COVID-19 Updates Features Health and wellness
Mental Health: Self-care and serving in a pandemic

Mental health could be one of the biggest casualties of the COVID-19 pandemic, but the story is not finished yet. There are chapters left to write. There is time, in fact no time like the present to prioritize self-care. The risks of a distressed state of mind are acute, and for firefighters all the more so.

Data on the prevalence of mental health injuries amongst first responders in Canada was studied in 2017 by the Canadian Institute for Public Safety and Treatment (CIPSRT). The paper – Mental Disorder Symptoms among Public Safety Personnel in Canada (R. N. Carleton, et al) – culminated the findings of self-reported surveys that showed 44.5 per cent of participants had clinically significant symptoms consistent with one or more mental disorders. Estimates of prevalence in the general public are 10.5 per cent.

Looking at the current climate and the public at large, American research in JAMA Psychiatry looked at the potential consequences of our current circumstances on suicide in April. The study – Suicide Mortality and Coronavirus Disease 2019 – the Perfect Storm? (M. Rheger, et al) – noted several risk factors for suicide caused by the coronavirus, including economic woes, social isolation, less access to community and religious support, problems accessing treatment such as a lack of childcare, existing health problems, a surge in firearm sales, and the fact that suicide rates tend to peak in spring and early summer in the northern hemisphere. The study’s authors also noted: “It is possible that the 24/7 news coverage of these unprecedented events could serve as an additional stressor, especially for individuals with preexisting mental health problems. The outcomes of national anxiety on an individual’s depression, anxiety, and substance use deserve additional study.”

However, there are reasons to be optimistic, the authors wrote — “There may be a silver lining to the current situation. Suicide rates have declined in the period after past national disasters (eg, the September 11, 2001, terrorist attacks). One hypothesis is the so-called pulling-together effect, whereby individuals undergoing a shared experience might support one another, thus strengthening social connectedness. Recent advancements in technology (eg, video conferencing) might facilitate pulling together. Epidemics and pandemics may also alter one’s views on health and mortality, making life more precious, death more fearsome, and suicide less likely.”

Crisis Services Canada, a suicide prevention organization has been reporting a rise in reach-out, with 26 per cent of calls and text messages received since March 26 attributed to COVID-19, reported Global News. In America, the Disaster Distress Helpline saw an 891 per cent rise in call volume when compared to last March, reported CNN. Tragically, reports of doctors and nurses dying by suicide are also making headlines.

Suicide is the worst-case outcome of mental illness, but one that happens far too frequently. An average of 10 people die by suicide daily, reports the Government of Canada, making it the ninth leading cause of death. For every suicide, there are 25 to 30 attempts. The Centre for Suicide Prevention documents 27 first responder deaths by suicide between April and December of 2014, and approximates that first responders experience PTSD at twice the rate of the general public. These are tragic consequences. Below this horror exist a range of disorders causing all sorts of disorders and serious malaise.

The mental wellness of frontline workers and the general public is of high concern as we face the valid fear of widespread crisis of the mind now and post-pandemic. Coronavirus has and will surely continue to inflict damage beyond its hosts.

But all is far from lost – the ways to protect oneself are many, and many people are thriving despite the anything but normal “new normal”. We can start by looking at the scope of contributing factors.

■ COVID-19 and the home front
One of the biggest stressors for firefighters may be the fear of bringing the unseen pathogen home to their loved ones, says Matthew Johnston, a clinician at First Responder Health and firefighter in lower mainland British Columbia. Johnston also serves on the mental health task force for the BC Professional Fire Fighters Association. Firefighters are used to stressors they can see and the trauma of this hidden enemy could be profound, he says. Johnston is seeing some trepidation towards firefighters from people in the community not used to seeing them donning so much PPE. In addition, neighbours may fear that you, as a firefighter, pose an increased risk and that can turn into “social distancing times three,” he says. It can be a disheartening time, depending on what you are experiencing. Circumstances are localized across Canada and experience will be subject to that. But no matter your specifics, you are affected for better or worse. This is a test we all have to write.

“In coming years, I see more of an injury to our intellect and our heart,” says Johnston. “This shifts things holistically, as a perception of you as a frontline worker in the community and throws traditional value systems [in the fire service] upside down: engage at all costs, function over feeling, show up to work without excuses…there will be a focus on people showing up to work sick after this pandemic. This changes the fire service’s mentality of our limitations. It will be interesting to see how these medical call protocols evolve over time – do we go to routine only, or to all, and what universal precautions are we going to take?”

In the lower mainland, Johnston says showing up to any medical call without an N95 mask is a thing of the past, and even once a vaccine is created, he questions whether PPE protocols put in place will be rolled back, a move he has rarely seen. This covert thug has heightened the awareness of contaminates on just about everything in our environment everywhere. This increases hyper-vigilance not only on the job, but at home. And if domestic challenges were simmering prior to COVID-19, they may be at a full boil now, adding to distress.

Firefighters train for hyper-vigilance through situational awareness and elimination of stress responses that would cause most people to run from the danger, rather than towards it. He says this baseline is unhealthy and needs to be managed to begin with. When you add other stressors like sleep debt or domestic challenges, and now COVID-19, it’s a whole other level. A hallmark of this pandemic is how many worries in can incite at once – it’s not only are we safe, it’s are our families safe? What will happen to the economy? The questions are numerous, endless really.

