When Stony Brook University Hospital became inundated with coronavirus patients in March 2020, Kristen Hansen had only been working there for a couple of months. She soon began treating an overwhelming number of patients who were severely ill with the unfamiliar germ and moved into the basement of the house she shared with her parents and sister, so she could avoid putting her family at risk. She also feared for her own safety as she tried to make a single N-95 mask last for six weeks, she said.
It was a kind of trial by fire that the now-25-year-old likens to being in combat without the proper training or weaponry. So little was known at the time about how the disease worked that hospitals statewide struggled to cope.
“Imagine sending soldiers to war with Nerf guns against people with real artillery,” she said in a recent interview. “That’s kind of what it felt like.”
Since starting therapy in November 2020, Hansen has come to acknowledge that she also has something else in common with many of those who have been to war: PTSD.
“I am definitely a more anxious person than I ever was,” Hansen told Gothamist. “I used to be very free-spirited and relaxed and go with the flow. And since the pandemic I've become very uptight. It also has kind of made me lose faith in people.”
Various studies on the effects of COVID-19 on health care workers show that Hansen is not alone in experiencing symptoms of post-traumatic stress disorder and other mental health challenges.
A study of 2,579 health care workers at New York City’s Mount Sinai Health System early on in the pandemic, between April and May 2020, found that nearly 40% of respondents were experiencing symptoms of PTSD, anxiety or depression. A much more recent national survey of approximately 12,600 nurses conducted in January 2022 found that acute care nurses were still experiencing high rates of burnout and that younger nurses were more vulnerable than older nurses. Among those under 35, two-thirds reported feeling anxious, and 43% reported feeling depressed.
These are alarming findings in a field where burnout and stigma around seeking mental health care were already concerns before the pandemic arrived.
Gothamist spoke to five mental health professionals who leapt into action early on to organize and provide targeted support to New York City health care workers. They provided insight into how health care workers have struggled — and coped — during the pandemic so far, and what types of services they might need moving forward. One example: a strong support network, and the ability to commiserate with colleagues who have shared experiences. Still, these experts noted, it may be a while before the full psychological impact the pandemic has had on health care workers comes into view.
Dealing with ‘complex trauma’
Hansen found her therapist, Kimberly Johnson, through a group called Emotional PPE, which sprung up in late March 2020 to connect struggling health care workers with those willing to donate free therapy sessions. Although the group had launched in Massachusetts, many of its volunteers and users were based in New York, the early epicenter of the pandemic.
Johnson said she was drawn to Emotional PPE because, in the past, she had lent out her services to first responders affected by other traumatic events, including 9/11 and Hurricane Sandy. But she and other mental health experts who spoke to Gothamist were careful to draw a distinction between a self-contained emergency like 9/11 and an ongoing crisis like the pandemic.
“It's so unique compared to other crises that I've watched communities recover from because there was no hard end, like it's over now and now we rebuild,” Johnson said.
Marianna Strongin, a clinical psychologist based on the Upper East Side, referred to COVID-19 as a “complex trauma” — a term often reserved for ongoing childhood traumas. In that scenario, she said, “Our body never goes to baseline. It never goes to safety.”
We would see things like patients would have really terrible nightmares, where they were not able to sleep.
Strongin helped launch Caring for Caregivers NYC, a similar service to Emotional PPE, which eventually stopped accepting new patients in July 2021 as the mental health practitioners enrolled in the program reached their capacity. She said some of the patients she and others have treated experienced delayed mental health symptoms that didn’t show up for weeks or months — until there was a lull between waves of COVID-19.
“So, we would see things like patients would have really terrible nightmares, where they were not able to sleep,” Strongin said. “They were having intrusive thoughts, intrusive images.”
In other cases, health care workers were triggered by new surges of the pandemic.
Hansen’s response to the pandemic also evolved over time.
