COVID-19 and Mental Health for Healthcare Providers

What is Mental Health?
Covid-19 Healthcare Providers

The COVID-19 pandemic has posed numerous well-known risks and stresses for healthcare providers who are taking care of sick patients. The risks faced by our healthcare providers include their own physical health, their families’ health, possible financial risks, and the personal and family issues that many others are currently facing. Given this, healthcare providers face challenges in maintaining their own well-being and mental health.

Information provided here will:

  • Discuss adaptive ways healthcare providers might cope with their stress reactions.
  • Provide a brief, practical overview of psychological and psychiatric difficulties that healthcare providers might experience during these difficult times.
  • Provide an overview of simple pragmatic approaches that can be used to enhance mental health and well-being for healthcare providers.

What You Need to Know

Covid-19 Healthcare Providers

Sources of Stress Related to COVID-19

Much of what we have learned about the impact of the COVID-19 pandemic on mental health is based on preliminary empirical studies out of the Wuhan, China region, where the first cases of COVID-19 were reported. Three studies examined slightly different aspects of the pandemic’s effect on mental health in providers.

There is preliminary evidence that healthcare professionals report some degree of mental health disturbance while taking care of patients in the pandemic and that individuals involved in direct care, particularly if they are female, are at greatest risk. Additionally, nurses and healthcare providers in rural settings reported the highest level of mental health disturbance.

Sources of stress for healthcare workers include:
  • Uncertain access to personal protective equipment
  • Exposure to COVID-19 at work
  • Lack of access to COVID-19 testing
  • Uncertainty about institutional support
  • Childcare access
  • Support for personal and family needs
  • Competence if deployed to a new area
  • Lack of effective communication

COVID-19 Related Anxiety Among Healthcare Providers

Several of the primary concerns focused on the risk of exposure to the COVID-19 virus, inadequate virus testing, and fear of passing the virus on to family members. Additionally, these providers articulated job-related concerns and concerns about support for their families during the pandemic. There were also clear concerns about being able to provide appropriate medical care effectively. The authors concluded that while tangible efforts to address many of their objective concerns were important, it was also critical that leaders of their health systems attempt to fully understand the sources of their anxiety, even if they cannot be easily addressed.

Shanafelt T, Ripp J, Trockel M. Understanding and Addressing Sources of Anxiety Among Health Care Professionals During the COVID-19 Pandemic. JAMA. 2020;323(21):2133–2134. doi:10.1001/jama.2020.5893

Covid-19 Healthcare Providers

Efforts to Promote Resilience

In the first few months of 2020, several publications emerged which described initial efforts to provide support to healthcare providers to promote resilience and mental health stability. Some of these reports involved simple descriptions of the importance of mental health support in Wuhan, China or in Tehran, Iran. Two other reports provided descriptions of more integrated and comprehensive efforts to promote resilience, well-being, and mental health stability in healthcare workers.

Several key features in these mental health programs include:
  • A strong and decisive central committee or task force to promote mental health in the health system.
  • Strong leadership in the health system administration regarding personal safety for healthcare workers, along with support for other personal needs such as transportation, childcare, and proximal housing.
  • Immediate, transparent, and direct communications from the health system leadership about changes and updates in the status of the patient census, strategic planning, and outcomes.
  • Creation of a confidential and multi-level mental health support system offering a continuum of care (e.g. employee assistance program, spiritual care, psychological interventions, psychiatric services) as well as trainings in self-help techniques which may help workers to regulate their emotional responding.

COVID-19 Related Anxiety Among Healthcare Providers

Resilience in Stressful Events (RISE) is a training program that teaches you how to set up a peer-to-peer support program in your hospital and how to teach a multi-disciplinary team of hospital volunteers how to respond and support a team member involved in an unanticipated patient event, stressful situation, or patient-related injury.

The RISE Program is a Johns Hopkins resilience and mental health program for healthcare workers during COVID-19.

Mental Health Support for COVID-19 Health Care Workers
Covid-19 Healthcare Providers

Promoting Personal Well-Being and Mental Health During COVID-19

Maintaining psychological stability during the pandemic will often require healthcare workers to develop new skills and attitudes to maintain mental health under extreme stress. There are numerous ways that healthcare providers can develop such skills and attitudes, including completing simple educational programs, intentionally developing practical coping skills, completing a more intensive self-help program for healthcare providers, and finally, turning to mental health professionals for assistance.

Education and Awareness
Developing Coping Strategies
Self-Help Interventions
Seeking Behavioral Health Support
Covid-19 Healthcare Providers

Education and Awareness

This webpage provides ways that healthcare providers can expand their awareness of stress, coping, and mental health issues during the pandemic. Such educational interventions provide information to help understand our behavior and how to maintain good mental health. In addition to the information in this module, below you will find additional resources that are scientifically and clinically sound.

