This month, we are sharing thoughts and insights on the importance of peer support services in healthcare, as well as other systems where peer supporters can be integrated. As the impact of the COVID-19 pandemic continues to be felt across the U.S. and around the world and folks struggle with the fallout, we are seeing an increased need for mental health and substance use disorder services and supports.

COVID-19 mental health impacts  

For many, the virus has taken a terrible toll. Family and friends have been lost. Millions of jobs have been lost. Our collective and individual sense of what is “normal” has been lost.

In a May 14, 2020 news release, the United Nations called for a substantial investment in mental health services to avoid a “massive increase in mental health conditions in the coming months.”

World Health Organization Director-General Dr. Tedros Adhanom Ghebreyesus said this:

“It is now crystal clear that mental health needs must be treated as a core element of our response to and recovery from the COVID-19 pandemic. This is a collective responsibility of governments and civil society, with the support of the whole United Nations System. A failure to take people’s emotional well-being seriously will lead to long-term social and economic costs to society.”

Focus on prevention

Public health experts, media and a growing number of policy makers are urgently emphasizing the critical necessity to take a preventive approach to this crisis, urging people to wear masks in public, practice physical distancing and increase testing. If we don’t embrace prevention, we will not beat this disease.

It’s not just infectious diseases like COVID-19 that require a robust, full court press preventive public health response. We need to get serious about prevention in mental health. A 2015 research article, Preventing Mental Illness: Closing the Evidence-Practice Gap Through Workforce and Service Planning stated:

Despite advances in treatment, there is little evidence that prevalence rates of mental illness are falling. While the prevention of cardiovascular disease and cancers are common in policy dialogue and service delivery, the prevention of mental illness remains a neglected area.

Note the reference to “evidence-practice gap” in the article title. What does that mean? Here’s a great, succinct description from a 2014 article published in PLOS Medicine.

Health research promises societal benefit by making better health possible. However, there has always been a gap between research findings (what is known) and health care practice (what is done), described as the “evidence-practice” or “know-do” gap.

Peer support contributions

So, what are the implications to the peer support workforce I mentioned at the beginning of this article? How does prevention apply to this discussion? Why is there still an “evidence-practice” gap with regard to peer support?

There are 200+ articles published in the literature on peer support. Peer support has long been recognized as an evidence-based practice. In fact, there are several peer-developed, peer-delivered models grounded firmly in the principles of recovery and resiliency, choice and self-determination, and an understanding of a holistic approach to wellness. And these models have been shown to have a positive impact on traditional outcomes, predominantly measured in behavioral health, including significant reductions in hospital admissions, fewer re-admissions and decreased spending on high-cost, restrictive settings like psychiatric inpatient. While peer support is not a clinical service, it has been shown to impact clinical outcomes. Beyond this, folks receiving peer support services express very high degrees of satisfaction with those services and report improved quality of life.

This is an excerpt from the Magellan Healthcare eMpowered for Wellness July newsletter. To read the full article, go here.

In light of recent events, Yagnesh Vadgama, BCBA, vice president, clinical care services, autism, Magellan Health, shared his perspective about how COVID-19 and racial and ethnic disparities may be combining to delay diagnosis and important early treatment for autism spectrum disorder in children.

 Magellan Health Insights: Yagnesh, thank you for chatting with us today. In the past there have been marked differences in the rates in which Black and Hispanic children are diagnosed with autism spectrum disorder (ASD). Why was that?

 Yagnesh Vadgama: For years, there was a disparity in the rates of ASD diagnosis of Black children versus White children – as recently as 2014 White children were 1.1 times more likely to be diagnosed with ASD by age 8. And in the 1990s, Black children were identified as having ASD later and were more likely to be diagnosed with conduct disorder or adjustment disorder than were White children. For the first time, the CDC has reported that this gap has closed as of 2016 for Black children, which is encouraging news, but was not the case in every state studied.

