Heading off a Tidal
Wave of Woe

Programs ramp up to respond to the pandemic’s effects on mental health

The world has been brought to its knees by a pathogen one thousandth the width of a human hair —transforming our lives in ways both saddening and surreal. And beyond the frightening, sometimes deadly course of the disease itself, the COVID-19 pandemic is affecting the mental health of millions of people.

“We may be flattening the curve, but there is no question that there will be a huge wave of mental health needs in the coming weeks and months,” said Barbara Coffey, M.D., M.S., chair of the Department of Psychiatry and Behavioral Sciences.

Everyone Feels the Impact

From low-grade anxiety to abject loneliness, obsessive news consumption to overeating, sleeping difficulties to full-blown burnout, Dr. Coffey and other experts say the emotional impacts of the crisis are felt by just about everyone:

  • Patients who narrowly skirted death from COVID-19 after days or weeks in intensive care are exhausted and disoriented, struggling to regain previous levels of mental functioning. As a further complication, the virus is sometimes associated with brain inflammation and central nervous system symptoms that are not yet well understood.
  • Families mourning the loss of a loved one during the pandemic must also grieve that they could not be there in their final days, were forced to leave important things unsaid and undone, and are unable to even mourn together.
  • Children confined at home, especially those with previously diagnosed mental health and behavioral disorders, may face difficulties with remote learning and stressful family dynamics.
  • College students who have had to leave campus to shelter in place at home have seen their once-blossoming lives nipped in the bud, their next steps uncertain.
  • People already being treated for anxiety or depression may experience aggravated symptoms during this stressful time, especially if they are confined and alone.
  • The seeming randomness of people of every age falling fatally ill, sometimes after fleeting encounters with asymptomatic carriers, adds to the extant anxiety.

Though the mental health impacts of COVID-19 may bear some resemblance to post-traumatic stress disorder (PTSD), “We have some precedents, but not at this scale and level of pervasiveness,” Dr. Coffey said.

Front Line Vulnerability

Especially vulnerable, of course, are members of the health care workforce: doctors, nurses, respiratory therapists, and hospital and administrative staff.

“They may never have had a psychiatric concern in their lives, but now they are confronted with the biggest disaster in our lifetimes,” Dr. Coffey said. “Nobody could have foreseen that, in caring for others, they signed up for a disaster that could endanger not only their own lives and well-being, but also those of their families.”

Those fears, combined with the hectic intensity of their work environments, and frustration at not being able to do more for critically ill patients, are spiking health care workers’ stress levels off the charts.

The University of Miami medical community is also feeling the pressure.

“Managing their fears, their expectations of themselves, and their concerns over how long this herculean push will be necessary are major hurdles for our frontline health care professionals,” said Orlando Gonzalez, M.S.Ed. ’93, director of the University’s Faculty and Staff Assistance Program.

For all of us, the day-to-day anxiety that deepens as the pandemic wears on reflects what happens when we are, in effect, all stressed up with nowhere to go.

“I have spoken with people who just wake up crying these days,” said Deborah Jones Weiss, Ph.D., M.Ed., a clinical health psychologist and research professor in the Miller School’s Department of Psychiatry and Behavioral Sciences.

“If we don’t respond early, that acute stress can become an ongoing, chronic condition” — one that can cause long-term damage to physical and emotional health, she said.

Especially because COVID-19 testing levels are still far below what is needed, the pandemic presents a public health challenge that calls for a mental health discipline known as psychological first aid — not therapy, per se, but information and suggestions to help ease emotional burdens.

“People are struggling with feelings of helplessness,” said Dr. Jones Weiss. “They don’t want platitudes; they want tangible tools and techniques.”

Resiliency Is the Common Goal

Available interventions in these days of social distancing are varied, but share a common goal: resiliency. Though the term pops up in discussions of everything from athletic flooring to at-risk ecosystems, it refers in this context to the ability of an individual to recover quickly from misfortune and difficulties without being overwhelmed or acting in dysfunctional or harmful ways.

Units across the University are fast-tracking efforts to foster resiliency among employees, clinical caregivers and the community at large.

Some programs showcase mindfulness, empathetic listening, and an emphasis on the individual’s own potential to achieve beneficial change. Others draw on cognitive restructuring, a component of cognitive behavioral therapy, often used effectively for common problems such as depression, anxiety disorders, and binge eating.

Together, they compose a flexible menu of options to help manage the mental ticker tape of anxiety that can afflict us even in the best of times, now more than ever.

The Center for HIV and Research in Mental Health (CHARM), which Dr. Jones Weiss co-directs with Steven Safren, Ph.D., and Daniel Feaster, Ph.D., is utilizing its expertise in public health, mental health and behavioral health challenges to highlight coping resources that are especially relevant during the pandemic.

