Suicide is killing frontline medical workers, but mental health experts say the situation is far from hopeless

• Two medical workers on the frontlines of the coronavirus fight in New York have died by suicide in the last week: Dr. Lorna Breen, of NewYork-Presbyterian Allen Hospital, and John Mondello, an EMT.
• Medical workers face grueling workloads, unprecedented stress, and steep death counts during the pandemic.
• Psychologists say stress for frontline workers could flare into chronic psychological problems if it's not managed.
• There are ways to support workers in such high-pressure roles, but Dr. Shauna Springer advocates not calling them heroes. "There's an invisible pressure that comes with that," she said.
• Visit Business Insider's homepage for more stories.

The US Navy's Blue Angels and the Air Force's Thunderbirds dashed across the clear blue sky above New York on Tuesday, honoring the people working on the frontlines of the coronavirus pandemic.

Two medical workers didn't get to experience the tribute.

Dr. Lorna Breen, the medical director of the emergency department at NewYork-Presbyterian Allen Hospital, died Sunday from self-inflicted injuries.

"Of my four children — well I guess now I've only got three — no one would've predicted that Lorna was having a hard time," Dr. Philip C. Breen, her father, told Business Insider. "She would not even be on that list."

Weeks of treating COVID-19 patients, some of whom died before they could be transferred from the ambulance into the emergency room, took a growing toll on 49-year-old Lorna Breen, her father said.

The case was similar for John Mondello, a 23-year-old in the New York City Fire Department's Emergency Medical Services (FDNY EMS). He'd been on the job less than three months before he killed himself on Friday, the New York Post reported.

As the pandemic has left millions under lockdown and triggered deep loss and widespread grief, medical workers and emergency responders like Mondello and Lorna Breen have faced the brunt of the crisis with grueling workloads, unprecedented stress, deep uncertainty, and a steep death count.

But while the situation is grim, mental-health professionals say the situation is far from hopeless. There's a lot that medical workers can do to help themselves — and many ways for the rest of us to help them.

'They carry a heavy burden of responsibility'

Dr. Shauna Springer, a licensed psychologist and trauma-recovery expert at the Stella Center in Illinois, said that medical workers today are battling an invisible enemy that's also upended their lives and forced them to step away from their own support systems.

"We're relying on a small number of people who can do what nobody else can do," Springer told Business Insider. "They're working really long hours, they're seeing these traumas that are burning into their minds, and they have very limited time to release."

She added that medical workers are drawn to the profession to alleviate suffering and protect their patients. During the pandemic, however, the virus has in many cases robbed them of the ability to achieve either goal.

They're like "warriors in the war zone, taking risks, seeing their colleagues fall ill and potentially die, [and] losing patients," Springer said.

"They tell me that they carry a heavy burden of responsibility when they lose a patient," she added, and that every life lost "can feel like a moral injury."

Mondello had graduated from the EMS Academy in February and worked as an emergency medical technician (EMT) at Station 18 in the Bronx. His friends described him as upbeat and outgoing, but said it was jarring for him to see so much death and destruction.

"He told me he was experiencing a lot of anxiety, witnessing a lot of death, he'd feel it was a heavy experience when he'd fail to save a life," Al Javier, Mondello's friend, told the New York Post.

EMS workers have faced an unprecedented loss of life lately.

Before the pandemic, the average daily emergency 911 call volume was around 4,000 per day, with about 50 to 70 of those being cardiac arrests.

At the height of the first surge in cases, however, the FDNY EMS units fielded between 5,000 and 7,000 daily calls. More than 300 were for patients experiencing cardiac arrest, about 200 of whom died outside of hospitals each day. (Some EMS leaders claim the death toll could have been less if the industry had solved its chronic issues of turnover and retention before the crisis.)

Anthony Almojera, the vice president of the FDNY's Local 3621 union in Brooklyn, said that first responders are struggling to "compartmentalize" the non-stop tragedies they're witnessing.

"I'm fighting this war against an enemy that's going around randomly killing people, and it makes me feel hopeless. How do I shake that?" Almojera, a 17-year veteran paramedic, previously told Business Insider.

Helping those who protect us all

Laurie Nadel, a psychotherapist and author, characterized the coronavirus as an "equal-opportunity destroyer" that's forcing frontline medical workers to go "mano-a-mano with mortality on a larger scale" than ever before.

In the short-term, she said they face a greater risk for acute stress, which can trigger insomnia, exhaustion, loss of appetite, and mild depressive symptoms.

"Just like people get sick if they're overexposed to this virus, people also become psychologically ill if they're overexposed to the kinds of stressors" that healthcare professionals deal with every day, Dr. Charles Marmar, the chair of the department of psychiatry and director of the PTSD research program at New York University, previously told Business Insider.

But he said it's necessary for healthcare professionals and first-responders to manage their stress to protect themselves from more "chronic psychiatric problems," including post-traumatic stress disorder, depression, substance abuse, and suicidal ideation. Not doing so can also prompt occupational, marital, and parental difficulties, he added, and make them vulnerable to stress-related illnesses, such as weight gain, cardiovascular disease, and hypertension.

For the rest of us not on the frontlines, Springer, also the author of a forthcoming book titled "Warrior: How to Support Those Who Protect Us," said we can help those we know embroiled in such work. She advises listening to whatever a healthcare worker may want to share without offering advice, and also by not asking what they need, but anticipating what may help them — and stepping up to provide it when possible.

"Trauma is destabilizing in and of itself. And so they don't have time to even think about what they need," she said. "Those of us who are doing social distancing, we can actually do things that will lighten their load so they can do things no one else can do. We could be asking ourselves, 'Could we take care of their kids or a beloved pet? Could we get groceries and drop it off?'"

"There is no reason why we should be sitting at home doing nothing that helps the people on the frontlines if we have skills and ability to help," she added.

'People are resilient until they're not'

Both Springer and Marmar highlighted "peer-to-peer support" among workers as an effective support system, advocating five-to-10-minute huddles to "share their pain, sadness, or frustration" with others who face similar situations as they do.

People on the frontline also need adequate time to "stand down" between shifts, whether it's to sleep, eat, exercise, meditate, or connect with their family and friends, Marmar said.

Nadel agreed.

"Trying to save people's lives in wartime conditions forces emergency medical teams to make triage decisions multiple times during a given shift," she said. And even though this isn't an actual war, Nadel added, the pandemic is their battlefield and "shortages of life-saving equipment and split-second life-and-death decisions can become overwhelming."

The type of chaos unleashed by the coronavirus not only triggers an adrenaline rush to save patients, Nadel said, but also "overrides unwanted emotions, which can resurface after the crisis has been resolved."

Springer said it's important for anyone on the front lines of any emergency not to become convinced that they are superhuman — and for the rest of us to avoid labeling them as such.

"We mean well when we call them heroes, but there's an invisible pressure that comes with that," she said. "People are resilient until they're not. And so people who are called out as resilient are often more reluctant to acknowledge human struggles and to reach out when they need help."

For his part, Philip Breen, a retired trauma surgeon and burn surgeon, knows first-hand how "horrible" it feels when patients die.

He recalled nurses who worked in the burn unit alongside him experiencing flashbacks, nightmares, and depression due to the condition of some people they treated.

"When you have a patient who you can save, that's the highest high you can imagine," he said. "And when they die with your hands in them, that's the lowest low you can imagine."

As a doctor, Lorna Breen gave of herself fully, despite facing trauma frequently and from up-close, Philip Breen said.

"I want her to be remembered as someone who did everything she could until it killed her," her father said.