Coping with COVID-19: Prioritizing and Addressing Mental Health in Your Rehab Therapy Clinic

COVID-19 has created the perfect witch’s brew of intense stress. People across the country are concerned about the health of themselves and their families; job security is shaky (and household incomes are dropping); and basic necessities like food staples and hygiene supplies are still—even after two months—difficult to find.  

All of this creates an environment for mental illness to not only grow, but flourish—which is why there’s never been more important time for clinic leadership to learn about mental health and refine how they approach it.  

The goal of this article isn’t to teach you how to fix you employees’ mental health problems. Even if that were possible (or a good idea), your employees have to take initiative when it comes to addressing their personal health. That said, there’s plenty you can do as an employer or colleague to understand mental health—and to empathize and better communicate with peers who are shouldering its burden.  

Why is this important?

For those who don’t experience it, mental illness is difficult to fathom—the same way it’s hard to imagine the pain of a broken foot if you’ve never broken a bone. The difference between that  broken foot and mental illness, however, is that people can easily identify when someone else has broken a foot (usually because the unlucky person is wearing a cast or using crutches). And, most people recognize that a person with a broken foot needs to take it easy; if he or she went on a jog, for example, it would exacerbate the injury—prolonging the healing process and causing unnecessary pain. 

It’s not a perfect comparison, but it might help to think about poor mental health like it’s a broken foot. When people ignore their own poor or failing mental state—when they push forward despite needing to slow down—it can lead to devastating effects. Symptoms can drastically worsen (e.g., social withdrawal can turn into complete social isolation) and temporary afflictions can turn into chronic conditions (e.g., an isolated bout of situational depression can turn into lifelong clinical depression). It’s also worth mentioning that poor mental health—and the symptoms that come along with it—can also weaken the immune system. 

In other words, if mental health is not given the attention and treatment it deserves, things can turn sour—very, very quickly. 

It’s affecting your staff more than you might think. 

Mental illness was widespread in the US long before the novel coronavirus found its footing. According to 2018 statistics from the Substance Abuse and Mental Health Services Administration (SAMHSA), one in five US adults experience mental illness each year. 

But, you don’t have to be diagnosed with a mental illness to experience its symptoms during high-stress situations. And that would likely explain why the number of people with poor mental health has increased in response to the pandemic. Different sources are reporting that: 

• “More than four in ten adults overall (45%) feel that worry and stress related to coronavirus has had a negative impact on their mental health.” (Kaiser Family Foundation)
• “88% of workers reported experiencing moderate to extreme stress over the past 4 to 6 weeks.” (Ginger)
• “The greatest increase was in prescriptions for anti-anxiety medications, which rose 34.1% from mid-February to mid-March…The number of prescriptions filled for antidepressants and sleep disorders increased 18.6% and 14.8%, respectively, from February 16 to March 15.” (Express Scripts)

The bottom line is that it’s very likely that some of your colleagues (job titles notwithstanding) are currently struggling with mental health troubles. Some may have struggled prior to the pandemic, but it’s likely that more are struggling now.

Mental illness limits workplace performance. 

When employees suffer from poor mental health, their workplace engagement takes a hit. According to a poll conducted by the American Psychiatric Association (APA), 24% of respondents said “they have trouble concentrating on other things because they’re thinking about COVID-19.” When employees aren’t fully engaged with patients (be it in the front office or on the treatment floor) the patient experience suffers—and now is not the best time to deal with patient complaints. 

But it’s not only the patient experience that takes a hit: the aforementioned Ginger survey found that, of those who reported that they were experiencing moderate to extreme stress, “62% noted losing at least 1 hour a day in productivity and 32% lost at least 2 hours a day due to COVID-19–related stress.” Now, those numbers might play out a little differently in a clinic than they would at a desk job, but even so, they are mind-boggling. 

What does poor mental health look like? 

Like many illnesses, there is no “one-size-fits all” list of poor mental health symptoms that applies perfectly to everyone. Poor mental health manifests a little bit differently in everyone, and presenting symptoms can vary based on the type of poor mental health a person is experiencing (e.g., depression versus anxiety). Additionally, those presenting symptoms can vary in severity. That said, here’s a list—compiled from the CDC, Mayo Clinic, and Healthline—of some of the most common symptoms associated with poor mental health due to COVID-19: 

• Feelings of helplessness, hopelessness, sadness, anger, anxiety, and fear
• Excessive irritability
• Difficulty concentrating 
• Difficulty completing daily tasks
• Hyper-vigilance
• Emotional dysregulation
• “Increased use of alcohol, drugs, or other drugs”

Don’t confuse symptoms for laziness or a lack of motivation. 

