Maintaining Mental Health During a Pandemic

May 28, 2020

Maintaining Mental Health During a Pandemic by Brady Blackburn, MA

COE was pleased to collaborate on this blog post with the North Carolina Oral Health Collaborative (NCOHC), one of our partner programs at the Foundation for Health Leadership & Innovation, on a discussion of the intersection of mental health, the oral health care world, provider well-being, and COVID-19.

“This pandemic is a perfect storm,” said Dr. Lisa Tyndall, an integration specialist with the Center of Excellence for Integrated Care, a program of the Foundation for Health Leadership & Innovation (FHLI).

As North Carolinians navigate COVID-19 and its various impacts, NCOHC decided to sit down with our partner program at FHLI to discuss how the pandemic poses significant mental health concerns, for patients and providers alike.

Tyndall, a licensed marriage and family therapist, said that the wide range of impacts caused by COVID-19 — from financial stress to anxiety and isolation — are serious stressors that negatively impact mental health.

“The fact that we can’t be with each other absolutely negatively impacts the coping mechanisms most people use of reaching out and spending time with friends and loved ones,” said Tyndall. “We are wired to connect, and right now we are limited in those personal, face-to-face relationships.”

For the provider community specifically, Tyndall worries that we tend to forget that they are humans, too.

“I think that we forget that the frontline providers are facing a lot of the same uncertainty that the rest of us are,” said Tyndall. “Especially for those providers who live alone or are caregivers in their personal lives. If a provider doesn’t have a support system, or if their support system is already stretched thin, it is an especially difficult time. There’s a physical as well as an emotional toll to the stress, and it builds up. Providers manage the stress of patient caregiving every day, and then still go home to manage their own households, potentially adding an additional layer of stress.”

“As doctors, we are trained to be the rock,” said Dr. Zachary Brian, NCOHC’s director. “We’re trained to be the provider, there to serve the community, sometimes at the expense of our own physical and mental health.”

Both Tyndall and Brian described a juggling act for providers, balancing service to their communities, personal and family safety, as well as financial well-being.

“It can feel as though you are navigating a sea of conflicting resources, literature, and research to determine the safest way to move forward with your practice,” said Brian. “Given that this is a novel virus, it is not uncommon to see this type of response. The issue arises in that there’s no one clear authority to look to for guidance, which makes informed decisions on behalf of your patients and staff ever more challenging.”

As health experts learned more about the novel COVID-19 virus in recent months, guidance from the American Dental Association, the Centers for Disease Control and Prevention, and other state and national regulatory bodies were released, but were not always in exact agreement with one another.

“The resources for providers that we have seen, although very helpful, have not necessarily always been in parallel,” said Brian. “This has created a surge in confusion.”

What can you do about the uncertainty?

Dr. Brian says, “While the provider community as a whole may be very isolated during this time, forced to make decisions with so many unknowns, there is support within your regional communities. Don’t be afraid to reach out to your colleagues. People need to be very open and transparent, so we don’t have to navigate this crisis in a vacuum.”  

Dr. Tyndall says, “We have to lift ourselves up and we have to lift each other up. We don’t have to talk about it all the time, but we also should give a voice to it and not minimize the stress. It is important to have outlets to express uncertainties, fears, and concerns.”  

Dr. Tyndall also shared a couple of resources for providers who need help managing their own mental health needs during this time.  

The Hope for NC Helpline is a free helpline for people who need assistance coping and maintaining resilience during COVID-19. The number for the 24-hour helpline is 855-587-3463.  

For first responders, the University of Minnesota, the Minnesota Department of Health, and the University of Minnesota College of Education and Human Development have released a First Responder Toolkit to help those deployed in emergency response maintain their own physical, emotional, and social well-being. The app can be accessed here (note: a login is required).  

Financial uncertainty is another stressor impacting many oral health care providers. This is especially salient in the private sector, where most dental practices are small businesses. On top of figuring out how to keep everyone safe and healthy, while still providing necessary care to the community, providers must also navigate out how to stay above water financially.

“Even though it seems like practices would be bustling during a health crisis, we also know that there is a side where providers aren’t seeing as many patients,” said Tyndall. “So that financial stress — especially for smaller practices, rural practices — is very real.”

Brian said that the oral health profession is on the low patient volume side of the equation. Largely due to the use of aerosolizing instrumentss, dentists, and hygienists in particular, are near the top of the list of most at-risk professions for COVID-19 transmission. In response to the elevated risk, most dental offices have only seen patients for urgent needs during the pandemic.

Brian said that in the oral health care space, safety net practices are facing profound and lasting financial impacts, as well. Practices that see patients regardless of their ability to pay, and who offer care on a sliding fee scale, have very thin to nonexistent margins to begin with. Nearly completely cutting off their revenue stream can be catastrophic.

What can you do to navigate financial uncertainty during COVID-19?

