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���������� Note: Here’s an extremely timely piece that references Dr. Peggy Swarbrick’s longtime groundbreaking work in promoting wellness for peers and providers, especially during these times. Peggy and Pat Nemec are presenting at today’s ���������� virtual Executive Seminar on “Self Care: A Habit for Personal and Professional Practice” from 10:45-noon. EST. See attachment for details and links.

Amid COVID‐19, Self‐Care As Important For Providers As It Is For Patients
Mental Health Weekly April 20, 2020

The COVID‐19 crisis has no doubt disrupted the lives of many, and the impact is being felt by mental health providers and front‐line staff who have had to get accustomed to different ways of delivering services. Behavioral health care leaders in the field, in interviews with MHW, are reminding providers to take care of themselves emotionally and physically as they care for patients with mental health and substance use needs during this pandemic.

“Our rhythm has just been shocked,” Peggy Swarbrick, Ph.D., FAOTA, coordinator at the Wellness Institute of Collaborative Support Programs of New Jersey and Rutgers University Behavioral Health Care director of practice innovation and wellness, told MHW. “We have to get back to basics: breathing, pausing and getting in a good sleep routine.” Many people are saying they’re needing more sleep now, said Swarbrick, whose work revolves a lot around wellness for community organizations, peer‐run groups and others.

Providers need to be putting the oxygen mask on themselves, said Swarbrick, speaking both metaphorically and physically. “The ‘fight or flight’ response is so out there for everyone,” she said. The time is more important than ever for people to adhere to a schedule and routine even though it has been so altered, she said.

Swarbrick has published Words of Wellness, a newsletter for providers, since 2008. The current issue focuses on such topics as social wellness, developing life skills for tough times and maintaining a journal, and also includes a number of resources for museum tours, meditations, games and doing science experiments at home.

At Rutgers, Swarbrick presents self‐care and mindfulness‐related activities for psychologists, social workers, peers and support staff in a webinar format. “We’re trying to share practical tools for keeping connected even during social distancing,” she said. “We could have done this before, but now we’re forced to do this.”

In 2016, Swarbrick developed the Eight Dimensions of Wellness for the Substance Abuse and Mental Health Services Administration: (1) emotional, (2) environmental, (3) financial, (4) intellectual, (5) occupational, (6) physical, (7) social and (8) spiritual.

Increased anxiety
The chief medical officer and director of mood recovery at Sierra Tucson, a residential mental health and substance use treatment facility in Tucson, Arizona, said staff has been more anxious than usual, both for themselves and their families. Providers are concerned about the virus’s impact and what they should be doing to keep themselves safe and whole, said Jasleen Chhatwal, M.D.

A major part of treatment is the connection between therapists and patients, she noted. “In psychiatric care, connection or rapport with your physician is considered essential for patient buy‐in and effectiveness of treatment,” Chhatwal told MHW.

In treatment, engagement with others is also key. “In inpatient hospitals, residential treatment centers and even outpatient programs, engaging with others, sharing insights and gaining support are vital elements of treatment,” said Chhatwal, also president‐elect of the American Psychiatric Association and assistant professor of psychiatry at the University of Arizona College of Medicine.

Chhatwal said that engagement allows for rebuilding of human connection for those who may feel disenfranchised and provides a source of validation for others who feel alone in their suffering. “During this time with COVID‐19‐related social distancing guidelines, this treatment milieu can become a source of anxiety for our patients rather than the source of healing it’s meant to be,” she said.

There are concerns for staff being able to connect with patients face to face versus virtually. “Not seeing them in person makes it hard for them to know how effective their treatment is,” said Chhatwal. “For a lot of clinicians, it’s not really knowing how patients are doing after investing months, even years, in their care.”

Providers are concerned about whether they’re putting themselves at risk.

“Like the general population, fears abound even for mental health physicians, providers and therapists,” Chhatwal said. “The ever‐changing guidance, limited clinical information on the virus and astronomical rise of cases, as well as the onslaught of information, can feel overwhelming.”

Much of the guidance put forth for health care providers and health care facilities fails to address the unique needs and challenges faced by mental health facilities, said Chhatwal. “This causes greater uncertainty for professionals who feel bound by their duty to patients who depend on them for care, while trying to balance safety from the COVID‐19 virus,” she said.

Sierra Tucson is offering a platform for staff to share information with one another. “We are providing information and giving our staff the opportunity to express concerns and ask questions pertaining to our response to the COVID‐19 pandemic,” said Chhatwal. “Additionally, our clinical director is coordinating the dissemination of self‐care resources available for our staff. We are now also offering a daily moderated call where staff members can call in and seek support for professional and personal challenges that they face.”

Supporting staff
“Supporting our staff is really important,” Debra L. Wentz, Ph.D., president and CEO of the New Jersey Association of Mental Health and Addiction Agencies Inc. (NJAMHAA), told MHW. Self‐care is important, said Wentz. “If you don’t ensure your own well‐being, how are you caring for others during COVID‐19?”

There is a silver lining in the cloud, noted Wentz. “This has really brought people together in a more meaningful way, even though some are working with reduced caseloads,” she said. There are a number of reasons for the reduction, including child care issues, self‐quarantining and apprehensiveness, said Wentz.

There are regular check‐in team meetings. Members are discussing challenges and what they’ve learned from this experience, sharing recipes and online yoga videos and telling funny stories about their children at home, said Wentz. “They’re learning to enjoy their downtime,” she said.

“They’re saying laughter is therapeutic and enjoying the opportunity to laugh out loud.” Cooking, baking, board games, reading, listening to music and knitting round out a host of other activities, Wentz noted.

Meanwhile, the NJAMHAA is helping staff adjust to the new reality and providing them the tools to do that, she said. It’s impossible to predict what’s ahead, so staff is encouraged to help one another let go of it, and to focus on the things they can control, said Wentz.

“Also, structuring a schedule is important for people off‐site,” she said. They need structure in their schedule and routines, said Wentz. Staff are communicating via Zoom meetings, and also building in time for their own well‐being. “They’re also sharing telehealth guidelines and creating mindfulness support groups,” she said.

Generally speaking, NJAMHAA members are trying to make the best of their time, said Wentz. “We’re in the mental health field,” said Wentz. “We know that maintaining mental health during uncertain times is challenging, but you will get beyond it.”

Psychological support
In general, providers all under undue stress, and a significant amount of it, even before the global pandemic, said Amin N. Azzam, M.D., faculty engagement coordinator, medical education specialist and board‐licensed psychiatrist at Osmosis, a globally‐ networked company headquartered in Baltimore, Maryland with employees working remotely across the country

Even prior to COVID‐19, all of the mental health providers in the University of California, Berkeley–University of California, San Francisco Joint Medical Program engaged in some kind of peer network support for one another. The Care for the Caregivers program was not a required training, but; rather, it is optional for UCSF faculty‐affiliates to offer themselves for psychological support for other front‐line professionals. Azzam, also a professor at the University of California, San Francisco School of Medicine, told MHW he will be co‐facilitating one of these events at UCSF this week.

Osmosis provides information in general about how providers can maximize their psychological health during stressful times, but it isn’t the organization’s primary focus, he said. “We are providing these resources publicly because we believe that it is a part of our mission and core values,” said Azzam.

“Communicating to others digitally and remotely doesn’t spread the virus,” Azzam. “We should be increasing our emotional connection in a time of increased social isolation.”

He added, “We need to raise the capacity of the health system to provide additional mental health services to all people touched psychologically by this unprecedented global pandemic.”