The next pandemic will be in mental health


I had my first full day of telemedicine today. Telemedicine is my happy place.  For the last two years, I have provided telepsychiatry for a rural facility in my home state. I had the privilege of talking to my patients in their homes today. I was beyond humbled that my patients embraced the change with me and invited me into their homes. As I saw them in their homes with their lives around them, it became even more evident that we are treading uncharted waters. We are all anxious, vulnerable, and want answers, yet there are no simple answers.

I recognized today that we are all going through grief and all of its stages: denial, anger, bargaining, depression, and acceptance.  It is evident by varying degrees of difficulty in our communities, in adopting social distancing. It’s scary to let go of what we have always had but taken for granted—losing our routine, our traditional ways of conducting life at work or at home and dealing with losing our social connections. Some are in denial that spring has rolled around without the usual burst of life and activity.  We are angry and sad that we are losing our celebrations, graduations, usual joyful transitions from winter to spring, and that too without a deadline for when we can have them back? We are struggling with losing the joy of gatherings, hugs, handshakes, and eating together.  Many of us are already bargaining and accepting this pandemic by adapting technology to wait this out until we come out on the other side.

As I saw my patients in their homes today, I recognized that even though I am a big proponent of telehealth to improve access to care, I am deeply saddened by being confined to my home office.  I miss seeing people in my tiny and peaceful office. I admitted today that I am dealing with grief. I miss seeing the bustling crowds of my small university town, as I go on my daily walks in the now quiet downtown. The “temporary closed” and “delivery only’ signs on cafes, restaurants, and coffee shops, while a reminder of a collective sacrifice my city is making, breaks my heart every day.  It feels like a small part of me dies every time I see the climbing number of cases and anticipate even longer shutdowns. The pain of millions of Americans who are scared and unsure about their jobs, next paychecks along with the fear that many of my fellow physicians, physicians in my family, nurses, and health care workers are exposed and at increasing risk every day; is a thought that I can’t seem to shake.

We are all grieving, and we need to let that sink in.  We must support each other, let each other cry, and lean on each other emotionally.  The only way out of this maze is through the twisting walls of grief, loss, sadness, and vulnerability. We all must be willing to brave through this maze together!

While we are in the midst of this physical pandemic, we have a massive mental health pandemic brewing in the shadows, and none of us are immune to it at this point.  Our doctors, nurses, first responders, and health care workers are overwhelmed. Our country, our world, the human race is watching the slow, unstoppable destruction of everything we have held dear, and there is no bigger existential threat at this moment.  This threat is tangible even though microscopic. In this war with an invisible enemy, we can’t afford to be ambivalent about the trauma it is inflicting on our medical community and community at large. The destruction is so painfully visible in the loss of human life and the human way of life, and it is hard to ignore. We must be ahead of the simmering mental health crisis before it boils over and explodes. Access to mental health services for all frontline fighters without questions asked is paramount. At no other time in our history, the disparities in mental health have been so relevant to our long term wellbeing as a society. The stigma of mental health, especially in health care, must be addressed and dismantled.

It is OK to break down, as long as we are prepared and armed to pick the pieces and put them back together.  We must address the mental health of our colleagues and communities and start talking about it now. Because through our collective grief and vulnerability, we will emerge as more grateful, mindful, and appreciative.

Najma F. Hamdani is a psychiatrist.

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