Peer Support Workers Provide Critical Behavioral Health Services During COVID-19 Pandemic
In the field of behavioral health, peer support workers – people who have faced similar stresses, trauma and mental health challenges to those they serve – have played a crucial role providing non-clinical, “experientially credentialed” support. That role has not abated during the COVID-19 pandemic, according to a recent editorial in the journal Translational Behavioral Medicine.
In fact, the editorial suggests that the role of peer support has increased and become more complicated amid the pressing demands for food, housing, safety and economic assistance that have grown during the pandemic.
Real World Health Care spoke with one of the editorial’s authors, Suzanne M. Miller, PhD, Director of Patient Empowerment and Decision Making Department, Fox Chase Cancer Center. Dr. Miller also serves as editor-in-chief of Translational Behavioral Medicine and as board member of the HealthWell Foundation, sponsor of Real World Health Care. Dr. Miller was instrumental in helping the HealthWell Foundation design and launch a new fund that provides grants to frontline health care workers to help them afford behavioral health treatments.
We asked Dr. Miller to address how stress and trauma have affected peer support workers over the past year and why peer support is particularly important for frontline health care workers.
Common Themes among Peer Support Groups
Real World Health Care: Your editorial in TBM focused specifically on peer support workers in parenting children with special needs, child protective services, and police. What sort of themes emerged among these groups that may also apply to health care workers?
Suzanne Miller: We have been studying peer support workers who were serving parents of children with special needs, child protective services workers, and police. We found three themes of services needed by these groups: (1) stressors directly related to the virus, (2) preexisting stressors that were exacerbated by the virus, and (3) styles of coping used to deal with these stressors.
First, stressors that police and child protection workers experienced directly related to the virus included known risks (e.g., face-to-face contact, inadequate PPE) and unknown risks (e.g., being “left in the dark” about exposures), changes to work schedules and arrangements, and a heightened complexity of work which peer support workers attributed to the additional financial and emotional stress facing the people they were serving.
Peer support workers and their clients are by no means the only ones dealing with these stressors. Health care workers are at high risk of exposure. Risk is especially high when proper PPE is not provided. Moreover, many health care systems have experienced an intensity of workload and a demand for staffing that have contributed to stress and burnout at the provider level, as well as the personal impact of being the lifeline to the patient.
Second, not only peer support workers, but also health care workers, need to deal with preexisting stressors among patients. These stressors include demands around childcare and education, housing and food insecurity, and health-related concerns. These demands have been exacerbated by the financial challenges that have been associated with the pandemic, along with the lack of available support services. Ironically, health care workers themselves face these very psychosocial/social determinant challenges, all the while trying to care for clients and patients who themselves are trapped in a downward health care spiral of stress and lack of access to services.
Third, in terms of coping, our research has shown that many people try not to think about health stressors or to “keep their minds busy.” We call these people “blunters” in behavioral science because they psychologically “tune down” incoming messages about health threats. Others, “monitors,” focus on and magnify incoming health threat messages. Peer support workers find that just “being there” and providing “space to talk” provides relief and support to the people they serve.
Although peer support workers are aware that they do not have the resources to solve many of the problems their clients face, simply providing space and empathy, especially for monitors, is a valued service which can help clients process the fact that being less productive or involved is the new normal. This message can also motivate individuals to get back to addressing their families’ most important priorities. This sort of psychological “space” (characterized by empathy and support) is directly relevant to health care workers as they increasingly deal with COVID-related challenges in discussions with their colleagues, clients, and supervisors. This approach enables providers to more effectively respond to the needs of patients and staff, and it helps them to maintain their own ability to carry out their essential work.
Psychological Impacts Intensifying
RWHC: Your editorial was published in the early days of the pandemic. Almost a year later, how are stress and trauma continuing to impact peer support workers?
SM: We are a year from the early days of the pandemic and yet the psychological impact has, if anything, become intensified. Psychological science has shown us that, over time, the toll of undergoing sustained psychological stress can and does grow in intensity and negative impact. For example, people become less committed to adhering to behaviors for their own and the social good (like distancing and masking) due to psychological and emotional fatigue. Our social nature as humans often pulls us to come together during times of distress, which is positive but also poses a challenge to protective health behaviors. Even individuals who were most vigilant in the beginning may be slipping into more leniency or complacency, despite new cases being higher now than the initial peak last April. We need to empower patients to connect and derive the therapeutic support of being together, while at the same time practicing the behavioral distancing that will protect them from potentially serious infections.
Among the good news, a new tool has emerged on the scene: the vaccine, which has been touted as the ultimate saving grace. Yet, the vaccine rollout in the U.S. has been disorganized and the stress of being one’s own navigator trying to get a vaccine can be exhausting. People are registering on multiple counties’ lists trying to get access, even though they’re within the eligibility criteria. That’s likely because the infrastructure for disseminating vaccines and the health communication about it has, until now, been generally conflicting, confusing, and disorganized. Even when people get past those hurdles and get vaccinated, the news is full of stories about new variants of the virus that the vaccine may or may not protect against. In addition, it is still not clear whether vaccinated individuals can be vectors of spread of infection, though asymptomatic themselves. These are some of the many conflicts that people have been living with and it is unclear whether and how they will change over time.
