Managing Mental Health of Health Care Providers During a Pandemic

In addition to impacting the general public, the COVID-19 pandemic is taking its toll on physicians and other frontline health care providers as it adds new tasks and concerns to deal with day in and day out.

When he arrives to work, Simranjit Bedi, DO, changes into scrubs, wipes down computers, wears a mask, and distances himself from others at least six feet. A GI provider at a large tertiary care hospital in Philadelphia, Dr Bedi acknowledged that it can be mentally exhausting to even think about all of these extra precautions aside from the actual work of caring for patients.

But these extra safety measures and the psychological drain that goes along with them are far from the only concerns faced by health care workers in the midst of a pandemic. “We are being stretched thin and being asked to work longer hours to fill the gaps of coverage,” he explained.

“We worry about getting sick and missing work—not getting paid during our sick time. We worry that we are not getting hazard pay while we are putting our lives at risk. We worry about our spouses, our mortgages, our student loans, our children, and our parents on a minute to minute basis.”

Beyond the added stress of fighting this widespread illness, many providers are facing disruptions to their home lives as well. Children are out of schools, parents are transitioning into teachers, and some of the childcare arrangements that have previously been relied upon, like kids staying with grandparents, are no longer a good idea.

Why This Crisis is Unique

Unlike many other crisis response scenarios faced by health care settings, this one will be much longer-lasting, said Tani Hemmila, MS, director of the MN Health Collaborative with the Institute for Clinical Systems Improvement (ICSI)—a nonproft health care improvement organization made up of roughly 50 medical group and hospital members in Minnesota and surrounding areas. “The other thing I would say that is different about the coronavirus crisis is the lack of information, lack of data, and uncertainty,” added colleague Claire Neely, MD, a pediatrician who serves as the president and CEO of ICSI. What we knew 2 months ago is different from what we knew yesterday, she said, which is different than what we will know in 2 weeks. That kind of uncertainty in a setting where decisions impact people’s lives—both staff members and patients—only adds to the mental stress.

Many health care workers are at a higher risk of contracting COVID-19, Dr Neely continued, and there is not enough personal protection equipment (PPE) for everybody to feel safe right now. “That is just increasing the anxiety level of not only getting sick yourself, but spreading it to your family, loved ones, and also spreading it to other patients who may be immunocompromised,” she said, and this dynamic is “really raising anxiety and even fear levels in some providers.”

Research examining the mental health implications of the battle against COVID-19 is beginning to emerge. A study published March 23 in JAMA Network Open, for example, surveyed over 1200 health care workers in multiple regions of China and found that a considerable proportion reported symptoms of depression, anxiety, insomnia, and distress.

Furthermore, frontline health care workers engaged in the direct diagnosis, treatment, and care of patients with COVID-19 were among those associated with an increased risk of adverse mental health outcomes. The findings suggest that frontline health care workers may require psychological support or interventions.

Health care professionals may be reluctant to reach out, however. Stigma surrounds mental health across the entire US population, and because health care workers are viewed as the helpers—not the ones in need of help—they may hesitate to seek out support even when it is needed. Still, providers and facilities can acknowledge this dynamic and work to overcome it.

Steps Providers Can Take

The COVID-19 pandemic is an essential reminder for providers to implement the airlines’ familiar prompt to put your own oxygen mask on first before helping others, explained Melissa Wesner, LCPC, owner of LifeSpring Counseling Services in Maryland.

There are a number of steps that care providers can take to help protect their emotional well-being, such as creating rituals to mark the transition between work and home life, sharing self-care resources with colleagues, or setting up virtual coffee meetings.

Providers can also make the effort to implement strategies that have worked for them during stressful times in their past, whether that means keeping up with a regular exercise regimen, eating sufficient and nutritious meals, getting enough rest, or staying in touch with close friends and family.

How Care Facilities Can Help 

Providers cannot be left to fend for themselves, however. Hospitals and health care facilities also need to prioritize the well-being of their workers if they are to continue supporting the public, Ms Wesner pointed out, which on a basic level may include providing information updates and necessary supplies.

Beyond that, facilities can offer services such as virtual yoga, online mindfulness meditation sessions, or online support groups. They can also provide a list of resources that encourages providers to take good care of themselves, including details about available counseling services.

Still other possibilities may seem obvious or overly simplistic but remain essential nonetheless. This includes checking in to ask how workers are doing and allowing them to feel heard and supported. Some workplaces do not ask for feedback in the first place, Ms Wesner pointed out, and others ask but fail to respond appropriately.

Ms Hemmila pointed out that some facilities are setting up an internal warmline—a phone help line that provides assistance for those whose need is not urgent. Initiating a buddy system made up of peer volunteers is another option so that providers have a colleague to check in with, as needed.

“One of the things that people are talking about and sharing quite a bit are different mindfulness and meditation apps,” she added, which can help providers take a brief breather and recenter in the midst of all the chaos. Head-space, for instance, is currently offering free guided meditations for health care and other frontline workers.

The logistics of staffing is yet another element that can be addressed by team leaders or managers within health care facilities. Options include rotating workers from higher- to lower-stress functions and partnering inexperienced workers with more experienced colleagues, according to a resource developed by the World Health Organization Department of Mental Health and Substance Use.

Addressing the Root Cause 

A variety of these suggested approaches have been implemented where Dr Bedi works. Health care providers at his institution have been communicating daily, and from his vantage point, administrative physicians have been receptive to hearing about what is going on, what is working, and what is not.

He and colleagues have also been provided with resources geared toward mental health and well-being, like free access to telephone mental health providers and apps for meditation.

Still, he feels that there needs to be some re.assurance that the root cause of some of the mental health issues, such as PPE shortages, is being addressed by both hospital systems and government so that providers can rest assured while carrying out their work.