today regarding the impact of the pandemic on mental health, psychiatric practitioners, and the way we do therapy as a result. I still see at least 50% of my patients virtually now. I'll put all the articles here for convenience: 

More and more psychiatrists are facing burnout amid the pandemic-related mental health crisis. (Business Insider)  

https://www.businessinsider.com/worst-mental-health-crisis-last-two-decades-psychiatrists-burning-out-2021-1 

Reflecting this crisis, wait times for a psychiatric-unit bed are sometimes reaching a month long in Massachusetts. (Cambridge Day)  

https://www.cambridgeday.com/2021/01/08/lack-of-psychiatric-beds-can-mean-30-day-waits-for-people-in-crisis-filling-up-emergency-rooms/ 

According to a study including a representative sample of the U.S. adult population ages 20 and older, telehealth was utilized by more than half of patients for a behavioral health condition during the early months of the COVID-19 pandemic. (Journal of General Internal Medicine) 

https://link.springer.com/article/10.1007/s11606-020-06358-0

Coloring to Cope with COVID

My art therapy colleagues Gioia and Rebecca highlighted the benefits of coloring during the pandemic as a way of coping with COVID.  Their Creative Wellbeing Workshops, LLC newsletter featured a coloring book that Rebecca created, called Coloring Creates Wellbeing:  The Desert Mandalas Coloring Book, so she is not only an art therapist colleague, she is also a fellow coloring book creator!  Check out their suggestions for helping deal with the continued effects of the C19 pandemic.

Coloring to cope with COVID

Sarah coloring "Agave Grande" from the Coloring Creates Wellbeing: The Desert Mandalas Coloring Book

With the heightened stress of the recent elections and the resurgence of the virus converging with the upcoming holidays, we've been asked to write more on coping with COVID.   One of our favorite stress reducing strategies is coloring.  This is perhaps not surprising, since this is one of Rebecca's passions and she illustrated a coloring book (more about the Desert Mandalas Coloring Book below).

The simplest and most compelling reason we promote coloring is that it is so effective at helping people relax.  You don't have to be an artist, or know how to draw, or even particularly like art.  The pre-existing designs invite people to jump in and then the repetitive action of filling in the designs gets them into flow.  

This is especially helpful for people who wish that they could meditate but who find it too difficult to sit still--coloring produces many of the same physiological effects.  Please note that we are not suggesting that coloring is a replacement for meditating.  However, it is remarkable that coloring is so successful at creating the stress reducing benefits that people are trying to achieve through meditating.  

For example, coloring induces the relaxation response which includes lowering of the heart rate and blood pressure, as well as beneficial changes in brain wave activity. It helps people focus, concentrate, and be more mindful.  It also provides a positive distraction from anxious and pressured thoughts.  Click here if you want to learn more about the scientific benefits of coloring.  

Now that adult coloring has become so popular, the selection of coloring books is practically endless.  There are coloring books that feature everything from your favorite pets and plants to your favorite musicians, actors, and public figures.  You can find coloring books that are more simple and straightforward or very complex and detailed.  

If you're ready to experiment with coloring, here is one the most popular images from Rebecca's  Desert Mandalas Coloring Book.    If you want to get the book for yourself or as a gift for someone who needs to relax more and manage his/her stress, i t will be on sale for 10% off the rest of November and December.   Click here to check out the book and  see thumbnails of the other images.  

As always, we send you our well-wishes during these challenging times.  Please know that we are with you in our thoughts and sending you our love and appreciation.   

 

Stay safe and well during the holidays, 

Positively Rebecca & Gioia

Art activity

Print either the coloring sheet above, this one here, or find one online that appeals to you.  Gather some art supplies--usually people use crayons, markers, and pencils but you can also use pastels or paints if the paper is thick enough.  See how you respond to the coloring process.  We hope if it helps you quiet your mind and relax.  As always, feel free to post your artwork on our  Facebook page .  We'd love to see them.      

Rebecca is available for online therapy sessions if you need support during this time. Click here to learn more about working with her.  Contact her directly at 202-352-5225 or at rebecca@creativewellbeingworkshops.com if you want to chat with her about what that would look like.
We are also available for workshops on coping with stress, combatting burnout and compassion fatigue, and increasing personal and professional wellbeing.  Click here to see our menu of workshops.   

ON SALE!   Rebecca's coloring book is available again and on sale for the rest of November and December!  

C oloring Creates Wellbeing: The Desert Mandalas Coloring Book.

10% Off during November and December.  Thirty unique designs showcasing the magical flora and fauna of the Arizona Sonoran desert to help you relax, reduce your stress, and get you into flow.   Includes   an introduction on the benefits  of coloring and suggestions for coloring.  

30 Unique Coloring Designs

10% Discount Nov and Dec/On Sale $23 (normally $26)

Spiral Bound so pages lie flat

Larger 10 x 10 inch format  

Printed on heavier one-sided paper

No bleed through 

Use discount code: holidaysale2020

Order  Coloring Creates Wellbeing: The Desert Mandalas Coloring Book  now to get the discount! Read about the therapeutic benefits of coloring  here .   

 

LEARN MORE ABOUT POSITIVE ART THERAPY!

Positive Art Therapy Theory and Practice: Integrating Positive Psychology.  

Available at a 30%  markdown.  We hope y ou'll find this manual both entertaining and practical--an invaluable tool for anyone looking to apply the most current theory and research on positive psychology and art therapy to their practice, or their life! 

For faculty who might want to adopt this book as a text, we added thoughtful discussion questions, a robust glossary, and useful lists of strengths and values. The book also includes a comprehensive outline of more than 80 of our favorite positive art therapy directives!

282 pages,19 Color Illustrations

Hardcover, $127.5 .00Paperback, $ 32.21 

Kindle Edition, $ 32.21

For more details or to request a copy for review please contact: 

Jean Pierre Jacome, Marketing Assistant, JeanPierre.Jacome@taylorandfrancis.com 

Click here to order

Want more wellbeing and less stress?  We can help!  

Visit us at our website

 or call 202 352 5225

Art Therapists are Heroes!

I got my new mask....Shout out to all the fellow art therapists who are working on the front lines, in-person and virtually! You are a hero to others!

The Mental Health Toll of COVID19

I think a lot of people know this, but this pandemic will have some long-reaching consequences. Please don't hesitate to reach out for support if you need it.

Therapist Resources During COVID for Clients

Here's a great website that has a lot of COVID resources for therapists to use with their patients. Check it out if you need extra support or ideas! 

https://www.psychotherapy.net/coronavirus-resources

University of Florida Seeks Participants in Pandemic Study on Isolation

A study in the UK is expanding to the US to look at the longer-term effects of isolation from the pandemic. They are looking for participants to fill out surveys to gather results to help provide recommendations to improve people's well-being and resilience throughout and after the pandemic. Click the link below for more information and sign up.  

https://arts.ufl.edu/academics/center-for-arts-in-medicine/researchandpublications/enforced-social-isolation-and-mental-health-covid-19/

VA COPES Provides Free Mental Health Support for Virginians

 If you are a Virginia resident and have been experiencing adverse effects during the pandemic (i.e, stress, isolation, fear, and other distress), you can call and talk to a counselor for free. They aren't for emergencies, but are a "warmline" for people who need support.

https://vacopes.com/

Crisis Counselors are available during the following times to take calls. Monday-Friday 9 a.m. – 9 p.m. and on Saturday-Sunday from 5-9 p.m. VA C.O.P.E.S can be reached by phone or text at 877-349-6428. Spanish speaking counselors are available.