Transcription:

Caitlin Whyte: If you're like me, you probably woke up this morning, rolled over, grabbed your phone, and started immediately scrolling through COVID-19 updates. I know it's not the best for my mental health, but it's hard to stop when there's so much information coming in and constantly changing new cancellations and other updates. Joining us today to talk mental health and COVID-19 is Tony Piro, the Director of Operations for the Behavioral Health team at Emerson Hospital. This is Healthworks Here, the podcast from Emerson Hospital. I'm Caitlin Whyte. Getting right into it. What are people's biggest concerns about COVID-19?

Tony Piro: Well, I guess I'd pick two or three. When is it going to end? What's going to happen to me and what's going to happen to the country? I mean those are the, those are the three biggest, the three biggest concerns. I think the expectation that this could last for a really long period of time without an end in sight at the same time is there's sort of at times conflicting information about what you need to do to protect yourself. How bad is it going to get? Will I have to stay home? Will I be cut off from my friends and family? When can my kids go back to school? And what can be done to protect oneself and one's family and one's loved ones is also been unclear. So a lot of uncertainty, I would say anxiety generated by uncertainty, very difficult for us, human beings to manage. And I think that's the overall overarching, all of this is a profound level of anxiety.

Host: I know people are telling each other to stay calm during this unprecedented time, but what are some concrete ways we can actually do that? To stay calm?

Tony Piro: No, that's a very good question. I mean, the first thing is, you know, people want to rush to calm their children, calm their friends, calm themselves, and we need to be able to be calm and reasonable about this. But it's also okay to be afraid. I mean, you know, we have to acknowledge that it's scary and that the unknown is scary. The fact that we don't have the, all the information we need or want is scary. So it's okay to be afraid. What's not okay or good is to panic. There's a difference between being afraid and being panicked. And being panicked leads people to do things that are unreasonable or irrational, like buying a hundred rolls of toilet paper, right. And stuff like that. Being afraid sometimes is good. It's the thing that lets our defense is click into play so that we can do things like avoid large gatherings, wash our hands. So we want to stay, we want to stay between being afraid and being panicked.

So the best way to remain calm is to realize that there is an end to this, that there's a way that you can make it better, and that at the same time there really are no guarantees. The reality is nobody knows whether they're a vector for this illness or there'll be a victim of the illness or both. Right. And you have to be able to manage a certain level of uncertainty to be calm. It's okay to be uncertain. It's okay not to have all the answers and to be a little afraid about that. But at the same time to remember that there are really practical things that we all can do to be, not only to be calm, but to protect ourselves and each other. So I think the best way to be calm is to, one of the tools you can use is get as much information as you can. Get it from a reliable source and realize that despite your best intentions, there are no guarantees. We'll be okay.

Host: Oh, that's so hard to accept though.

Tony Piro: Yeah. I mean, okay, in the end meaning it'll end, you know, nothing, nothing. This too will end. But it is very hard to hold that. You're absolutely right.

Host: So what can I do, you know, looking day to day to support myself and my loved ones?

Tony Piro: Well, a couple of things. You know, we here at the hospital we've, we're having now, bi-daily. Really briefings, things are changing so quickly and things are changing so quickly. Guidance from CDC is changing. And so one of the things we're working on, and I think as a group, as a leadership group, as a, as a hospital, is something that everyone else can work on, which is taking care of ourselves. You know, let's use a paradigmatic situation, where we have a, you know, a mom and dad, they have a couple of kids at home, let's say young kids, latency aged kids. You know, your kids are only going to be as sturdy and as calm and as secure as you are. And if you're not taking care of yourself, then you can't take care of anybody else. And it also sometimes, can put people in a position of feeling like they need to take care of you, right? So one of the best things we can do is to take care of ourselves, do the things we need to do that we all know we need to do, get enough rest.

Try to keep ourselves as engaged in the world in a positive way as we can. For example, if he can't see somebody, you can FaceTime them, we can talk to them on the phone, you can text them. Another words, make every effort to make life as normal as we possibly can, though we're going to be, our freedom is going to be, I presume, I think we all presume a little even more impinged on as this moves on over the next, let's say two or three weeks. There's still a way to enjoy life. We have to take care of that for ourselves. We have to make sure we eat right. We have to make sure we get enough exercise. We have to make sure that we treat each other with patience and kindness because if we don't treat each other ourselves and each well, we'll, we'll be succumbing to the virus in what we're talking about today is how once it comes to the virus, psychologically not physically, and we'd be succumbing psychologically to the effects of COVID-19 and we don't want to do that.