In close collaboration with CHARM the Department of Psychiatry’s Wellness Committee, headed by Radu Saveanu, M.D., has created a series of webinars for health care professionals that focus on mental health and psychological aspects of COVID-19, such as dealing with grief, practicing mindfulness, managing anxiety and parenting. To help attendees “find the middle” between acute and chronic stress, the webinars offer common-sense tips to “unplug and anchor” such as limiting the consumption of pandemic news and seeking out emotional support and pleasurable activities.

All You Can Do

Because health care is, for many, a calling as well as a vocation, attendees are also urged to accept that they cannot be strong and in superhuman “savior mode” at all times. In other words, said Dr. Jones Weiss, “Once you have done everything you can do, that is all you can do.”

Beginning April 28 and continuing into May, the sessions are available to rotating groups of faculty, residents and fellows, nurses and staff members.

For both frontline caregivers and current patients, psychiatry faculty members are on call and available 24/7 for telehealth consultations and, when needed, remote adjustment of prescriptions to manage intensified symptoms of anxiety and depression. For older patients who are less comfortable with technology, the Department offers guidance in using computers for virtual office visits and to track their care. The Department is also reaching out to hospitalized COVID-19 patients and their families with palliative care and grief counseling resources.

Employees throughout the university can turn to the Department of Human Resources and the Faculty and Staff Assistance Program for assistance with both pragmatic and psychological difficulties.

Current offerings, which are continually being expanded, include confidential one-on-one employee consultations, an online session on balancing working from home with parenting, a webinar on navigating change in challenging times, and an introduction to dance therapy as a way to relieve stress.

In another vein, as a serene visual distraction from the pandemic stress, the University’s Lowe Art Museum offers online Mindfulness and Mindful Looking sessions featuring various objects from its collections every Tuesday at 1 p.m.

As if all the other pandemic pain points weren’t enough, quarantine lockdowns have also disrupted fitness regimens, fraying the well-established tie between physical and psychological well-being. While treasured gym routines may not be reinstated any time soon, the UHealth Fitness and Wellness Center has expanded digital resources for stress management, nutrition, and other topics.

The Center’s Ask the Experts wellness speaker series, which has addressed topics such as optimizing stress and nutritional tips to manage weight while sheltering in place, is now being offered online. Other digital offerings include web-based group fitness classes and guided meditation sessions led by Lunthita Duthely, Ed.D., M.Sc., a research assistant professor in the Miller School’s Department of Obstetrics and Gynecology.

Similarly, The Miami Project to Cure Paralysis has created eight weekly Zoom sessions (MWF, 11 a.m. and 4 p.m.) that are opportunities for people with paralysis, or other physical challenges, to stay connected, active and in tune with their bodies. The sessions are also open to all faculty and staff and the public.

For staff, patients and their families, Cancer Support Services at Sylvester Comprehensive Cancer Center is offering via Zoom an extensive program (M-F, 10 a.m. to 6 p.m.) of yoga, exercise, meditation, music and music therapy, eBeauty, art, spiritual words of wisdom and acupressure, as well as sessions for children and pet therapy.

Inspiring Health Care Innovation

Though the outlines of a post-pandemic future have yet to come into focus, the COVID-19 crisis is inspiring innovative ways to deliver health care. Dr. Coffey noted that requests for research proposals focusing on mental health are proliferating, and study guidelines are becoming more flexible to accommodate the gathering of data online.

“Virtual health care and telehealth have been around for a while, but the use of these technologies is now so widespread that we are finding new ways to use them,” Dr. Coffey said. “As we implement tools to evaluate vital signs remotely, we can expand community access to various subspecialties and build a blended health care delivery system that combines telehealth and office visits. We have a lot of resilience within us as individuals and as teams, and this is an extraordinary opportunity to draw on it.”

Paradoxically, embracing today’s uncertainties may ultimately foster a greater ability to cope with them.

“People struggling with a loss of control over their lives should recognize that control is, to some extent, an illusion,” Dr. Jones Weiss said. “There is no secret sauce that will restore it. We can really only control our response to events. But there is comfort to be gained in knowing we are not alone, and that others have experienced and worked through these fears.”

Mental Health Resources

Anyone who is experiencing unmanageable levels of stress and anxiety or thoughts of self-harm during the COVID-19 pandemic is urged to call 9-1-1 or the National Suicide Prevention Lifeline (1-800-273-8255). For additional information on University of Miami mental health resources for employees, caregivers and patients, please review the following resources:

UNIVERSITY OF MIAMI MEDICINE
SPRING 2020