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.[13] 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:

  • Develop a multifaceted, bidirectional communication strategy that facilitates frequent connection through e-mail, employee portals, and updates at routine meetings (even if done virtually). Where possible, tap into existing communication channels with special attention to COVID-19-related topics.
  • Hold managers accountable for regular and meaningful contacts with their direct reports.
  • Provide managers with concise talking points to ensure that communications are consistent and as direct as possible.
  • Include updated scientific and other factual information about COVID-19 in messaging.
  • Utilize executive walk rounds to reinforce communications and as a vehicle to hearing frontline concerns.

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:

  • Clear, user-friendly (e.g., use of graphics) and updated guidance for use of PPE (e.g., type of mask required by level of exposure risk).
  • “Real-time” access to PPE coaches to reinforce messages and improve adherence, as well as how to access limited resources (e.g., PPE and testing for workers) and reasonable alternatives.
  • For those who were potentially exposed to COVID-19, guidance for work restrictions and self-monitoring of potential symptoms aligned with the level of exposure.[16]
  • Information and resources with a focus on how to keep workers’ loved ones safe, including: living arrangements, basic hygiene and coping strategies, particularly for children.[17]

3. Provide appropriate training and resources to support changing workforce needs

The 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:

  • Up-to-date information about how to manage patients with suspected/confirmed COVID-19 and reduce risk to healthcare personnel. [18]
  • Delineation of “Contingency” vs. “Crisis” strategies to manage staff shortages that include information about minimum staff requirements to provide safe care and decisions about which high priority (essential) types of care should be offered.[19]
  • Programs to support retraining or skills enhancement.[20]
  • Provide strategies and tools for healthcare workers caring for people experiencing psychologic distress such as psychologic first aid.[21]
  • Resources to help offload responsibilities (e.g., administrative tasks or clinical tasks that could be assumed by medical assistants or advanced practice professionals).
  • Legal guidance regarding licensure, credentialing and malpractice insurance requirements.[22]
  • Technical, clinical, legal/compliance and billing counsel to promote adoption of telehealth.

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:

  • Food: Sweetgreen has developed an “Impact Outpost Program” to provide free delivery to healthcare personnel[23]l; Off Their Plate works with local restaurants to provide meals to healthcare workers and first responders on the coronavirus front lines[24]; and UberEats has pledged 10 million free rides and deliveries to frontline healthcare workers, seniors and others in need.[25]
  • Child and elder care: the University of Washington School of Medicine provides information about resources to support child and elderly backup care, as well as homeschooling.[26]
  • Financial coverage: For workers who are unable to work due to illness or quarantine restrictions, some organizations are covering the cost of accessing clinical care as well as compensating for lost wages.

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:

  • Educate workers about options and resources available to learn basic self-care practices including coping skills. Many healthcare organizations are offering the use of popular apps such as Headspace free of charge.
  • Promote opportunities to maintain connectedness through peer and support groups. The AMA has recommended PeerRxMed as a free option for physicians and other healthcare providers.[27]
  • Encourage and support the use of a buddy system.[28]
  • Make access to behavioral health specialists readily available and affordable (e.g., links to EAP/PAP websites, 800#, placement in highly trafficked areas).
  • Build integrated care capability into primary care practices.[29]
  • Augment behavioral health specialty services in EDs and other sites to address urgent issues (e.g., delirium, suicidality, severe anxiety/depression).

Conclusion

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.

Additional Resources

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:

  1. American Medical Association: https://www.ama-assn.org/delivering-care/public-health/managing-mental-health-during-covid-19
  2. Attorney General of Commonwealth of Massachusetts: https://www.frontlinema.org/
  3. CDC https://asprtracie.hhs.gov/Workforce-Virtual-Toolkit
  4. Dallas County Medical Society (www.herefortexas.com)
  5. Kaiser https://www.ocregister.com/2020/04/13/kaiser-offers-help-to-workers-on-front-lines-of-covid-19-outbreak/
  6. National Academy of Medicine (https://nam.edu/initiatives/clinician-resilience-and-well-being/clinician-well-being-resources-during-covid-19/)
  7. University of Washington School of Medicine https://faculty.uwmedicine.org/covid-19/

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Authors

Mark B. Wenneker, MD
Principal, Behavioral Health Segment Leader
[email protected]

Melissa Biber
Engagement Manager
[email protected]

Pamela Damsky
Director, Service Line Planning Practice Leader
[email protected]