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.
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.
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.
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.
I was thinking I need to do more art lately. I came across a 2020 planner that I never ended up using at all, and it's a cute little hardback calendar. I hate to throw out a totally unused item, and then I got to thinking....I recommend altered book making to my clients fairly often, and had the epiphany that I should turn the planner into an altered book to process the year. I started the first pages today! I will keep adding to this post as I finish other pages. I hope you enjoy this as well and perhaps consider making your own art, too!
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)
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)
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.
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, it 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!
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.Includesan introduction on the benefits of coloring and suggestions for coloring.
30 Unique Coloring Designs
10% Discount Nov and Dec/On Sale $23 (normally $26)
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
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.
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.
This is important for both mental health employees and employers to read and be made aware, if they haven't already considered it and the potential aftermath.
Mental Health Workers: The Other First Responders in this Pandemic
Why mental health workers need safeguarding and protection more than ever
In response to the COVID-19 outbreak, there has been a lot of talk in the media about the importance of preventing overload to our health care system. What we are only starting to hear about is its (anticipated) overwhelming impact on mental health services… and its providers.
Mental health workers are just as prone to burnout as any other care providers. Given the predicted impact of this pandemic on the well-being of virtually everyone, we need these service providers to be stronger than ever. Mental health workers need protection now, to ensure that they are available and prepared for the coming mental health crisis.
Nobody is immune to the pandemic’s negative mental health effects.
Social distancing measures keep loved ones apart, businesses and schools closed, people without steady work or income, and other services overloaded. The stress to essential workers and their families is obvious. We are living in a time of great uncertainty, with no end in sight.
Psychiatrists Dr. Andrew L. Smith of The Ottawa Hospital and Dr. Neil de Laplante of the University of Ottawa support that while social distancing measures are necessary, they could “lead many of us to feelings of isolation and powerlessness”, which are both linked to anxiety, depression, and possibly suicide.
The pandemic could be detrimental for those already facing complex mental health challenges: chronic anxiety, trauma, delusional paranoia, and addictions to name a few. There are people without the cognitive ability to understand the situation. Some are without a working memory. And others could be further subjected to daily abuse.
Health care workers and first responders are also high-risk groups for mental health challenges during this pandemic. They face prolonged exposure to high-stress work environments, in addition to the personal struggles we all face waiting out COVID-19. Post-trauma effects are a real threat to this group. Positively, there are mental health resources specific to first responders, but I wonder how accessible or effective these services will be long-term.
With the anticipation of a mental-health crisis secondary to this pandemic, mental health services could be more important than ever. Undoubtedly, we will need a strong system to help those most at-risk to the consequences of this pandemic, and to continue caring for our most vulnerable persons. To maintain a strong mental health system, we must protect and safeguard its most important resource: its workers.
Without its workers, the mental health system will breakdown, and this is already starting to happen.
As a mental health worker, I can tell you that many of us will be or are on the verge of burnout, the longer this situation continues as is or worsens. The state of the world is pushing people into survival mode; those who feel powerless and unprotected will resort to fighting for themselves. In survival mode, one can hardly help his or herself let alone others. In my field, workers are already walking off the job for self-preservation.
I am a front-line mental health worker supporting persons who require 24-hour care. I work in a home in close proximity to about 8–11 people (workers and residents) during my shift, where social distancing is near impossible, and PPE availability is extremely limited.
Last week, I was informed for a second time that someone in the home would be tested for COVID-19. I was left to wonder what will happen if the results are positive. How will we manage a potential outbreak at work? Will I be put off work to isolate? Have I exposed the elderly person I live with to the virus? What will I tell my family if the result comes back positive?
For confidentiality reasons, I cannot give specific details. I can tell you that at this time, there is no confirmed case of COVID-19 at my place of work. But this is a possibility that I need to be prepared for, and yet, there is very little certainty on what will happen if there is an outbreak.
Not knowing what to expect leads me to feel powerless and anxious. Still, I try to remain strong and composed for the people I support, who depend on my care.
I support people who have a very limited understanding of what this pandemic means. For them, it means a lot of changes to regular routine, a lack of contact with the outside world, and a lot of waiting and boredom. Without structure and purpose, their risk of self-destructive behaviour increases. It cannot simply be explained to them what might happen if there is an outbreak in the home. This could create further anxiety, paranoia, and undue stress.
To the best of our ability, my front-line team tries to keep routine in the home, offer alternative activities, and practice a lot of supportive counselling and patience. Most importantly, we try to keep individuals safe and healthy, not only from the virus, but from mental health crisis.
This means that we as essential workers need to keep ourselves safe and healthy. We must be so careful not to come in contact with the virus and bring it to work. Conversely, we are trying not to bring the virus home to our loved ones should there be an outbreak at work.
Just as important, we must look after ourselves mentally, so that we can continue to work effectively for those who need us. This is easier said than done, given the circumstances.
We have limits, and a lot of us will be prone to burn out the longer this situation continues to negatively impact us both personally and professionally.
We are human, not super heroes.
I think I speak for most mental health professionals during this time. I have helpers and healers in my own life who I know are struggling personally in this pandemic. One even said she is cutting back on work to look after herself and her family.
I know front-line workers who are thinking about a leave of absence or extended holiday at some point, knowing that they cannot sustain working under stressful conditions long-term without hitting “reset”. Some have even opted for early retirement to protect their health and their loves ones. Meanwhile, many of us are currently working overtime, and this field was facing a staffing crisis even prior to the pandemic.
We are only in the beginning stages of this pandemic, and essential care workers are already walking away.
If mental health workers all burnout, what replaces us? When mental health crisis reaches its peak in response to the pandemic and overloads mental health services, what happens then?
As Dr. Andrew L. Smith and Dr. Neil de Laplante note, the mental health system is already “chronically under-resourced”, and vulnerable persons face the greatest consequences if the system breaks-down in response the pandemic crisis.
Funding is necessary to keep mental health resources in place or develop new services as the effects of the pandemic evolve. Additional funding is required to implement health and safety measures to protect people living and working in group-homes, institutions, and long-term care facilities. But money is not the only important resource.
In addition to funding, mental health workers need safeguarding and protection. The most important resource in the mental health system is its workers. Without anyone available to provide the service, funding loses its purpose.
Eventually, COVID-19 will no longer be a significant health threat. However, we can expect a long-term impact on society. Loved ones will be lost. People will struggle to recover financially. Some might be traumatized. Vulnerable persons could face significant abuse in isolated situations. Addictions could surge. Not everyone will come out of this pandemic being able to continue on their previous life.
Mental health workers are not miracle workers, but they are necessary when people are in crisis, which will be an inevitable result of the current situation.
So, how can we protect and safeguard the most important resource in the mental health system? Really, how can we better protect all essential workers right now?
Protecting Rights
In emergency situations, employers are allowed (under government Acts) to override collective agreements to “protect” the safety of its workers or clients. For example, employers might be allowed to temporarily change an employee’s job classification or location to provide support where needed. Unfortunately, this gives employers a lot of free reign, rendering unions who protect employees almost powerless.
Employers should still be held responsible for their decisions. Yes, temporary changes may need to be implemented under extraordinary circumstances. But as much as possible, employers need to consider the mental well-being of their employees. This means listening to employee concerns and respecting their right to refuse unsafe work. If we are facing a pandemic that will impact us for months to a year, employers need to ensure that they do not make decisions that cause undue long-term stress to their employees. Otherwise, they risk being left short of those essential persons.
Compensating According to Risk
Appropriate compensation to me means that employers consider unforeseen risks associated with jobs and what that means for their employees. While I do agree that wage increases should be implemented in some cases (kudos to these companies), there are other ways in which essential workers can be compensated or supported during this pandemic.
Increased paid “personal days” for full and part-time employees will allow essential workers to take time off to care for themselves and their families. Extra sick days should also be provided if a worker comes into contact with COVID-19 on the job. Expectations that employees use their vacation time or go without pay are unreasonable when workers are coming into contact with an unforeseen risk associated with the job.
Protecting Health
Government and employers need to take more responsibility in ensuring that essential workers have what they need to stay healthy right now. Sourcing products like disinfectants, gloves, and hand sanitizer, and ensuring that essential workers have these items will reduce at least one stress associated with this pandemic. I support that everyone needs access to these items, but front-line workers especially need them to keep themselves and the people they live and work with safe.
Additionally, initiatives could be set forth to ensure that essential workers have the means of obtaining nutritious foods for themselves and their families. Employers can only benefit from keeping their workers strong during these times.
Providing Solutions
We are in a time of great uncertainty, and I can respect that experts in health and government are dealing with a situation that they have never handled on this scale before. I do believe that there should be honesty and transparency regarding the pandemic and its predicted course.
What is concerning is the presentation of scary problems without action or solution. Advising everyone to “get used to this way of life” (i.e., social distancing) for months to a year or longer is not practical or helpful. This is not sustainable. We all know this, and it will become increasingly difficult to support people through this pandemic without long-term solutions.
Mental health workers can help people manage and cope with the situation they face, but that only goes so far. Until people start to feel hope and control, until they can re-establish some normalcy in their lives, the looming mental health crisis will grow.
— — —The only way to prevent or minimize this crisis is to come up with alternatives to just “staying home.” -- -- --
Nothing about this pandemic is simple. There are no easy answers. I respect that most advisors and decision-makers, at all levels, are doing their best.
We need to work together to see the situation from all angles, to prevent further crisis.
The people who make up health care services are the most essential resource to safeguard. In the coming weeks, it is imperative to everyone’s well-being that action plans are implemented to keep workers safe and healthy.
Now is the time to help and protect these workers, so that they are available and strong when they are needed.
Many people, including art therapists, are looking for resources to help people manage during this unprecedented time of managing a global pandemic with the novel coronavirus COVID-19. The American Art Therapy Association has worked hard to create a resource page with many kinds of links to provide assistance to help art therapists as well as for the public to access for themselves. Click on the picture below for the resource page.
It was very cool to come across a post about 5 self-care things that you can do during the pandemic in self-isolation, and they included "Color Me Stress-Free" as a way to help occupy your mind and ease stress. A perfect way to spend your time at home! I'm truly honored to be included.
Day-to-day life as we all know, has come to a screeching halt due to the COVID-19 pandemic. As the realities of adjusting to social-distancing and self-isolation start to kick in, it’s easy to feel anxious and stressed. In these times, it’s so important, if not essential to prioritize self-care.
Here are 5 self-care products that will help you get through the next few weeks of social distancing without losing it.
Coloring books and chill are now a thing. So if you want to de-stress, relax, and take your mind off this crisis: get coloring!
Adult coloring books are not the ones we grew up with, the adult version has more intricate patterns and pictures. The Color Me Stress-Free by Lacy Mucklow is one you’ll find therapeutic to color!
