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How nurses can combat mental health stigmas during COVID-19 and after

Jayne Gmeiner is the chief nursing officer at Dayton Children’s Hospital, and she is pictured leading the hospital’s incident command center, which is a group of employees who are crisis trained to lead internal and external efforts related to COVID-19, including operations, logistics, communications (staff and media) and more. Gmeiner, along with Dr. Adam Mezoff, chief medical officer, led the incident command center for 50 days due to COVID-19.

Every nurse encounters mental illness in the course of a working day, even those who don't work in psychiatric or mental wellness settings. In the coronavirus pandemic, mental health issues are even more prevalent, both in medical staff, the patient pool, and the general public.

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And the stigmas long associated with mental illnesses only complicate a patient's ability to seek or receive effective treatment, coronavirus or no. "There are many roadblocks in the path to psychological and emotional wellness," certified nurse executive Mary Sturdy-Martin explained in RN.com. "Chief among them is the stigma surrounding mental health conditions. Individuals and families are often reluctant to seek professional help because of the misinformation, sense of shame, and negative perceptions that surround mental illness."

When the world or the medical community attaches stigmas to mental illness, the results are destructive, according to the National Alliance on Mental Illness. "Because of stigma, those who experience mental illness are often labeled and seen as their condition—and nothing more," the science-based mental health advocate explained. "They are often held responsible for their conditions, expected to change their thoughts and behaviors, and avoided, isolated and ostracized... Living with a mental health condition is already challenging, and the added burden of stigma leads to tragic outcomes."

The onset of the COVID-19 pandemic has ramped up the incidence of emotional outcomes and unleashed new or recurring mental health disorders, making it even more essential to banish the stigma of mental illness. "During the COVID-19 pandemic, you may experience stress, anxiety, fear, sadness and loneliness. And mental health disorders, including anxiety and depression, can worsen," the Mayo Clinic explained.

» RELATED: The 5 most common signs of nursing burnout

According to an article from medical doctors Betty Pfefferbaum and Carol S. North recently published in the New England Journal of Medicine, a bunch of other stressors from the pandemic are contributing to "widespread emotional distress and increased risk for psychiatric illness associated with Covid-19." It listed a few of the most obvious, and said "uncertain prognoses, looming severe shortages of resources for testing and treatment and for protecting responders and health care providers from infection, imposition of unfamiliar public health measures that infringe on personal freedoms, large and growing financial losses, and conflicting messages from authorities are among the major stressors."

And while this wave of depression, anxiety, and other negative emotional outcomes is hard to witness and even harder to cope with, nurses are in a unique position to help reduce the stigma associated with mental health disorders. It's a lot to ask, since nurses are already stretched to the limit emotionally and physically. But taking a bit of extra time to alleviate shame or denial about the need for mental health assistance can ease symptoms and save lives.

While advocates from the World Health Organization to the authors of the NEJM piece are calling for systemic mental health training for nurses worldwide, there are more immediate steps you can take now, just in the course of working as a nurse.

RELATED: A silent epidemic: How to combat depression as a nurse

Here are some ways nurses can help reduce the stigma associated with mental illnesses and psychiatric disorders:

Understand how the stigmas act as a barrier to accessing treatment. "Just like physical conditions can escalate to serious health problems when they are unchecked, mental health issues can worsen when they go untreated," Sturdy-Martin added. "They fray relationships with family and friends, derail careers, and prevent people from leading fulfilling lives and doing the things they love to do. Those who struggle with mental health conditions may begin to internalize the stigma, causing them to become pessimistic and losing hope for their recovery. The stereotypes that people with mental illness are dangerous and to be feared also results in their social isolation. They may find themselves shunned by friends, neighbors, and family members."

Work on self-awareness of your personal bias. Sturdy-Martin said she asks fellow nurses and medical staff to consider their attitudes towards someone with, say, diabetes or cancer versus a patient with depression or schizophrenia. If you're aware that you consider mental illness as somehow being more self-inflicted or less worthy of treatment, you'll have a basis for improvement.

Discuss mental health freely to demystify it. Instead of talking about depression, anxiety, or bipolar disorders infrequently or in hushed tones, mention any mental health topics often and with confidence. It's important to "Get comfortable with discussing the topic to help others better understand mental health and the importance of seeking help for mental health conditions," Sturdy-Martin advised.

Use person-first language with patients and co-workers. "A person is not defined by a condition, and someone should not be addressed as such," NAMI emphasized. "A person experiences bipolar disorder—he's not bipolar. A person experiences mental illness—she doesn't belong to a group called 'the mentally ill.'"

Skip casual references to mental health conditions. "You shouldn't call yourself 'OCD' because you like to organize or say the weather is 'bipolar' because it keeps changing," NAMI emphasized. "This undermines legitimate diagnoses." At the same time, don't call even close friends or family members "crazy," "psychotic" or "insane," even if you're joking around or particularly exasperated. "For people going through challenging symptoms beyond their control, it can be very harmful to be labeled as 'crazy' on top of it all," NAMI added.

Skip the term "abnormal"; there's no such thing. "Referring to people experiencing mental illness as 'others' or 'abnormal' creates an 'us versus them' narrative," NAMI explained. "This can make people with mental illness seem inferior, different and as though they're the outliers of society—which they are not."

Let patients know their COVID-19 stress is normal. "On the milder end of the psychosocial spectrum, many of the experiences of patients, family members, and the public can be appropriately normalized by providing information about usual reactions to this kind of stress and by pointing out that people can and do manage even in the midst of dire circumstances," recommended the NEJM article. "Health care providers can offer suggestions for stress management and coping (such as structuring activities and maintaining routines), link patients to social and mental health services, and counsel patients to seek professional mental health assistance when needed. Since media reports can be emotionally disturbing, contact with pandemic-related news should be monitored and limited."

There's one other benefit of doing your part as a nurse to banish mental health stigmas, and it's a big one. A working knowledge of the genetics and body chemistry behind emotional distress and psychiatric disorders may help you be more aware of what's going on if symptoms strike you, and more willing to get help yourself if depression, anxiety or other psychosocial disorders strike or worsen.

As the Drs. Pfefferbaum and North advised, "self-care for providers, including mental health care providers, involves being informed about the illness and risks, monitoring one’s own stress reactions, and seeking appropriate assistance with personal and professional responsibilities and concerns — including professional mental health intervention if indicated."

If you or anyone you know is struggling or contemplating suicide, call or text the 24-hour hotline at 800-273-8255. For more information, go to www.suicidepreventionlifeline.org

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