COTTAGE GROVE, Minn. — The coronavirus pandemic had a profound impact on Emily Allen.

“COVID has completely changed my life,” said Allen, a nurse from Cottage Grove who spent a year working with coronavirus patients. “My god, has it left me with some scars. I pray one day they will heal.”

For many frontline medical workers and caregivers, the coronavirus pandemic is far from over — and it’s taking a dire toll.

Recent studies from the Centers for Disease Control and Prevention, Kaiser Family Foundation and other groups have found that during the pandemic, more than half of health workers have experienced adverse mental health symptoms — ranging from stress and exhaustion to depression, anxiety and even thoughts of suicide.

Those symptoms can often be exacerbated by concerns over their physical health and that of their families because of exposure to COVID-19.

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It’s a national, even global, struggle and health officials, advocates and workers say it is having an impact here in Minnesota.

Allen was a nurse in two COVID-19 intensive care units in St. Paul, first at St. Joseph’s and then at Bethesda Hospital. “I saw the sickest of the sick, unfortunately,” she said.

Patients young and older we constantly fighting for life. Some lost the battle.

“The mental toll it has taken on me and several of my colleagues has been something … I never thought I’d be here and feel the way that I feel,” she said. “It gets to the point where you feel helpless.”

Eventually, Allen sought counseling and was diagnosed with post-traumatic stress disorder. She’s speaking about her experiences to encourage others with similar problems to seek help.

“I don’t want people to feel sorry for me,” she said. “I needed help and I got it.”

But Allen says it shouldn’t have been as hard as it was for her to get help. She feels the health care system doesn’t have enough supports built into it to help workers who face trauma daily.

During the pandemic, patients always came first, but self-care was often disregarded.

“If anything, we need to learn from our mistakes here,” Allen said. “It’s hard because you are so busy, with so many things, yourself is an afterthought.”

Access isn’t the only problem. Nicole Mattson, a vice president at Care Providers of Minnesota who is working to help long-term care workers access mental health services, says it can be hard to convince health workers they need help.

“What we have found is that health workers are not good at asking for help or accepting resources,” Mattson said. “They are inherently accustomed to putting other first.”

What workers are saying

There’s been a number of surveys by national agencies of groups of health workers and the impact the pandemic has had on their mental health. The findings have been largely similar with workers experiencing stress, exhaustion, burnout, depression, substance abuse and thoughts of suicide.

Here are more specifics:

  • The CDC found more than half of public health workers surveyed had experienced symptoms of adverse mental health conditions. Symptoms included depression, anxiety and PTSD with a small number experiencing suicidal thoughts.
  • A survey by the Kaiser Family Foundation and The Washington Post found 62 percent of health care workers surveyed said the stress of working through the pandemic had a negative impact on their mental health.
  • Mental Health America found 75 percent of health workers surveyed experienced physical and emotional exhaustion and burnout on the job. The same percentage worried about infecting their children and family members.
  • Another CDC survey found 70 percent of parents and unpaid caregivers of adults had mental health struggles.

What are the causes?

Sue Abderholden, executive director of the National Alliance on Mental Illness-Minnesota, said the pandemic was a taxing event for nearly everyone. Worry, uncertainty and upended routines were hard for people across the board.

“We all just went through a pretty traumatic experience,” Abderholden said. “We are all in the same ocean, just in different boats.”

Yet, health workers were dealing with unprecedented sickness and death on top of the typical pandemic struggles.

“For them to keep going there and to be experiencing these deaths and doing everything they can, not really knowing how to best help people. That’s just really tough,” Abderholden said.

She noted that the pandemic had a more severe impact on communities of color, including those who work in health care — including on their mental health. It’s another reason the state needs to do more to diversify the ranks of its mental health caregivers.

Dr. Ruth Lynfield, state epidemiologist for the Minnesota Department of Health, said misinformation, threats and bullying have also taken a toll on health workers. The CDC survey of public health workers found a quarter of respondents felt threatened in some way because of their job.

“We are used to being under the radar,” Lynfield said of public health workers. But suddenly, they were under intense scrutiny from the public, who often didn’t like the outbreak mitigation strategies they were recommending.

“It’s hard when you are tired and burnt out. You don’t have the same fortitude,” Lynfield said. “We know ways to decrease the transmission of this virus. It’s hard when there’s people who just don’t care.”

What can be done to help

Kathryn Como-Sabetti, the COVID-19 epidemiology section manager at the state Department of Health, said one thing the pandemic made clear was that many public health operations lack adequate resources to respond to a widespread pandemic.

The state reassigned hundreds of workers to aid in the pandemic response. Smaller county agencies didn’t have that luxury.

“The scale of this was so much larger than we ever imagined,” Como-Sabetti said. That can make it hard when a staffer needs to take time off to deal with personal issues.

“I think what was hard for people when they say they have to step away is they worry they’re causing more stress for their colleagues,” she said.

There are similar challenges in long-term care, an industry that was already struggling with low pay and worker shortages before the pandemic. Mattson, of Care Providers of Minnesota, said it is time society re-evaluates the importance of the services caregivers provide.

“Care work allows for other work,” she said. “There needs to be a re-evaluation of what it means to care for our caregivers.”

The Minnesota Legislature recently approved new funding to shore up the ranks of long-term care workers. There’s also a working group that will decide how to divide $250 million in “hero pay” to frontline workers.

Health workers have called both efforts a “good first step,” but note that much more needs to be done.

Employers also are working to make mental health care and other resources more readily available. Some are establishing “personal harbor” spaces with on-call counseling services. Others are using smartphone apps to regularly screen workers to see if they need help.

Yet, Abderholden says employers also need to do a better job communicating to employees the resources that are available. Many workers may still feel they will face discrimination if they are open about their need for mental health treatment.

Additionally, Abderholden says she hopes the pandemic, and the challenges it brought, will bring a better understanding of mental health care and those who may be struggling.

“Truly, I think there are very few people that didn’t experience a day or two or more of being depressed or anxious about the situation,” she said. “I’m hoping there’s far more empathy going into the future.”