Before we move on, I want to briefly talk about the “difficulty concentrating” and “difficulty completing daily tasks” symptoms. These symptoms should never be confused with laziness or a lack of motivation—but often are. The affected person could be putting in their best effort (maybe even 110%), but he or she might only make the smallest dent in his or her workload. 

It’s kind of like trying to push a heavy piece of furniture across a tile floor while wearing socks. No matter how hard you push, that piece of furniture isn’t going anywhere; you’re just going to slide around like you’re Tom Cruise dancing in Risky Business.

It’s also worth noting that difficulty concentrating and completing daily tasks can be a result of other, lesser known symptoms of depression or anxiety, such as: 

• brain fog (lack of mental clarity),  
• executive dysfunction (difficulty focusing on “desired information while suppressing uninteresting or irrelevant information”), or
• dissociation (feeling disconnected from the present moment).

Poor mental health can create physical symptoms. 

As I mentioned in the opening of this article, poor mental health can lead to a weakened immune system—but that’s not the only effect it can have. Poor mental health can cause other physical symptoms like: 

• Stomach pain, 
• Back pain, 
• Headaches, 
• General aches and pains, 
• Changes in eating patterns (i.e., eating too much or too little), 
• Changes in sleeping patterns (i.e., insomnia or excessive sleeping), or 
• Exacerbation of chronic health problems.

Symptoms of poor mental health align with symptoms of burnout.  

Did any of those symptoms look familiar to you? If you’ve been reading up on burnout, then they should—because there’s an almost one-to-one match between symptoms of poor mental health and symptoms of burnout. In fact, many experts recommend looking at mental health if you want to address employee burnout. 

How do I identify when staff members are struggling if everyone experiences mental illness differently?

We’ve established that poor mental health manifests differently for every person who experiences it. So, how exactly are you supposed to identify when your staff is struggling?

According to this Engaged HR resource, the best way to spot potential cases of failing mental health is to pinpoint unusual changes in employee behavior, like: 

• Changes in work habits (e.g., decreased productivity or poor concentration);
• Changes in physical appearance (e.g., decreased grooming);
• Changes in demeanor (e.g., increased agitation, restlessness, irritability, passiveness, disinterest, or worry);
• Increased absenteeism or tardiness;
• Sudden lack of emotional regulation (e.g., mood swings, outbursts, or disruptive behavior); or
• Changes in social habits (e.g., self-isolation or unwillingness to communicate). 

However, don’t assume you’ll always pinpoint when your employees are in the thick of it; some people are extremely adept at hiding their poor mental health. You’ll only know they are struggling when they feel comfortable coming forward and seeking help—and that will typically only happen in an environment that foundationally encourages empathy, acceptance, and mutual respect. 

How do I communicate with employees who are struggling?

The best way to communicate positively with employees who are suffering from poor mental health is to lead with empathy and compassion. 

Understand that mental health is still stigmatized—and that talking about it makes everyone uncomfortable. 

Mental health can be uncomfortable to talk about, especially for those who experience it. Though poor mental health is more widely talked about now than it was, say, ten years ago, it’s still attached to some stigma, and that stigma too often leads to prejudice. According to the National Alliance on Mental Illness (NAMI), “People with mental illness were shown to be perceived as incompetent and less promotable, receive lower wages and have less access to quality jobs. Even in terms of supporting existing employees with depression, about 25% of managers reported they did not feel confident in doing so effectively.” 

This prejudice directly contributes to employees’ reluctance to talk about their mental health. But beyond that, talking about your poor mental health makes you feel vulnerable. Opening yourself up to that kind of vulnerability is tough—especially in a work environment, and especially in an unsupportive work environment.  

The best way to encourage open communication about mental illness is to support your employees by chipping away at that stigma and creating a non-judgemental environment that thrives on mutual respect. If they trust you and feel supported by you—if they respect you and feel respected in return—they’ll feel less vulnerable when opening up about these topics. If you normalize conversations about mental health and sustain judgement, that will help foster open, honest communication. Keep in mind that it’s not enough to just tell employees that they can trust you. You have to earn that trust by actively demonstrating that you won’t withdraw your support when they explain aspects of their mental health. 

Lead conversations with empathy. 

