Lisa CarlsonAPHA President Lisa M. Carlson, MPH, MCHES, writes about today's National Public Health Week theme, mental health, and its connection to COVID-19. Carlson is co-hosting a special members-only APHA Town Hall on COVID-19 on Tuesday, April 7, from 4-5 p.m. EST. Register now for the live event.

The ongoing COVID-19 pandemic has created enormous challenges for the protection of public health. From supply shortages and infrastructure gaps to the frightening and sometimes life-threatening symptoms of the disease, the physical aspects of this crisis are many and visible. 

No less critical is the toll on mental health, with the potential to impact everyone as a result of illness, economic stress, fear, scarce resources, disrupted routines and the grief of these experiences.

First responders, health care workers and public health professionals, who are confronting the challenges of this crisis daily, are under enormous strain. We are faced with a stressful time of unknowns. This is a critical point for public health to address mental health. When we talk about COVID-19, we must acknowledge its impact on mental health broadly.

CDC guidance acknowledges that “everyone reacts differently to stressful situations.” Even so, feelings of fear and anxiety are common, even the norm, during a pandemic and can erode our mental health. For responders and public health workers, the emotional toll can include secondary traumatic stress reactions. 

In a study in JAMA Network Open, health care workers in China reported “striking” levels of symptoms of depression, anxiety, insomnia and psychological distress. “Protecting health care workers is an important component of public health measures for addressing the COVID-19 epidemic,” wrote the researchers, who called for interventions to promote mental well-being.

As a first step, we should all be aware of symptoms of stress that can be heightened by COVID-19. Those can include feelings of fear, worry, numbness or disbelief; changes in appetite; difficulty sleeping, concentrating or remembering; frustration; physical reactions, such as headaches or increased tension and pain; and increased use of alcohol, tobacco or other substances. 

The most important thing we can do — as public health professionals and advocates, and in our families and communities — to address mental health is to talk about it. Self-care for public health workers and others includes:

  • Asking for help if you need it.
  • Taking breaks from the news, avoiding media focused on hype and getting the facts from trusted sources such as APHA, the Centers for Disease Control and Prevention and the World Health Organization.
  • Taking care of yourself by focusing on the basics. Eat healthy meals, get plenty of sleep, avoid alcohol and drugs, take deep breaths and exercise regularly. Remember to move throughout the day.
  • Creating structure for your days. Maintain routines, such as morning rituals and activities you enjoy.
  • Making time to disconnect, wind down and rest.
  • Taking reasonable steps to protect yourself, such as washing your hands often and disinfecting commonly used surfaces.
  • Connecting with your community to stay grounded. Call a loved one. Have a meal with family or friends by video conference. Wave to your neighbors. Spend time with your pet.
  • Getting out into nature.

These last two points are critical in a time of widespread isolation. Maintaining emotional connection, even while physically distant, and experiencing the natural world can provide relief from the stress and anxiety of responding to COVID-19. 

During emergencies, such as floods or wildfires, “we are called on to come together,” wrote Jason Mark, editor of Sierra magazine, in March. “Now, we’re being called on to stay apart. 

“Yet even as we must distance ourselves from one another to protect public health, nature remains one place where we can find a feeling of reconnection,” Mark wrote.

Our natural spaces are sacred spaces. Getting outside to breathe fresh air, see the sun rise and feel the breeze can be centering experiences that are vital to our mental wellness. There is evidence that time in nature mitigates a variety of critical physical and mental health challenges, including anxiety. 

The downstream consequences of chronic stress during this crisis are likely to linger for health workers and beyond. Public health professionals can make a difference by including mental health in all public health policies in general, and especially related to COVID-19. 

Every time we talk about public health, every time we talk about COVID-19, we need to mention mental health. Public health depends on it.