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Q&A: The mental health toll for health care workers in the pandemic

After sharing her experience with a CU Anschutz podcast, 9NEWS asked Dr. Michelle Barron of the CU School of Medicine about mental health for health care workers.

DENVER — About a month into the pandemic, Dr. Michelle Barron, professor at the CU School of Medicine specializing in infectious diseases, took the advice she had been giving others for years and sought the help of a therapist. 

She shared her reasoning in an episode of the CU Anschutz podcast "COVID Reflections" which focuses on the evolution of the coronavirus pandemic. 

We asked Barron why she decided to publicly share her struggles with mental health in the pandemic and what she hopes others in the health care profession may learn from her experience. 

(Editor's note: Answers have been edited for context and clarity.)

9NEWS: Why did you decide to publicly share your struggles with mental health in this pandemic?

Barron: "I think it's so important for people to recognize that you can see people that are high achieving, high functioning, working hard, can be in leadership positions, and they still don't always handle stress, as well as they should. I think there's still a tinge of, ‘be tough and just work through it,’ and it's just such a terrible way of dealing with things and not allowing yourself to recognize your own internal vulnerabilities and the need for help.

I mentioned it on purpose and they sort of took that lead and asked me more questions about it. I think that is part of the stigma especially in people that are successful and doing well. I wanted to make sure I put it out there that you know, for all that you've seen me do, I'm still inside a human being with feelings and stresses and trying to find balance in the universe and sometimes I can't do that by myself and that's okay. There's nothing wrong with that. There are so many resources available that I think people just hesitate to try and access because of fear of, ‘oh my god, what are they going to think about me’ or, ‘there must be something wrong with me that I can't figure this out on my own.’ I just felt strongly that that was an important message for people to see because I consider myself a very high functioning individual. I obviously do a lot of things, and I’m pretty easy going, most of the time, but I have that same struggle I think everyone else is having."

What is the stigma like for healthcare professionals when it comes to seeking help?

Barron: One of the things we've learned a lot from this pandemic is the need for self-care, whatever form that takes. Self-care is not just the physical it's the mental. We obviously focus in medicine a lot on being good about exercising and eating good foods and not smoking and not drinking too much but I think we don't really talk about, the mental part of that. I think going through this round of the pandemic it's something we're all conscious of and trying to check in with individuals and say, ‘how are you doing? Are you okay? Have you done something for yourself today? Even if it's that five minutes of just quiet time and breathing or a walk or whatever you can connect to that allows you to have some of that reprieve. I think you just go, go, go, go, go and then you forget, ‘wait, what about me? Did I check in on me today? I think as a provider. That's the hardest part right, you're so used to taking care of patients you forget, ‘wait, did I take care of myself today?’ I think we're all trying to renew our energy and have that focus. Even if it’s five minutes, you have to take care of you in the day or you don’t get taken care of.

At what point in the pandemic did you identify the need to speak to a professional? 

Barron: We were about a month in. Things were pretty intense in terms of how things were escalating both on the patient side and then also on what we were trying to do and trying to predict. There were so many moving parts. As part of our initiatives, we were putting people out there for the staff to have access at the end of shifts to decompress and debrief and just let them have moments to where they could share that. The psychiatry department said the leadership should be doing something similar. When I finally attended it, I almost fell apart on the call. I just thought, ‘oh my god maybe I really do need some extra support,’ and everybody was incredibly gracious about it. It was great because it did lead me to getting little extra help, and the tools that I learned will be with me I think forever. 

The first exercise that triggered this was they asked, ‘if you're looking at your gas tank and you’re the car, how full are you? Where were you a month ago and where are you now?’ That’s what really triggered me because I’ve been on empty for weeks. I don’t think I have any gas yet I’m still sort of chugging along. That’s a very simple exercise that showed me, ‘okay, I need some help. I help all these people. I can get help too and it’s okay. It’s not going to change who I am. It’s not going to change how people perceive me. Actually it will make me better. That’s why I mentioned it on the podcast because I think there isn’t always that transparency. People think, ‘wow, how do people do all these things?’ We all have help!

