Preparing to Transition: An Opportunity to Change for the Better

Collectively, how has this pandemic impacted our mental status and function? Our experiences in getting through the “COVID Era” have varied. Then, of course, we have different baselines with our mental health. But we have all been touched with a “collective trauma,” since this pandemic is a global health issue and has caused major disruptions and various traumas in many aspects of our lives (https://dana.org/article/pandemic-brain-parsing-the-mental-health-toll/?gclid=EAIaIQobChMIjtjNxt-m7wIVyuDICh0ZxgzhEAMYAyAAEgJgNPD_BwE).

 Our mental health problems are linked to numerous stressors during these times. Top on the list is the illness and death of our loved ones. We should all take a moment of silence right now and never forget this as we move forward. We had too many leaders throughout 2020 who were too cavalier about this loss. The remaining list of pandemic stressors is exhaustive: job loss and loss of healthcare coverage, financial struggles, restricted socialization, cancelled events, challenges with childcare and education, threats of (or actual ) loss of housing, feeling unsafe in general, loss of trust (fill in the blank), travel restrictions, feeling alone, and more.

For some of us it took time to find coping mechanisms; for others it started right away, and perhaps some, not at all. Personally, I decided it would be “walking through the virus,” and as I write this, I will be celebrating my one-year anniversary with the friend who decided to join me. My husband also initiated the idea of staying connected (through ZOOM cocktail parties and weekend hikes) with our dear friends – two other couples. We shared so much together. These choices “saved us.” A place to begin in order to counter these stressors is to keep active, connect with others, be mindful of our surroundings and state of mind, utilize relaxation techniques, serve others, be grateful for small things, seek help when needed, and keep learning. A key component to caring is: Before caring for others, take care of yourself.

What has become fuzzy during the pandemic is whether the anxiety and depression related to these stressors will escalate and create long-term mental health problems or that the response to these stressors will be determined as adaptive – what is expected to happen during a pandemic – and many of us will return to  our “normal” mental health status.

But statistically, depression is increasing. In JAMA’s 9/2020 edition, the population study results found that symptoms of depression increased three-fold during the pandemic. Per March 2021’s Lancet, a systematic review and meta-analysis concluded that 1 in 5 healthcare workers have experienced moderate depression, anxiety and PTSD during the COVID-19 pandemic (https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0246454).
     
The red flag for disaster-related mental health issues is how many stressors does an individual have to deal with? What we have learned from 9/11 and the hurricane crises is that there is a cumulative effect of the stressors, which occur both during and after the disaster. The groups that are historically hit the hardest with large-scale collective traumas are women, minorities, the elderly, and the poor (https://dana.org/article/pandemic-brain-parsing-the-mental-health-toll/?gclid=EAIaIQobChMIjtjNxt-m7wIVyuDICh0ZxgzhEAMYAyAAEgJgNPD_BwE). During COVID (as compared to other disasters), there has been a noteworthy exception: young adults are reporting more stressors than older adults with this pandemic. These populations are not considered weaker; rather, these are the groups of people who are either hit the hardest with stressors; they are more vulnerable; and/or they are forced to take on more responsibilities, along with making more sacrifices.
     
One of the biggest challenge areas will be for those who were sick with COVID-19. One in five survivors were recorded as having a first time diagnosis of anxiety, depression or insomnia (https://www.reuters.com/article/uk-health-coronavirus-mental-illness/one-in-five-covid-19-patients-develop-mental-illness-within-90-days-study-idINKBN27P34P). We still do not know the many COVID-related ramifications, especially in determining the impact on mental and cognitive functions. People recovering from COVID have reported a variety of physical symptoms (such as muscle weakness and pain), but there are an assortment of brain function issues such as problems with concentration, cognitive function, memory, as well as anxiety, sleep disorders, depression or PTSD – post-traumatic stress disorder (https://www.medpagetoday.com/infectiousdisease/covid19/86556). These issues are especially complicated for those people who were seriously ill and required hospitalization in the ICU. “These patients may experience post-intensive care syndrome (PICS) that could manifest as a combination of physical, cognitive, and mental health impairments following an ICU stay for a critical illness” (https://www.medpagetoday.com/infectiousdisease/covid19/86556).
     