And, a gap still exists for Hispanic children. White and Black children were 1.2 times more likely to be identified with ASD than Hispanic children. Reasons for this difference include lack of access to healthcare services, differences in Medicaid vs. commercial insurance coverage of ASD services, parents and children speaking a primary language other than English, and potentially fear of seeking out care because of one’s immigration status. It’s still the case that Hispanic and Black children receive evaluations at a later age than White children. Often, children with Medicaid don’t get diagnosed until they begin attending school.

Magellan Health Insights: Why does age of evaluation and diagnosis matter?

 Yagnesh Vadgama: With ASD, time is of the essence. The earlier we get kids into services, the better the health outcomes are going to be. If an individual gets treatment early, there is less risk of developmental delays becoming permanent. A recent University of California San Diego study indicates children should receive ASD services as early as 18 months. During this time, the brain is able to acquire new skills at an earlier age. Also, as individuals get older, they are more likely to develop a comorbid diagnosis, so it’s important to begin services prior to the onset of other comorbidities.

 Magellan Health Insights: How might COVID-19 be affecting the age at which children are being evaluated?

 Yagnesh Vadgama: People are avoiding nonurgent care. Utilization rates of elective services have plummeted. Also, since school is the first place many children get evaluated for ASD, that may not happen with schools closed or moving to remote learning. And since many individuals’ health insurance is provided by their employers, many newly unemployed individuals may not be able to afford COBRA premiums and may lose coverage. Time is of the essence, and delays may have long-term or permanent effects.

 Magellan Health Insights: What can healthcare providers do to help ensure early, accurate diagnosis?

Yagnesh Vadgama: Healthcare providers should conduct early and frequent screenings as recommended by the American Association of Pediatrics. But, as important, providers should make appropriate recommendations for follow-up care and really help parents understand the next steps. They need to create a sense of urgency for follow-up care – encourage parents to act now, not to sit on it, see someone now. Then follow up with additional testing and screening on subsequent visits, because ASD can evolve over time. But never use a “just wait and see” approach, because time is of the essence.

Magellan Health Insights: What can parents do to help ensure a correct, early diagnosis if they have concerns?

Yagnesh Vadgama: Understand developmental milestones for your child’s age and the signs of ASD. Speak up about your concerns, especially where a child has a hearing impairment or an intellectual disability – because both situations could lead to a later ASD diagnosis. Be your child’s biggest advocate and ask about concerns and next steps.

One of the beautiful things is that in all 50 states, there is a mandate that commercial insurance carriers provide autism coverage. Covered members now have access to screenings, psychologists, developmental pediatricians and services that weren’t available when I began practicing over 16 years ago. And keep pushing until you get the care that best meets your child’s needs. Don’t wait!

Magellan Health Insights: We couldn’t agree more! Thank you, Yagnesh!

Q: What is the cumulative effect on mental health of COVID-19, social distancing and now the protests/riots on African-American and other BIPOC adults, both immediately and in the long term?

A: The COVID-19 pandemic has worsened longstanding ethnicity-based healthcare disparities that have resulted in disproportionate infection, morbidity and mortality rates for BIPOC adults, specifically Black Americans. Black Americans represent approximately 11.9% of the workforce, however they make up 17% of the front-line, essential workforce that is at higher risk for contracting and transmitting the virus[1]. At a time when the pandemic has resulted in an employment loss of 17.8% among Black workers compared to 15.5% among White workers, the risk to individual health safety is compounded by the risk of occupational hazards, job loss and financial insecurity[2]. As such, the compounded crisis of police brutality and increased social awareness of protest movements and civil unrest adds an additional layer of uncertainty, worry, fear, anger and sadness. Studies show that Black Americans are more likely to develop both physical and mental consequences to prolonged exposure to the chronic stress associated with discrimination and socioeconomic status, particularly high blood pressure, asthma, diabetes, depression and anxiety[3] [4]. In the week following the release of the George Floyd police brutality video, the rate of Black Americans experiencing depressive or anxiety symptoms increased from 36% to 41%, and among Asian Americans, the rate jumped from 28% to 34%[5].

Q: Are there unique signs of mental distress in African-American and other BIPOC adults that differ from those presented by Caucasians?

