27 Jun A Call to Action: The Mental Health Impact on Our Frontline Healthcare Workers

The pandemic especially impacted the lives of our healthcare workers, who were expected to go out when everyone else was expected to stay inside and socially and physically distance themselves from the rest of the world. Most of us attempted to cope with the fear and uncertainty from our homes, but our healthcare workers exposed themselves to the COVID-19 virus every day, continuously witnessing the direct effects of the pandemic as it spread throughout communities. 

As the pandemic winds down, healthcare workers are suffering from more than just burnout. A report by the Department of Health and Human Services reveals the depth of distress throughout the health care system.

The human brain goes into fight or flight mode and enacts biochemical responses to avoid harm in the face of danger. Adrenaline rushes. Our stress response works well for short-term threats; however, long-term, sustained stress, can overwhelm our ability to cope. One cannot heal from trauma when the mind and body is still in survival mode.

Mental Health and the Pandemic

More than half of frontline healthcare workers say that the pandemic has impacted their mental health, experiencing symptoms of anxiety, depression, and PTSD.

Statistics tell the story:

• More than 60% of frontline healthcare workers say the pandemic has negatively impacted their mental health, according to a national survey published from the Kaiser Family Foundation and the Washington Post.
• About 13% of those surveyed reported accessing mental health services or medications while 18% said they needed such services but didn’t get them. Those who didn’t get help cited being too busy or unable to get time off work, feeling afraid or embarrassed or not being able to afford it.
• The fear of burnout led the Joint Commission to issue a bulletin encouraging providers to offer more mental healthcare access to staff along with fostering more open and transparent communication.

 
Now that there seems to be an “end” in sight, the brain can start to calm down and process what happened. Our healthcare workers have been a direct witness to the devastation and loss that has occurred. Frontline healthcare workers may begin grieving or just adjusting to the concept of the new normal.

The “Stigma” of Seeking Mental Health Care

Then, there’s this thing known as stigma. This word has been used in association with mental health and substance use disorders for decades, but what is stigma? Stigma is a process by which we label, devalue, and discriminate against someone. It can occur on multiple levels simultaneously- intrapersonal, interpersonal, and structural. There has been stigma around mental health in our communities for as long as most of us can remember, despite the growing numbers of people affected by mental illness, mental health disorders, and substance use disorders.

More than half of people with mental illness don’t receive help. Often, people avoid or delay seeking treatment due to concerns about being treated differently or fears of losing their jobs and livelihood. That’s because stigma, prejudice and discrimination against people with mental illness is still very much a problem.

A 2016 study on stigma concluded “there is no country, society or culture where people with mental illness have the same societal value as people without mental illness.” A 2019 national poll from the American Psychiatric Association (APA) found that mental health stigma is still a significant challenge in the workplace. About half of workers were concerned about discussing mental health issues at their jobs. More than one in three were concerned about retaliation or being fired if they sought mental health care. Only about one in five workers were completely comfortable talking about mental health issues.

Such an understanding is helpful for appreciating how stigmatization occurs throughout the healthcare sector and can lead to reluctance for these frontline workers to seek care or disclose mental health struggles or illness. The pandemic has certainly brought this crisis to everyone’s front door, but has it changed how we think and respond to someone who is struggling with mental health issues? Do we understand mental health more post pandemic? Are we less fearful?

Mental Health Care and Medical Professionals

While it may seem easy for a doctor, nurse, medical assistant, or healthcare administrator, who are surrounded by healthcare providers every day, to find a therapist, in fact, difficulty accessing care is quite common. While the need for privacy is important in all forms of healthcare, it seems to be critical to physicians and nurses. Many state licensing boards tend to ask open-ended questions about whether licensed clinical providers have sought or are seeking mental health care, and many medical providers become concerned that they may encounter future issues with their license if they do seek treatment. It is important to note that these requirements are state dependent; however, questions such as, “Do you have any mental or physical conditions or take any medications that may affect your ability to competently and safely perform your job?” are often asked. 

Additionally, an article published by the American Journal of Psychiatry shows that the consequences of truthfully responding to these questions can be considerable. The article notes that “Although state dependent, the repercussions of full mental health disclosure can include being asked to appear before state board examiners or to pay for a board-appointed physician examination.” The lack of privacy around mental health information can lead our healthcare workers feeling unsafe, and contribute to a reasonable awareness of bias against mental illness.

Bias towards mental health issues and treatment is especially concerning considering the prevalence of reliance on self-treatment, minimal peer support, and increased risk of suicide among frontline healthcare workers. The American Addiction Centers note that in 2013, seven years before the pandemic, nearly 70 percent of medical professionals reported having misused prescription drugs at least once in their careers, with opioid use being predominantly common. And perhaps most frightening, physicians die by suicide at twice the rate of the rest of the population.

These grim statistics highlight the consequences of unaddressed mental health needs for our frontline healthcare workers. The pandemic has only intensified the impact on their mental health and well-being. The effects of unmet mental health needs are not just harmful to providers themselves, they can be detrimental to patients, too. Feelings of depression might cause physicians to make mistakes they wouldn’t ordinarily make, while nurses also reported that their mental health affected their work performance.

It is time as a community that we begin caring for our caregivers. Advocate for health systems and healthcare organizations to establish an infrastructure and resources to support physicians, nurses, and care teams. Prioritizing mental health and well-being across the medical and mental/behavioral/substance use health sector. Providing trauma-informed care, changing workplace trends, building resiliency tools for the future. Most importantly, create safe spaces to discuss mental health struggles without fear. One can’t rush recovery from prolonged stress or trauma, but there are ways to help our frontline healthcare workers move forward. We can. We must.