Host: So what are some signs I can look for in, you know, my loved ones or even in myself that they're having difficulty just taking this all in?

Tony Piro: Yeah. You know there's always in difficult situations is always a fine line between whether it's the death of a loved one or something as unprecedented as this. There's always a fine line between somebody being worried, anxious, right? Scared and being despondent, depressed or out of touch with reality, right? The line at both ends at the two ends. It's easy to tell, but there's some room in the middle where sometimes it gets a little fuzzy and I think the thing we have to watch out for in ourselves is if these feelings, thoughts, feelings, concerns, are beginning to limit our lives. In other words, if they're causing functional difficulties in either ourselves or we notice this, we notice functional difficulties in a loved one, that's when we need to be concerned. What do I mean by that? I can't go to work. I can't go to school. I can't sleep, I can't get up in the morning, I can't eat, I can't stop eating.

I have lost my will to live. I'm hopeless. Those kinds of things are a pretty clear demarcation for me that someone has gone beyond what we're all feeling, I suppose, anxious and worried and concerned, and has perhaps become in an incapacitating way, anxious or depressed. So I think you have to look for a functional change. Is this person not able to meet the kind of, whether it's you or anybody else, a loved one friend, a coworker, are they becoming unable to meet the demands of their lives, the things they need to do to take care of themselves and to take care of their families. Once that starts to happen, you know, someone has a problem that goes beyond what we're all experiencing to one degree or another, and may require some help. Professional help.

Host: That leads me into my next question, which is, you know, if you're reaching that point, where do you even go to seek out that help, I guess at this point?

Tony Piro: That's a great question. I mean, you know, the dearth of psychiatric and mental health providers is a, well I think it's a well-documented, a well-documented problem in our state and actually around the country, but there are ways. The first thing that I think a person can do if they've never had, for example, I'm presuming this is a Denovo situation where a person has had no let's say no previous contact with any kind of psychiatric or mental health provider, right? That I think would be the probably the case we'd want to highlight the most. The first thing to do is contact your primary care physician and say, look, this is what I'm experiencing. You know, we tend to assume rightly or wrongly that, and I think it's wrongly that our physicians don't want to hear about this kind of stuff. We want you to go and you know, if you want to tell him you have a sore throat, if you want to tell him you belly hurts. If you want to tell him you got a headache, they want to hear about that, but they need to hear about this too. Right? This is, in my view, a medical complaint, right? It's the same thing as calling up and saying, I have chest pain, you know, or I can't move my leg.

So the first call is to the PCPs office. So look, I think I'm, I really need some help. I think I'm not able to manage this myself. Can you direct me, most primary care practices have affiliated psychiatric or mental health providers that they can refer you to? Some don't, but most do. And they're a great starting point because this is a person presumably who knows you or knows something about you. May, they may know you very well if you've been with the same physician for a while and who can point you in the direction of a colleague who can help. So I think a first call to the PCP, if that doesn't work, a call to your insurer also works. I mean, if you're down to nobody, no professional who you know, are you familiar with or comfortable with, can make a referral, you can self-refer. And one way to do that is if you have insurance, you can go to your insurer's website or actually call their customer service line to find a list of providers who take your insurance and you can call them.

That's another thing you can do. There's also the various organizations in each State that represent the professions. So like for example, in Massachusetts there's the State Chapter of the National Association for Social Workers. You can call them, they have a referral line. There's the State Chapter of the American Psychological Association. They have a referral line, there's the Mass Medical Society. They have a connection to referral lines. So in other words you can call the representatives of the organizations that provide mental health care. The best of all possible worlds is one calls one's doctor and says, look, I need some help. And typically folks have a place to put you.

Host: Could you talk about the balance of getting news? Like you don't want to absolutely avoid any updates, but you don't want to be scrolling Twitter 24 hours a day, which is kind of where I end up leaning. I'm just wondering, you know, how with all this information coming in all the time, how do you just kind of take a step away to kind of, whew?