A: Though various forms of mental distress are characterized and diagnosed by commonly reported symptoms and behaviors, it is not unusual for individuals to have unique experiences that don’t look or sound the same, depending on who’s experiencing them. Additionally, cultural and spiritual norms specific to certain ethnic populations can influence the ways in which we communicate our pain, worry, sadness, anger and fear to healthcare providers, which often leads to misdiagnosis and/or ineffective treatment planning for ethnic minorities. Moreover, a 2019 study conducted by Rutgers University, indicates that Black Americans with severe depression are more likely to be misdiagnosed with Schizophrenia, which reveals significant provider bias in overemphasizing psychotic symptoms compared to mood symptoms[6] . In these instances, it appears that Black respondents’ endorsement of mistrust, hopelessness and paranoia due to extenuating sociocultural and political circumstances can result in unique clinical presentations that pose significant obstacles to understanding and healing, and that this effect is heavily influenced by the identity and implicit bias of both the patient and the provider. Ethnic minorities are also more likely to somaticize mental health symptoms, meaning they often report physical complaints like pain, fatigue or headaches, as well as sleeping difficulties as their chief complaints, rather than attributing the combination of symptoms to a mental health condition like depression or anxiety. This dichotomy often leads to further limitations in access to care, weakening of trust in the healthcare system, and escalating feelings of traumatization, oppression and isolation for marginalized demographics.

Q: How can African-American and other BIPOC adults help each other process their thoughts and emotions about the general unrest in our country?

A: It’s often said that there’s strength in numbers, and this is equally true as it relates to emotional support for marginalized communities in times of social unrest and collective trauma. Generational exposure to workplace and community discrimination is a shared experience for many ethnic minorities, and this commonality may make it easier for individuals who are feeling distress to share their thoughts with friends, family and providers who have a firsthand experience with the same issues in our society and across the world. This familiarity may also reduce mistrust within the healthcare system, if BIPOC patients feel they have an opportunity to share their feelings without judgment, misdiagnosis or repetitive traumatization and discrimination. Likewise, ethnic minorities are more likely to rely on spiritual or other cultural leaders for support and guidance in times of stress or civil unrest and are more likely to benefit from clinical behavioral health services when these alternative modalities are considered and integrated as fluidly as possible.

Q: Are there unique barriers to mental health treatment for African-American and other BIPOC adults?

A: Apart from generalized limitations in access to healthcare that have been noted for Americans across the spectrum, behavioral healthcare remains out of reach for millions of people, including those who actually have healthcare coverage. Shortages in available providers, clinics and hospitals means that there are longer wait times for appointments, and fewer resources available for maintenance of chronic mental conditions. Many mental health providers have moved to cash pay only practices, and this may serve as an obstacle for people who don’t have the disposable income available to pay out of pocket for psychotherapy or medication management. Inpatient bed shortages and the lack of long-term behavioral healthcare facilities are also shown to contribute to chronic homelessness, frequent ER visits and more interactions with the criminal justice system, which has become the largest provider of mental healthcare and boarding for chronically mentally ill patients over the last few decades[7]. Finally, stigma remains a very prominent barrier to seeking care for many ethnic minorities. In some cases individuals may fear judgment, mockery, maltreatment or discrimination due to their mental illness, while others may simply lack adequate information about the mental health field due to relatively less cultural reliance on these modalities within certain ethnic groups.

Q: What would you recommend to Caucasian individuals who want to reach out to their BIPOC friends and acquaintances and show their support, but don’t know what to say or are afraid it would not be received well?

A: In times of social division, strife and unrest, marginalized groups who are experiencing emotional distress and traumatization are likely to be concerned about safety, survival and stability. Allies and systems of support outside of ethnic peer groups can be helpful in building trust and solidarity across demographics, and this may aid in the development of healthier coping and conflict resolution strategies. It’s important that friends, family and coworkers be mindful that not every BIPOC person experiences distress or social events the same way and be open to simply listening to how the person feels first, before rushing to offer apologies or solutions that may not be indicated or helpful. MLK said that riots are the language of the unheard, and it is indeed the case that marginalized identities continue to live social and emotional experiences that so often go unnoticed, misunderstood and unaddressed by the ethnic majority. An expression of willingness to hear, care and help despite not knowing all the answers or solutions is sometimes all that’s necessary to convey empathy, sympathy and solidarity.

