MENTAL HEALTH AND WELLBEING AMONG PUBLIC HEALTH PROFESSIONALS

The public health workforce is not okay. In this series of articles, I will share what it has been like to work on the public health frontline during the COVID-19 pandemic and how these experiences have changed me forever. I will share the lessons I have learned and what I want the people around me to know, both inside and outside of the public health sector.

This post was originally published at JPHMP Direct.

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In previous installments, I have explained my background and motivation for speaking out, and I have made some suggestions about much-needed improvements to public health workplaces. In this installment, I explore the mental health impacts of working through the pandemic on public health professionals, through some examples from my own experiences.

Family impacts and trauma

After 2½ years of working on the public health frontline, I am delighted to finally see the emergence of a conversation recognizing that there is no such thing as work-life balance. The pandemic has brought years of previous vague grumbles into sharp focus: there is no separating the personal from the professional, particularly during an emergency response, if indeed ever.  

For example: when alerted by contact tracers to someone known to have tested positive for COVID-19 violating the requirements of isolation by attempting to board a plane, it was my job to work with officers of the CDC Department of Global Migration and Quarantine to stop the plane from flying until the passenger could be removed. These calls would come without warning at any time of day, seemingly most often during family mealtimes or while I had a child on my lap. My children became familiar with the lingo of quarantine and isolation, just as my colleagues at the Health Department became familiar with the phone calls from my children’s teachers. Whether I was working in-person or remote, my work days were always intense, but not too busy to be frequently interrupted by emergency phone calls to deal with the latest crisis at home or school. Another memory snapshot: during the early fearful days of the pandemic, when we didn’t yet understand the mechanisms of disease transmission, each time I returned home from the Health Department and my young children rushed to greet me, I would shoo them away — no hugging allowed until your mother has had a hot shower and thrown all her clothes into the washing machine on the hottest setting. 

During this pandemic period, I have experienced bereavements and mental health challenges among my close family members. I have cared for my three young children and supported them through online school and social isolation, as well as the usual rollercoasters of tween and early adolescent development. Much longed-for family celebrations have been postponed indefinitely. My children have lost many friendships. I call upon our lost community: invite them for an outdoor or masked playdate. And if they act up, please cut them some slack — we have all lost social skills, and they have witnessed a whole lot of stuff going down. These days they are often much too loud or much too quiet. Both are problematic.

The role of schools and teachers in helping my children to rebuild their disrupted lives cannot be underestimated. Every day back in school was a small step in the journey towards healing. Sometimes the step was forwards, sometimes it would veer off in an unexpected direction. So teachers, please don’t talk to me about my kids’ grades before talking to me about their socioemotional development. Our kids’ experiences have all been so unprecedented, I genuinely don’t think their teachers realized how crucial they were (and continue to be) to the healing process.

As for me, every time I drive past a nursing home in my county, I still get flashbacks. One of my first jobs in the pandemic emergency response was to develop a surveillance system to track COVID-19 infections and deaths at nursing homes within my county. Our rudimentary counting system manually tracked daily running totals, from which I would painstakingly construct colorful graphics showing seven-day rolling means; but it could not document that each data point represented an experience of abject fear and trauma for a family such as my own.

Providing technical advice and guidance to friends

The acute response to COVID-19 is thankfully subsiding now, but new questions continue to come up during every surge. I will continue to be the friend you can call any time for advice about dealing with COVID-19 infections and exposures among your loved ones. I will still provide advice in accordance with latest research evidence and national/local guidance. I will not judge.

When I give advice, I have learned not to make follow-up calls because they always end up sounding judgmental, as if I am checking up on whether or not you stuck to the rules. However, I am always keen to know what happened next and how I can continue to offer support. Please always feel free to circle back with me and continue to discuss.

I will give all the evidence-based advice that I can, but I cannot simultaneously be a cheerleader for moving forward out of the pandemic. This ain’t over.

There’s no going “back to normal” when you have seen all of this, both professionally and personally. I am changed forever. Don’t ask me to return to how things were — invite me to build something new. But bear in mind that whatever you are suggesting, I would rather be at home alone reading a book.

Addressing mental health among public health professionals – some suggestions

Data from surveys conducted among public health professionals during the pandemic reveal the extent of mental health concerns among our workforce. So 44% of public health professionals have considered leaving their jobs? I’d like to know what the other 56% are thinking and how on Earth they manage it. More than half of us report at least one symptom of PTSD: as striking as that figure is, it still feels like an underestimate. And how can it be post-traumatic when the triggers are ongoing?

We’re finally starting to hear concerns expressed about the debilitating experiences that public health professionals have been through. Best case scenario, policy makers will pontificate about the design of an intervention to reach us. But I still don’t qualify for a “health worker and first responder discount” when I purchase my children’s glasses. I suggest that policymakers first work towards achieving parity in health worker status and make sure that public health workers gain meaningful recognition for their brave public service – best expressed as respectful compensation and secure career development prospects.

I’m not going to sit and wait for a mental health intervention to reach me and suggest that I prioritize self care by taking a long hot perfumed candlelit bath. I don’t know how the proposed interventions are going to reach those of us who worked through the emergency response anyway, since so many of us are now being laid off and dispersing into other sectors. And besides, I have no interest in a compulsory online yoga session or an office party with enforced jollity — I “simply” want long term job security and professional development. 

Instead of adding Obligatory Fun commitments to employees’ overcrowded schedules, I’d like to see public health employers address burnout by considering what obstacles they can remove from employees’ to-do lists to reduce workload and free up time: Which meetings can be cancelled or replaced by an email? Which labor-intensive processes can be streamlined or eliminated? How can we make the pointless bureaucratic busywork regulations and processes make more sense?

I’ve developed my own coping strategies to deal with burnout, which include swimming and inventing new fruit smoothies with my kids (AKA cocktails). I continue to volunteer at vaccination clinics, which has become a self-help strategy reminding me of the importance of community outreach and the true meaning of diversity, as much as it is also a way to contribute to my local community. I am building community among public health professionals by starting to recognize others online with similar experiences and sharing our reactions and coping strategies. I genuinely believe that meeting like-minded people has become its own supportive reward, providing validation and solidarity especially in the absence of workplace-sanctioned collegiality. Forget Obligatory Fun, I’d settle for Open Communication as a first step to addressing the effects of burnout and trauma in the public health workplace.

My threshold for BS these days is at zero. Start with me at your own risk. Maybe I should have authored this column anonymously, as I still harbor hopes of continuing to work in our beleaguered field and I’m trying to avoid sabotaging my professional reputation. Or maybe I am just done with biting my tongue and I want to start speaking out in order to begin fixing a broken system. 

Let me know in the comments if this goal appeals to you too.