Engaging in simple acts of family connection is a great form of protection for your mental wellbeing.
PHOTO: kalinichenkod/Adobe Stock

■ Positive interventions and setting intentions
At Ornge, an air ambulance and medical transport provider in Ontario, Tom Walker serves as human factors specialist, where one of his key responsibilities is providing therapeutic interventions for paramedics and staff. He is focused on getting people to worry about just what they need to worry about in the moment. This is a particularly difficult time for those already struggling with compassion fatigue or PTSD. From a clinical perspective, the sympathetic nervous system fires up in the face of a perceived threat and when that happens for an extended time period, damage can result. This highly wound state also creates reactions from the primitive mind rather than the executive logician — our pre-frontal cortex — which can lead to bad decisions and ongoing anxiety. One key element to support people with is how they view stress.

“If you see it [stress] as the enemy, it’s going to hurt you. If you see it as something that’s helping you stay safe and moving you along and making you more energized and focused, you’re a lot more likely to benefit from it and not develop health or psychological problems as a result.”

What Walker recommends people do is totally counterintuitive but clearly wise: Relax. And, get super Type-A about self-care. Be the best you can be at taking care of yourself, whether that’s exercise or talking to someone, he says. Be intentional about this self-care. When you are stressed, don’t ignore it and hope it goes away. Instead, do some sensory grounding — “I’m safe, I’m here at home” — do some breath work. Find your form of meditation, whatever it may be. Walker, a former pro boxer, hits his heavy bag. Prioritize connecting with your partner at home. Have faith that your PPE, used correctly, will keep you safe and you’ll keep your family safe too. Do what you can to relax that nervous system and calm the hyper-vigilant state. You don’t want to be in a state of arousal where you get up six times during a television show because your nervous system is too keyed up to sit still, he cautions.

Another important facet that Walker addresses is unconscious empathy. When we witness the trauma of others, seeing someone die and hearing the families crying, or seeing people struggling to breathe, can get us locked into their nervous systems through our mirror neurons. He tells his paramedics to be empathetic, but don’t imagine what the patients and families are going through. In his words: Like their shoes, know their shoes, but stay out of their shoes. Be compassionate, but don’t get locked in.

Since avoiding this fate is easier said than done, it’s particularly important for organizations to support its members and the members support each other. At Ornge, virtual “town halls” have been created for staff that address a range of issues, including how to talk to kids about the virus and not take stressors home.

“It’s a huge responsibility of organizations, to take care of their people and families. If they have a healthier outlook at home, they’ll be healthier at work,” says Walker.

With the right supports, there are positives and in the longview, Johnston at First Responder Health sees a chance for post-traumatic growth that could arise from this pandemic.

There is an opportunity to emphasize self-care and reconnect with your family; to be more mindful of planning your day. This is a time to be reminded of simple things like taking a family bike ride, which, Johnston says, is just the type of humble community and family engagement that psychologists have been recommending first responders do to protect themselves for years.

“I think that the COVID pandemic has put this under the spotlight for a group of people that may have had their check engine light on for a while and not had their car serviced, so to speak.”

And perhaps the unpreceded nature of the event will help further break down stigmas around mental health. Johnston sees the chance for more meaningful conversations that normalize exchanges about everyday domestic issues. He also sees an opportunity for renewed solidarity between labour associations and management; a chance to come together on what’s really important – that everyone is healthy, happy and thriving. Peer support is also a critical form of protection.

At Orgne, Walker is working towards getting people engaged in a way that they can still be supported by setting up forums where people can have some connection, but have it be confidential and safe.

“We heal together and we co-regulate together,” he says, of the importance in forging these connections.

■ Resources
To increase the resources available to first responders, Johnston created a new YouTube Channel in collaboration with BC Professional Fire Fighters Association. The video series features a variety of psychologists presenting or being interviewed on strategies to cope through COVID-19 and beyond. There is a message being repeated often within them and elsewhere: Put intentionality into your day. There is much to be said for being purposeful in an era where so much is out of our control.

Both Walker and Johnston emphasize the value in online counselling. Clinicians are available to do sessions by video through the pandemic, and both say it is effective and offers many benefits like discretion and not needing to travel (fight traffic in usual times). First Responder Health is a conduit for training clinicians to work with first responders specifically, equipping them to better build a rapport with fire service members. First Responder Health has a directory of occupationally aware clinicians.

Connecting by video is especially key on many fronts, says Walker, because you can very much clue into people’s energy and thus be more connected when you can see them. So much of communication – 93 per cent – has nothing to do with the actual words you choose and all to do with the nonverbal and auditory signals you send. In person is irreplaceable, but online is still a very high quality and effective experience.

And of course, as a form of protection, gratitude begets good feelings and helps avoid ruminating over what you can’t control, an act that is likely to make people more ill or get ill, Walker says. While he says it’s hard to see how there wouldn’t be a rise in mental health struggles throughout and in the aftermath of this pandemic, hopefully support strategies and resources can mitigate this. It’s key for first responders to remember all the good they are doing in the world, and just how good that can feel.