17 Jun How COVID-19 Could Harm Clinician Mental Health for Years to Come
Early this year, as the coronavirus started to spread through the United States, mental health professionals braced for a side of the pandemic that hadn’t lit up cable news channels. With chaos and tragedy consuming hospitals and clinics, physicians and other healthcare workers were not only at risk of developing COVID-19. A pandemic unlike anything this nation has seen in a century also threatened to batter the well-being of frontline healthcare workers. “I think we all kind of knew the mental health toll that was going to come with this much trauma and uncertainty and anxiety,” recalls Stephanie Zerwas, PhD, a psychologist in Chapel Hill, North Carolina.
Drawing on a University of North Carolina Healthcare System program geared toward connecting physicians with mental health care, Zerwas decided to act. The private-practice psychologist, who also teaches at UNC, began building a network of mental health clinicians to provide free virtual care to frontline workers in the state. In a few days, 90 therapists signed on.
The movement drew attention, prompting clinicians from elsewhere to ask Zerwas how they could help. She had hoped to play matchmaker by linking patients to the therapist best-suited to meet their individual needs, but demand was growing too high for that level of curation. So, she teamed up with Eleos, a health IT company focused on telemedicine for mental health, whose leadership—with a get-stuff-done attitude formed in the Israeli military—quickly launched a website. By early May, the initiative, named Project Parachute, had built a national network of 600 therapists and matched 150 frontline workers.
As vital as the work was for patients, Project Parachute also offered Zerwas a window into the larger mental-health challenges facing the people who keep hospitals functioning and patients breathing in the pandemic. “Our frontline workers can feel really, really lonely,” she says, “because they’re having these big feelings, and they worry about burdening the people around them. They don’t want to bring anybody down, and they don’t always get the empathy that they’re looking for.”
The COVID-19 Mental Health Crisis
Project Parachute is an attempt to solve a new outcrop of a problem with which healthcare is grimly familiar. Physicians were already facing an alarming mental health crisis before the coronavirus began its global journey. They kill themselves at nearly double the rate of the general population, almost half report experiencing burnout, and 15 percent say they battle feelings of hopelessness or thoughts of suicide.
Perhaps unsurprisingly, the coronavirus has exacerbated healthcare’s mental health struggle. Healthcare workers have spent long shifts laboring under inappropriate conditions, at great risk to themselves and their loved ones, amid a backdrop of incalculable suffering and death. As of this writing, more than 106,000 Americans have died from COVID-19, often in healthcare facilities. No one has seen or tried to quell the devastation of this pandemic like our doctors, nurses, and frontline workers.
And they’re paying the price. In China, where data on the crisis is more readily available, more than half of physician and clinician survey takers reported symptoms of depression. Nearly two-thirds said they felt distressed. Other researchers have argued that the coronavirus pandemic has set the stage for deep mental health wounds—and we might not be prepared to respond.
The mental health problems posed by COVID-19 won’t dwindle when the pandemic fades into history. Healthcare workers will bear the scars for years to come. But healthcare and political leaders can take actions to stop the bleeding.
What Are Physicians Facing on the Ground?
Consider how strange and novel the past few months have been for almost everyone. As we stopped going out to eat or spend time with friends, we began wearing protective masks, practicing social distancing, and working remotely. It’s hard to think of any aspect of life that hasn’t changed, at least in some small way.
Now, imagine going through this kind of all-encompassing shift as a healthcare worker, who’s responsible for patient lives and our broader campaign against the coronavirus. Their personal lives, of course, have been turned upside down much like the rest of populace. But the pandemic’s sweeping tides of change—and new stressors—have affected healthcare workers’ personal and professional in ways that are totally unique to their profession. Even worse, many were already dealing with mental health conditions.
“So, it’s like putting people in a boiling pot, right?” says Jessi Gold, MD, MS, a psychiatrist and writer who teaches at Washington University School of Medicine in St. Louis.
Healthcare workers, for example, now face inherent risks to themselves and their loved ones, just for showing up to work. “I don’t think we’ve ever been in that situation,” Gold adds, “unless you’re a wartime physician, maybe, or you go in the navy or the army.” The pandemic, however, has brought the frontlines to healthcare workers who otherwise wouldn’t be there. They know they might get sick or die, and they understand that their efforts could infect their family.