Tony Piro: Yeah. It is something, isn't it? Today, you know, when I was a kid, it wasn't that hard. You know, to avoid information if you wanted too, it was pretty easy. You know, you just didn't watch TV or listen to the radio, but that really, even though that's was easier, then it's still sort of the same recipe, right? It just takes much more of a willful act for people to do that now. Right. One has to put down one song, turn it off, put it away. If you're feeling like some people really, really can process a lot of information and deal very well with it. Right. But for a lot of people, you're absolutely right. It's just too much information. Not only that, the more of it you get, the more of it will be conflicting. It's just a mathematical reality. But the more information you get, the more varying viewpoints you will hear. And ultimately you will hear someone say something different than the person or the organization you said just before that one. Right?

And it gets to be very, very confusing. And when you hear about projections, prognostications about the future, sometimes those are offered without context or by unscrupulous individuals online. You know, this is going to turn out to, you know, this is going to turn into a world, you know, world ending catastrophe. You know, and you never know what you're reading. So I think that, I wish I had an easy answer. It's a willful act of distracting oneself, right? Of saying I'm going to do something else instead of this. I could turn on the news, right? But instead I'll watch a movie. I could, you know, go and look at my Twitter feed or I could take a look at a magazine online or read a book. These things all become harder when there are more distractions. I'm not suggesting any of this is easy, but it's an act of distraction. I mean, we run an inpatient unit here and I help run it frequently. We have patients who are, I mean, doesn't need, we don't need COVID-19 for folks to be anxious and scared. You know, we manage it and try to help a lot of people who are anxious and scared all the time. And they deal with this themselves on a daily basis. How can I limit the information I'm getting because I'm getting too scared or I'm getting too many calls from my friend? I don't know how to answer. You know, I can't talk. Every time I talk to her, I feel worse.

And so in other words, there's variations on this theme with people we see every day. You know, about how to limit information, limit contact with the outside world so that it's useful to you. And what we tell people is they have to develop other skills. Most of us, if you're like me, I mean, using my digital devices as a coping skill, that's what I do. You know, I look at my phone a lot, you know, and a lot of people do that. There's nothing wrong with that. It's just that it can't be your only coping skill. It used to be people could take a bath, you know, or you know, listen to music, take a walk. These are the kinds of things, despite the fact that they seem antiquated and you know, low tech, they're actually very useful and one has to have a whole repertoire of ways to manage any difficult feeling, including anxiety. The more avenues one has to manage their feelings, the more successful one is going to be in managing those things, and that goes double or triple or quadruple for the attachment we have to information, we have to distract ourselves in other ways. And it takes a willful act of saying, I'm going to try something different. I'm going to try something else I enjoy.

If you do it enough, if you work at it hard enough, you might be able to get yourself to the point where you do go to that. Where that becomes something you can rely on like watching a movie or reading a book? So I think distraction and developing other reasonable healthy coping mechanisms is what we all have. And I'm not excluding myself from this, we all have to do. But if you are going to, you know, read your Twitter feed or look at the news, just remember that you're being hit with a fire hose of information, right? And just like if you were being hit with a real fire hose, you can keep your balance only for so long, then it will knock you over, right? So you know, you have to, what can you do that? And you've got to get out of the way. You've got to either turn down the water or turn down the pressure or get out of the way. And that's how I really, I have that image in my mind when I think about information I really do. It's like a fire hose and it's like hitting me, you know? And it's pushing me back and knocking me down. And you have to get out of the way or turn down the pressure, so that you can manage it. But it is an inevitability of our culture and our time in history right now. That information is so constantly available that it's just foolish to say we can ignore it altogether. We can't. We just have to try and distract ourselves as much as we possibly can.

Host: Well, Tony, thank you so much. This information will go to great use as we navigate this virus. Tony Piro is the Director of Operations for the Behavioral Health team at Emerson Hospital. Thanks for listening to Emerson's Healthworks Here Podcast. Subscribe to this podcast on your favorite podcast source, including Apple Podcasts, Google Play Music, and Spotify. I'm Caitlin Whyte. We'll catch you next time.