It’s the Wild West of the Coronavirus out there!

Coronavirus in Flickr Public Domain

Coronavirus (from Flickr.com in Public Domain, April 8, 2020)

It’s the Wild West of coronavirus out there, and it doesn’t seem to be letting up around here yet! In my previous blog post, immediately prior to this one, I explained that I am a counselor at a mental health facility in the Southeastern United States. Thankfully, especially in situations such as that happening right now with the coronavirus shelter-in-place orders and curfews, I have and been able to keep my part-time hours. However, the Wild West of coronavirus still puts every person at risk of getting it, particularly when people persist in not taking it seriously.

In my prior blog post, I stated that I was exposed to a colleague (who also works at another mental health hospital) who was exposed to a patient who had been hospitalized and in serious or critical condition due to the coronavirus. My exposure to this colleague occurred on March 29, 2020 when this colleague came to work, and we were in the same department office and he was using my desk in that office. I should also state that this colleague worked all day at our mutual workplace the day before that – March 28, 2020. Between those two days and his travels throughout the hospital, he exposed dozens of staff and patients to potential coronavirus. He was informed by his employer of potential exposure on March 29, and left our mutual workplace once informed.

On Monday, March 30, 2020, my colleague got tested for coronavirus, and yesterday, April 7, 2020, was informed that he tested positive for it. Thankfully and with great relief, my colleague has been asymptomatic, as per his reports. It is my understanding, however, that people who are asymptomatic can still (obviously) be carriers of coronavirus and can infect other people with it. It is also my understanding (as well as through my own observations on March 29) that my colleague who worked at our mutual workplace on the weekend of March 28-29 did not wear any protective equipment to prevent a potential spread of the coronavirus until after he stated he received a call from his employer about his potential exposure to it. Only after that call did my colleague begin wearing a surgical mask.

On March 29, I informed the charge nurse at the hospital of my colleague’s potential exposure to coronavirus, as well as my own exposure to this colleague. At that time, she informed the hospital’s nursing director about it. Yesterday, I was informed by my supervisor that staff who came into contact with this colleague do not need to be tested for coronavirus! This is per information from the Health Department, apparently! And, there was no word about informing patients at the hospital of their potential exposure to coronavirus.

So, here we are in the Wild West of the coronavirus, folks! You’re on your own. When you go to work in a healthcare facility, and if you’re a patient at a healthcare facility, you’re risking exposure to – or you’ve already been exposed to – coronavirus! You have to make your own decisions and you have to do your best to take care of yourself, as well as your own famiy. I would guess that there are those facilities such as my own workplace that are not requiring staff or patients to take extra precautions to prevent the infection or spread of coronavirus. I would estimate that there are healthcare facilities such as my own that do not require staff and/or patients to wear masks, gloves, or other personal protective equipment. Recall from my prior blog post that I purchased and have been wearing my own, and I was the first staff member at my facility that I observed to wear any PPE at all. And, to my knowledge, the department office in which I work was not cleaned or disinfected (any more than what it typically is) on the weekend that my colleague worked there, beyond what I cleaned with Lysol after he left.

That stated, I am very confident that I do not have the coronavirus, nor that I’ve passed it to my family. I do my very best to wear my own PPE at work all day, except for when I eat or drink something. When I arrive at home, I put my clothing and gloves in the laundry for washing. However, I have typically been using my N95 masks for an average of three days, which likely increases my exposure if the virus is on the outside of my masks. This is not the safest way to proceed, however I hope that it does extend the wearability of the masks that I have.

Our president is banking on social distancing to eliminate coronavirus in the United States, however so, so much more still needs to be done! Why aren’t factories churning out ventilators? Why doesn’t every person in America have masks and personal protective equipment? At least, if they don’t want to use it or wear it, it still should be made available to everyone, and in plentiful rather than limited supply. More testing for the coronavirus still needs to be done on a greater scale, and people who have coronavirus should not be prevented from being admitted to hospitals, and instead, be forced to stay in self-quarantine.

That’s all just not good enough. That’s not America. That’s not the United States that I know – doing less than the bare minimum in the hopes that our country will get through this. It’s not enough to just get through it. It’s not enough to just have faith – we need intelligent action, too. We should be putting absolutely all of our efforts into eradicating this horrific virus rather than allowing an inept federal administration to continue contributing to the deaths of so many people as a result of delays, denials, and inaction. This is a killer virus not to be taken lightly. In short, more needs to be done to stop the Wild West of the coronavirus!