In terms of taking time for yourself. I think it's so hard, especially if you are trying to take care of other people and trying to do all these other things and certainly if you have families and you're trying to juggle all these pieces. One of the exercises my therapist actually made me do was draw a circle and cut out all the pieces of the pie and align how much of the pie is for your family, how much is for work, and all the different things. She looked at it and said, ‘where are you in the pie?’ I said, ‘I’m in all the pie.’ She asked again, ‘no, where are YOU? What slice is just yours.’ I think about that a lot. You cannot have a full pie without me having my own little slice. To have it put so concretely really made me ask every day, ‘what slice of the day is part of my pie? Is it my walk at lunch? Is it my 10 minutes in my office listening to music?’ With the pressure everybody's feeling right now, that's important. I think we sort of tell ourselves, ‘oh, self-care has to be a week and I have to go to the spa.’ No! You can take 10 minutes and it’s kind of be like a week and I got to go to the spa. You can take 10 minutes, and still it's amazing when I do this how centered I feel. I'm like, ‘okay, I can do this today. I took my five breaths, let my mind clear, and I'm ready. Let's go again.

How does this third spike impact your mental health and others who haven’t sought the help that you have?

Barron: It's even more complicated now than it was potentially over the summer months because they were already trying to figure out what's going to happen with the kids. What about my spouse or somebody else in the household? The economics certainly are now really starting to press some individuals harder than others. I think they're probably already tired. It’s a lot. It's a lot to try and handle. Recognizing that sometimes you need some help and that little boost is okay and that it's okay to take the time to do it. As health care workers I see some of my friends who are nurses and at the bedside all the time. They're so selfless. All they think about all day long is, ‘what does that patient need?’ You have to remind them to take a break and do something for themselves on their break. Maybe a little more. Maybe something even deeper. Maybe you need tools that you don’t know about that are helpful to get you through the day and all the chaos that we live in now. 

Other events we've had feel a little more finite, even natural disasters. We have the aftermath and obviously there's a lot of emotions and issues that go around getting through that but then it’s done. This just seems to just be chugging along to where I think that's the struggle. Nobody knows when it's going to end. Nobody knows what's next. I think underlying fear and anxiety persists for so many that it’s just really taking a toll on society at large if you ask me.

How can the nature of COVID-19 impact a provider's mental health?

Barron: That is an extra level to this that is currently and, in the past, took a toll on health care workers. I can certainly relate to that. The things we normally do to keep people comfortable and make them feel better, we were limiting. We were limiting people going to the bedside. I had colleagues who were very distressed because they hadn't actually physically seen the patient. They see them from the window but so much of being in medicine is having that connectivity of being next to the person and talking to them and seeing them react and being able to give them that sense of comfort.  

Then for visitors and for their loved ones it was heartbreaking to not be able to allow them that access that they so desperately needed. The patient needs it and yet the risk is so high. At one point we let them in and they got sick. There are so many pieces to this. It hit both sides. It obviously affected the patient and the families but it affected the providers. We got some people very distressed about the fact that they couldn't advocate for their patients in the way they normally would. 

Being on the other side, the one making those rules, that was also horrifying. Understanding this is still the right thing to do but gosh it tears at your heart. You go home thinking, ‘I’m a bad person today.’ You’re not and you understand that but seeing both sides of that equation, being a provider and being on the rule making side, it’s tough. It weighs on your mind and you ask, ‘how do I deal with this today?’ Some of the tools I got were really helpful in terms of just allowing myself to have those emotions. We’re all supposed to be strong and happy and some days you’re just not. You can still project otherwise because we’re all professionals and that’s what you do but it doesn’t mean you don’t acknowledge those feelings. You need to acknowledge them at some point in your day. I used to play really loud heavy metal music while I drove home. It was cathartic! Screaming with the guitar and the drums and all that energy comes out. I would pretend I was the drummer or the singer and it was amazing how much better that made me feel.

Are you hoping that by speaking publicly about addressing mental health and the need for self-care allows other providers to feel comfortable doing the same?

Barron: Absolutely. When it was brought up on the podcast and even afterwards, they asked if I was okay with them sharing that. This is not a secret. I’ve been talking about it. I don’t blare it normally but that’s okay. I think it’s important for people like me in positions like I have to just acknowledge that I'm a human being and I need help. That's okay. We all can use some help. There are so many resources now with technology. Do it from your phone, do it from your computer, you can do it from your basement wherever you happen to be. That’s one of the silver linings of this. Access shouldn't have to be limited.