COVID-19 Impact on Behavioral Health: Essential Focus on the Frontline Worker
The COVID-19 pandemic is having a profound negative impact on mental health, particularly of frontline healthcare workers.[1,2,3] They are at significant risk due to worry about virus exposure for themselves and their family members, changes in workload demands and the potential for “compassion fatigue."[4,5,6] Addressing this impact will be critical to maintaining an effective workforce, both to manage the current surge as well as the anticipated demand for services post-surge. With a growing acknowledgement of the longevity of COVID-19, the workforce will need ongoing support as they try to cope with the anticipated peaks and valleys of the curve, which will continue until there is an effective treatment or vaccine.
We outline five strategies informed by research and experience of leading healthcare organizations to support workforce wellness in the face of disasters, including the COVID-19 pandemic.[7,8,9,10,11,12] Four of these strategies are focused on mitigating the causes of worker stress and anxiety. The fifth outlines targeted behavioral healthcare interventions to address worker psychologic needs. At the end of the brief we provide references to resources to assist organizations in this effort.
1. Communicate frequently to understand and address worker concerns
Feelings of stress and anxiety are often fueled by uncertainty. A recent Gallup poll found that forty-seven percent of healthcare workers believe their employer has communicated a clear plan of action for COVID-19. Even if leaders are not able to provide answers to all of the issues raised, communicating regularly with workers will assist leaders in identifying and addressing the most pressing issues and provide some level of comfort to workers that they are being heard. To do this, leaders should:
2. Offer guidance regarding ways to minimize the risk of exposure for both workers and their families
Frontline workers are most concerned about how they can stay safe and minimize exposure to others, particularly vulnerable patients and family members. Few U.S. providers have either the experience or training necessary to care for patients in a pandemic.[14,15] The guidance that is most needed includes:
3. Provide appropriate training and resources to support changing workforce needs
pandemic has caused significant flux in the healthcare workforce which
has varied in degree and character. One source of stress relates to
changes in workload. There is too much work for many hospital-based
staff who have had to face a surge of COVID-19 cases with a decreased
supply of workers from quarantining and illness. And, conversely, there
is not enough work for many ambulatory practices that have eliminated
elective care and had to furlough or layoff providers and staff.
Hospital-based workers are too often working in “crisis” mode.
Ambulatory personnel must adapt to new care models (e.g., virtual care,
new protocols to screen for COVID-19) while feeling pressure to quickly
recapture lost volume to address unmet care needs as well as ensure the
financial stability of the practice. To accommodate these changes, many
providers and staff must assume new or added responsibilities, including
learning new skills.
Leadership can mitigate the impact of these changes by providing the following:
4. Support the basic needs of frontline workers and their loved ones
The pandemic has created an added personal burden for workers who must work additional hours to cover for colleagues, who have school-aged children that are sheltering in place or elderly parents who need support. This has a differentially greater impact on lower-income workers who have fewer resources, both financial and social. While workload redistribution (described in #3 above) will help, many healthcare organizations and companies are also making it easier for their workers to access basic services. Examples include the following:
5. Provide behavioral healthcare tailored to help cope with the impact of the pandemic
In addition to the system-based strategies to address many of the causes of psychological distress that are outlined above, providing workers access to behavioral healthcare resources is also important. The types of care support should range from self-care programs for all workers to direct clinical support to address individual needs. This includes:
To maintain an effective workforce, it is essential to support worker well-being. The strategies outlined above are a “no-brainer” for healthcare organizations that already have robust provider wellness programs. For other organizations, this is an opportune time to launch new programs to recognize the value of and better support frontline workers. The short-term benefit will be a workforce that is as engaged and productive as possible. And, as organizations focus on recapturing demand lost during the acute phase of the pandemic, these efforts will help promote the collaboration, commitment and allegiance required to be successful. As organizations work to safely reopen and earn the trust and confidence of patients, having a confident and supported workforce is essential.
Fortunately, many of the strategies outlined above do not require a significant financial investment. In fact, many are available free of charge. Additional information about resources to support healthcare workers have been compiled by a variety of organizations and are listed below: