This article is part of State of Health, a series about how Michigan communities are rising to address health challenges. It is made possible with funding from the Michigan Health Endowment Fund.

The COVID-19 pandemic has caused a major spike in depression, anxiety, and other mental health issues across Michigan — and medical professionals are certainly not immune. Those on the frontlines are facing tremendous stress and trauma, and several new initiatives have sought to provide them much-needed support.

For the past 13 years, Dr. Srijan Sen, associate vice president for health sciences in the Michigan Medicine Department of Psychiatry, has been studying how stress and other mental health issues impact physicians. At the University of Michigan Sen Lab, research examines interactions between biological factors and stress in the development of depression. Even before the COVID-19 pandemic, ongoing studies found high rates of depression in U.S. and Chinese physicians.

Dr. Srijan Sen.

"How things are changing for them with COVID-19 is an important issue. Physicians' wellbeing and mental health matters," Sen says. "We know that unhealthy depression may make them not be able to provide high quality of care."

Sen notes that COVID-19 compounds the usual stress physicians feel because of their heightened concern for patients, more patients dying under their care, lack of personal protective equipment (PPE), and fear that exposure to the virus puts them and their loved ones at risk. Data on those effects are still being collected. But Sen says anecdotes from Detroit-area hospitals confirm that frontline medical professionals struggled physically and mentally, especially during the pandemic's peak in spring, when they worked long hours without PPE.

"In the U.S., we still don't have a definitive answer. We've seen and heard high-profile reports of suicides, the most tragic outcomes, and other concerns of physicians' mental health," Sen says. "... Also, there was an element early on in the pandemic, a sense of health care workers and physicians being held as heroes. That might also have a really positive effect for physicians and frontline workers, but it probably isn't sustainable."

New support systems

Living up to heroic expectations does not always allow health care professionals to seek the help they need, notes Sarah Slamer-Wasil, director of development for Starr Commonwealth.

Sarah Slamer-Wasil.

"If they believe they need to be superheroes, it puts a lot of pressure on. It almost doesn't normalize that they have feelings, symptoms, and reactions," she says. "Those professionals who are not able to stay for 24-hour shifts think there is something wrong with them. 'I should be able to do this. Why am I exhausted [or] making mistakes?' They start to struggle at home with personal relationships."

Starr Commonwealth provides behavioral health services to patients at Children's Hospital of Michigan. While working with these patients during the pandemic, staff realized that the hospitals' residents also had a need for mental health support.

"Many of the staff are being heavily impacted, living in fear of contracting the virus, living in that toxic stress space as well," Slamer-Wasil says. "At Children's Hospital, we wanted to provide a level of comfort, safety, and interventions so residents feel safe to do their jobs."

While Starr Commonwealth's caseload at Children's Hospital typically slows over the summer, this summer numbers have increased as a result of COVID-19-induced stress. People are feeling more anxiety and depression. At home, more families are experiencing violence, abuse, and neglect. To cope, more individuals are abusing substances. As a result, medical professionals have more people coming to them for help. Whether it be via telehealth, in clinics, hospital admissions, or in the emergency room, caring for these patients takes a toll on providers. Resident physicians are especially at risk because of long hours, exhaustion, and an expectation that they have to keep going well after their bodies signal that they cannot.

"We're reaching them on the front end and preparing them on what to do," says Dr. Caelan Soma, Starr Commonwealth's chief clinical officer. "We want them to notice that they are moving into a distress category rather than getting to a place where they shut down, burn out, or experience harmful impacts."

No stranger to the impacts of trauma, Soma helped with the aftermath of the Sandy Hook shooting and Hurricanes Katrina and Rita, and has authored Starr's courses and several books on the topic. She says the pandemic's effects on medical professionals have been similar to those of toxic stress.

"It's been an ongoing, prolonged, exaggerated experience for all of us, six going on seven months," she says. "The intensity has been its duration."

In helping Children's Hospital residents to cope, Starr Commonwealth is educating clinic staff and residents rotating through the clinic about trauma and resilience. Staff who become overwhelmed can access immediate crisis response face-to-face or virtually with a Starr Commonwealth practitioner. Scheduled group sessions offer residents and other health care professionals a space to practice defusing, a technique that helps them process the traumatic experience by normalizing their symptoms and reactions while providing opportunities for self-care.

"It's like defusing a bomb. If you think about a Coke bottle, shaking it up and letting a little fizz out, you don't take the top off the bottle until after defusing the fizz," Soma says. "It's a structured process with specific questions that ask about their exposure, symptoms, and reactions. We normalize their reactions and talk about what to expect in the weeks to follow. It really is a great way to ward off that secondary trauma."

Caelan Soma.

Similarly, Michigan Medicine has made mental health professionals available to its staff, face-to-face and virtually. This has helped the medical professionals deal with the trauma and stress they face daily during the pandemic. In addition, Sen notes that a mobile health app, Headspace for Healthcare Professionals, has helped Michigan Medicine staff access meditations that relieve stress, reduce panic, or promote wellbeing at home.

"If people need help at 3 a.m., they can get access there. We don't know yet how much it's being used and how it's working, but it's great to see it being used here at Michigan and in other places," Sen says. "... People seem more willing to talk about mental health and the stress of caring for patients."

Mental health help needed now and post-COVID-19

Sen notes that pandemic-prompted relaxation of regulations about sharing electronic medical data and allowing telehealth has helped medical professionals' stress while increasing patients' access to care. He hopes these regulatory changes remain in place after the pandemic.

"The levels of stress and depression among health care workers and physicians has been a problem for a long time, even before COVID-19. The pandemic has brought it into the forefront in a way that we can make some changes," Sen says. "We have to prioritize physicians' mental health and the patients who need healthy health care workers to do well and survive."

"We need to do a better job," Soma adds. "A lot of health care providers don't even realize what they are experiencing in this state-of-survival mode. Your body is meant to do this for a short time – four to six weeks, not six to seven months."

Medical professionals' friends, families, and communities can also do their part for their frontline heroes.

"They should not be isolated, alone on a pedestal," Slamer-Wasil says. "They are human beings and need a minute to decompress. Support groups, mental health intervention as individuals – all of that would be so helpful. But don't underestimate the power of lunches, dinners, and comfort measures like massages, activities, and fun. We need to do all of these things to reset after so much stress and exposure."

A freelance writer and editor, Estelle Slootmaker is happiest writing about social justice, wellness, and the arts. She is development news editor for Rapid Growth Media, communications manager for Our Kitchen Table, and chairs The Tree Amigos, City of Wyoming Tree Commission. Her finest accomplishment is her five amazing adult children. You can contact Estelle at Estelle.Slootmaker@gmail.com or www.constellations.biz.

Caelan Soma photos by Nick Hagen. Srijan Sen photo courtesy of Michigan Medicine. Sarah Slamer-Wasil photo courtesy of Sarah Slamer-Wasil.