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Mental Health First Aid for First Responders

Updated: Apr 1, 2020

This article was originally posted online on March 18, 2020 in Psychology Today. Retrieved 3/28/20

Mental Health First Aid for First Responders: Five imperfect tips for a public health crisis.

By Deborah R. Glasofer, Ph.D., Associate Professor of Clinical Medical Psychology (in psychiatry) at the Columbia University College of Physicians and Surgeons.

Articles about how to cope with anxiety and stress about the novel coronavirus, COVID-19, are flooding my social media feed. I’m contributing to the torrent because I — like many others — find myself grasping for ways to help people through this time of uncertainty.

I am a clinical psychologist and while much of my work has quickly shifted to a telehealth model, some responsibilities will keep me showing up in-person on a rotating schedule, alongside a hospital workforce of physicians, nurses, social workers, administrators, housekeeping staff, and security personnel. Across the street from the psychiatric research institute where I work is a medical hospital which will be even more robustly staffed — the proverbial “frontlines” as I’ve learned to call them from all my COVID-19 reading.

This post is dedicated to the first responders in our healthcare system. It is not comprehensive. It is not perfect. But it is “ready enough” to share, and I offer it in all its imperfection because sometimes “ready enough” is the very best we can provide.

  1. Breathe. I know, I know. It’s hokey and you’re busy. And you don’t have the luxury of a long, socially distanced walk outside in the middle of your workday, and you can’t set up your yoga mat and props in the middle of the hospital or office. But I suggest it nonetheless because (a) it works and (b) your breath is with you wherever you go. The simplest exercise that does not involve touching your body with your hands is to inhale while counting how many seconds a deep inhale takes you, and then exhale, using a count one second greater than your inhale.

  2. Lean. Yes, there will be a lot of people leaning on you and your expertise, but you will need to do some leaning of your own. Establish a work “buddy.” Use check-ins to listen, share, process and validate your experiences, and acknowledge small victories. Monitor your buddy’s workload. Exchange ideas for stress management. Encourage each other to take breaks when possible. Also, talk to your senior colleagues. Maybe they worked on the frontlines during the AIDS epidemic. Perhaps they were among those waiting, with hope and desperation, for patients to flood the emergency department on 9/11. On the one hand, these were entirely unique circumstances. On the other hand, they are all exceptional circumstances. The medical professionals who were there then have something to offer to you now, just as you will have the wisdom to offer future clinicians.

  3. Accept. Make room for anxiety, like an undesirable out-of-town houseguest with no return tickets booked. Anxiety is uncomfortable, but it’s not dangerous, and in its essence, anxiety is communicative — your anxiety may be telling you that you’re in unchartered territory, which is true. Rather than fight the internal alarm, see if you can redeploy the energy in another direction. Because anxiety tends to be future-oriented, it can help to gently shift your attention to present-oriented activities such as singing along with a favorite upbeat song or moving your body by jumping a few times or stretching. Will the anxiety go away? No. But remember: That’s not the point. The point is to remember that you can experience anxiety and get focused — lasered in, even — on what’s right in front of you. 

  4. Take stock. The decisions you may be asked to make (or carry out) in the weeks ahead may not come with ease, or without impact on your psychological well-being. Secondary trauma can manifest in ways including sleep disruption (such as nightmares) or an exaggerated startle response. If you, or someone you work with, is experiencing trauma symptoms, remember that there are other people to help (you and the public!), that is not selfish to take breaks, and that the quality of your contribution may be improved by a modest reduction in the quantity of your contribution.

  5. Recharge. When there is time to decompress, use it. Reading the news endlessly will only further deplete you, so consider playing with limits — on when you read, for how long, and from which news sources. Consider your arsenal of pleasurable activities that can be built into the day — perhaps listening to an entertaining podcast on your home from work, re-watching a beloved show, or connecting with other friends in healthcare, who may be sharing a similar day-to-day experience.

To the healthcare workers who read this, thank you for your very best, “ready enough,” efforts yesterday, today, and tomorrow.

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