Dr. Brian points to the ADA’s resources for providers, especially the following the guidance:  

Return to Work Toolkit Financial Assistance for Dental Practices from Third Party Payers
COVID-19 Coding and Billing Interim Guidance: Virtual Visits
COVID-19 Coding and Billing Interim Guidance: PPE
Financial Obligations to Staff During COVID-19  

Additionally, the North Carolina Division Health Benefits has issued temporary modifications for telehealth billing, and NCOHC has launched a teledentistry fund with support from the Blue Cross and Blue Shield of North Carolina Foundation.  

If your practice is a safety net provider in need of teledentistry software, please reach out to ncohcinfo@foundationhli.org for information on how to apply for funding through the NCOHC Teledentistry Fund.

Please note: The aforementioned guidance documents are only to serve as a resource, and are not necessarily founded in scientific evidence, or endorsed by NCOHC or COE.

According to Brian, it is important for providers to be aware of oral signs and symptoms that can alert them to potential mental health needs of their patients.

“You have parafunctional habits such as clenching and grinding that can develop as a result of stress, and from this you can see detrimental effects on teeth and other oral structures, such as extensive attrition and fractured teeth,” said Brian. “I saw that a lot with my patients when they were going through stressful events in their lives. They would come in with three or four fractures in their teeth, sometimes where the fractures extended past the gumline requiring surgical interventions.”

Brian also said that dietary changes due to stress and anxiety can negatively impact oral health. Increased sugary food and carbohydrate intake, as well as alcohol consumption, can both increase risk of tooth decay and gum disease.

“One thing that we’re not talking about enough is that we’re only seeing emergency patients right now,” said Brian. “There are people who are delaying appointments or not seeking care, and by the time they come in, what could have been a simple filling previously has now advanced to the point where it requires a root canal or an extraction. This is also particularly important for routine oral and pharyngeal cancer screenings.”

How can an oral health provider look out for mental health strains in patients?

Dr. Brian says, “Look for attrition patterns from clenching and grinding, fractured teeth, and TMJ pain.”  

“As an oral health professional, having a relationship with someone in the mental health space is vitally important, also. You need to have a sounding board to discuss mental health concerns of your patients, and a trusted referral source to help route that patient to proper care.”  

“It is crucially important that you have deeper conversations with your patients. Make sure that you take a whole-person care approach by including the mental health of your patients into the patient experience.”  

Both Tyndall and Brian agreed that taking time to reflect and take care of yourself is incredibly important for providers during this pandemic. Taking steps to interact with family, friends, and colleagues is an important way to cope with the isolation and stress we all are experiencing.

“Dig deep into your resource and faith buckets, and be kind to yourselves,” said Tyndall. “Take time to make sure that you’re taking care of yourself, too.”

“This too shall pass,” said Brian. “Dentistry remains a profession that allows us to impact our patients in direct ways, see immediate results, and change lives. That doesn’t change with the pandemic.”

Posted in Mental Health AwarenessTagged ,

Uncertainty in the time of COVID-19

May 13, 2020

Grace in Uncertain Times

by Lisa Tyndall, PhD, LMFT

In the midst of COVID-19, most mornings I wake up unsure of how the day will find me. I know what I am supposed to do, and how I am supposed to feel. The experts say I should slow down, take time to be grateful, some say to meditate during the day, and we have all heard the ever-present suggestion to get outside and exercise. Don’t get me wrong, I like all of these suggestions – it is just that ironically sometimes it feels impossible to do these tasks that are supposed to make life easier right now. How hard is it to just take a time out for 10 minutes to breathe?

Turns out that 10 minutes can actually be hard to find indeed. Everyone has different working situations right now, some are working more than ever on the front lines of the healthcare system, some are working remotely, some are dividing their time between the office and home, some have been furloughed, and some have lost their jobs entirely. Our work environments have changed dramatically. Clinics can be deserted, and some may be overrun. Co-workers can become second family if they were not so already, and those at home may be squeaking out a somewhat professional and quiet work-space that invariably will compete with the other life demands peeking from behind the cracked door. For me it is a new “work from home” environment, which includes children home from school but yet somehow still in school. While there have always been best practices as far as remote working is concerned, these days I come across even more “work from home” tips floating around various websites and depending on the day I am either fairly receptive or I want to tear them up into little pieces.

If you are at home, be sure to keep a schedule. Shower and get dressed every work day. Wherever you are, be sure to take a daily meditation break. Be present with your family, either in person or through a glass door. Slow down but meet your work expectations. For those of us with kids, don’t forget to add to that parenting, refereeing fights, fending off questions about hanging out with friends, teaching, and don’t forget to flagellate yourself for the increased screen time.

You get the picture – there are a million potential directions a day could take and often does take – during this time where we are supposed to be adjusting to the “new normal.”