Say you notice that one of your therapists seems a little off. Her productivity is flagging; she’s not engaging with her patients as enthusiastically as she used to; and she’s distancing herself from her coworkers. You suspect that she might be suffering from poor mental health. So, how should you reach out to her? This resource recommends following these nine steps: 

1. Choose a neutral, private, and quiet space to start a conversation. 
2. Assure the employee that this information is confidential. Communicating about personal mental health is a huge exercise in trust—and if you spread that information to your peers (even to other members of leadership) without permission, you could severely damage your relationship with the affected person. 
3. Don’t make assumptions about the employee’s symptoms or how it affects his or her job. Give the employee a chance to explain what’s going on. 
4. Listen attentively and respond to the individual—not to the problem. Poor mental health manifests in a myriad of different ways, so there’s no single approach that’s going to solve every person’s problems. Your best bet is to “focus on the person, not the problem. Adapt your support to suit the individual and involve [them] as much as possible in finding solutions to any work-related difficulties.”
5. Prioritize honesty and clarity. “If there are specific grounds for concern, like high absence levels or impaired performance, it’s important to address these at an early stage.” 
6. Collaborate on an action plan. Work with the employee to understand what kind of a solution he or she is looking for, and develop a plan that helps the employee identify:
7. how his or her mental health affects his or her work,
8. what his or her stress triggers are, and
9. how you can adjust his or her work process to support better outcomes.
10. Effective adjustments can be as simple as offering flexible work hours, increasing managerial communication, shifting caseloads, or changing break times. Other times, an employee might need more significant intervention—like task reallocation, mediation between colleagues, or even position redeployment (i.e., moving the employee to a different role in the clinic). If the employee suggests an adjustment, but you’re not immediately sure if it’s feasible, set aside some time to evaluate the proposal’s: 
11. practicality,
12. effect on service,
13. financial cost, and 
14. effect on other employees. 
15. I strongly advise against evaluating the proposal during the meeting. Remember, the affected employee came to you from a place of vulnerability, and an immediate discussion on the potential negative impact of the request may cause the employee to feel ashamed for reaching out—and to withdraw from the table altogether. If you determine that the proposed adjustment isn’t feasible, then pinpoint your biggest hangup and reach out to the employee at a later time. Communicate your concern and ask if the employee can collaborate with you to find an alternate solution that addresses your worries. (The key here is to keep the collaborative spirit alive and well. This is essential if you don’t want to accidentally shame the employee for asking for help.) If, however, you determine that the proposed solution is totally doable, then touch base with the employee to confirm when the adjustments will begin, and plan a future meeting to review the situation and determine if your intervention is working. Please note: Do not implement work adjustments that the employee did not agree to. No matter how good your intentions, you should not violate the collaboration aspect of an action plan. For example, if the employee asks for a change in his or her break time, and you instead reduce the employee’s caseload, that may come across as a punishment—especially if your therapists are evaluated based on their productivity. 
16. Encourage the employee to seek advice and support. How your employee chooses to address or treat mental health outside of the workplace isn’t your business—however, it doesn’t hurt to share a gentle reminder that seeking professional help can make a big difference when managing mental health.
17. Get educated. Don’t rely only on this article to learn about mental health! Do your own research to find additional information. Understanding the parameters of mental illness and mental health will help you make smarter and more empathetic choices when you interact with your employee.
18. Offer reassurance. Even if you do everything right, the employee you’re concerned about might not be ready to talk about his or her struggles. Let the employee know that you’re always ready to talk and that you’ll support him or her—no matter what. 

Are there other ways for me to support my employees? 

There are many other ways you can support your employees! Some of them cost a little money (so this might not be the ideal time to implement them)—but others don’t. Here are some suggestions from the CDC: 

You can invest in offering clinic-wide employee support. 

• Offer mental health self-assessment tools. 
• Provide free or subsidized clinical mental health screenings from a qualified mental health professional.
• Provide health insurance plans that cover (or reduce the cost of) mental health counseling and mental illness medication. 
• Host depression and stress management workshops that offer actionable suggestions (e.g., mindfulness training).

Or, you can find free resources to support your employees.  

• Promote external digital mental health and stress management webinars or programs.
• Establish and maintain a dedicated quiet space for at-work depressing.
• Train all leadership about mental health. Help them recognize the signs and symptoms of poor mental health, and teach them strategies to communicate effectively and empathetically with employees about these topics.
• Create a forum where employees can give feedback about your clinic’s work processes and collaborate to foster an environment that encourages and bolsters everyone.

These are stressful times, and everyone is doing their best to muddle through. If you’re in a leadership position at your clinic, you have the unique opportunity to help your staff weather this crisis. Our communities can come out of this pandemic stronger than we were before—but we have to actively work to support each other—physically, emotionally, and mentally.