While all hands are on deck in the battle against COVID-19, there is another battle that is looming: the mental health of frontline health workers (HW). Amid the frenzy to try to assist patients, there is a real concern that the mental health of these HW is being neglected. The World Health Organization (WHO) reported in May that 47% of health workers in Canada believed they needed psychological support. In one of the earliest reports after the COVID-19 outbreak in Wuhan, it was found that a significant proportion of frontline HW experienced increased mental health problems, such as depression, anxiety, insomnia, and distress. It is unfortunately not surprising that HW are experiencing mental health issues, since the connection between pandemics and the deterioration of mental health in HW is well known. A lot of research from past pandemics, particularly from the SARS and H1N1 outbreaks, highlighted this connection.
Despite the knowledge we now have on this subject, why is the mental health of HW still deteriorating dramatically during the current COVID-19 pandemic? I believe that the answer is a combination of different factors. This article will highlight a few of the stressors in the COVID-19 pandemic that are together exacerbating the mental health deterioration of HW.
The first problem is surrounding the shortage of personal protective equipment (PPE). Healthcare facilities have often been incapable of providing their HW with adequate protection, which creates a serious mental health problem, since in addition to caring for patients, HW now must worry about their own well-being. HW must also make a number of tough decisions, as a result of the PPE shortage, which impact their mental health. First, they must choose whether to even risk their own health by working without adequate PPE, and if they choose not to work, they then may experience guilt from leaving their co-workers to risk their own lives, or perhaps from actively choosing not to help sick patients. Second, they must choose whether they want to risk their jobs by using their own PPE. Reports show that HW who have used their own PPE, as a result of the lack of PPE provided to them, have been fired from their jobs. In addition to this, HW who speak out about the shortages or inadequate working conditions also face the risk of termination from their jobs. HW are clearly being denied their basic rights to health and a safe workplace.
Burnout is another widespread problem. Even before the COVID-19 pandemic hit, reports were being published about the severity of the burnout problem that afflicts HW. One of the many reports, published in 2012, found that just under half of physicians in the US were struggling with burnout. Burnout has only become more of a problem in the age of COVID-19 now that healthcare facilities around the world are overloaded with patients and employing a shrinking workforce as a result of many contracting the virus. Dr. Irwin Redlener, director of the National Center for Disaster Preparedness at Columbia University, stated in an interview that “The reality is that we’re facing the inevitable shortage of health care providers.” Further reports from India show that HW have indeed been experiencing severe burnout, largely as a result of working without breaks since the COVID-19 outbreak. Similarly, in Canada, HW have been protesting that they are exhausted and suffering from extreme burnout as a result of the government barring them from taking any vacation days since the outbreak. Ensuring that there is a large enough HW workforce, both in the presence and absence of pandemics, is key.
While there is scant evidence to suggest that governments are actively trying to solve the burnout issue, some governments have implemented policies that may inadvertently ease the workload of HW. Several countries, for example, have requested that retired HW come back to work. This approach comes at a consequence, however, because it places at-risk individuals on the frontlines. Some countries, like Canada, have also been granting foreign-trained HW permits to practice medicine in Canada. Despite these programs, there is still ongoing reporting on the elevated levels of burnout among HW. More must be done by governments to address this issue.
In difficult times, HW often mitigate some of their mental health problems by leaning on their social support systems. However, because of how contagious the virus is, as well as the concern of being an asymptomatic carrier, HW have had to isolate themselves from their families and friends. Despite the precautions taken at healthcare facilities, many HW have still been terrified of spreading the virus to their loved ones. This has resulted in HW being unable to benefit from their social support system in the same way that they previously were able to.
In May 2020, The WHO ratified a resolution on how to respond to COVID-19. One of the calls to action by member states says that they should:
“Provide health professionals, health workers and other relevant frontline workers exposed to COVID-19, access to personal protective equipment and other necessary commodities and training, including in the provision of psychosocial support, taking measures for their protection at work, facilitating their access to work, and the provision of their adequate remuneration, consider also the introduction of task-sharing and task-shifting to optimize the use of resources.”
Many governments have now recognized these mental health concerns, and as such, have funded and expanded mental health resources. Is this enough though? Are governments doing as much as they can to support HW? The likely answer is no.
Unfortunately, government action has primarily been reactive rather than proactive. In other words, governments waited until the problem grew and became unavoidable, rather than using lessons from past pandemics to address this inevitable problem from the very beginning. That is a big failure.
The world recently learned of the tragic suicides of Lorna Breen and John Mondello, two HW in the US. This has undoubtedly shined a light on the extreme vulnerability of HW during COVID-19, particularly because of their increased risk of suicide. Past research has highlighted the fact that HW are at an increased risk of suicide even when there is no pandemic. Despite this information, governments still failed to take measures early on to address these concerns, and as a result, many have now called for there to be better suicide monitoring for HW during this pandemic.
Another concern is that governments have primarily expanded their mental health resources by offering virtual support. Ontario, for example, on May 5th provided $12 million to expand mental health resources for HW by establishing internet-based Cognitive Behavioural Therapy. While virtual therapy is useful in many ways, it is inherently limited as well, due the lack of face-to-face interaction, and potential inability to address more serious mental health conditions.
These are only a few of the failures in many government’s response plans to the COVID-19 pandemic. There are many more. Consequently, HW all over the world are currently being denied their basic rights to health and safe workplaces. This is completely unacceptable. Moving forwards, countries must rethink their approach on how to address the mental health problems faced by HW. Let this be the last crisis where the mental health concerns of HW are not prioritised from the very beginning.