[1] https://www.epi.org/publication/black-workers-covid/

[2] https://www.epi.org/publication/black-workers-covid/

[3] https://www.ajmc.com/focus-of-the-week/high-levels-of-chronic-stress-high-blood-pressure-linked-in-african-americans#:~:text=African%20Americans%20who%20report%20high%20levels%20of%20chronic,serving%20as%20possible%20catalysts%2C%20according%20to%20study%20findings.

[4] https://www.washingtonpost.com/health/2020/06/12/mental-health-george-floyd-census/?arc404=true

[5] https://www.washingtonpost.com/health/2020/06/12/mental-health-george-floyd-census/?arc404=true

[6] https://ps.psychiatryonline.org/doi/10.1176/appi.ps.201800223

[7] https://www.theatlantic.com/politics/archive/2015/06/americas-largest-mental-hospital-is-a-jail/395012/#:~:text=As%20sheriff%2C%20Dart%20is%20also%20responsible%20for%20Cook,considered%20the%20largest%20mental-health%20facility%20in%20the%20nation

When your workplace is disrupted by a tragic event, employees may feel overwhelmed, anxious, insecure, and distracted. Everyone reacts differently to stress events, but tragic workplace events are serious and can cause significant physical, cognitive, and emotional reactions. A team of experienced mental health consultants can help reduce the negative impact of the event and its long-term impact on the organization, speed recovery, and return people to everyday life. Critical event interventions can also prevent post-traumatic stress disorder (PTSD).

Types of traumatic events

Tragedies come in many forms. Typical traumatic events include the unexpected death of an employee, a chronic illness of an employee, an injury at work, robberies, shootings and other acts of violence, criminal attacks, industrial or natural disasters, or even organizational restructuring or dismissal. People who have witnessed the event or know the people affected can experience a number of symptoms of the stress response, such as:

• Insomnia, nausea, dizziness, fatigue, racing heart, headache and loss of appetite
• Nightmares, hyper vigilance, panic attacks, intrusive images and poor concentration
• Feelings of anxiety, guilt, depression, irritability, anger and fear
• Social withdrawal and self-medication with alcohol or other drugs [1]

Critical events can also trigger memories of previous intense stressors.

How Magellan’s Employee Assistance Program Can Help

Magellan’s Critical Incident Response (CIR) team consists of specially trained clinical staff who are available 24 hours a day, 365 days a year. CIR Consultants help employees process and manage the emotional and physical effects of a traumatic event.

The first step is to consult with you about what has happened and assess the situation. Once the situation is assessed and an action plan is developed, we will send a CIR consultant to your workplace within a reasonable and agreed time frame. The CIR consultant will carry out a structured intervention on site to help deal with the incident, if necessary, and will also be available to managers and individual employees if needed. Services are confidential and provide employees with the resources and support they need to cope with the stress and anxiety caused by the event and return to normal life.

Our broad spectrum of CIR services includes management consultancy, telephone crisis support, group and individual support for affected employees, as well as follow-up care.

Critical incidents and tragic events occur in all types of companies and industries. Preparation with an existing CIR program is key to effectively managing the aftermath and associated risks.

[1] https: //www.osha.gov / SLTC/emergencypreparedness/guides/critical.html

Anyone who has gone through a traumatic event can develop symptoms of stress disorders such as post-traumatic stress disorder (PTSD).  Although the COVID-19 pandemic in general would not meet the criteria for formally causing a stress disorder, many of the same issues can result from such a widespread and overwhelming event.

The pandemic could be viewed as a long-term stress event.  It has become life-changing for the whole world.  As COVID-19 spreads across the globe, people may experience increased anxiety and fear triggered by the pandemic and constant news. In addition, the pandemic can be traumatizing for others: healthcare workers, people who have lost friends and loved ones, and people whose lives have drastically changed.