American Mental Healthcare Facilities are Woefully Unprepared for Coronavirus

Protecting Against Coronavirus 3-30-20

My Coronavirus Gear

I work as a counselor at an acute mental healthcare facility in the Southeastern United States. I love what I do, but what I’ve observed during the past one month is that acute mental healthcare in the United States is woefully unprepared to tackle the coronavirus. Mental healthcare is something that we’re not hearing much of anything about during this crisis because of the focus on medical care, though protective precautions for patients and employees in the mental healthcare industry – particularly acute, long-term, and residential facilities – must be addressed and improved.

On Friday, March 6, 2020, I began wearing my own N95 masks – that I bought from eBay sellers – to work. I paid a high price for the masks, but it was worth it. I was the first employee (to my knowledge) to wear any type of mask at my place of employment, due to my own coronavirus precautions. Beginning on Friday, March 20, 2020, I also added cotton gloves to my arsenal of gear, also purchased from a vendor on eBay. Keep in mind that I’m not sick, and I’m doing whatever possible to stay that way with having to go to work.

Medical and healthcare policies toward protecting patients and staff from potential coronavirus exposure and infection need improvement in American mental health facilities. Only last week did my facility begin requiring employees to get temperature checks before entering any units. Each person is on their honor to now do their own temperature check and log the correct temperature. No medically-qualified staff are present when this occurs, nor to confirm the results. It may also be a good idea to have staff check their temperatures prior to leaving work, as well, though that has not yet been required.

Patients coming into my facility from other hospitals are generally already wearing masks that they’ve gotten from the previous facility. Only last week did my hospital begin supplying surgical masks to those patients and staff who ask for them. My understanding is that there is a low supply. More and more staff during the course of the past one month are wearing masks, including a few wearing N95 masks, and the majority wearing surgical masks. I would estimate, however, that not even one-quarter of the staff who work at my hospital during the day are wearing masks.

Yesterday, I wore an N95 mask for 14 hours. I wore it for 8.5 hours at work, and also for the rest of the day, including at home. I would ordinarily only wear the mask while at work, but yesterday, I was exposed to a staff member who was exposed to a patient at his other hospital who is in serious, if not critical, condition due to the coronavirus. I did inform two supervisors about it, and I wiped my department office down with Lysol since this colleague was also using my desk. Today, my work colleague got tested. When I checked-in with him, he stated to me that he has to wait 5-7 days for results and stay quarantined for 14 days. There was also a patient on the unit I was assigned to who was sent out to a medical hospital, yesterday, due to potential coronavirus symptoms. So, while I wasn’t exposed to that patient, I was exposed to staff who were exposed to that patient. Thankfully, I wear my mask and gloves at work for everything except eating and drinking, so I hope I’m safe from being infected.

Today, I’ve already worn the same N95 mask for 12 hours that I wore yesterday. I’m taking precautions to protect my family in case I have the coronavirus. I also washed in the laundry today three pairs of cotton gloves that I’ve been wearing – while also continuing to wear another pair. I figure that if I have coronavirus symptoms, they’ll start to appear within about three days, from what I’ve read. By Wednesday evening, I should know one way or the other.

Of course, I’m also doing social distancing, both at work and at home, while also wearing my mask and gloves. I’m also doing my laundry after work, as well as running the dishwasher to keep dishes clean. In the shower, I’m using latex gloves and I’m not keeping my soap in the soap dish, so no one else uses it. I’m also wearing latex gloves while cooking for my family. Hopefully, all of this will help prevent this ravaging virus from infecting me and my family!

I’ve been saying for weeks at work that everyone – including patients and staff – needs to wear masks. At my facility, that has not been encouraged to say the least, though I hope it will be in the near future for everyone’s protection. Everyone in facilities throughout the United States needs to wear masks, and if they’re not already wearing gloves, to wash their hands often and sanitize their areas as much as possible. We don’t know everything there is to know about this virus, though what we do know is scary and tragic. Too many people have already been lost to this horrible pandemic. People in the United States – and around the world – need to take coronavirus much more seriously, including mental healthcare professionals – for our own welfare as well as that of everyone we treat!

 

“Completed Suicide Risk Highest Within First Six Months After Incomplete Suicide” (By: Michele Babcock-Nice)

Child mental health is becoming an area of ever-increasing concern and research, including within the area of child sexual abuse, depression, anxiety, suicidality, and bullying that lead to suicide.  Recently, within the past two months, I had opportunities to visit a large metropolitan hospital in Atlanta at which mental health care is provided on an inpatient and outpatient basis for people of all ages.  I primarily made observations in the children’s mental health unit in which children from ages 4-12 were hospitalized as inpatients.

