written by: Omaha Integrative Care

These are unprecedented times. Never before have we experienced such a far-reaching event as that of the COVID-19 pandemic. It has changed so many aspects of our lives: Who we see. What we do. Where we work. Where we go. How we interact. Our entire reality has shifted, and it is no wonder that we are all reeling, staggering to catch our footing, wondering why we feel so strange, so rattled. If you, too, are wondering why you’re feeling so “off,” know that there are several processes at play in this, our collective experience.


Stress is a normal and inevitable part of being alive. And like all living things, we humans have developed a natural response to stress that is meant to keep us safe and help us survive. You might know it as “Fight, flight, or freeze.” Over the course of human history, the stressors we face have shifted from evading predators and surviving the elements to juggling packed schedules and tackling unending obligations at work and at home. But while our stressors have changed, our stress response has stayed more or less the same: Fight, flight, or freeze. When the stress response is activated, the body prepares to take action by pumping adrenaline and thereby increasing our heart rate, blood pressure, and respiratory rate. It also diverts energy away from digestion — deemed nonessential in a moment of survival. What this means for us now is that we may be feeling restless, on edge, unable to focus, and may be experiencing digestive problems.

The stress of COVID-19 is also different from our day-to-day stressors in that it is chronic rather than acute. While our everyday stressors are distinct, like specific notes or instruments in a song, the stress of COVID-19 is more like a low and ever-present hum. This puts us in a perpetual state of stress, which can have long lasting negative effects on our minds and bodies.


Whenever we experience a significant change or loss, we experience grief. Consider all the things that have changed or been lost in the wake of COVID-19. Daily interactions with coworkers, friends, even strangers. Celebrations like birthdays, graduations, weddings, baby showers. Handshakes, hugs, and even smiles, which might now be obscured behind masks. We no longer have access to these things in the same way we did before, and we are grieving the loss. Grief takes many forms and might show up as anger, denial, bargaining, or depression, until eventually shifting into acceptance and meaning. Acknowledging this grief can be a first step toward processing it and making peace with all that has changed or been put on hold.


The global experience of COVID-19 is one of collective trauma. The circumstances that we are experiencing — as individuals and as members of the global community — are overwhelming, distressing, and threatening. We are in the midst of a crisis, and our minds and bodies are responding accordingly. Trauma impacts our ability to function in many ways: Cognitively, it can impair our memory, learning, concentration, and decision-making abilities. Emotionally, it can reduce our impulse control and regulation. Physically, it can increase our risk for many ailments, including heart disease, diabetes, and substance abuse. Relationally, it can alter our concepts of ourselves and of others, perhaps viewing ourselves as weak or responsible, or viewing others as dangerous or not to be trusted.


While COVID-19 has increased our stress, elicited grief, and exposed us to collective trauma, it has also impacted our access to resources that normally help us cope: exercising at the gym, attending spiritual or religious services, going out to bars and restaurants, attending concerts or events. (Add these losses to the list of things we are grieving.) Many of us may have noticed that because of this, we are turning to other forms of coping. As humans, we have a limited amount of energy — physical, mental, emotional. When our energy is depleted, we turn to the coping strategies that require the least amount of energy, like snacking, pouring a drink, or retreating into a cozy cocoon of procrastination or avoidance. While these strategies make sense and provide some comfort or relief in the short term, they often are not very effective in the long term. Intentionally cultivating productive coping and regulation strategies can help replenish our stores of physical, emotional, and mental energy. Here are just a few options:

  1. Relaxation: The counterpart to stress is relaxation. We can achieve this through specific relaxation techniques, such as meditation or progressive muscle relaxation, or through enjoyable activities that boost feelings of relaxation, such as reading, crafting, or cooking.
  2. Physical movement: Physical movement helps us release some of our built-up stress energy (the “flight” in “fight, flight, or freeze”). This movement can be as simple as going for a walk or doing gentle stretching.
  3. Seeking support: Our relationships and connections with others have been shown to increase our ability to handle stress. Seeking support can look like reaching out to friends or loved ones (whether in person or virtually). It can also look like talking to a therapist, receiving medical care, or finding a connection to a community, such as a faith group, hobby club, or other organization.


If you are looking for further support, Omaha Integrative Care can provide treatment and care to support your wellness in mind and body. We recognize that our patients are more than just their symptoms, and we strive to approach each person as a unique and complex individual, shaped by the many facets of their lives, relationships, resources, and identities.

We provide primary medical care, integrative mental health therapy, psychiatric medication management, yoga and meditation classes, and body-focused healing modalities, including massage, acupuncture, reiki, and sound bath healing. Our integrative team of providers collaborates to provide patients with the most comprehensive care possible. For more information, visit www.omahaic.com or call 402-934-1617.

By Dr Laura Leone, DSW, MSSW, LMSW
Integrated Health Consultant for Practice Improvement, National Council for Behavioral Health

Suicide prevention can seem like a daunting undertaking for any health center, but as the number of deaths by suicide keep increasing, it becomes a necessary public health issue to be addressed within primary care. If your health center is overwhelmed with how to proceed, the following eight steps are a framework to give you the guidance on what to do.

  • Step 1: Identify Leadership, Champions and Task Force: It’s important to get many people involved in suicide-prevention efforts, supporting it both from the “bottom up” and from the “top-down.” It is most effective to find staff in several disciplines and roles that are not just from behavioral health, as well as to consider how to include the voice and choice of patients.


  • Step 2: Educate and Inspire Change: When people understand why change, new workflows or asking the hard questions is necessary, they are more likely to engage in doing it, and doing so well. Educate people on suicidality, including national and local statistics; on the various opportunities during work to ask people about suicide; and on ways to intervene when necessary.


  • Step 3: Gauge the Current Organizational Landscape: Understand the baseline metrics around suicide for your organization, such as when people are most “at risk,” how many deaths by suicide, how many suicide attempts, how many safety-planning interventions are used with patient expressing suicidality, etc.


  • Step 4: Practice Improvement: Take education a step further with understanding best practices around suicide inquiry, screening and evidence-based interventions. There are opportunities to assist clients in their outpatient setting rather than them visiting a hospital emergency department.


  • Step 5: Imbed Throughout Organization: Consider how to optimize your electronic health record around suicide-prevention efforts, including the use of decision supports, problem lists, and other features. Effectively communicating around patients who are “at risk” in real time could save a life. Likewise, find multiple ways to discuss suicide prevention efforts with staff, such as at staff meetings and during huddles; creating a continual feedback loop using the data collected.


  • Step 6: Ongoing Mining of Resources and Supports: There are constantly new resources, trainings and support around suicide prevention for both patients and staff. Take the time to periodically check in on what’s new, from organizations such as the National Council for Behavioral Health, Suicide Prevention Resource Center, Zero Suicide, Now Matters Now and more.


  • Step 7: Collaborate with Patients, Community, External Organizations, and Stakeholders: Consider how to best share information and support patients in the community around their suicidality, and to help create opportunities for wellness. Efforts and success will be greater and stronger when people and organizations collaborate, as well as share information and resources.


  • Step 8: Wash, Rinse, then Repeat! Don’t get comfortable in going through these steps once. Instead, run through them again and again to keep your continual quality improvement going for suicide prevention. Continue to use your metrics to gauge improvement opportunities and successes.

Remember that the Health Center Association of Nebraska and the National Council for Behavioral Health are available to provide support around building internal and external capacity for suicide prevention. You can make a difference by preventing deaths by suicides and the negative impact that every death has on the surviving 135+ lives that the person leaves behind.