When you read all of the advice columns – it seems like it should be simple. And yet, what we are often missing is the layer of uncertainty that drains the energy from each of us like an app open on your phone which can never close. It isn’t the same right now. We aren’t just working from home some, changing our clinical workflows, having lots of zoom calls and for some, working in pajama bottoms. Whatever your environment, a large percentage of our energy is going towards emotionally processing the uncertainty that looms over the entire world. What will it be like when the world re-opens? How long will it look like this?  Will we get back to celebrating life’s milestones? Or will we even get back to being able to be at someone’s bedside during their last moments? Surely the basic human needs for touch and connection won’t be forever gone from our reality…will they?

I do believe that this collective trauma will eventually be settled. What “settled” looks like I am not sure – but I know that developmentally and all through life when the hardest of times has come as people and as a country, there is a pendulum of reaction and response that swings but eventually finds the middle and settles. We all wish for the return of the freedoms we once took for granted, but are currently hazardous, to stop being afraid of seeing people in masks in the store, to wish to start seeing more people in masks, to learn how to work from home while missing live human interaction with others, we all want to feel productive and balanced again. As human beings, we always want to rush through the uncomfortable parts – and it is very uncomfortable right now to say the least. How in the world do we sit in the waiting for this pendulum to settle?

In those moments where I feel guilty for not being more productive, guilty for not parenting better, guilty for still having a job, yet afraid of the very clear temporary nature of jobs we never deemed temporary, there are so many conflicting emotions and states of being. In these moments, I do my best to choose grace. That also sounds simple – but it isn’t. It takes my village of people to remind me to choose grace for myself. It takes my spiritual practice to remind me to choose grace. It takes what I know as a therapist to choose moments of grounding and gratitude to eventually get lead back to grace. The irony here is that I also have to forgive myself for the moments I forget to choose grace, when my pendulum swings too far to one side or the other.

There are enough suggestions out there in the world for how to handle and cope with the current situation, both personally and professionally, a few even on our own website! And with May being mental health awareness month, we are particularly aware of the importance of taking care of not only our mental health, but our behavioral and relational health as well. My experience has been that those, as well as our physical health of course, are all connected. Keeping those connections in mind, how you choose to manage the swings of the pendulum is up to you. But overall I would say listen to your heart, give yourself and others large amounts of grace, and take it one day (even one minute if need be) at a time.

Stay tuned for more from the COE team during Mental Health Awareness Month 2020!

Posted in Mental Health AwarenessTagged ,

Stress and Coping during COVID-19

May 11, 2020

A Normal Reaction to an Abnormal Situation

Unprecedented, uncertain, unparalleled… just a few of the words that have been used to describe the happenings surrounding the COVID-19 virus. Even those who never struggled with worry or anxiety before have likely felt a pang of concern over these recent events. At COE we recognize that people are unique and are having different experiences and reactions to the stressors we are facing. While everyone will react differently, we want to offer a few tips and guidelines that will help lessen the negative impact and promote resiliency for you and your loved ones.

RESOURCE

A Normal Reaction to an Abnormal Situation

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Learn more here about how COE supports health organizations.

Posted by Lisa Tyndall, PhD, LMFT

Posted in ResourcesTagged

Self Care

Practical self care for health professionals during the COVID-19 Crisis

At the Center of Excellence for Integrated Care, the work we do allows us to collaborate and assist some of the most amazing healthcare professionals. Our appreciation for the work of these providers, clinicians, staff, and administrators grew exponentially with the onset of COVID-19 and the added responsibility and stress. Our team at COE has experience providing direct services to patients as clinicians and we know how important it is to take care of yourself. Now more than ever we are encouraging providers, clinicians, and all healthcare staff to pay attention to what they need to be able to take care of themselves.

While it may seem like extra work we know that it is critical for healthcare providers and staff to put gas in the tank so that they can stay well themselves, continue to help others, and be there for those they love. The document below is a resource and reminder to healthcare providers and staff of a variety of tools they can use to help take care of themselves. As a starting point, consider choosing one tool that sounds the most reasonable and add more strategies as you like. Thank you again for all that you do for so many.

RESOURCE

Taking Care of Yourself so You Can Take Care of Others

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Learn more here about how COE can help your organization.

Posted by Lisa Tyndall, PhD, LMFT

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Making the Transition to Teletherapy

Making the Transition to Teletherapy

Teletherapy is a wonderful resource for both providers and patients. Prior to COVID-19 many clinicians were dabbling in the world of teletherapy; however, now a majority of clinicians and patients are being asked to jump feet first into this virtual experience.

There are a myriad of resources on teletherapy, however, the document below highlights some of the key aspects that would be helpful during the transition.

RESOURCE

Making the Transition to Teletherapy

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Learn more here about how COE can support your practice transformation.

Posted by Lisa Tyndall, PhD, LMFT

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