Since making my observations, I have done much research in the area of medicine and counseling related to depression, anxiety, suicidality, and bullying that ultimately ends in the suicide of the victim.  I have also consulted with many professionals in these areas, including pediatricians, psychiatrists, psychologists, and licensed professional counselors.  Further, I have communicated with school teachers, school administrators, school mental health professionals, school system administrators, and religious about these issues.  This blog article will share some of what I discovered related to these critically important issues in mental health care.

At the hospital in Atlanta at which I made my observations regarding inpatient child mental healthcare, the most significant part about it that was very noticeable was that most of the children were boys.  On one particular day, there were 16 children housed in the unit, and 12 of them were boys, with the majority of the boys being African-American.  Of the girls present, the majority of them were Caucasian.  It was also my understanding that the majority of the boys were hospitalized due to suicidality (and/or other mental health concerns related to it, such as depression, anxiety, and/or sexual and/or physical abuse or neglect).

To me as an untrained observer, I found this to be very significant because my personal expectation was to observe there to be a greater number of girls than boys present in the unit.  Because there were significantly fewer girls than boys present in the unit over a period of several days, it became important to me to understand the reasons for it.  I got to thinking about several possibilities to explain this reality.

Perhaps girls are more open about their feelings and experiences, and/or a depressed or otherwise upset mood in girls may be more visible to others.  Perhaps boys are keeping their feelings too much to themselves due to the societal and cultural expectations for them to “be a man,” and thus, not to show their feelings.  Possibly, adults were unable to recognize signs of suicidality or depression in boys compared to girls.

Further, it may be possible that adults did not view boys’ depression or suicidality to be as serious as that of girls until a crisis point was reached.  Culturally, it is also significant that most of the children housed in the unit were African-American boys.  Specifically related to cultural or ethnic differences, I do not yet have particular potential explanations for this.  Additionally, perhaps there are other general explanations and reasons that I have not thought of for there being significantly more boys in the unit than girls.

As I stated previously, since the time of my observations of the children’s mental health unit in the metro Atlanta hospital, I have researched several issues relating to child mental health, and I have consulted with many professionals in the field.  In a study completed by Cynthia R. Pfeffer (2001, p. 1057), she stated that during prospective follow-up into adulthood of children at risk for suicide showed that a “history of sexual abuse (RR: 5.71, 95%; CI: 1.9-16.7) imparted the greatest risk” for it.  Reading this was saddening and disheartening for me because it appears that most suicide attempters and commiters have internalized their pain and suffering, are taking it out on themselves, and appear not to be able to successfully cope.  They were hurt, have lost hope and trust, and are now hurting themselves, possibly in efforts to make the painful memories disappear.  For them, suicide seems to be the only answer for removing and escaping the emotional pain.

In a study by Stanley, Brown, Brent, Wells, Poling, Curry, Kennard, Wagner, Cwik, Klomek, Goldstein, Vitiello, Barnett, Daniel, and Hughes (2009, p. 1005), the researchers reported that individuals who attempted incomplete suicide are at the greatest risk for repeat attempts and/or actually committing suicide within the first six months following the incomplete attempt (as this study particularly relates to adolescents, aged 13-19 years old).  This is extremely important to understand because those who are untrained in this area do not understand the seriousness or severity of it, or are, perhaps, in denial that the situation is serious or severe.  Regarding children, I believe this particularly applies to those in education, including teachers, administrators, and other staff because they are not equipped with the knowledge and understanding about the manner in which to best support students who have been suicidal.

And sometimes, those adults in education who are bullies toward children truly have absolutely no understanding or compassion toward students who made an incomplete attempt at suicide because they simply do not seem to care.  In fact, those type of adults may even do more damage to the child through their insensitivity and failure to understand the situation by being even more punitive or retaliatory toward the student because the issue is one with which they, themselves, are unable to successfully cope.  It remains easier for such adult bullies of students in education to bully, blame, and revictimize the student victim.

Also unhelpful are the student peer bullies with whom the suicide attempt survivor must cope.  Student peer bullies of the victim seem to bully the survivor even more because they are aware of the emotional vulnerability of the survivor, and they capitalize on that because it makes them feel good.  Therefore, in a school environment in which bullying goes unchecked, unresolved, and not corrected, suicide attempt survivors are at an even greater risk for a future successful suicide attempt because they experience bullying from adults and peers.

