Help the Helpers

By Christopher Johnston, MD ABPM-ADM, Chief Medical Officer, Pinnacle Treatment Centers

There’s a graphic that makes its way around social media platforms every time there’s a serious crisis in the U.S. Over the past few years, I’ve seen it after hurricanes, floods, tornadoes, and wildfires. I’ve also seen it circulate after mass shootings and other tragedies.

It’s a quote from someone who’s almost universally loved among Americans: Mr. Rogers.

Yes, the friendly man with the kid’s TV show. Almost everyone knows his famous tag line:

“Won’t you be my neighbor.”

If you haven’t seen the social media post I’m talking about, it describes a piece of advice Mr. Rogers received from his mother at a young age. In a nutshell, the advice goes like this:

In times of tragedy and crisis, it’s easy to get overwhelmed by sadness and despair — but there’s one way to find your way out of those negative emotional states. You look for the helpers. No matter how bad the tragedy, if you look closely enough, you can always see people helping. The direct quote is short and simple:

“Look for the helpers. You can always find people who are helping.”

During the coronavirus pandemic, the nation sees our frontline healthcare workers as the most important helpers. It’s easy to understand why. Doctors, nurses, and healthcare staff — from people working in admissions to people working in maintenance — share space with coronavirus patients on a daily basis. They expose themselves to risk, yet they show up to help heal those in need. They’ve been doing it since the beginning of the pandemic, and they’ll keep doing it after the pandemic, because they’re wired to help. Helping is what they do.

They risk their safety to help others — which makes them admirable, and even heroic, in my book. I have more to say about them, but I’ll return to them in a moment.

I want to take a moment to talk about risk and coronavirus.

COVID-19 and Mental Health

The risk I want to talk about is different than the COVID-related risks that concern many of us every day, such as the risk of getting COVID-19 from doorhandles, shopping bags, packages from Amazon, or aerosolized droplets in the air.

I want to talk about the impact of the pandemic as a whole on our risk of developing mental health symptoms and mental health disorders, including substance use disorders — which is directly related to my work as a physician in the field of addiction treatment.

A paper published in June of this year identifies the following psychological stressors that can increase risk of substance use and relapse:

· Prolonged time under shelter-in-place orders

· Uncertainty about the unknown elements of the disease, which can result in:

o Depression

o Panic

o Anxiety

· Income instability

· Unemployment

· Uncertainty about/inability to access treatment resources

The authors of that article joined a chorus of mental health professionals warning the pandemic could have dire consequences not only from the risks of SARS-COV-2, the virus that causes COVID-19, but also from our response. At the time, experts warned that the factors listed above could accumulate to the point where we’d have a third crisis on our hands. In addition to the opioid epidemic and the coronavirus pandemic, we’d have a mental health crisis on our hands.

It turns out they were right.

A New Survey from Kaiser Health

A poll conducted this summer surveyed the effect of the pandemic on mental health. As you read these results, I want you to keep something in mind: an increase in mental health issues is a risk factor for increased alcohol/substance use, a risk factor for typical alcohol or substance use escalating to disordered alcohol or substance use, and relapse. I urge you to do that because that’s my reality: when I read about an increase in stress and mental health issues, I know it means I’m going to see an increase in the prevalence of alcohol and substance addiction.

With that in mind, here’s the mental health data from the Kaiser poll:

Percent Answering that COVID Stress Negatively Impacts Their Mental Health

· March 2020: 32%

· Early April 2020: 45%

· May 2020: 39%

· July 2020: 53%

From March to July, we see an increase of 21 points, which is an increase of 65%. That’s something we need to pay attention to: I know I am. The researchers at Kaiser also asked about how their worry or anxiety over COVID manifested. Here are those results:

Percent Identifying Adverse Effects from COVID Stress

· Trouble with sleep: too much or not enough: 36%

· Eating: too much or not enough (low appetite): 32%

· Difficulty controlling anger: 18%

· Frequent headaches or stomachaches: 18%

· Increased alcohol or drug use: 12%

· Worsening chronic health conditions (i.e. diabetes or hypertension): 12%

· Experienced any of the above: 52%

Look at the last bullet point on each of these lists: more than half the people surveyed said they’d experience some form of negative behavioral or emotional impact from COVID-related stress. Now I need to share one last set of data, because it’s equally relevant:

Percent Identifying COVID-Related Financial Difficulty

· Falling behind on credit card payments: 22%

· Problems affording health insurance: 18%

· Problems paying medical bills: 17%

· Difficulty paying for food: 17%

· Difficulty paying utilities: 17%

· Falling behind on rent or mortgage: 17%

· Problems with any of the above: 40%

I include that last list because everyone knows that money problems lead to stress. And the money problems listed above are related to survival necessities like food, shelter, and healthcare. Worries about those things surpass all others, because they’re survival worries, which means that our bodies — our brains and our endocrine system specifically — treat them like they’re matters of life and death.

