Coping with disasters in health

The onset of the COVID-19 pandemic brought unprecedented challenges for our health-care community, the impact of which is still being felt today, almost three years later. In this podcast, Dr. Frank Sommers, founding chair of Disaster Psychiatry Canada at the University of Toronto, addresses the toll health disasters, like pandemics, take on society dependent upon the effects and subsequent reactions. Trauma, he notes, takes on many forms and the mental health impacts cannot be ignored. Moving forward, Dr. Sommers emphasizes the importance of compassion, communication, engaged leadership and an informed public for recovery and in preparedness for what’s to come.

Transcript

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Georgia Balogiannis: In this podcast the Ontario Medical Association looks at current issues of interest in health care. Spotlight on Health gives you all the straight talk. We're Ontario's doctors and your health matters to us. I'm Georgia Balogiannis for the Ontario Medical Association.  

The pandemic has taken its toll on the mental and physical health of many overworked, stressed-out healthcare workers and a fatigued public. 

In this episode, Dr. Frank Sommers, founding Chair of Disaster Psychiatry Canada, shares his thoughts on how disasters can cause emotional damage, and how one can regain their psychological footing. 

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Dr. Frank Sommers: Disasters have been part of our human history forever. 

But in the current COVID-19 pandemic it's likely that it's the first disaster that many people who are not yet alive when the previous disaster struck us in a widespread format like a pandemic, global in its outreach. So for many people, this is a first instance of this disaster. It's a trying time.  

This has been a prolonged stress, in many cases involving trauma for many people who were directly affected by the coronavirus and of course immense death and illness. This is not yet over, after almost three years. So, the newness of this experience in many people's lives, including many doctors, puts that special burden on understanding the very significant personal, societal, and organizational costs that this kind of massive illness imposes on our common humanity. 

The dimensions of the COVID pandemic disaster are still being evaluated because it's ongoing, but people's lives have, in many cases, changed radically. And, of course, in the way that we physicians are delivering care has also been changing.  We have been called upon to rise beyond our comfort zones in many cases, dealing with death and illness on the level that is beyond the experience for many. 

The number of adults presenting for mental health help has increased enormously. The number of antidepressants which have been prescribed has also significantly increased during this time, compared to the previous period. Teenagers, for example, who obviously have no or very little experience with disasters in their personal lives in most cases have had over 17% increase in the use of anxiety medications just in the first few years of the pandemic. Conditions being treated are worse than than many mental health practitioners have experienced before. The condition of people who were already decompensating prior to the pandemic is another factor where, in many cases, there have been decompensating quite to a significant effect with the additional burden of the pandemic.  

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Dr. Frank Sommers: The impact on the wellbeing of the healthcare workforce has been quite significant. In many cases we have heard from colleagues who have not been prepared for the kind of frequent dealing with very severe sickness and, in fact, inability to help people to recover, and deal with the number of patients dying. This has been an extra burden on our already burdened healthcare worker population. 

The hopeful sign in terms of recovery phase from disasters, including this pandemic that we have, or are going through, is that the vast majority of people actually find ways of coping. And we are learning and we are forcing some of the protective factors which include, of course, having an organization that’s supportive, having a leadership that is sensitive to the extra burdens that the frontline healthcare workers are facing, being aware and dealing with aspects of compassion fatigue, which is a very important reality in terms of the vast numbers of illness and even death that medical workers are facing daily. Organizational help is extremely important. 

It is very important that there be an element of cohesion within that community, and that can be reinforced profoundly by the means of communication that exists within the community, among members, and also very profoundly affected by the leadership provided to that community. So this, of course, involves the political leadership from the top down. This involves knowledge about messaging, appropriate messaging, using the right words, the right tone, the right time, the right place. It requires a feeling of fostering participation by the whole community with a notion that we indeed are in this together, and we are going to get through this together, and we need to support one another in this difficult time.  

So there are various elements in the community. Obviously the professional services of the community are very important, such as the services provided by the paramedic organization, law enforcement organizations, even the firefighting organizations. All of these we have involved in our disaster psychiatry training programs because we recognize that establishing networks before disasters happen help us to cope better when disasters do happen. 

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Dr. Frank Sommers: You have to make yourself available to your patients. You cannot have your patients phone your office and not get an answer, nobody picking up the phone, nobody able to interchange, to exchange with you on your concerns. So doctors on the front lines have an enormous role in simply being available for our patients. And that, in these days, obviously means usually in a virtual modality and many, many patients are reassured by the ability to reach their health care provider. And, conversely, if they can’t reach their health care provider, which does happen, that raises anxiety enormously.  

So that is a fundamentally important element is to be available. Then, obviously, you need to also have sufficient knowledge of the psychological elements of dealing with anxiety and stress and grief, that you can provide the reasonable, at least first aid, primary care modes of helping people with these very significant yet common emotions. And this may go beyond reaching for your prescription pad. Very significantly I would say, talking is rather important, but before talking, listening is probably even more important 

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Dr. Frank Sommers: There are many people who are having difficulty accessing appropriate mental health care and who are, in many cases, suffering with a sense of isolation. feeling of life restriction, significant life alteration, significant uncertainty and, in many cases, grief. A lot of people have been traumatized with the pandemic experience over the past almost three years and I'm not sure that we have fully processed that or integrated that yet. I'm hoping that, with creative minds and good dedication, we're going to find ways of reaching out and expanding the mental health care that we're able to provide than has been the case before.  

Obviously, virtual reality, for example, which has come to the fore during the pandemic, is a major step forward because we're able to access connection with our patients more readily, more easily, less cost, and also helps the environment where people don't have to travel too much. But this is an evolving process and the brushstrokes are only coming into view in a fairly faint way. We still have quite a ways to go. 

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Dr. Frank Sommers: One of my pet peeves is that we are not educating our vast numbers of people who are getting into relationships, marriage, particularly long-term marriage, without the skillset that we now know helps people to ensure longevity in coupledom. They’re a skillset. There's also a skillset, a science skillset — psychological science — between how parents speak with children. And it would be a different world if this was more widely spread. 

It would be a different world if the knowledge that you so gained through the hard knocks of life, if before parents take on the role of parenting they would spend a little time equipping themselves with this tool set, with this knowledge. So much help we could give. We talked about community resilience. I mean ultimately it all begins with the individual and then, if people are in coupledom then with the couple.  

A couple who is supportive of each other, empathic with each other, is well able to resolve the inevitable difficulties or hiccups of relationships. You know divorce rate is what, 46-7% roughly? I mean it’s enormous! It's again very straightforward simple life skills, but its application can change lives because we all have stress.   

We all need ways of dealing with negative thinking, for example, with learning to appreciate the present moment. These skillsets are trainable, learnable, and I think they can be life changing, 

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Balogiannis: This podcast is brought to you by the Ontario Medical Association and is edited and produced by Jodi Crawford Productions. To learn more about the Ontario Medical Association, please visit oma.org. 

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