Additionally, O’Connor, Gaynes, Burda, Soh, and Whitlock (2012, p. 15) reported in their study that “psychotherapy did not reduce the risk for suicide attempts in adolescents in contrast to adults.”  They (O’Connor, Gaynes, Burda, Soh, and Whitlock, 2012, p. 11) further reported that “psychotherapy did not reduce suicide attempts in adolescents at 6 to 18 months” into a suicide prevention treatment program.  They (O’Connor, Gaynes, Burda, Soh, and Whitlock, 2012, p. 11) also stated that “psychotherapy had no beneficial effect on suicide ideation beyond usual care” in adolescents.  These findings are shocking, disturbing, and disheartening, particularly when there may be the extant societal belief that counseling and psychotheraphy benefit individuals with emotional disturbances and/or self-destructive ideations.  If psychotherapy is not beneficial to adolescents who have attempted suicide and/or who have suicidal ideation, what benefit is psychotherapy to children who have had similar experiences and/or beliefs?

A professional friend of mine who is a psychiatrist provided me with an article written by a women who is a sexual abuse survivor, and who was hospitalized on three occasions throughout her life due to depression and suicidality related to her traumatic experiences.  The article, “How ‘Person-Centered’ Care Helped Guide me Toward Recovery from Mental Illness,” by Ashley R. Clayton (2013), was extremely helpful to me in better-understanding what is going through someone’s mind when they are hospitalized for a mental health crisis.  The article was further assistive to me because, as a graduate student in counseling who is working on my second master’s degree, it was important for me to perceive and understand the great value of Person-Centered Therapy in counseling suicide and sexual abuse survivors.

Because so much hope and trust has been lost in survivors of sexual abuse and suicide, it is obviously critically important for others, including mental health professionals, to be as sensitive and supportive as possible of them.  The author shared that she experienced the greatest improvement through the person-centered approach and caring relationship that a particular nurse developed with her.  This is something important for me to remember and put into practice in my own counseling of trauma survivors.

Further regarding children’s mental health in relation to surviving trauma and suicide attempts, as well as those areas in relation to children’s school attendance, I spoke with two pediatricians regarding the issues.  Both pediatricians took the issues seriously, however, they did not desire to take responsibility for children who were suicidal because they stated they were not trained or highly-experienced in those areas.  Both pediatricians also desired for parents to work with the expectations of schools, even though such expectations, stresses, and pressures may be too overwhelming for some children.  Regarding the experience of child sexual abuse, both pediatricians believed that counseling was needed for child survivors, however they both believed that medication to manage the child survivors’ moods were necessary as long as they believed the child was “functioning.”

For me, the perspectives of both pediatricians – both of whom are Caucasian women with many years of experience in pediatrics – were discouraging in many areas.  First, both doctors appeared to be very quick in the desire to refer suicidal patients to other medical professionals.  While that has advantages and disadvantages, it places those at risk in the position of believing that their doctors are unable to properly care for or understand them.  Both also believed that child survivors of sexual abuse need not be medicated if they were “functioning.”  I believe that it is one thing to survive, and quite another thing to thrive.  Merely “functioning” is not fully living or thriving, to me.  And also, both pediatricians appeared to also be too quick to go along with schools’ expectations for students, including maintaining the same academic and/or disciplinary standards for students who are trauma survivors.  As an individual who is an experienced teacher, I know that students have different learning styles; placing everyone in the same category is detrimental to those who have suffered trauma.

Both a psychologist and a licensed professional counselor (LPC) with whom I consulted about difficult, damaging, challenging, and/or overly stressful and overwhelming school experiences of child trauma survivors both believed that people in education are or may be unable and/or unwilling to change in a manner that is more supportive, understanding, and compassionate toward them.  The psychologist believed there is not likely any school that would be able to meet the needs of a child who is a trauma survivor.  And, both the psychologist and the LPC believed that schools are part of the problem in not successfully supporting and understanding trauma survivors and their needs.  Those who are in education – perhaps including school counselors and school psychologists – may be unequipped in schools at being able to fully or successfully support children who are trauma survivors; this can and does have devastating effects on such children.

Of all those in the medical and mental health fields, I believe those who are most fully trained and equipped to successfully both treat and understand trauma survivors – in particular, those who have experienced sexual trauma, depression, anxiety, and suicide attempts – are psychiatrists.  Psychiatrists are in the best position to provide urgent and necessary medical and mental health care to suicide attempters, including hospitalization, evaluations, medical care, and medications.

I assume that the psychiatrists are those who most often see patients who are suicide attempters; and they see them at their lowest points, emotionally.  Therefore, psychiatrists who truly have what is best for their patients in mind seem to help suicide attempters and trauma survivors become stabilized and recover as quickly as possible.  Psychiatrists are in a wonderful position with their patients to be supportive, understanding, and compassionate; and to inform and educate society, in general, about the medical issues and needs experienced by suicide attempters and other trauma survivors.