Worries of that magnitude — and I don’t need data for this statement — can most certainly lead to an increase in mental health symptoms and an increase in alcohol and substance use. They can easily trigger an increase in substance use that carries an individual from occasional use into an active addiction.

That’s why I worry about those worries.

But there’s another statistic from another report that I want to talk about, because it brings us back full circle to the people I mention at the beginning of this article: the helpers.

Centers for Disease Control (CDC) Morbidity and Mortality Weekly Report (MMWR)

In the last week of June of this year, June 24–30th, researchers from the CDC asked a representative sample of the U.S. population questions about the mental health challenges they experienced as a result of the coronavirus pandemic. Here’s what they answered:

· 31% said they experienced symptoms of anxiety of depression

· 13% said the started or increased substance use

· 26% said they experienced symptoms of trauma-related disorders

· 11% said they seriously considered suicide

Those answers were only for that week. And during that week, the CDC researchers also found that, compared to non-essential workers, essential workers were:

· 42% more likely to experience symptoms of anxiety of depression

· 136% more likely start or increase substance use

· 52% more likely to experience symptoms of trauma-related disorders

· 176% more likely to seriously consider suicide

That’s not all. They also found that, compared to non-caregivers, unpaid caregivers for adults were:

· 155% more likely to experience symptoms of anxiety or depression

· 428% more likely start or increase substance use

· 163% more likely to experience symptoms of trauma-related disorders

· 764% more likely to seriously consider suicide

That’s the data that I want you to understand. Essential workers include those working in our health, utility, and food infrastructure, among others. They include everyone from dishwashers to power company linemen to grocery cashiers to nurses to physicians.

They’re helpers.

And unpaid caregivers for adults?

If anyone meets the criteria for being a helper, it’s someone who stays home with a friend or loved one and looks after them for no money. I can’t climb inside all their heads, but they probably do what they do because it’s the right thing to do.

That’s how they’re wired.

They’re true helpers.

Along with essential workers, the CDC data tells us they’re far more likely than nonessential workers to experience adverse mental health consequences of the coronavirus pandemic. And because of who they are and how they’re wired, they may not ask for the help or support they need.

But our helpers are in trouble and we need to help them.

How We Can Help the Helpers

This part is not rocket science. Or any kind of science. It’s not data or evidence based. It’s about being a human being. It’s about learning a new piece of information and acting on that piece of information because — well, for the same reason many essential workers and unpaired caregivers do what they do. Because it’s the right thing to do.

Here are three simple ways we can help the helpers:

1. A Phone Call. Pick up the phone and call anyone you know is an essential worker. Tell them you appreciate what they do, and let them know you’re there to support them if they need anything, or they just need to talk through the stress of the past six months. If they claim they’re doing “fine, fine, just fine” then that’s okay. Don’t hang up. Keep talking. Eventually, they’ll get something off their chest — and that’s the whole goal of this. We can’t leave them alone with what’s bugging them.

2. Stand in for Them. Granted, this is not possible in most essential worker cases. You can’t just take someone’s shift at an ER or a restaurant. But for unpaid caregivers, this could make all the difference in the world. If it’s medically and epidemiologically safe (meaning COVID-safe) then tell them you’d love to stand in as caregiver for an hour, an afternoon, an evening, or an entire day. I’m not exaggerating when I say that all some of these selfless people need is to go for a walk without worrying their loved one is uncared for.

3. Send Food. Really. When essential workers get home from an essential shift, they may not even have the energy to order takeout, much less prepare a good meal from basic ingredients in the fridge. But you can do that: make them a home-cooked meal, order them good food and have it delivered, or give them a gift card to their favorite restaurant. And if you want to go the extra mile and help a whole group of helpers, find an essential business — again this may be anything from a health clinic to a preschool — and send everyone lunch. This may seem small, but a well-made hot meal at just the right time can make a world of difference.

I’ll circle all the way back to the beginning of this article — to the Mr. Rogers story — and edit the advice his mother gave him about how to avoid falling into sadness and despair during times of significant crisis. She said:

“Look for the helpers. You can always find people who are helping.”

During this stressful time, when there are helpers everywhere, helping people every day, I think we’d do our world a favor if we changed that to:

“Look for the helpers. And go help the helpers — because they may be too busy helping others to help themselves.”

P.S. I encourage you to take the time to read this NYT editorial, How Can We Bear This Much Loss. I found it very interesting and helpful, and hope you will as well.