There and Care: A Call to Ears

The Stress of eHealth Life
It isn’t a rose garden! Well, unless you consider the thorns! eHealth professionals practice in stressful environments. This includes those who apply electronic health systems in health organizations as well as the people who work in companies who conceptualize, develop and maintain those systems.

The stresses they face come at many different points and they are non- stop. At the beginning of every project it is essential to select the right applications, equipment, staffing, plans, educational programs… the list goes on and on. There is the need to engage everyone in the project, from senior administration to the clinical staff plus all those who will implement and support it. Engagement alone, not to mention change management and re-engineering, can deplete one’s energy and sap one’s patience. Inadequate engagement and the failure to re-engineer are the mortal diseases that have disabled or killed many efforts. Everything must be accomplished within a projected budget and timeframe, both of which often suffer from optimism. Slippages in either of those cause the institutional equivalent of major corporal inflammation (a veritable ‘cytokine storm’ in medical terms). Slippages injure, they hurt, they are urgent, they must be addressed, and they can entail the adverse outcome of premature employment mortality.

It’s not just that way in healthcare institutions, either. Every company that creates and maintains major software and systems faces deadlines that can wreak terror among staff, constraints that can cause frustration and the inevitable design flaws and bugs that require immediate fixes. All this occurs against the background of maintaining existing products and somehow looking good every quarter on the stock market. A company’s survival depends on everyone rowing together and recognizing that the boat can sink.

But You Know This
We are preaching to the choir here. You all know what it’s like wherever you sit. It does not matter if you are in senior management or at the mine face of development and maintenance. eHealth technologies have become the analog of electrical utilities with which we move information rather than electrons. Institutions and patients’ health and lives depend on them. Information is the lifeblood of healthcare agencies and the success of technologies that manage this information is the lifeblood of many companies. It hasn’t been aback-room game for over 2 decades. It is really important, real time, online, often-on-fire reality and you are immersed in it.

Is there any wonder, whatever, that we, the people submerged in this field, suffer from mental health problems? In fact, if this were not the case that would be abnormal. We would be akinto race car drivers who didn’t get scared sometimes, nuclear engineers or pilots unflustered by alarms sounding or police remaining stoic when someone points a weapon at them.

This is the important recognition: that we face intense, daily stress and that can compromise our mental health. But we must also recognize that people perceived as having mental health problems are often stigmatized. They are looked down upon, seen as ’different’, judged to be weak and considered somehow less than they should be. To admit to fears, to depression, to insecurity, to severe insomnia, to feelings of emptiness and meaninglessness, to social and sexual dysfunction, and even to disordered thinking right up to considering suicide, means we risk social isolation or the loss of ‘face’, our friends or our jobs. Certainly, in many instances we risk losing the respect of and closeness with those around us. We may be judged and incarcerated in a private psycho- social fishbowl, quarantined to thwart the contamination of others.

This stands in the face of a reality: that mental health issues are part of the natural human ecology of stressful professions and, for many of us, they are unavoidable. They may really be a consequence of dedication and commitment. Not everyone will have serious mental dislocations, but almost everyone will face at least minor ones.

What the Heck Do We Do About This?
As we pointed out in Volume 32, Issue 3 of this magazine, we are writing a book on health, the practice of Medicine, healthcare and the healthcare System. A major section of the book is on the topic of mental health. In writing that section over many months, we have given a great deal of thought to explaining and clarifying what mental health is all about, what can go awry with our minds and what can be done about it. One important concept in the mental health section is that all of us have the capacity and the abilities to deal with the mental health problems of those around us.

It probably goes without saying that to help others, we need to get our (expletive deleted) together. That does not connote that we must be mentally flawless or not have issues ourselves. Even professional care providers have those. Helping others depends on two major things:

  1. Recognizing that mental health issues are endemic, universal and the product of the everyday grind and vicissitudes of life itself, amplified in stressful environments.
  2. Realizing that there are some relatively simple interventions – think of these as DIY therapies – that we can all apply both to ourselves and to those with whom we have contact.

How We Can Act
Beyond looking at ourselves, recognizing our problems, dealing with them and carrying forward steps that assure and improve our own stability, the next step is to peel our eyes and unclog our ears so we notice when others have issues.

When we work with others and rub shoulders with them, we can use our personal powers of observation and listening skills to notice if someone has a problem. We can consider if someone looks tired and overworked. We can sense if a staff member is upset a lot. We can lend an ear to the scuttlebutt in the organization and take note of others mentioned as facing problems, like financial or relational difficulties. We can meet with our friends and co-workers and ask how things are going. And we can make sure that we really hear and internalize their responses. We can look at their eyes and faces, not just listen to the words. Or, for some, we can listen carefully to the words despite the expressions on their faces. Expressive and appropriate affect is difficult or filtered when emotional burdens sit heavily on the mind. We can notice if someone shows signs of a drug or alcohol problem. We can carefully read our textual communications from people, remembering the communication via email or instant messaging is stripped of most affect; signs of problems are a bit more difficult to detect in those media. We can notice the quality of a person’s work, not to judge its excellence but to wonder why it has degraded in any way. Most of all we can be aware, turn up the sensitivity of our spider sense and remember that mental health problems are endemic.