We need to evaluate these varied aspects of mental health as we move forth with the transition that follows this pandemic.  During our recovery phase, too many people are isolating their perspectives by only looking at their own nations – or even their own states or towns; that perspective is naïve and fruitless. Realistically, the road to recovery must be collective or all of us will continue to suffer. The virus that caused this pandemic knows no boundaries, despite one’s thinking in those terms. The solution to our recovery is “collective care” (https://www.cdacollaborative.org/blog/4-ways-to-transition-responsibly-during-a-global-pandemic/).
  
This is not a time for “business as usual,” nor will we likely go back to the “way things were.” Maybe the silver lining to this pandemic is that we will be forced to address our broken mental health care system here in the U.S. Can we change our course that will lead us to a mentally healthier society?

1. Mental health care must be made affordable and more widely utilized
2. Make mental health screenings a routine part of primary care services
3. Expand the use of telehealth mental health visits
4. Establish a payment system for peer support; peer support has proven to be very beneficial
5. Develop guidance for evaluating the quality, safety, and effectiveness of mental health apps, which serve as good resources
6. Expand provider networks that are more diverse, and a system that supports the education and training of providers from underrepresented minority groups. We have witnessed the preexisting health disparities even more so during the pandemic.
7. Recognition that mental illness and suicide were on the uprise, especially with young adults, pre-COVID and we are lacking treatment modalities (https://www.mhanational.org/issues/state-mental-health-america/)

     
The bigger picture with the transition is that we will likely see change, but will we aim to restore that pre-2020 life or will we create a different, better world?
       Here are some questions to ask and ponder:

1. “Will global solidarity triumph over vaccine nationalism and will we overall boost international cooperation?” (https://www.bbc.com/worklife/article/20201118-coronavirus-how-will-it-affect-inequalities-mental-health)
2. Do we understand that the economy and society depends on education?
3. Will we address income inequality and recognize the need for technology-enabled workplaces as well as safer workplaces?
4. Will we invest in the necessary economic and social forces that create healthier communities with changes in developing safe housing, good schools, livable wages, gender equity, clean air, drinkable water, a fair economy…?
5. Although we may be utilizing the virtual lifestyle more, will we promote the value of daily face-to-face interactions?
6. Will we redesign our living space, especially our workplace? Perhaps the focus of the office will change in order to promote team interaction and collaboration as opposed to individual work. This also includes “co-working space” with different businesses recognizing the need for interaction and collaboration.
7. Will we be able to develop systems for tracking public health safety and yet protect data privacy and security?
8. Will we seriously look at existing inequalities in society and demand new ways for us to thrive in 2021 and beyond?

    
Although we are certainly not at the post-pandemic stage yet, we should be preparing for the steps within the transition. The transition involves a process, and one that we will all be going through, regardless of the variations in our mental health status. COVID-19 is a global health issue that resulted in humanity experiencing a collective trauma. As human beings, we all “share the same sorrows, the same hopes, the same potential” (https://www.bbc.com/worklife/article/20201118-coronavirus-how-will-it-affect-inequalities-mental-health). Perhaps we can begin to change society’s norms and recognize that humanity can only thrive if we accept that we are one community in need of cooperating with each other. We have been drilled with the concept of “survival of the fittest,” but in reality all life forms in nature are dependent on each other and require cooperation in order to survive. So it is in the wake of this pandemic that we have the opportunity to change for the better.

Charlotte Michos is a clinical nurse specialist who values personal-centered care and serves as a Healthcare Consultant in helping others make informed decisions. For more information, email her or call (845) 548-5980.