What are stress-related disorders?

Stress-related disorders can occur after you have been through a traumatic event. A traumatic event is something horrible and scary that you see or that happens to you. During this type of event, you think that your life or others’ lives are in danger. You may feel afraid or feel that you have no control over what is happening. These symptoms can change your behavior and how you live your life.

How can reaction to the COVID pandemic be similar to a stress disorder?

When you struggle with a stress disorder, it can be hard to anticipate when anxiety or depressive symptoms may flare up. Although it may appear that symptoms come out of nowhere, in most cases they are cued by factors called triggers. Internal triggers are the feelings, thoughts, memories, emotions, and bodily sensations that you feel or experience. External triggers are the people, places, and situations that can bring back memories of the traumatic event.  In the current environment this could be caused by news reports, social media or discussion with friends or family.

The first thing to realize is that many fears are unwarranted; anxiety may arise when you are in a completely safe environment. When you begin to despair or your fears consumer you, try to remember that your worries and fears may be extreme because of previous experiences and not current facts. Once you’ve realized what may trigger these fears and anxiety, you can begin to try to deal with them.

How to cope with stress-related symptoms amid COVID-19

• Cultivate ways to be calmer. It’s understandable to feel anxious and worried about what may happen. While circumstances may be stressful and beyond your control, you can try to offset them with positive, calming activities. Practice slow, steady breathing and muscle relaxation, as well as any other actions that are calming for you (yoga, exercise, music, keeping the mind occupied).
• Understand what is within your control. Accept circumstances that cannot be changed and focus on what you can do. Evaluate your risk of contracting the virus, practice social distancing and follow clinical guidance on other practices. If you are in quarantine or isolation, do things that can support your mental health.¹ Focusing on what you can control and do can help you deal with the unknown.
• Remain hopeful. Keep a long-term perspective. Look for opportunities to practice being more patient or kind with yourself, or to see the situation as an opportunity to learn or build strengths. Celebrate successes, find things to be grateful about, and take satisfaction in completing tasks, even small ones. Remember that this will not last forever.
• Lean on your network. Make the most of technology and stay in touch with colleagues, friends and family via phone calls, texts, social media and video conferencing. Consider joining a free support group online to stay connected.² If you have a therapist, try to continue your treatment by phone or online.
• Focus on the potential positives. Try and focus on the things that can be viewed positively such as spending more time with family and a experiencing a potential to grow. Many times, going through a stressful time like this can lead to post-traumatic growth. This growth can be seen as though the stressful event was a trial or challenge that you conquered, something you learned from and became more resilient through. Sometimes stress can stimulate personal growth and improved overall coping.

For more information and tips, www.MagellanHealthcare.com/COVID-19.

May is Mental Health Awareness Month. This is an opportunity to increase public awareness of mental health conditions.  We can break down the stigma by ending the silence. About 1 in 5 Americans experience mental illness. It is important to be able to talk openly about it to get people the help they need. It is particularly timely this year, as we are seeing stigma associated with COVID-19, and we must do what we can to stamp out stigma in all its forms.

Understanding mental illness

According to the National Alliance on Mental Illness (NAMI), a mental illness is a condition that affects a person’s thinking, feeling or mood. Such conditions may affect someone’s ability to relate to others and function each day. Each person will have different experiences, even people with the same diagnosis. If you have — or think you might have — a mental illness, the first thing you must know is that you are not alone. Mental health conditions are far more common than you think, mainly because people don’t like to, or are afraid to, talk about them.

Mental illness can affect anyone regardless of age, gender, income, social status, religion or race/ethnicity.

• 1 in 5 U.S. adults experience mental illness each year
• 1 in 25 U.S. adults experience serious mental illness each year
• 1 in 6 U.S. youth aged 6-17 experience a mental health disorder each year
• 50% of all lifetime mental illness begins by age 14, and 75% by age 24

Depression and anxiety disorders are the most common mental health disorders worldwide.