Therapists can become adept at a lot of this sensing, but not all do. However, there is nothing at all that prevents any of us from becoming better at it, unless we are lazy or aloof. Human beings have powerful abilities to recognize and ‘read’ faces! Neurological research indicates that facial recognition is one of the most powerful abilities of the human brain. We all have the fundamental tools, but we have to use them and maybe even hone them for the sake of those around us. The old declaration that “Mind your own business is the 11th
commandment” be damned! The issues of those around us are our business, for one thing. Those around us are part of our environment and we depend on them not only for work but also socially and emotionally. We need to care. We must mind them as part of our business!

What Can We do About Others’ Mental Issues?
All of us have an amazing set of social skills in our personal tool chests, so to speak. Consider the following:

  • We have a mind and we have ears and we have a mouth. We can plan an occasion using that mind; we can ask questions using that mouth and we can listen using those ears. Probably the most powerful tool we have is called active listening. This means that we absorb what another person is saying, we think about it and we clearly demonstrate that we are listening, understanding and concerned. Sometimes that’s all that people need. How many times has a spouse or partner told us: “You’re not listening!” or “You never listen!” The usual excuse is: ”I was listening” and we have the innate short-term memory capacity to repeat back the last 10 words. But we were not actively listening and were not engaged. Hence the ‘F’ on the domestic report card! Active listening is a powerful and highly-effective step. It will almost certainly improve your grades.
  • Human beings can gain simply from the presence of other human beings. Sometimes, just being with a troubled, lonely or isolated person, sitting with him or her or attending a meeting together while perceptibly connected can make a big difference. Sometimes people just need someone to be there. Few words may be exchanged, but the sense that someone else is there and especially if it is apparent that they care, that can really help. There and care! A powerful intervention. Sometimes this is even better than words. Think of how long it takes in a relationship until people can just enjoy each other’s presence.
  • Sometimes others need a little provocation. Gentle questions can be asked, followed by patient silence. The objective is not so much to solicit information (it’s not an opportunity to be nosey), but rather to create a space into which the other person can pour feelings. Sometimes gentle questions can lead to a tsunami of feelings that have been bottled up, bothering or torturing the person. They needed the opportunity (your silence and that space) to get it out. Listening, active listening, absorbs what is said. Once the person has expressed what is upsetting or troubling, that opens the door to say something or to act in a way that shows empathy or sympathy or concern and a willingness to help, even if that might require someone else’s assistance.
  • There are pathways to deeper help. Beyond the many other ordinary human-to-human interventions we all use without much thought almost every day, there is the possibility of helping someone get additional help. This offer must be handled carefully as there is usually a reason the person has not done it on his or her own. How we proceed is crucial. It may take another meeting and further discussions. It might even require going with that person to get help or arranging help with the person’s permission. This is a sensitive area. If it’s handled badly it can sound like we have judged the person as being beyond normal help. But it is normal help! The person may simply need more formal help or more arm’s-length help if our relationship with them stifles their showing certain feelings or revealing potentially embarrassing situations and thoughts. However, if we care, this will not be an unusual step.

The Realities of Mental Health Treatment Today
We wrote this piece because we have recognized that far too many people with ordinary mental issues wait for months for formal therapeutic intervention or suffer quietly in pain and despair. If they do get access to therapists, they might end up medicated, engendering another layer of problems. That may be necessary in the case of someone with serious mental health issues or a physical health issue that causes mental problems. Those require dramatic intervention. The focus here, though, is on the more mundane, but still debilitating, difficulties that result from the frictions and setbacks of life and career. If we do encounter more serious challenges, then the ultimate intervention we mentioned above – forwarding to deeper help – is the way to go.

Our contention and the reason for this is that many of our confreres are left marooned and unaided on a bleak mental beach or sent for unnecessarily invasive, costly and drug-oriented professional intervention. This happens although we all have the potential of helping them, of helping each other. We believe that all of us can recognize mental health problems. We do not need to form a formal diagnosis! We can see that these problems are part of everyday life. We can understand they are not stigmata nor are they signs of weakness or disease. We can comprehend and accept that we have a role in helping others with these problems. And we can realize that we can do something significant in helping overcome them.

Whatever else you get out of this article, please really be there and really care: there and care. That may make the difference in a person’s happiness, peace and survival.

A Solicitation
We would welcome your feedback and thoughts. It would be particularly valuable if you could relate any anecdotes about problems you have seen or experienced and people you have helped or wish that you had. Another possibility is your suggestions about how we can make caring for our own and others’ mental health become the status vivendi of our organizations. With your permission we will consider these for inclusion in our book either attributed to you or anonymously, as you prefer.