The psychological wounds of restrooms after covid-19: how we can help them

At this point in the game, we all know and value that we have survived this pandemic thanks to the sacrifice of the toilets those who have generously exposed their lives to care for our sick people who are lacking for long weeks the adequate means for their protection. At the same time, an army of dedicated residential caregivers lovingly cared for our elders in truly difficult conditions.

Overcoming this tough test involved being thrown into a healthcare setting characterized by a host of stressful elements. In addition to the dreaded risk of contagion, they dealt with rapid changes in a daily or reorganized hospital or healthcare context where there was no time to adapt to the operation of the teams and where, in addition, a high technical qualification different from their usual functions was required, but, at the same time, imperative, as they had to supply the lack of more specialized human resources.

Also added offering warm and caring support to emotional needs of patients and the elderly who were sick, alone and scared. Aware that both forced isolation and the absence of familiar faces increased their feelings of vulnerability and helplessness.

During the epidemic, our health workers and caregivers suffered from stress overload and enormous emotional exhaustion

Unfolded before our eyes all a gigantic unreal scene more typical ofe an interwar film that of a modern and technological society prey to the illusion of control and omnipotence.

The consequence of all this is that many of our toilets and caregivers suffered from stress overload and enormous emotional strain. And, not only because of occupational risks and overwork, but also because of the added difficulty of addressing their own family contexts and social restrictions on confinement.

Psychological responses to a pandemic

The British Psychological Society He has recently published a "Guide on Psychological Needs in caregivers facing the Coronavirus pandemic" which details a range of psychological responses that we can observe in health care providers and caregivers and that vary according to the different phases of the outbreak. When people go through these stages they don't they do it sequentially but depending on the course of the pandemic and they can quickly jump from one to the other.

They described a first “preparatory phase” where it appears anticipatory anxiety because they have very limited time to adapt to the pandemic and verbalize not feeling somehow prepared to face the situation. They also experience intense feelings of anxiety about the unknown.

A following "Active phase" which subdivide into two others:

1. The subphase "heroism and effort to find solutions". There are many responses included in this section, so we will select some significant ones.

• They may experience feelings of camaraderie when working together as a team.

• Feeling overwhelmed when witnessing situations they have not seen before. For example, when they see many people die suddenly without being able to do much more for a sudden worsening of the disease.

• Discuss with the team about the perception of urgency

• Begin to dilute the boundaries between work and rest spaces and begin to overwork.

• A second sub-phase is characterized by "feelings of disappointment and extreme fatigue" and that it is considered the period of greatest psychological risk.

• In it, human teams begin to operate with high levels of adrenaline and in an “automated” way or with the “autopilot” in place. Sensations of extreme fatigue may suddenly appear.

• They begin to neglect their self-care and begin to consider it as a non-priority.

• They feel emotionally disconnected from work and experience compassion fatigue.

• They suffer from great stress in the face of moral decisions that conflict with their ethical code, for example, when they see people die without the accompaniment of their relatives, or they must decide to whom they offer a respirator, etc.

• The effects of accumulated stress are well reflected in exaggerated reactions to minor setbacks.

Finally describe a third "recovery phase", where team members have time to reflect. Many of them successfully go through it and make full use of their social supports and individual resources and reflect this in the vivid account of post-traumatic growth that this experience has brought them.

Their social regard as “heroes of the pandemic” makes it extremely difficult for them to speak with their hearts in their hands of concerns

However, other people may experience this phase intrusive thoughts about what they should have done in a different way or stopped doing and feel deeply ashamed for not reacting according to certain expectations or also developing intense feelings of guilt. Their social consideration as "heroes of the pandemic" makes it extremely difficult for them to speak with their hearts in their hands of the worries that torture them, which increases their distress and the intensity of their emotional distress. Other people begin to feel differently in their jobs or about the organizations they work for, and deep feelings of resentment emerge for being exposed to the pandemic the way they were.

From the UK the teacher Neil Greenberg world trauma expert from King's College of London He warns his own National Health System, the English NHS, that it is precisely now that the peak of the crisis has passed when these professionals are more at risk of suffering psychological alterations if we do not help them with adequate psychological support. Consider that as we return to a reality with a more normal aspect, we must make a psychological and emotional monitoring of these professionals for months and in some cases it will be years if they have post-traumatic stress.

Now when the peak of the crisis has passed is when these professionals are more at risk of psychological disturbances

This need is corroborated by the conclusions drawn by a group of European researchers from different countries (Spain, Norway, Australia and the United Kingdom). What they did was review the impact on mental health of healthcare workers in the face of viral outbreaks. They found 61 studies on past epidemics including 3 on COVID-19. These produced devastating scientific evidence that supports the existence of mental health problems in health professionals and caregivers.

The scandalous data show a high prevalence in:

1. Anxiety ………………………… .45%

2. Depression ………………………… 38%

3. Acute stress …………………… .31%

4. Burnout …………………………… 29%

5. Post-traumatic stress ……… .19%

The Laboratory of Work Psychology and Safety Studies of the Complutense University of Madrid In its latest study, it produces even more worrying data on the emotional impact on COVID healthcare personnel19 with figures of almost 80% with symptoms of anxiety, 40% feeling emotionally drained and 53% having symptoms of post-traumatic stress.

These studies also identified a set of sociodemographic, social, and occupational factors that significantly increase the risk of mental health problems. They have a higher risk:

• Women and younger professionals

• People with lack of adequate social support

• Those who experience social rejection or stigmatization. We all have in mind the embarrassing episodes in which toilet cars have been damaged or have been painted pointing at them.