So the nature of stress and trauma remains significant and people continue to live with a chronic stressor with no clear end in sight. Further, the burden of having to maintain long-term preventive behaviors (like distancing and masking despite the magic vaccine bullet) takes its toll on every aspect of life, including the economy, personal identity, social connectedness, parenting, and the list goes on. “Monitors” are increasingly sensitized to it, are afraid to move about, and are somewhat paralyzed by how to proceed. “Blunters” are increasingly engaged in distraction and denial, often with feelings of invulnerability, and are less and less likely to adhere to public health directives. These diametrically opposed coping strategies can add to the complexity of the situation as each group deals with their own confusion, anger, and other barriers to healthful responses.
RWHC: How do stress, trauma and fear impact one’s physical well-being and ability to resist and/or recover from COVID-19?
SM: When people are depressed and anxious, it has a significant impact on their physical well-being. Decades of robust evidence on the relationship between the mind and the body show that stress is capable of impairing one’s immune system, disease vulnerability and recovery, sleep patterns, and other physiologic functions. This physiological pattern can also lead to a lack of energy that can behaviorally paralyze patients from participating in essential protective behaviors, such as exercise, activity, nutrition, social connection, and recommended screening, diagnostic, and treatment regimens. All of these factors combined are vital to maintaining immune function, psychological well-being, and health. This biobehavioral process can set up a perpetuating spiral of increased stress and decreased health behaviors, which can intensify stress and disease vulnerability. These complex biobehavioral factors can leave individuals at increased vulnerability to a myriad of diseases, such as cancer and cardiovascular disease.
RWHC: How do stress, trauma and fear impact one’s mental well-being in the longer-term?
SM: Stress, trauma, and fear are toxic for long-term mental well-being because they set the stage for hopelessness, pessimism, and self-destructive behaviors, including drug use, alcohol, and smoking, as a way of self-treating the stress. This means there is an increasing burden on the health care system, not just directly from COVID, but from the psychosocial aftereffects of COVID. Yet, the very people who need behavioral health services (e.g., first responders, frontline health care workers, the underserved) are now less likely to have access to them, as these services are overwhelmed and put on the backburner.
Resources for Health Care Workers
RWHC: How is your institution providing or enabling peer support among its employees?
SM: Fox Chase is often dubbed a “family” institution by its employees which is an indication of the supportive culture, the work-life balance, and the care of patients as if they are family. This provides a rich foundation on which peer support can flourish. Throughout the pandemic, Fox Chase/Temple Health has provided special gifts to staff, addressed frequently asked questions about the vaccine, and offered multiple types of virtual support sessions through Carebridge, the employee assistance program. Notably, Fox Chase Cancer Center/Temple University Health System (FCCC/TUHS) is the first health system in the country to partner with Ginger, a 24/7 therapy and psychiatric service app that is available for all medical plan participants. Further, Fox Chase has shifted relevant services to the telehealth platform which allows health care workers to communicate with patients by phone, video, and other remote channels, thereby lessening unnecessary exposure.
In addition, FCCC/TUHS has been highly communicative about the protective policies, the procurement and availability of PPE, and the rollout of vaccination (which is now vaccinating patients and, soon, the community), which are critical for COVID management. These protocols build a sense of trust which bolsters the feelings of support and security in what is an otherwise chaotic time.
RWHC: How can other health care workers access peer support services?
SM: For the Frontlines provides free text-based crisis counseling 24/7 to all those on the frontline (text FRONTLINE to 741741 for those in the U.S.). The American Academy of Experts in Traumatic Stress (AAETS) offers online support groups for emergency responders and health care workers. There are other resources, specific to health care workers, like The Emotional PPE Project, the Physician Support Line (1-888-409-0141), and NurseGroups. All of these are free of charge.
To help meet the mental health needs of frontline health care workers during the COVID-19 pandemic, the HealthWell Foundation has launched a new fund to provide copayment assistance for behavioral health treatments. Through the COVID-19 Frontline Health Care Workers Behavioral Health Fund, HealthWell will provide up to $2,000 in financial assistance for a 12-month grant period to eligible health care workers who have annual household incomes up to 500 percent of the federal poverty level.
In addition, as FCCC/Temple Health has done, employers can provide support sessions that validate the challenges and stressors facing employees. Providing the psychosocial “space” to express and discuss is a benefit on its own, as we have seen with peer support workers. Further, demonstrating acts of gratitude can go a long way with employees, especially ones who have been on the frontline. Other resources, such as employee assistance programs or counseling services that are tied into medical plan offerings, can be critical sources of support. Social media has also been shown to help mitigate the psychosocial effects of COVID for frontline workers, health care providers, and patients.
If a health care worker wants to start their own peer support group, a good place to start is by bringing one’s stress and uncertainty to a supervisor so that potential institutional or departmental support can be activated. There may well be counseling professionals within the organization whose duties could be arranged to cover support sessions and other outreach activities. Standing departmental or team meetings could also be an opportunity for this sort of programming. In addition, self-organized virtual or socially distanced meetings, like an outdoor/masked walking group, could build camaraderie.