Early on, she found some solace in helping others through a popular support network she created, known as “Adopt-A-Nurse.” The project, which began in Suffolk County and inspired chapters across the country, paired individual nurses with people who wanted to send them care packages and notes of encouragement. Hansen struck an optimistic note in a May 2020 segment on NBC when she referred to the project as “a positive light in such a dark time.”
That project petered out along with New York’s first wave that summer. But Hansen said the feelings of anger and resentment she developed early on toward those who didn’t follow COVID-19 guidelines or downplayed the severity of the pandemic never went away. And she’s been plagued by other issues that she never experienced before, such as insomnia.
It was the arrival of omicron in late 2021 that brought on the panic attacks, Hansen said, explaining, “I’ll get physically sick to my stomach and I’ll start shaking, get really cold.”
Johnson, from Emotional PPE, said she has seen health care workers during the pandemic who were having trouble sleeping, leaning heavily on alcohol or drugs or dealing with the deaths of patients or their own family members, while also feeling that they couldn’t stop working.
“It's the culture that you see in a lot of the helping professions,” she said, “which is, ‘I'm not supposed to be sick. I'm not supposed to have problems. I'm not supposed to struggle. I'm supposed to be the caretaker.’”
The idea for Emotional PPE initially was born in February 2020, before COVID-19 was a major concern in the U.S. Ariel Brown, one of the founders of the organization, said it came out of conversations she was having with a friend at the time who oversaw residents at a hospital.
“We were exploring the idea of how he could best support the wellness of his residents, because it's a very, very hard time in a physician’s life,” Brown said. Physicians – especially early in their careers – are at high risk for suicide.
As the pandemic wears on, Brown said Emotional PPE is shifting its focus toward advocating for changes that could improve mental health access for health care workers in general, such as pushing for state medical licensure boards to eliminate questions that probe into physicians’ mental health histories.
While COVID-19 did not launch the conversation about the need for a new approach to mental health in the medical field, it has created a new sense of urgency for advocates and policymakers.
Last month, President Joe Biden signed the Dr. Lorna Breen Health Care Provider Protection Act into law, which will fund research and evidence-based programs to promote mental health and resiliency among health care workers. It’s named after an emergency room doctor at New York-Presbyterian who died by suicide in April 2020.
Mental health professionals say they have seen some health care workers who have struggled during the pandemic improve.
In June 2020, Mount Sinai Health System launched its Center for Stress, Resilience and Personal Growth, which provides health care workers with tools and group training to help them cope with stress and mental health challenges, as well as free access to one-on-one therapy for those who need it.
Jonathan DePierro, who serves as the center’s clinical director, said he wanted the department to build on knowledge Mount Sinai had gained through its World Trade Center Health Program. He too acknowledged that the scale and nature of the catastrophes were very different, but said some of the lessons learned in treating 9/11 first responders could be applied to the pandemic. One of the most important protective factors, he said, is having a strong social support network, whether at work or at home.
“The statistics show that those folks with a lot of social support going into something terrible, during something terrible and immediately after have lower rates of depression, anxiety, and PTSD over time,” DePierro said. “And that's a modifiable factor, right? We can encourage people to build their support network going into something challenging.”
Of course, when the pandemic arrived, many social connections broke down. But DePierro said he especially encouraged health care workers to speak to their colleagues and try to recognize when others were in emotional distress. Johnson likewise said she encouraged her patients to speak to coworkers — people who could relate to what they were going through when they felt like no one else could.
DePierro added that those employees who have come in for cognitive behavioral therapy and, if necessary, medication, during the pandemic do “get better.”
“We can see that session after session because we give them scales to assess their well-being,” he said. “They engage, they do the work, they get better and they don't need to come back.”
Still, the threat of another COVID-19 surge remains, and the pandemic continues to make life more stressful for health care workers. For instance, some hospitals have suffered staffing shortages as full-time staff have left.
But Hansen, who now works at a different hospital on Long Island, said despite the stress, she can’t imagine abandoning her chosen profession.
“I do think it’s the right career for me,” she said, “but it comes with a lot of heartbreak. It comes with a lot of frustration.”