Covid-19 Healthcare Providers

Developing a Coping Strategy

For some people, maintaining good mental health is fairly straightforward. It is simply about trying to avoid situations and behaviors which make things worse and moving toward situations and behaviors which make things better. The internet is full of “dos and don’ts” regarding the pandemic, and undoubtedly some of these can be helpful. Below, we will provide a very simple list of behavioral strategies you can consider to promote your mental health. Not all of them will appeal to you, but pick the ones that do. Try and develop a simple behavioral routine that you follow each day to help you manage the stress of the pandemic. These skills will require practice and personal investment for them to be useful.

Checking my thinking
  • Problem solving is an instrumental coping mechanism that aims to locate the source of the problem and intentionally generating solutions that might help. This coping mechanism is often helpful in work situations.
  • Adjusting expectations includes anticipating a variety of outcomes to situations at work and tolerating frustration while still pursuing excellence.
  • Try to maintain the most helpful and adaptive thoughts. Try to gather as much information as possible to inform your thinking.
  • Stick with objective evidence (i.e., The odds are that the patient has the more common diagnosis rather that the more improbable one).
Choosing adaptive and helpful personal behaviors
  • Regular exercise, such as running, or team sports, is a good way to handle the stress of a given situation. This may involve yoga, meditating, progressive muscle relaxation, among other techniques of relaxation.
  • Get outdoors and enjoy nature or other activities.
  • Spend some time reading or reflecting on something other than television or computer screens.
Calming my body
  • Engage in relaxing activities, or practice calming techniques which can help to manage stress and improve overall coping.
  • Sit quietly with increased awareness of your surroundings can improve mood.
Managing my relationships effectively
  • Seek support and ask for help, or find emotional support from family members, friends, or work colleagues.
  • Avoid challenging conflictual relationships during high stress unless it is absolutely necessary.
  • Spend time with people who help you to feel better and more in control of your life.
Emotions
  • Humor. Pointing out the amusing aspects of the problem at hand, or "positive reframing," is thought to help deal with small failures.
  • Spend some time trying to think what you are feeling and experiencing. Give it a name. Try and understand what the feeling is about.
Covid-19 Healthcare Providers

Self-Help Interventions

Self-help treatment is a more intensive technique for helping healthcare providers promote well-being and resilience. This requires the individual engage in a more systematic and intensive behavioral training program to help manage stress and mental stability. There are many books and online programs that are available which meet these criteria.

The Worry Cure: Seven Steps to Stop Worry from Stopping You

Robert L. Leahy

A new, comprehensive approach to help you identify, challenge, and overcome all types of worry. This empowering seven-step program, includes practical, easy-to-follow advice and techniques.

Anxiety Free: Unravel Your Fears Before They Unravel You

Robert L. Leahy

Leahy looks at the origin of anxiety and teaches you how to outsmart your fears for a less stressful life. He lays out the symptoms associated with some of the most common anxiety disorders, including panic and agoraphobia, obsessive-compulsive, generalized anxiety, social anxiety, and post-traumatic stress and provides simple, step-by-step guides to help you overcome the fears associated with each of these.

Healthcare Toolbox

Center for Pediatric Traumatic Stress and the National Child Traumatic Stress Network

This toolbox is more comprehensive and systematic than simply practicing adaptive coping skills. It helps the healthcare provider to think about the way they are appraising work situations and examine their thoughts, feelings, and actions in their work setting. For motivated healthcare professionals, such an intervention can be very useful, not only during the COVID-19 pandemic, but for life in general.

Covid-19 Healthcare Providers

Seeking Behavioral Health Supports

For some healthcare providers, seeking some level of professional support and guidance could be very useful. There are a range of different possibilities including visiting your health system’s employee assistance program, talking to a chaplain or spiritual advisor, or seeing a counselor, psychiatrist, or psychologist. Many health systems are providing such services for healthcare providers during the pandemic.

For example, “Reach for Resilience” is a COVID-19 help line and resource center for healthcare professionals that was formed in partnership between Sanford Health and the North Dakota Department of Human Services’ Behavioral Health Division. You can visit their site at www.reach4resiliencend.com.

Making a decision to seek mental health care is personal and based on a variety of factors. Simply put, if you are experiencing significant personal distress or impairment in any of your roles in life, it is reasonable to consider seeking help.

View the information on Understanding Impact of COVID-19 on Your Mental Health to better recognize common feelings of worry and sadness associated with a global pandemic, and those feelings that may be symptoms of a more serious mental health concern.

In addition to a variety of services that might be available through your health system, especially during the COVID-19 pandemic, considering viewing How You Can Gain Access to Mental Health Supports.

Modules describing signs and symptoms of behavioral health conditions are not diagnostic. If you have questions or concerns about your mental well-being, contact My Sanford Nurse at 701.234.5000, 1.800.821.5167, or click here to find a Sanford Health care professional. If you are having thoughts of self-harm, call the suicide prevention LIFELINE anytime at 1-800-273-TALK (8255). If this is an emergency, please call 911.

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