As they confront the coronavirus pandemic, frontline healthcare workers are at risk for mental health conditions such as depression and anxiety.
During the coronavirus disease 2019 (COVID-19) pandemic, the mental health needs of healthcare workers should not be overlooked, a disaster response expert says.
Healthcare workers are in a precarious position on the frontlines of the struggle against COVID-19. In China, Italy, and Spain, thousands of healthcare workers have been infected with the coronavirus. Last week, more than 150 healthcare workers in four Boston hospitals were reported to have been infected.
HealthLeaders talked with disaster response expert Regardt "Reggie" Ferreira, PhD, to get his perspective on the mental health impact on healthcare workers during the pandemic. He is an associate professor at Tulane University School of Social Work, and program director of the Tulane University Disaster Resilience Leadership Academy in New Orleans.
Ferreira has been program director of the Disaster Resilience Leadership Academy for the past four years, and he has worked in the disaster response field since 2002.
The following is a lightly edited transcript of his discussion with HealthLeaders.
HealthLeaders: Do you have any overarching comments on supporting the mental health of healthcare workers during the COVID-19 pandemic?
Ferreira: The mental health aspect of a disaster oftentimes gets left behind. Especially for first responders and medical personnel, more attention should be given on this subject.
HL: For healthcare workers, what are the primary mental health concerns during the pandemic?
Ferreira: Medical professionals are likely to experience fear, anxiety, and a sense of powerlessness. There could even be aspects such as rage and anger toward the folks who have not followed the social distancing protocols.
There can also be compassion fatigue. Healthcare workers already had stressful jobs day-to-day. Adding the additional stresses from the COVID-19 pandemic—where there are so many unknowns—is going to be difficult on healthcare professionals. There is a lot of uncertainty about what is going to come at them and that can compound and filter into their home life. There is a range of emotions that is being felt at this stage of the pandemic.
HL: Are there emotional responses that could lead to a serious mental health crisis for healthcare workers?
Ferreira: For all of the things that I have mentioned, if they are not addressed, they can compound, and depression can set in and anxiety can set in. Over the long term, if healthcare workers are constantly operating under fear, they can make mistakes.
HL: What can healthcare workers do to avoid developing mental health problems during the pandemic?
Ferreira: Healthcare workers can focus on self-care, which can include reading, participating in self-help forums, keeping a diary, limiting social media exposure, talking to a friend or loved one about what they are experiencing, doing physical exercise, engaging in meditation and mindfulness, and switching off when they go home. These are all things that healthcare workers can do that are fairly easy to do if they are made a priority.
If healthcare workers are slipping into depression, they should be talking with a counselor or a therapist.
HL: What can health systems, hospitals, and physician practices do to support the mental health of healthcare workers during the pandemic?
Ferreira: At the top of the list is having clear communication with healthcare workers. They should be getting constant updates—this is a very fluid situation and there is new research coming out. There can be regular town halls with MDs, nurses, and other healthcare professionals.
Healthcare facilities should also be providing the necessary resources for providing care safely, which is difficult with shortages of materials and equipment.
Something tangible that can be of help is providing transportation to and from healthcare workers' places of residence; and if they are sequestered, healthcare facilities can provide housing. I spoke with a doctor in New York, and he said there are a lot of staff members who are afraid to go home because they have relatives who have diabetes, COPD, and other conditions, and they don't want to go home and infect family members.
Healthcare organizations can provide counseling and have support groups available—they can amplify the social support system at work. I'm sure there are many therapists at health systems who are willing to step up to the plate and help healthcare workers.
HL: From a mental health perspective, what aspects of this pandemic could be most challenging for healthcare workers?
Ferreira: The unknown. We fear the unknown, which creates stress. My advice is to take the situation day-by-day because it is so fluid. It's important not to look too far into the future. It's better to go day-by-day because if you try to look two or three months into the future, fear can lead to anxiety and depression.
If we have care rationing, there are going to be decisions that have to be made that are life-or-death decisions. Clinicians are going to be faced with those decisions—they are going to have to turn some patients away.
Christopher Cheney is the senior clinical care editor at HealthLeaders.
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The top action healthcare organizations can take to support the mental health of healthcare workers is to communicate pandemic developments clearly.
Mental health challenges for healthcare workers during the pandemic include fear of the unknown.