“I hope they don’t forget about us when this is past.”
That’s what an ICU nurse told Yale New Haven Health CEO Marna Borgstrom and other executives when they were talking about the support and generosity of the community during the COVID-19 pandemic.
For frontline providers who have dealt—and will continue to deal with—packed-to-the-brim ICUs and way-too-high patient death rates, experts say the mental health toll of this pandemic will linger for a while.
“They have seen things. They have been the only source of support for a lot of people who have drawn their last breath. This will impact health care workers for a long time,” Borgstrom said.
A study from researchers in China, published in JAMA Network Open, found that of 1,300 health care workers surveyed from the frontlines of the COVID-19 pandemic in Wuhan, more than half reported symptoms of depression, 45% reported symptoms of anxiety, 72% reported symptoms of distress and 34% reported insomnia. Those on the frontlines reported more severe degrees of all measurements of mental health symptoms than other workers, the researchers found.
Infographic: The mental health impact on COVID-19 frontline providers
“Essential and frontline workers are making an impossible choice every day, risking their health and their family’s health. Saving lives. Keeping society afloat. They are making such a tremendous sacrifice for our communities. I expect many of them will experience higher rates of depression, anxiety and post-traumatic syndrome disorder (PTSD),” says Renee Schneider, the vice president of clinical quality at Lyra Health and a clinical psychologist.
Many health care organizations are taking this problem head on, trying to tackle it before the mental health issues grow worse. When it comes to providing mental health support for frontline providers, experts shared a few areas to get started.
Focus on enabling resiliency
COVID-19 will have a mental health impact on everyone. But for those providing the care, it’s going to be a tough hill to climb.
“They are seeing much more death than they expected, dealing with the anxiety of virus exposure and may have separated themselves from their families,” says Deborah Marin, MD, Professor of Psychiatry at the Icahn School of Medicine at Mount Sinai Health System in New York City.
Marin also predicts many frontline providers from the COVID-19 pandemic will suffer from PTSD. In NYC, the epicenter of the coronavirus in the U.S., two emergency workers committed suicide in April, including the medical director of the emergency department at NewYork-Presbyterian Allen Hospital.
These mental health concerns have prompted Marin’s Mount Sinai to open a Center for Stress, Resilience and Personal Growth. She says the center will focus on early interventions, screening for depression symptoms and resiliency training. Mt Sinai specializes in resiliency and post-disaster intervention through its 9/11 first responder monitoring and treatment services. Based on what the health system has learned in that program, it estimates 25 to 40 percent of first responders and health care workers will experience PTSD as a result of COVID-19.
“We will be having classes to improve methodologies to improve one’s resilience,” Marin says. “There are lots of behavioral and mindfulness techniques that can be used —writing down affirmations, focusing on spirituality. It’s all work from Dennis Charney, MD, the Dean of Mount Sinai Medical School and what they know are resilience building factors.”
Michael Goldberg, the president of Child & Family Psychological Services, a private outpatient behavioral health provider in Massachusetts, is working with Atrius Health and other frontline providers on resiliency training of its own. Goldberg says the “Provider Resiliency Program” includes evidence-based practices, using Albert Roberts’ Seven-Stage Crisis Intervention Model to guide trauma response. He says he is making the resource free for every behavioral health provider in Massachusetts.
Establish a systematic approach
Patrice Harris, MD, President of the American Medical Association (AMA), advises health care organizations to take a systematic approach to becoming a resilient organization and proactively caring for the mental health problems of frontline providers. She says a systematic approach means the onus isn’t on individuals.
“Self-care is important, but we think institutions and organizations need to put systematic solutions in place. This COVID-19 pandemic is occurring on top of a crisis we had pre COVID-19 regarding physician burnout. If you have this pandemic, which is a crisis on top of a pre-existing crisis, that exacerbates the issue. We want frontline clinicians to feel supported within their institutions,” Harris says.
Read more: Physician burnout: 5 steps CEOs can take to fix the problem
Health care leaders, she says, can use surveys and workgroups to understand the specific problems frontline providers are having within their organization. Once they have that data in hand, they can develop the proper resources to address those issues. Goldberg is taking the systematic approach a step further. His organization is developing a system wide measurement method to track outcomes rather than relying on patients to self-report their progress.
