In an online discussion group for physicians, as the Covid-19 crisis was gaining ground, Dr. Mona Masood noticed a trend.

Doctors were saying that they felt like quitting. They were afraid of infecting their families. They couldn’t sleep at night. Were other group members starting to make wills?

In short, said Dr. Masood, a psychiatrist, there was a marked increase in posts indicating mental distress. “It was starting to become a very obvious issue,” she said.

On a whim, Dr. Masood posted in the same group, asking if fellow psychiatrists were interested in starting a hotline for physicians working on the front lines.

“It went nuts. All of these people started to ping, ‘Yes, I’ll volunteer,’” she recalled.

With the help of four colleagues, Dr. Masood launched the Physician Support Line, a mental health hotline dedicated to helping doctors working during the Covid-19 pandemic. Today, the group has about 600 volunteers, who staff the hotline in turns.

Doctors call most frequently late at night, often unable to sleep. “We get a lot of those phone calls after the kids are asleep and they have a few minutes,” Dr. Masood said.

At first, before the coronavirus made much headway, doctors were experiencing what Dr. Masood called “a lot of anticipatory anxiety.”

When Covid-19 began to hit hospitals and clinics, doctors were stressed about managing the disease and worried about infecting their families.

“More recently, it’s become, ‘I’m losing patients, and they’re dying, and they didn’t get to say goodbye,’” Dr. Masood said.

The Physician Support Line isn’t the only such resource. Around the country, mental health providers are providing treatment and support to people on the frontlines, whether they’re physicians, group home workers, or janitors at health care facilities.

They’re helping health care workers express and find ways of managing feelings of anger, hopelessness, and fear. They’re teaching mindfulness techniques, helping people identify support networks, and sometimes even calling for ambulances in a crisis.

And whether it’s guilt about working in relative safety or anxiety for the health workers they serve, the work they’re doing occasionally takes its toll.

An Ongoing Trauma

Dr. Nicole Washington, also a psychiatrist, has focused her practice on doctors for the past few years.

She conducts her appointments through a telemedicine platform – it’s more convenient for patients and helps them avoid being seen at a psychiatrist’s office. (Dr. Washington explained that stigma around seeking mental health care is still alive and well in the medical profession.)

Doctors were already under significant pressure before Covid-19, she said, with many confronting anxiety, depression, and burnout.

But since the coronavirus appeared, “things have really shifted. I’m seeing people who maybe had a pre-existing condition and dealt with it on their own until they maybe weren’t able to anymore,” Dr. Washington said.

Concerned about what she saw as a growing need, Dr. Washington had bought the domain for a website, Physician Mental Health, several years ago. She’d intended to build it into a resource to help health care workers find mental health providers who were willing to treat them remotely.

Covid-19 spurred her into action. Working through social media, she found psychiatrists willing to offer telehealth treatment at a discount or even free of charge.

“When all of this started, it seemed as if we as physicians didn’t have enough issues to deal with…we were also going to be faced with the mental health consequences,” she said. “The system itself, it wasn’t set up for mental wellness.”

In her practice, Dr. Washington said, she hears guilt from doctors who aren’t working on the frontlines, and symptoms of trauma from those who are.

She described doctors who spend the entire day without eating – or even drinking – and find themselves unable to sleep at night.

“Most traumas that we experience, it’s an isolated event and it just happens,” she explained. “They’re just in it…every day that they go to work, it’s the same.”

Holding a Bucket

Through a North Carolina-based hotline designed to provide support to workers in the healthcare space – whether they’re doctors or janitors – Andrew Short hears frequently from people who feel a lack of control over their surroundings.

“With the burden of the number of cases coming in and the resources being put into it, people are being put into a situation where they feel a great deal of helplessness,” he said.

Doctors, used to having enough equipment and PPE, are feeling the lack acutely. Low-wage workers “have dictates coming down and they feel like they didn’t have any input.”

Short and a colleague, Tatyana Kholodkov, working with the state’s Department of Health and Human Services, founded the hotline Hope4Healers to assign health care workers with mental health providers, who work with their patient for between one and three sessions.

Kholodkov and Short are co-chairs of the North Carolina Psychological Association’s disaster task force, which informs the way they’re approaching Covid-19. “We base it on disaster mental health,” Short said. “You expect the person to be able to recover to normal function. You treat them very much as an ally in figuring out how to deal with this situation. It’s a real problem-solving approach.”

There’s a focus on making the caller feel heard – “We sort of hold a bucket of them to put into it whatever they feel they need to,” Kholodkov said – helping them normalize, and working with them to develop coping strategies, such as a mindfulness exercise that can be performed whenever it’s needed.

“One of the sayings we use with folks is they’re having a normal reaction to an abnormal situation,” Short said.

Practicing what they Preach

The hotline provided by Magellan Health, a for-profit health care company, offers a similar approach.

Christine Schulze, the company’s director for clinical care, explained that “most of what we are doing is really providing validation and affirmation” to health care workers and first responders, along with teaching mindfulness techniques and helping callers figure out ways to incorporate self-care into their routines.

Magellan Health frequently sets up a hotline when a disaster sets in, Schulze said. But this crisis is different.

“One of the things that makes this situation unique is that [the health care providers] are also being impacted by this pandemic,” Schulze said. “Oftentimes when we’re providing support in a natural disaster or some other crisis, we’re not necessarily impacted by it as directly as we are with this pandemic.”

That – along with the stresses of working from home – can affect clinicians’ mental health, she explained. It’s important that mental health providers are “practicing what they’re preaching. They need to practice mindfulness and utilize the same resiliency and self-care strategies.”

Letting Go

While providing mental health care to pressured and distressed health care workers is an essential service, “we as psychiatrists…are all having this kind of guilt that they themselves are not on the frontlines,” Dr. Masood said.

In addition, dealing with callers who are intensely distressed or in difficult situations can be highly distressing itself, said Dr. Allison Cotton, one of Dr. Masood’s co-founders of the Physician Support Line.

Dr. Cotton recalled a caller who at first seemed cheerful, only to reveal that they had lost a family member and, with no time to grieve, had returned to high-stress frontline work.

Working with a deeply distressed patient during just one phone call “goes against what we’re trained to do as physicians. You have to work very quickly. You have to ensure the safety of the caller,” Dr. Cotton said. “You have to build rapport so quickly so that they will trust you and tell you if they are suicidal.”

For patients whose safety concerns Dr. Cotton, she will offer to call an ambulance, or, if they refuse, try to develop a safety plan with the caller, helping them to identify warning signs and support systems.

“And then,” she said, “we let them go.”

Health care providers seeking mental health support can reach the Physician Support Line at 888-409-0141; Hope4Healers at 919-226-2002; and Magellan Health’s hotline at 800-327-7451. The Physician Mental Health website can be found here.