Leading During an Emergency
Think about the behaviors you model for self-care and workplace mental health. What would you change? What would you keep? Respond to one other person with a probing question or constructive comment regarding what they would "keep" or already do well.
Personally, I went back to therapy because things were getting so bad in terms of stress/ anxiety/ burnout/ and just so. many. feelings. I did this during work hours (at the end of the day) so I didn't cut into personal time. I was open about where I was with work because I think normalizing therapy is really helpful for creating a culture of self-care.
Before I address the self care question, I am going to go on a tangent: In 2020 I accepted a full time role in our COVID program with the ability to move back to my old position whenever I wanted. I had planned to stay until at least July 2024, but my mental health was diminishing and I was losing patience with our leadership. In 2021 our leadership began discussing mental health as a priority and expressed that they were working on plans to support us, however I never saw much of a change and ultimately decided to leave my full time roll in the COVID program. The mental health plans that I have seen include 4 hours of mental health leave yearly, access to debriefing sessions with other colleagues, and promoting an in house therapy program that already existed. This is good (not great), but the biggest impact on mental health that I experienced and witnessed was with boundaries and demands from our leadership for things that were claimed to be urgent, rarely were. Over a year later, my colleagues in the program are still struggling to see progress. They are still getting late night and weekend "urgent" calls and texts. They never get a break from the pressure, which is only exacerbated by working from home.
For my own mental health/boundaries (working in and out of COVID), I schedule an hour into my day for a workout (I don't always take it, but it's there). I also block off "focus time" when needed. I admittedly eat lunch at my desk everyday, only b/c we don't get paid lunches and I would rather finish work early than take a lunch. I DO try to step away in other ways though so I am not at my desk all day with no breaks.
One more thing I've been trying to implement is ending meetings 4 minutes before the end of the blocked time. I spoke about it to Senior Managers. I don't think anyone else is *trying* to do this, and I fail more than I succeed. But I am thinking about it so that I don't always just *fill* the hour.
The morning time is super helpful also so that no one tries to sneak in an 8am meeting without me realizing until it's too late, lol. The intent of it originally was for me to try to rapid respond to all the emails from yesterday that weren't urgent, so that I could basically do them on my own time rather than at the whim of the sender. It worked really well in those days of mayhem but now things are a bit slower so it's not quite as necessary. We're mostly back in the office now so it's also a time I use to touch base with coworkers, visit other people who are in the office that day (we're hybrid) and try to reconnect with staff- it's nice to know it's somewhat protected from meetings, etc and I can sort of ease into the day on my own terms.
As for mental health protections I am curious if anyone has seen/heard of strategies that actually work for staff. When we were at the EOC for the first 6 months of COVID they had an onsite person from our state mental health agency, but from the epi staff I talked to who paid her a visit they either said that she was largely useless or they felt uncomfortable opening up because she was still within the state system (as opposed to a private therapist with no ties to the state) and could also be working with the person(s) they wanted to complain about, lol. I have seen on site therapists as a "strategy" suggested for help with emergency response, but in our experience it didn't work too well in DE from my understanding.
ERICA E. SMITH, PhD, MPH
Deputy State Epidemiologist
(she/her/hers)
Delaware Department of Health and Social Services<http://dhss.delaware.gov/dhss/index.html>
Division of Public Health<http://dhss.delaware.gov/dhss/dph/index.html>
Jesse Cooper Building
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Office: (302) 744-4737
erica.smith@delaware.gov<mailto:erica.smith@delaware.gov>
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I think we are talking about two separate things - what we can do as individuals and how our workplace systems are structured to support mental health for us (and our teams). I find the "self-care" model to be challenging, in that the pressure to implement it is carried by individual alone, and often within a unsupportive or challenging workplace system. I'm seeing some excellent examples of the ways you all have been able to incorporate self-care into your routines by blocking off time, blocking off lunch hour, meditating and journaling.
I am fortunate that Washington State Dept of Health has tried to prioritize mental health of staff during the last two years - offering up to 3 therapy sessions through our Employee Assistance Program, incorporating a psychologist to talk through trauma response during regular statewide COVID-19 meetings with local health jurisdiction and WA DOH staff, allowing staff to use sick time to take personal vacation (mental health days), and partnering with University of Washington to bring in psychologists to talk through resilience and burnout. Even with these supports, there are ways that we could have done better, and many staff have burned out and left.
To support my own and my team's mental health, I try to find the space(s) that I can control. While I can't change some of the WA DOH policies or some leadership styles that put too many expectations on staff, I can control how I talk about self-care and create a system for my team (12 epi and health service consultant staff). I model self-care by taking vacation and turning off my phone, minimizing how much I work at night. I try to create a supportive system by talking with staff about their work load and prioritizing tasks together during regular check ins, building a team space where people feel safe bringing up challenging situations, intentionally leading discussion about burnout and self care during team meetings, and outlining for staff the ways that WA DOH can support them in their self care and mental health.
Thanks to everyone for sharing their experience and ways that they practice self-care. It's helpful to read through and validating for me.
I try to manage others' expectations for what my team is capable of and what their different expertise should be used for. I also manage my teams' internal expectations of how far they need to go with any given situation and that it's okay to not do someone else's job for them if they're not doing it well. As a group I think government public health people lean to the selfless and "help out wherever it's needed" side of the spectrum which comes back to bite us when it's taken advantage of.
Here's my most recent selfcare win: During a particularly busy phase of the monkeypox response I was taking afterhours call. I didn't sleep Monday night (I actually got paged about a goat bite at 5am which I'm still grumpy about) and barely slept the next two nights. Thursday night I didn't get any calls but I didn't sleep anyway because I was so anxious about getting called. I recognized that this was what I experienced in my previous career and that being so anxious that I couldn't sleep was going to end badly. So I did this miraculous thing that I never do - I asked for help. Our branch chief took the rest of my nights and I kept my days and slept soundly. I'm grateful that she took my concerns seriously and jumped in to help, but I'm also worried about what stresses she's under that she pushes to the side to make sure her team is staying healthy!
I love the idea of making a difference where you can. Our systems are so slow to change when it comes to mental health and that's piled on top of the bureaucracy of government work. Working within the system can be so frustrating but it's so important that we don't feel responsible for fighting the battles that we're not equipped to win.