In communicating with several people who are education professionals regarding survivors of sexual trauma, suicide attempts, and bullying (both by peers and adults in school), I have largely encountered  biases against the survivors, as well as an incredible absence of sensitivity toward them.  Such refusals of understanding, sensitivity, and compassion toward survivors by the majority of education professionals with whom I communicated can possibly be attributed to a lack of or refusal toward being educated and informed about the needs of the survivors.  Such outright insensitivity by the education professionals – the majority of those who were insensitive toward survivors were administrators – could also be attributed to a denial about the seriousness or severity, or fear due to stigmas or the unknown, regarding the issues related to survivors.

In some situations of communicating with administrators, upper administrators, and school psychologists of schools and school systems related to student survivors of sexual trauma, anxiety, depression, suicide attempts, and bullying, I also encountered not only insensitivity and a lack of understanding toward the survivors, but also inconsistencies in their behaviors toward them.  In most school and/or school system administrative personnel and school psychologists with whom I communicated, I encountered adult bullying by them toward the child survivors that was sadistic.  In such education professionals, it appeared that their incredible harshness toward the survivors was something that they wanted to occur, regardless of the outcome or effects that may or may not have resulted in actual suicide.

In other situations in communicating with education professionals about such survivors, however, I encountered empathy, compassion, understanding, and sensitivity toward them.  Such supportive actions were those exhibited by other particular school system administrative personnel and/or educators and counselors.  Such desparities in the treatment of survivors by various school personnel reflects that education professionals must be on the same page in order to consistently understand and support, as well as be compassionate and sensitive toward survivors.  This appears to be direly and desperately needed in education in order that students who are trauma and suicide attempt survivors receive the greatest possible support and understanding in their educational environments.

Therefore, it was personally extremely shocking and disturbing to me in a life-changing manner that some of the very leaders of schools and school systems not only do not support said survivors, but are actually bullying and sadistic toward them.  In these situations, I believe it would take not less than a miracle to convince such individuals to even consider a different and more positive and understanding perspective toward said survivors.

In regard to particular religious leaders with whom I have communicated about issues related to survivors of child sexual abuse, anxiety, depression, suicide attempts, and bullying, I have – thus far – experienced their compassion, kindness, and prayers toward survivors.  I have also learned, however, to carefully choose which religious to approach; not all religious are as understanding and supportive as others.  And, I am further aware that there are those religious who would take such information and use it against the victims and/or survivors in order to revictimize them.  Presently, however, that is not what I have experienced in my recent and present communications with particular religious about these issues related to survivors; and I am thankful for and relieved about that.

I believe that society has come a long way in supporting and understanding the experiences and needs of trauma survivors, including those who have experienced sexual abuse, depression, anxiety, trauma, bullying, and suicide attempts, however there is still much more progress to be made.  Those who best-recover from traumatic experiences are those who have positive, stable support in their lives.  Stressful and overwhelming situations are serious set-backs that only cause them to regress, and to continue not to hope or trust.

It is so critically important for sexual abuse survivors and suicide attempt survivors to have the consistent and unconditional support of those around them, including family members, community members, those who are in education, and others.  Without such support, compassion, and understanding – and, in fact, if the survivor experiences the opposite of those – he or she could make a future suicide attempt that is successful.  Such tragedies are avoidable and preventable if everyone practiced more patient, respect, appreciation, and compassion toward each other, particularly trauma survivors who have attempted suicide.

References

Clayton, A.R. (2013).  “How ‘Person-Centered’ care helped guide me toward recovery from mental illness.”  Health Affairs, 32 (3), pp. 622-626.

O’Connor, E., Gaynes, B.N., Burda, B.U., Soh, C., & Whitlock, E.P. (2012).  “Screening for and treatment of suicide risk relevant to primary care.”  Annals of Internal Medicine, pp. 1-22; pp. W-1 – W-5.

Pfeffer, C.R. (2001).  “Diagnosis of childhood and adolescent suicidal behavior: Unmet needs for suicide prevention.”  Society of Biological Psychiatry, 49, pp. 1055-1061.

Stanley, B., Brown, G., Brent, D.A., Wells, K., Poling, K., Curry, J., Kennard, B.D., Wagner, A., Cwik, M.F., Klomek, A.B., Goldstein, T., Vitiello, B., Barnett, S., Daniel, S., & Hughes, J. (2009).  “Cognitive-Behavioral Therapy for suicide prevention (CBT-SP): Treatment model feasibility, and acceptability.”  Journal of the American Academy of Child and Adolescent Psychiatry, 48 (10), pp. 1005-1013.