he past several months have been challenging, and as an inpatient child and adolescent psychiatrist working with kids and teenagers, I have seen the impacts of multiple broad, societal stressors on our overall mental health and well-being. Many people—the children and adolescents I work with, as well as adults—are feeling anxious and nervous about how events like the global COVID-19 pandemic affect their day-to-day life right now and how these events will shape the future. 

In the midst of health concerns related to coronavirus, the nation watched in horror as George Floyd was killed by a law enforcement officer, setting off a wave of protests against injustice, inequality, and systemic racism. 

These two crises have also highlighted what many health care providers have long known, that racial inequality is a public health crisis. Despite changes to medical curriculum, medical education does not fully address the root of racial inequalities, which in turn affects delivery of health care by providers on an individual level. There are multiple barriers to accessing good quality health care on a systemic level with examples ranging from lower rates of health insurance coverage in marginalized communities, residential segregation, and mistrust in the medical system due to a history of racial discrimination. These public health concerns are not new, but they have been exposed like never before. 

Acute and chronic stressors are currently converging

As we deal with significant stress, it’s important to understand how we conceptualize trauma. There are acute stressors or triggers, and then there are chronic stressors and triggers, and we often process them differently. What’s unique right now is that these two different stressors are converging in a significant way. 

COVID-19, in many ways, is an acute stressor. It’s a novel virus with no vaccine and early data suggests that it spreads easily and is more deadly than other viruses we have come to live with (like the seasonal flu). It has also disrupted our lives as governments and public health officials close down businesses and mandate or recommend isolating from others to prevent spreading the disease. No matter how resilient you are, it is creating some level of psychological distress for most everyone.

Racism, on the other hand, is a chronic stressor that Black, Indigenous, and People of Color (BIPOC) experience from a very young age. It may not always be overt, but the discriminationThe unjust or prejudicial treatment of different categories of people or things, especially on the grounds of race, age, or sex., microagressionsA statement, action, or incident regarded as an instance of indirect, subtle, or unintentional discrimination against members of a marginalized group such as a racial or ethnic minority., and implicit biasThe attitudes or stereotypes that affect our understanding, actions, and decisions in an unconscious manner. are daily battles. As these traumas compound over time, it can feel exhausting to continue to fight. The ways that we address these issues on an individual level—individual therapy, process groups, coping skills and strategies—still do not solve the root of the problem. 

Start by identifying different solutions for different stressors

One of the first steps in coping with stress is simply to identify how you are feeling and what is causing stress or trauma. When you recognize the signs, both mental and physical, you can take steps to help you feel more in control. 

Solutions for the stressor of racism

This is a systemic issue that exists in our society (government policies, the criminal justice system, health care delivery), but there are actions we can take on both an individual and an institutional level that can lead to change.

Institutional solutions

1. Equity and diversity groups: ​help spread information to educate individuals about health concerns in underserved communities, but also to examine where these disparities stem from, and how we can provide better care and promote better understanding among our health care peers. At UNI, we have the committee University Neuropsychiatric Institute – Fellowship In Equity & Diversity (UNIFIED), which promotes diversity and multiculturalism in order to enhance the experience of employees and patients.

2. Institutional acceptance: everyone within an institution should also be looking out for subtle or overt racism and calling attention to it in order to put a stop to it. Creating an institution where BIPOC can stand up for themselves with allies to support them will eventually eliminate behaviors that add to the chronic stress of racism. I have struggled to stand up for myself in the past when faced with microaggressions, but I want to use my voice and privilege and put in the work to learn strategies for myself and to help others in my community.

3. Promote BIPOC voices and leadership: the people who live these experiences, whether it's in health care or other fields, are going to be the best individuals to listen to as we’re trying to figure out truly impactful policy changes. Having more diverse voices in leadership will move the conversation in the right direction and can spur meaningful action for real change. 

Individual solutions

Making changes at the institutional level is fantastic, and essential, but we also have to look at ourselves and how our own actions contribute to (or fight against) racism.

1. Educate yourself: find resources that offer a perspective different from your own and that amplify BIPOC voices. Understand how racism has impacted our systems, as well as our own ideas and stereotypes. It may feel uncomfortable, but that’s how you grow as a person and how we all grow as a society.

2. Listen: one of the most important things that you can do is listen to what others are saying. Avoid getting defensive or trying to tear down someone else's experiences, and instead examine how these broad systemic forces have shaped your own thoughts and views.

3. Support BIPOC communities: find ways to support organizations and groups that advance anti-racist ideas, for example, by donating to or joining a community group. Everyone can also examine how they can personally amplify BIPOC voices. For example, hiring more people from diverse backgrounds or speaking up in a meeting to help your BIPOC colleagues’ voices be heard.

Solutions for the stressor of COVID-19

Most of us won’t be able to change coronavirus in a meaningful way, but you can gain some level of control over what you do on a daily basis. 

1. Consume reliable information: examine where you get news and information, seeking out reliable and fact-based sources like the Centers for Disease Control and Prevention (CDC) to avoid sensationalism or inaccuracies. Limiting your information intake can also help avoid burnout. Take a break from social media, turn off the television, and do something that reduces stress, like meditation, exercise, or reading a good book.

2. Maintain a consistent schedule: physical health is also important, so try to keep a consistent schedule, get adequate sleep each night, engage in regular physical activity, and eat nutritious foods. 

3. Stay connected: find ways to stay in touch with your social circles (friends, family, coworkers) through phone calls, texts, video chats, socially distanced/masked visits or other ways that are safe.  

The last few months have been stressful on many levels, but I am hopeful that our work to start fighting the racial disparities highlighted by the current pandemic is not just a passing fad, and that we won’t just “return to normal.” We have an opportunity to address long-standing issues to create enduring change. 

Some of these strategies are going to be difficult, and that’s a good thing. We should all lean into the discomfort and work through our emotions together to promote a more just and equal society.