As a child survivor of the Holocaust and former refugee, Dr. Frank Sommers has what he calls “indelible emotional scars.” His work as a psychiatrist has led him to explore the psychological damage inflicted by disasters of any sort.
Dr. Sommers is a member of the University of Toronto’s Faculty of Medicine. His career has ranged from private practice in psycho-sexual therapy to work with the Queen Street Mental Health Centre in Toronto and to military psychiatry service in Afghanistan while deployed with the Canadian Forces. He’s the founding chair of Disaster Psychiatry Canada in the Department of Psychiatry and has organized five annual Psychiatric Dimensions of Disasters CME training events dating back to 2018.
He shares some thoughts on the toll disasters can take on the public and health-care workers and how one can regain their psychological footing.
“This has been a prolonged stress and is not yet over.”
OMR: We’ve seen disasters of various extents over the years across Canada, from wildfires and floods to violent attacks and now COVID-19. The physical damage is always evident. What have we learned about the psychological damage of mass-scale disasters through the pandemic?
Dr. Sommers: Disasters have been part of human history forever. But for many people this is a first instance (with COVID-19). This has been a prolonged stress and is not yet over. The newness of this experience in many people’s lives, including many doctors, puts a burden on understanding the personal, societal and organizational costs that this kind of massive illness imposes on our common humanity.
The number of adults presenting for mental health help and number of antidepressants prescribed has significantly increased. Teenagers, who have no or little experience with disasters in most cases, have had over a 17 per cent increase in the use of anxiety medications in the first few years of the pandemic. The conditions being treated are worse than many mental health practitioners have experienced before.
OMR: How prepared has the medical community in Ontario been to respond to the psychological impacts of disasters?
Dr. Sommers: We have not paid particular attention in any organized way to deal with mass casualty events. We have been learning on the fly. A significant issue has been our colleagues’ mental health. They’ve been called upon to do extraordinary work in very difficult circumstances. This has been an extra burden on our already burdened health-care worker population.
OMR: Within society and the health-care system, has the pandemic opened our eyes to the urgency to respond to disasters in every way, including the psychological dimension?
Dr. Sommers: This is not yet happening to the extent that it should. Many people are having difficulty accessing appropriate mental health care and suffering with a sense of isolation, significant life alteration, uncertainty and, in many cases, grief. A lot of people have been traumatized, and I’m not sure we have fully processed that yet.
OMR: Are you confident about the system’s capacity to care for them?
Dr. Sommers: I’m hoping that with creative minds and dedication, we’re going to find ways of reaching out and expanding mental health care.
OMR: What kind of role can remote or virtual care play?
Dr. Sommers: That’s a major step forward because we’re able to connect with our patients more readily, more easily and at less cost. This is an evolving process and the brushstrokes are only coming into view in a faint way. We still have a ways to go.
OMR: The psychological fallout from disasters can linger for years, but not always, and not for everyone. What’s the most encouraging thing you have learned about how people can improve their mental health post-disaster?
Dr. Sommers: The hopeful sign in terms of the recovery phase from disasters, including this pandemic, is that the vast majority of people actually find ways of coping.
OMR: Within the health-care system, what are some of the protective factors?
Dr. Sommers: Having an organization that is supportive, having leadership that is sensitive to the extra burdens that the front-line health-care workers are facing, including moral injury, and being aware and dealing with aspects of compassion fatigue.
“Primary care doctors have an enormously important role, because they are the entry point for most people’s health care.”
OMR: That can help with personal and organizational resilience. More broadly, what defines a resilient community in the wake of a disaster?
Dr. Sommers: Community resilience is of course related to the resilience of the individual. In terms of community-wide resilience, it is very important that there be an element of cohesion. That can be reinforced by the means of communication within the community, and the leadership provided to that community. So, this involves political leadership from the top down, knowledge about appropriate messaging and fostering a notion that we indeed are in this together. We need to support one another in this difficult time. Establishing functioning networks before disasters helps us to cope better when disasters do happen.
OMR: No matter their specialty, what role can physicians play in the well-being of people affected by disasters?
Dr. Sommers: Primary care doctors have an enormously important role, because they are the entry point for most people’s health care. Many patients are reassured by the ability to reach their health-care provider. Conversely, if they can’t reach their provider that raises anxiety enormously. So, a very important and seemingly simplistic statement about this: you have to make yourself available to your patients.
Then, you need to also have sufficient knowledge of the psychological elements of dealing with anxiety, stress and grief, to provide at least primary care modes of helping people with these very significant yet common emotions. This may go beyond reaching for your prescription pad. Talking with empathy is rather important but listening mindfully is probably even more important.
Stuart Foxman is a Toronto-based writer.
Physicians know all about COVID-19 precautions, yet they’re far from immune against one of the pandemic’s biggest risks: the impact on their own mental health.
“A lot of studies have identified high rates of symptoms in health-care workers during the pandemic: anxiety, depression and post-traumatic stress disorder,” said Dr. Rima Styra, an associate professor of psychiatry at the University of Toronto, and a staff psychiatrist at Toronto’s University Health Network.
Dr. Styra was speaking at the Psychiatric Dimensions of Disasters virtual training course earlier this month.
Read more in the OMR online exclusive, Health-care Professionals Shoulder Mental Health Burden of the Pandemic.