As such, some healthcare workers have chosen to self-isolate by living and sleeping apart from their support systems. “For many people, that’s their only source of coping,” Gold says. “Then they’re removed from that, and that’s an additional stressor.”
What’s more, hospitals and clinics nationwide are struggling. Some have struggled to keep critical supplies such as personal protective equipment and ventilators in stock. Even certain medications have been tougher to come by. Healthcare workers, meanwhile, have taken on unfamiliar roles, often in intensive care units, to fill gaps. And health systems have cracked down on employees who aim to expose subpar conditions.
Then there’s the obvious: Healthcare workers have borne witness to people suffering and dying in droves like no other time in American history.
For those who don’t think #COVID19 is real;
I’m sitting in my office writing refill prescriptions for another family doctor’s patients in my community. He’s been in the ICU on a ventilator because of COVID for almost a month. For me, it can’t get any more real than this.
— Linda Girgis, MD (@DrLindaMD) May 22, 2020
“A lot of what I’m hearing from people is pretty heavy stuff day to day,” Gold says. “And that’s very different from what a lot of people are using to seeing.”
COVID-19’s Long-Term Effects on Mental Health
Although findings remain limited, early studies suggest physicians and other clinicians are facing serious mental health risks by providing care in the COVID-19 pandemic. But preliminary data hardly illustrate the potential long-term ramifications of this trying moment.
In the coming years, Gold says, clinicians will likely face:
- Post-traumatic stress disorder
- Substance use
Which conditions and in what ways they will afflict frontline healthcare workers depend on many factors. But we’re talking about major disruption to their daily lives—and our healthcare system. Some physicians might not return to work, Gold notes. Some might develop problems at home, which could affect families, including their children. And, as is too often the case in medicine, some physicians might die by suicide.
As Greg Eghigian, PhD, writes for Psychiatric Times, we lack comprehensive data on the effects of past pandemics, particularly the Spanish flu pandemic of 1918-1919, on mental health. That’s not only true for healthcare workers, but the general population. Still, he cites one author’s work that found first-time hospitalizations of patients with mental health conditions shot up by an average annual factor of 7.2 in the six years after the pandemic. While Eghigian cautions against taking too much from the Spanish flu pandemic, he writes that the incident “gives us reason to expect that the present pandemic will carry in tow its own set of mental health challenges.”
The truth is, we don’t know precisely how the COVID-19 pandemic will attack the mental health of anyone. We know this strenuous period in global history will take its toll, but to which degree and in what ways must be studied.
How to Help Healthcare Worker Mental Health
Regular COVID-19 testing, proper PPE supplies, and support from the top are critical to physician and patient safety as the pandemic progresses. This is not enough to provide for their mental health, though.
“It’s really important that when we think about the people who are out there on the frontlines, risking their lives and also their emotional health for us, that we think about supporting both of them,” Gold says. “If we make it through physically, we need to also then realize that there are going to be emotional ramifications for why we might still not be able to do our job at the same level.”
That’s why initiatives like Project Parachute are so significant. They fill gaps that are too easy to overlook or, in some cases, too burdensome for certain stakeholders to contemplate tackling. Still, free and protected mental health services aren’t enough. If it wasn’t obvious by now, healthcare needs systemic change to address physician and clinician mental health at scale.
The National Academy of Medicine provides a strong starting point. Its report on systems-level approaches to clinician burnout, published last year, calls for structural changes across healthcare organizations, governments, medical schools, licensing boards, and technology vendors. No more grueling hours, no more stigmatizing those who solicit mental healthcare, no more cumbersome technology. These calls to action remain even more relevant as COVID-19 brings more urgency to the challenges of physician burnout and suicide.
The culture of medicine must also change, Gold says. Mental health must be valued in the same way as physical health. Governments, meanwhile, need to invest in mental health. Prior authorizations and limits on telehealth, which often hamper the work of mental health practitioners, need to be lifted, she adds. Zerwas says we need to listen to clinicians and then implement solutions to their problems.
We need to act now, they say. If healthcare and government stakeholders only act on clinicians’ physical health threats right now, we’ll lose the opportunity to help their mental health when that care is needed most.
What’s at stake if we don’t fight for physician and clinician well-being as the pandemic grows globally? Their quality of life. Their lives. Our healthcare system.
“We need healthcare providers,” Gold says. “And we need to not have a mass exodus out of healthcare.”
— Jack Murtha. Connect with him on Twitter.