A physician assistant participating in a virtual workshop began to cry, confessing that she felt overwhelmed with guilt because New Yorkers were hailing her as a frontline hero in the pandemic. That was when Joe Ciavarro knew he was in the right place.
“She was saying all the things I could not verbalize because I, too, didn’t feel like I deserved all this praise and thousands of people cheering for us every evening when people were losing jobs, didn’t have money for food, and their loved ones were dying without family at their side,” says Mr. Ciavarro, a PA at Mount Sinai Medical Center in New York.
Mr. Ciavarro, who also manages 170 other PAs on two of Mount Sinai’s campuses in Manhattan, has been on the front lines since COVID-19 first hit; he lost a colleague and friend to suicide in September.
The mental anguish from his job prompted him to sign up for the resilience workshop offered by Mount Sinai’s Center for Stress, Resilience, and Personal Growth. The center – the first of its kind in North America – was launched in June to help health care workers like him cope with the intense psychological pressures they were facing. The weekly workshops became a safe place where Mr. Ciavarro and other staff members could share their darkest fears and learn ways to help them deal with their situation.
“It’s been grueling but we learned how to take care of ourselves so we can take care of our patients,” said Mr. Ciavarro. “This has become like a guided group therapy session on ways to manage and develop resilience. And I feel like my emotions are validated, knowing that others feel the same way.”
Caring for their own
Medical professionals treating patients with COVID-19 are in similar predicaments, and the psychological fallout is enormous: They’re exhausted by the seemingly never-ending patient load and staffing shortages, and haunted by fears for their own safety and that of their families. Studies in China, Canada, and Italy have revealed that a significant number of doctors and nurses in the early days of the pandemic experienced high levels of distress, depression, anxiety, nightmares, and insomnia.
after witnessing the deaths of so many patients who were alone, without family.
But the resilience workshop that Mr. Ciavarro attended offers some hope and is part of a multifaceted program that aims to be a model for other institutions and communities. The Mount Sinai health system already had some programs in place, including centers for 9/11 responders, for spirituality and health, and a wellness program to aid burned-out doctors. But the leadership at Mount Sinai, which includes psychiatrist Dennis Charney, MD, dean of the medical school and a leading expert on PTSD, knew early in the pandemic that emotional and psychological distress would plague health care workers, according to Deborah Marin, MD, director of the new center.
“We decided to quickly put in place a program that we could do virtually, with workshops and apps, that would give access to several services above and beyond what was already going on,” says Dr. Marin, a professor of psychiatry at the Icahn School of Medicine at Mount Sinai, New York, who also directs their center for spirituality and health.
The key components include a comprehensive screening tool that helps doctors at the center identify which potential participants are most at risk. Participants build personal inventories that detail the intensity of work-related exposures, personal or family stressors that have arisen because of the pandemic, or any mental health conditions or substance abuse problems that may make staff members more vulnerable.
The weekly workshops led by trained staff are designed to give participants the tools to foster resilience and process their experiences. Online apps provide feedback on their progress and engage them with video and other resources around meditation, relaxation, and resilience techniques.
In addition, all 40,000 members of the Mount Sinai staff are eligible for up to 14 one-on-one sessions with psychologists and psychiatrists who specialize in treating trauma.
“That’s highly unusual – to offer this at no cost to everyone,” said Dr. Marin. “We also have a treatment service that is specifically focused on behavioral health care, so people can learn better coping strategies, and we also have social workers to provide coaching.”
While the center doesn’t have specific numbers on how many nurses, physicians, and other staff have participated in treatment, they have trained over 70 peer leaders for their five workshops that home in on the most important factors of resilience.
“We’ve gotten enthusiastic responses from PAs and nurses,” said Craig Katz, MD, an expert in disaster psychiatry at Mount Sinai and a workshop moderator. Physicians have been slower to get on board. “Doctors are a tough nut to crack – it’s largely a culture where they may burn out but don’t want to talk about it. And asking for help is a hard transition for physicians to make.”
How to protect in midst of trauma
In formulating the program’s platform, Mount Sinai experts drew upon their extensive experience aiding 9/11 responders at the World Trade Center (WTC), as well as their system-wide wellness program that aids demoralized and burned-out physicians. While the reach of the pandemic is much broader than 9/11, experts see some commonalities in conditions that emerge after traumatic events, and they also discovered what can help.
“We learned from our WTC experience about what are protective factors – what are the social supports that buffer against depression, anxiety, and PTSD,” said Jonathan DePierro, PhD, clinical director of CSRPG and a psychologist at the Mount Sinai WTC Mental Health Program. “We also learned that people who have more prolonged exposures are at greater risk of developing mental health difficulties.”
The program itself reflects these lessons – and that’s why it’s open to all employees, not just medical professionals. Housekeepers, security staffers, even construction workers are also dealing with their lives being in danger. “That wasn’t in their job description,” said Dr. DePierro. “These people tend to have fewer social and economic resources, make less money and have fewer structural supports, which makes them even more vulnerable.”
Dr. Charney’s strategies on building resilience became a bible of sorts for the workshops, according to Dr. Katz, who authored the training curriculum. Sessions deal with how to build up reservoirs of realistic optimism, keep gratitude journals, find spiritual meaning in their lives, maintain physical wellness and create networks of social support. The workshops are meant to help participants create action plans, to reach out for support in their social networks, and keep the focus on the positives.
The goal is to give demoralized health care workers a renewed sense of competence. “The resilience workshop is a launching point to get people to show up and talk,” said Dr. Katz. “And if we do that, we’ve accomplished a lot just getting people in the door.”
The center will also have a research component to identify what works and what doesn’t so their platform can provide a template for other institutions; Dr. Marin said they’ve gotten inquiries about the program from major hospital systems in Michigan and California. They’ll also conduct longitudinal research to determine what lingering problems persist among healthcare workers over time.
Since the center opened its virtual doors, the curriculum has also been altered in response to feedback from the support staff, many of whom live in the community that surrounds Mount Sinai in northern Manhattan, which is largely lower-income Latinx and Black individuals. Workshop materials have been translated into Spanish and now feature people who reflect a more diverse set of experiences.
“Many of our employees and the population we serve identify as non-White so we’ve been doing outreach with a lot of the local unions,” said Dr. Marin. “Our next step is to take what we’re doing and work with local community organizations.”
A version of this article first appeared on Medscape.com.