Healing for the healers: Mental health needs for health care workers after COVID-19

The daily COVID-19 figures show new cases every day. Guidance is clear: emphasize safety and distancing measures to reduce the risk of spread and flatten the curve. Those who are diagnosed with COVID-19, and whose symptoms are manageable, are either sent home to self-quarantine or admitted to hospital if required. Health care workers are providing care to those with the virus or to presumptive cases in hospitals, and are doing so at surge capacity during this time. Long-term care facilities are facing challenges with the vulnerability of their patients and the speed with which the virus has spread, with high death tolls in some cases. Concerns about personal protective equipment (PPE) shortages underline the significance of how hard health care teams are working to provide care.

In general, there is increased risk for health care workers to be diagnosed with a mental health condition after an epidemic. This can include feeling helpless, demoralized, or a sense of mourning over losing the person they were before the crisis [1]. Lessons from specific crises in the past provide more detail. The lessons from SARS showed there are significant mental health and substance abuse risks for health care personnel in the time after the crisis has passed. Hospital workers in China were more likely to suffer PTSD and misuse alcohol as a means of coping after the SARS crisis [2]. A similar study on SARS health care workers from Singapore found that 20 percent of doctors and nurses were diagnosed with PTSD as a result of caring for the sick [3]. The H1N1 outbreak in 2009 showed that health care workers were concerned about treating a new disease they didn’t know much about. In Australia, their concerns were for the safety of their patients, fear of transmitting the disease across patients or to other members of the health team, and the overall capacity to deliver care [4]. The COVID-19 pandemic has many of the same characteristics as the H1N1 crisis: a disease that is new, not as well understood as other diseases, with health care workers putting in long hours and expressing concerns over long-term safety from the potential of PPE shortages.

The mental health challenges for health care workers may not follow on immediately from the COVID-19 pandemic stabilization. It may take time for symptoms to materialize, giving the false impression in the immediate term that health care workers were unaffected by their experience. A Canadian study showed that, during SARS in 2003, health care workers were no more likely to experience mental health challenges than non-health care workers. However, in 2004, one year later, health care workers showed significantly higher depression, anxiety, and post-traumatic stress symptoms [5]. This underlines the potential for a future crisis of mental health needs for mental health workers after the crisis passes.

With the prevalence of digital technologies for people to stay connected while self-isolating and physical distancing, there is potential for digital tools to be developed to provide more options for mental health service delivery. Virtual care appointments, allowing patients to speak with mental health professionals, means those needing service can access it more conveniently. Digital chat services based on text can be expanded for crisis service, where needed. Providing patients with instructional and education material using digital and interactive means can be developed to allow for improved self-awareness and self-care outside of other options. Although face-to-face contact continues to be the prevailing delivery method for psychotherapy (e.g., cognitive-behavioural therapy [CBT]) and psychopharmacotherapy (e.g., selective serotonin reuptake inhibitors [SSRIs]), some evidence suggests that, for many mental health conditions, remote therapy and medication consults can be provided – or integrated with in-person services – with similar effects [6]. This could be especially useful to address a potential surge in mental health needs, especially from health care workers who were involved in the COVID-19 response.

The benefits of integrating new tools into mental health treatment options could have broader societal benefits. Reducing barriers to access and improving access on a societal level could be significant in improving broader access for other vulnerable or marginalized populations. The COVID-19 crisis will eventually pass. Solutions to help us, as a society, manage the consequences of the crisis likely have wider societal applications. These should be harnessed wherever possible.

Dr. Mathew Fetzner is a Calian Clinical Psychologist and Acting Program Manager at CFB Petawawa for Canadian Forces Health Services. Jordan Miller is Program Manager, Strategic Initiatives, for Calian.

Notes
[1] Damir Huremović, ‘Mental Health Care for Survivors and Healthcare Workers in the Aftermath of an Outbreak,’ Psychiatry of Pandemics. 2019 May 16 : 127–141.

[2] Ping Wu; Xinhua Liu; Yunyun Fang; Bin Fan; Cordelia J. Fuller; Zhiqiang Guan; Zhongling Yao; Junhui Kong; Jin Lu; Iva J. Litvak. ‘Alcohol Abuse/Dependence Symptoms Among Hospital Employees Exposed to a SARS Outbreak,’ Alcohol and Alcoholism. 008 Nov-Dec; 43(6): 706–712.

[3] Angelina O. M. Chan; Chan Yiong Huak. ‘Psychological impact of the 2003 severe acute respiratory syndrome outbreak on health care workers in a medium size regional general hospital in Singapore,’ Occupational Medicine. 2004 May; 54(3): 190–196.

[4] Amanda Corley; Naomi E. Hammond; John F. Fraser. ‘The experiences of health care workers employed in an Australian intensive care unit during the H1N1 Influenza pandemic of 2009: A phenomenological study,’ International Journal of Nursing Studies. 2010 May; 47(5): 577–585.

[5] Lee AM; Wong JG; McAlonan GM; Cheung V; Cheung C; Sham PC; Chu CM, Wong PC; Tsang KW; Chua SE. ‘Stress and psychological distress among SARS survivors 1 year after the outbreak,’ Canadian Journal of Psychiatry. 2007 Apr; 52(4):233-40.

[6] Carlbring P; Andersson G; Cuijpers P; Riper H; Hedman-Lagerlof E. ‘Internet-based vs. face-to-face cognitive behavior therapy for psychiatric and somatic disorders: an updated systematic review and meta-analysis. Cognitive Behavior Therapy. 2018 47(1): 1-18.