• Those who carry out front-line care tasks: nurses or those who do not have specialized training in these situations or who have less work experience.

What can we do?

The British Psychological Society considers that it is important in the current pandemic to reflect on two significant aspects. Health professionals and caregivers are known to be people with high levels of resilience and to act as a powerful protective factor. The term resilience designates the capacity that people have to extract positive growth and put latent coping tools into play in the face of adversity. And, in part, this is so because we find a group that assumes as their own caregiver or health condition and that it is they who have to deal with difficult and traumatic situations. They are psyched.

Health professionals and caregivers are people with high levels of resilience and who act as a powerful protection factor.

But in turn this crisis contains factors of specific vulnerability risks, such as the fear of contagion itself or of compromising the health of their families and the loss of social supports from the professional context because many of them worked outside their usual units, in addition to the urgent need for social distancing. These changes entail a significant loss of habitual affective and professional supports.

Everything is so recent that the surprising ones still remain engraved on our retinas images of hotels enabled exclusively for toilets or how some groups of brave and generous caretakers of Residences locked themselves up to live with their elders well to avoid infecting them well so as not to return home distressed thinking that “they could carry the virus stuck in their clothes, in their hair, or in their shoes , etc. or because they were greatly concerned about extending the COVID-19 that way "," I stay calmer ", Rosa told us a caregiver in a residence.

Recovery with psychological support

What specialists say about the psychological impact in terms of mental health of this crisis is that it will depend largely on the support these people receive and how much stress do they handle when trying to recover of all the pressure to which they have been subjected, which will act as key elements in their recovery. Only in this way can it truly become a transforming experience where they can value what they have lived.

Your recovery will depend on the supports you receive and how much stress you handle when trying to recover.

Several toilets related to me in his psychological treatments after having overcome episodes of acute stress, the following:

“I feel that I have learned many things and that this experience has changed me. I feel turned inside out. Now I am much more empathetic and human. I understand their fears better and I feel closer to other people as far as our condition as a human being unites us and we share. ”

"I trust my colleagues more, during the crisis, friction and conflict they were parked. I felt that we were all a pineapple, whatever our professional category. We were all going to one. ”

“I have tested myself and I have known and dealt better with my limitations. I understand myself and I know myself better, I have made new friends, and now I value things that I previously inadvertently took for granted. ”

"I have lost the fear of death or at least I begin to consider it as a natural part of the process of living. "

But let's not forget that without the proper supports and without taking into account their specific emotional needs, these people who have so generously fought for others, will be able to develop psychological complications including post traumatic stress disorder and then everything will be much more difficult to manage. Sometimes with recovery times of between 18 months and two years.

Without proper support, these people could develop psychological complications including post-traumatic stress disorder.

When people were dealing with the peak of the crisis, the demand for psychological care was not very high, but this does not mean that because there was no such demand, there was no need for it. these professionals but they just didn't have a minute. It is after the peak of the crisis that specialized and structured psychological care is required.

Professor Greenberg, mentioned above, proposes to apply similar measures to when soldiers return from mission and provide necessary breaks. Many have worked continuously without librazas, and he proposes to gradually reincorporate them to work. The reality in different regions of Spain is very different, not only do they not increase hiring of restrooms or caregivers in residencesInstead, they fire many of the hired reinforcements and go to work with depleted and exhausted staff, and this is because many of their colleagues are infected. This comes at a price.

In order to preventively prevent them from reaching the brink of collapse and their emotional well-being being compromised, some particular initiatives emerged, such as the one led by the Official College of Psychology of Madrid, which financed with its own resources at the beginning of the state of alarm a care program for interveners still in force both during the "active phase" and during the "recovery phase" where a group of psychologists offers specialized psychological attention to health personnel and caregivers subjected to high levels of stress.

Through this program in which I intervene and know in detail, the professionals speak with a Psychologist for a maximum of three sessions to process this experience of maximum stress. We help them dive into their fears to manage them and that they do not paralyze them, we provide them with emotional management tools to manage their anxieties and anxieties and to look for the best way to reach negotiated solutions between the binomial of generous commitment to helping others and personal exhaustion. They know they are facing a long-distance race because the virus will not disappear.

It's enough?

As reflected here, some of these initiatives are private and limited both in the number of sessions in the psychological interventions they offer and in the amount of time they can sustain it with. their own funding resources.

There is the option of referring them to specialized mental health services and requesting a Psychologist. But the current outlook is not very encouraging and the Ombudsman himself has issued in 2020 a report where urges the government and the Autonomous Communities to study "urgently" measures to increase mental health care in Spain.

The UN calls on our rulers to invest in the emotional well-being and psychological health of their health workers

We have a very poor ratio of 4.5 psychologists per 100,000 inhabitants compared to 18 for the European average. This means that if, for example, you request a Psychologist / or in the Community of Madrid, you will have to wait until they receive an average of 8 or 9 months or you will have to go to a Private Psychologist. The scandalous consequence is that, by delaying the wait, the psychological problems that can be solved without difficulty are aggravated and great suffering is generated.

The UN calls on our rulers to manage yourself with perspective and invest in emotional well-being and the psychological health of its healthcare workers and caregivers to avoid compromising its functionality and for us to find ourselves in the near future in the face of a new outbreak with a staff that is unusable due to huge sick leave due to poorly managed stress.

Because caring for them is caring for all of us.

Raquel Tomé is a health psychologist and director of the Madrid Psychotherapy Guide Center. Specialist in trauma, stress, anxiety, depression, and eating disorders, among others.