COVID-19 and Mental Health in the Workplace: A conversation with Rachelle Scott, MD and Casey Flax, LCSW.

Though the COVID-19 outbreak puts the public’s physical health at risk, it’s taking a tremendous toll on people’s mental health as well. Since May is Mental Health Awareness Month, we spoke to two of Eden Health’s behavioral health experts about the outbreak’s impact on employees’ peace of mind. Dr. Rachelle Scott is Eden’s Medical Director of Psychiatry, while Casey Flax is a mental health clinician at Eden Health. 

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What are some of the specific issues people are experiencing during this crisis, particularly employees working from home?

Rachelle: As you might guess, there’s a lot of loneliness, worry, dread, and confusion out there. For a lot of folks there’s a sense of loss over what their lives were like before all of this, all the freedoms they had until recently. There’s anticipatory anxiety about, “will I get COVID-19? How will all of this affect my loved ones?” There’s the fear of losing a family member or someone they know.

Working from home, we don't have as many boundaries. I think some people are really struggling with the lack of structure, where everything just kind of blends together. They wake up, they just turn on the computer and go to work. There’s no sense of delineation between work time and family time.

Casey: There’s a feeling of helplessness for folks who have family in another state or if they’ve moved to other areas. They feel guilt and regret for leaving behind their friends, who they're not able to commiserate with or support like the way they did before.

 

What are some effects of COVID-19 on mental health that you weren’t expecting?

Rachelle: Obviously elderly people are higher risk. And they're in a stage of their life where connection is even more important, so they can maintain a sense of purpose. It's something that is a struggle for them on a regular basis anyway. And so now, we're taking away the opportunities for connection that they once had, which can lead to loneliness. So, they have to learn technology to remain connected, and that can add a lot of anxiety.

Some unfortunate issues you might not have expected are the increased rates of domestic violence and child abuse. This happens when people don’t have appropriate outlets or coping skills. People are at their wits’ ends, so what we're seeing is anger and lashing out. Meanwhile, victims don’t have a separate space to go to for safety. There’s substance abuse as well as people try to escape from the anxiety and uncertainty out there.

 

What patients with certain diagnoses are you most concerned about right now?

Casey: The big ones are anxiety and depression. Depression is obviously the most concerning during this time. These people already have a pretty serious sense of isolation and then you add all the social distancing procedures and stay-at-home orders and people feel even more isolated and helpless.

For some patients, their obsessive-compulsive tendencies are being exacerbated during a time like this, such as the rigorous hand-washing that’s suggested anyway. As people try to exert a sense of control over their environment, they may overcompensate in terms of maintaining personal safety.

Rachelle: Interestingly, though there are disorders or illnesses that get worse in a crisis like this, there are actually some people that are doing better. For patients who have social anxiety, this has been easier for them because it cuts down on the anxiety they feel in social situations. They have a little bit more control thanks to Zoom and other video chat platforms. For patients like agoraphobics who are afraid to go outside, this time has been helpful because they feel like other people are living the same way they are.

 

What challenges for employees do you anticipate as they go back to the workplace?

Rachelle: For New York city residents and workers especially, there’s a lot of anxiety around taking public transportation. They’re thinking, “How am I even going to get back to work? I really don't want to jump on the subway. If I live in Manhattan, maybe I could bike. But if I'm coming from further away, that might be difficult.” For parents, their kids are home and out of school, and they still have to figure that out in addition to thinking about going back to work.

Casey: The prolonged nature of this situation—"how long will we be affected?”—can be disheartening for people. Like maybe you just got into a routine working from home, and now that your office is open you're going to have a staggered workweek. What does that feel like? I think it's just going to be a continual adjustment period, which makes things feel unstable.

There's unprecedented unemployment right now, so people are probably going to be working ultra-hard to be keeping their jobs. When they go back to the office, they’ll feel like everyone is watching them closely, so they’ll feel even more pressure than before. Having HR and managers set very clear expectations for employees is going to be so important in reducing stress.

 

If HR senses that an employee is really struggling as they come back to work, how should they initiate the dialogue with the employee?

Rachelle: The manager is probably the first person who ordinarily would be hearing about this, and ideally that's how it should go, right? There really should be that relationship where the one-to-ones are happening and the manager is aware of any employee issues.

But what HR can do is help create a culture where it's safe and acceptable to be able to talk about feelings or concerns without being labeled or criticized. And they can make sure that everybody knows the resources and the benefits available to them. In times of stress, people forget about benefits, so I think encouraging employees to “feel free to use these benefits, they're here for you” can go a long way.

 

As you deal with patients with anxiety and all these other symptoms, what do you tell them to help them find some comfort?

Rachelle: We tell people, instead of focusing on the things that you really can’t control, think about things in your life that are in your control. Try and focus on other things, whether that's connecting with your family, whether it’s a new hobby that you've picked up like puzzles, playing board games, or reading.

These days we’re online so much and that’s primarily a visual thing. So think about ways to open up your other senses. Listen to music  and use your ears a bit more. Light candles and use your sense of smell. Or knit or garden and do things with your hands. All of that helps you to be mindful, to be present in the moment. And staying in the moment keeps you from worrying too much about the past or the future.

Many times when we feel helpless and hopeless, we're just focusing on our individual situations. It’s useful to reach out and help other people, whether that's through volunteering or finding other ways to be beneficial to others. Also, you can keep a gratitude journal or write down five things that you’re thankful for. It shifts the focus from the things that are going wrong and reframes it towards the things that are going well or that we're thankful for.

Casey: While people are struggling, they're also becoming more aware of the things that they really value. Maybe they’re able to focus on tidying a space in their house that they haven't been able to use for a long time. Or they simply appreciate being able to sit down and have dinner with their partner every night. There is, I think, some value in the way our lives have simplified.

Also, realize that this is a universal experience for people all over the world, something that unites us and like actually connects us to other people. For someone who feels isolated, to know everybody is feeling the same way can be extremely validating.

Plus, there’s the resiliency that can come from a traumatic experience. People learn just how resilient they really are. They get a real sense of their strengths, the coping skills that they have and how well they work for them. There's lots of room to grow in a crisis.

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