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Caring for the Mental Health of Front Line Workers During the COVID-19 Pandemic

During this unparalleled novel coronavirus pandemic, the majority of the global population has been instructed to practice social distancing and stay at home. However, front line workers have no choice but to continue serving the public during this critical time. These workers include, but are not limited to, hospital staff, nurses, physicians, police officers, firefighters, paramedics, and many more. Under normal circumstances, society relies on these individuals for our wellbeing and understands the importance of protecting their mental health. However, in the context of COVID-19, our collective reliance on and heartfelt gratitude for this population is highlighted. Thus, it is incumbent upon us as mental health professionals and as a society to care for the specific mental health struggles these individuals will face during this devastating time. These individuals are knowingly exposing themselves and their loves ones to the virus to serve the public. Taking this risk comes with its own set of mental health challenges that I will speak about, drawing from a psychological understanding of how chronic exposure to trauma affects individuals.

Isolation 

Front line workers understand that their job requires them to be exposed to events outside of the average person’s experience, including having to work to protect the public in a state of global crisis. At the same time, the rest of the world is social distancing. This exposure creates isolation as many front line workers live with a sense that others do not understand what they go through and that people around them are concerned with “more trivial” issues. This sense of isolation can lead to further disconnection from loved ones during a time when front line workers need support. Additionally, feeling isolated can result in their apprehension to raise their challenges with loved ones, operating under the assumption that they will not be understood. Thus, a deep sense of shame and alienation about one’s internal struggles can ensue, furthering isolation, and helplessness.

Disconnecting from Difficult Emotions 

As front line workers are taking risks to their own (and loved ones’) safety and security, they must adopt coping strategies to manage their own painful emotions of fear, powerlessness, sadness, and more. These strategies may include suppression, dissociation, and avoidance and are, to a certain extent, standard in response to trauma and crises to maintain functioning. While these mechanisms are necessary to allow front line workers to perform heroic acts of bravery, there are detrimental effects to chronic use of these coping strategies. These damaging effects involve operating on “autopilot,” as if one’s survival is continuously threatened, lack of engagement in the present moment, being indifferent, withdrawn, or cutoff. Moreover, the complex emotions engendered during times of crisis do not get processed in a healthy way that allows for constructive meaning to be made. Further, enduring chronic trauma increases the risk of substance use and other forms of self-destructive behaviour.

The Effects of Chronic Stress Response 

Unfortunately, front line workers will also suffer from the chronic activation of anxiety associated with always being in “fight or flight” mode. The persistent activation of this kind of psychological stress also has harmful physical and mental effects. Such effects include: 

  • destabilization of mood, 
  • distorted perceptions of events, 
  • hyperarousal of the nervous system, (resulting in elevated blood pressure, heart rate, physical tension, and stress hormone production) 

Moreover, nervous system dysregulation results in increased difficulties with primary bodily rhythms, such as sleep, appetite, digestion, body temperature, sexual desire/arousal, and energy levels. These detrimental psychological and physical effects of chronic stress levels make it even more difficult for front line workers to cope and less capable of accessing their baseline levels of resilience.

Supporting Front Line Workers During the Pandemic 

At CFIR and in the broader community, we are enormously grateful for the sacrifices front line workers are consistently making daily during this global crisis. CFIR clinicians are skilled in providing trauma related-care and assisting family members of front line workers. Collectively, we can support front line workers by increasing our awareness of the specific challenges they have and will endure and letting them know that mental health support is available to them. We also recognize that, particularly at a time like this, front line workers need to be confident that the world around them is ready and able to provide much-needed care and support. If you are a front line worker during the COVID-19 pandemic, you are not alone—we see you, we value you, and there is support for you!  

Tracie Lee, M.A. (Ed)., R.P. is an Associate at CFIR (Ottawa).  She provides psychotherapy to adults and couples who are experiencing issues related, but not limited to, anxiety and depression, self-esteem, interpersonal and couple relationship functioning (e.g., divorce/separation, infidelity, intimacy issues, family issues), sexuality, body image concerns, personality disorders, identity issues (e.g., professional, gender, sexual), suicidal ideation or self-harming, trauma and domestic abuse, and workplace and school functioning (e.g., burnout, workplace stress, performance). She recently spoke with CBC News Ottawa co-host, Adrian Harewood, about the psychological effects of COVID-19.