The exact causes of mental illness are not fully understood. However, factors that can contribute to mental health problems include:

• Genes and family history
• Biological factors such as brain chemistry and brain injury
• Serious medical conditions
• The use of alcohol or other drugs
• Traumatic life experiences
• Isolation and other social factors

Mental illness is not a character flaw or something that a person can just “snap out of.” For many people, recovery — including meaningful roles in social life, school and work — is possible, especially when you start treatment early and play a strong role in your own recovery process.

Sadly, many people never seek treatment out of fear and shame. The stigma of having a mental illness or substance use disorder is two-fold: people suffer needlessly even though effective treatments are available, and they’re also at higher risk of premature death. For example, people with depression have a higher risk of heart disease and cancer. Studies also show that people with severe mental illness have a higher incidence of chronic diseases and tend to die 10 – 25 years earlier than the general population.¹

Stamping Out Stigma

Everyone experiences the ups and downs of mental health. Many people have a mental illness or know a friend or family member who has struggled with one. To stamp out stigma and get people the help they need NAMI offers these practical tips:

• Talk openly and honestly about your own experiences with mental illness and addiction.
• Educate yourself and others about the facts of mental illness. Mental disorders are treatable just as physical diseases are, and people with mental illness are not to blame for their condition.
• Recognize the signs of mental illness and seek professional help when needed.
• Show empathy for those living with mental health and substance use disorders.
• Be aware of your attitudes and language used to describe mental illness and people with mental illness. Jokes and name-calling are hurtful and perpetuate demeaning stereotypes.

Let’s work together to Stamp Out Stigma!

Sources:

[1] Management Information Sheet. (n.d.). Retrieved from https://www.who.int/mental_health

²Social Stigma associated with COVID-19. (2020, February). Retrieved April 10, 2020, from https://www.unicef.org/media/65931/file/Social%20stigma%20associated%20with%20the%20coronavirus%20disease%202019%20(COVID-19).pdf

The stress of COVID-19 can present many challenges to those who are in recovery. In particular, social distancing is limiting people’s ability to get support from friends, family, and support groups.

Connection to others in recovery is a big part of the solution for many in recovery. Meetings make people feel supported and understood in ways nothing or no one else can. With much of the world under orders to quarantine or shelter in place, people in recovery can struggle to maintain a connection to their support groups. The good news is many recovery groups are scheduling virtual meetings, and that number is increasing each day.

Below are links to information about virtual 12-step and non-12-step meetings. These meetings take place in a variety of ways: over the phone, in online community posting forums, in social media groups, and through video.

Also, if you have a sponsor, peer specialist, or other special relationship, maintain that connection through text, email, phone, and FaceTime, or Skype.

12-Step Programs 

• Alcoholics Anonymous (AA; aa.org): For regularly scheduled virtual meetings, visit aa-intergroup.org and click on Online Meetings.

• Narcotics Anonymous (NA; na.org): For regularly scheduled virtual meetings, visit www.na.org/meetingsearch. In the NA Meeting Search box on the right, select “Phone” or “Web” in the Country field drop-down list.

• Al-Anon (for families and friends of alcoholics; al-anon.org): For regularly scheduled virtual meetings, visit al-anon.org/al-anon-meetings/electronic-meetings.

• Nar-Anon (for families and friends of addicts; nar-anon.org): For regularly scheduled virtual meetings, visit www.naranon.com/forum.

Other Programs

Some in recovery prefer non-12 step programs. Listed below are a few organizations who provide virtual support.

• SMART Recovery (for people with addictive problems; smartrecovery.org): To find online forums and meetings, visit www.smartrecovery.org/smart-recovery-toolbox/smart-recovery-online.

• LifeRing (for people addicted to alcohol or drugs; lifering.org): To find online video meetings via Zoom, visit www.lifering.org/online-meetings.

• Women for Sobriety (for women facing issues of alcohol or drug addiction; org): For information on the online community, visit wfsonline.org.

For more information and tips, visit MagellanHealthcare.com/COVID-19.

As the pandemic grows, healthcare workers are experiencing a new level of stress and fear. Since our first piece about healthcare workers and mental health, the toll that COVID-19 cases have taken on them has become more difficult than any could have imagined.

First, let us again say thank you to all of you, from EMTs who answer the first calls to the doctors and nurses who tend to the sickest. Your selflessness and heroism is inspiring.

We’ve set up a counseling hotline for healthcare workers and first responders at 1-800-327-7451 (TTY 711). Your call will be answered by our licensed mental health clinicians. Our team is trained and ready to listen and help during this difficult time.

There are so many things that are out of our control. We are dependent on others to address many aspects of the big picture, but there are things outlined below that we can do for ourselves and those close to us. No single recommendation is enough by itself, but when taken together, they may help.

Talk about it

Acknowledge your anxiety, fear and grief, and talk about it.

Many of our colleagues and friends say that leaning on fellow healthcare workers is very difficult. Everyone’s heart beats a little bit faster when they greet a COVID-19-positive patient, so how can we ask them to support one another? Yet this is what we do as a medical community daily. Peer support is key.

• If a compassion fatigue group isn’t available at your workplace, work with your employer to put one together.
• If a group option isn’t available, talk to your co-workers about what you are seeing and how it is affecting you. You’ll be surprised at how many share your feelings but have been afraid to say anything. Hospital workers have talked about how a quick meeting at the beginning of their shift, during a break or at other times—to talk, pray, or have a moment of silence—has helped them tremendously.¹
• Many hospital systems have been deploying their psychiatric workforce as volunteers to help colleagues who need it.² Ask your employer if this is available.
• If you don’t want to talk about it at work, find a former co-worker or friend from school or training to talk to, or contact Magellan Healthcare at the phone number above.
• Finally, if you are at a point where your feelings impact your ability to perform or feel comfortable in your role, talk to your supervisor or your organization’s human resources group about your employee assistance programs. Monitor your physical and mental symptoms. You may reach a position that you need to be treated by a behavioral health professional. If that happens, contact one as soon as possible.

Make your voice heard

Some healthcare workers are feeling betrayed by their employers and others.² Whether it’s lack of PPE, feeling unappreciated or being expected to work excessive hours, these feelings can make an already untenable situation worse. While there is much you cannot control, don’t let that stop you from advocating for yourself and others.

• Ask for more PPE or the protocols for how it is allocated. Understanding why things are happening can help people accept them and enable you and your colleagues to offer suggestions from the front lines.
• If you are frustrated about things that you see, think about how you would make them better. Make a list and discuss them with coworkers to come up with solutions. Once things slow down, you’ll have strong suggestions for improving your work environment.

Maintain focus

• Remember why you became a healthcare worker. Maybe you watched a family member battle an illness, or you felt a calling to help people. Think about that during these times.
• Remind yourself that what you are doing is noble. The cognitive impact of recognizing the value you offer will help you serve your patients in a positive way.
• Consistent with your training and dedication, keep your focus on the patient in front of you, on protecting yourself to the best of your abilities and extending those protections to the home setting when you are off work.
• When you are off work, turn your focus to what is happening in the moment.

Take care of yourself

• We acknowledge that recommending meditation or focusing on breathing in the midst of chaos and fear may not seem helpful for some. Think about how you breathe when you are stressed. Some of us hold our breath without realizing it; others breathe very shallowly. We don’t realize it until we get around to taking a real breath.
• As you work around people with COVID-19, you might be afraid to breathe deeply. If you can, try to go to a place where you feel comfortable doing so, and take a few deep, slow breaths. Something as simple as this can release stress and clear your mind.
• Exercising may feel like a lofty goal as well. Try to find 10 minutes for a brisk walk, or a quick set of jumping jacks, sit-ups and push-ups.
• If you don’t have time or energy to cook, find easy-to-eat fresh foods like bananas, oranges and carrots.
• To help you relax and get to sleep, try apps like Headspace, Calm and Balance. AMA members can access these for free.
• Finally, if you are on medications for a pre-existing behavioral health condition, don’t stop taking them, and contact your provider if your symptoms are getting worse.

For more information and tips, visit www.MagellanHealthcare.com/COVID-19.