Health workers’ mental health: Addressing the invisible global pandemic

The World Health Organization defines mental health as a state of mental well-being in which people cope well with the many stresses of life, can realize their own potential, function productively and fruitfully, and contribute to their communities. By that standard, health care workers are in deep trouble.

While no group of people or profession is immune to mental health challenges, health care workers face disproportionate stress and burnout, putting them at greater risk of anxiety, depression, insomnia, post-traumatic stress disorder, or suicide. These stressors and risks intensify during public health emergencies, especially in low- and middle-income countries, where the ratio between health care workers and the overall population can be tiny.

I’m a humanitarian health care worker implementing programs across five continents, and what my colleagues and I at Project HOPE, a global health and humanitarian relief organization, see time and time again is how widespread and troubling mental health challenges are among this group. Yet there is also hope for a future with less stigma and more support for this essential workforce.

Even before the Covid-19 pandemic emerged, doctors and nurses were more likely than the general population to die by suicide. Health care workers who worked in emergency departments in Hong Kong during the 2003 SARS outbreak reported high levels of ongoing mental distress several months after the disease’s peak. After health care workers who volunteered in West Africa during the 2013-2016 Ebola epidemic returned home, many described symptoms of isolation, depression, stigmatization, interpersonal difficulties, and extreme stress.

In recent years, we’ve learned more about vicarious trauma, or secondary traumatic stress, and how often it’s experienced by health care workers who have engaged empathetically with patients who are enduring primary trauma.

The Covid-19 pandemic has taken a major toll on mental health worldwide, especially among health care workers. Forced to put themselves and their loved ones at risk day in and day out to care for their patients, health workers didn’t have the luxury of taking time off or working from home. All the while they coped with the trauma of witnessing significant loss — not only the loss of those they were caring for but losses within their own families and communities. In one study, more than half of those responding to the coronavirus reported experiencing mental health issues.

The problem has been compounded by the global health worker shortage, which has left far too many health systems understaffed and under-resourced. The remaining workers must manage high patient volumes without adequate support. In developing countries and rural communities, where resources are even more limited, this is particularly problematic and contributes to the rise in infectious diseases, declines in life expectancy, and increases in maternal and infant deaths.

And in places like Afghanistan, Ethiopia, Haiti, and Ukraine, health workers are on the frontlines of more than just the Covid-19 pandemic.

Across continents, mental health continues to be one of the most misunderstood and neglected areas of public health. While barriers to treatment include a lack of resources and trained health workers, the social stigma and shame surrounding mental health is often the greatest impediment to care. This is particularly true for health workers, who take on the role of caretaking often without the ability to take a moment to care for themselves. Physicians, nurses, and other health care providers may also be especially likely to suffer in silence because they’re concerned about confidentiality and its potential impact on their careers.

One place I’m finding help for health workers is a training series developed by NYC Health + Hospitals called the Healing, Education, Resilience and Opportunity for New York’s Frontline Workforce (HERO-NY). Its goal is not only to equip health workers with the tools to manage their own mental health, but also to break down the stigma that may prevent them from managing or acknowledging it. Across five modules, the program teaches health workers how to identify common stress and trauma reactions, implement self-care and stress management techniques, and seek support.

My colleagues and I at Project HOPE have adapted and implemented the program into multiple languages and cultural contexts, reaching more than 60,000 health workers and 400 health institutions in 35 countries around the globe. We’re now expanding it to high-conflict regions in Colombia, Ethiopia, Syria, and Yemen.

A future with less stigma associated with mental illness will require taking the responsibility off individual health care workers to recognize and manage their mental health challenges on their own. While there can be value in teaching people self-care and coping strategies like acceptance, active coping, mindfulness, and positive framing, it’s up to health care leaders and decision makers to raise the psychological resilience of health care workers and prioritize their needs. On a workplace culture level, this includes normalizing discussions about workers’ mental health and establishing screening and prevention programs, so workers can not only express their needs but also be given ways to have their needs met long term.

What’s needed on a systemic level is to continue implementing evidence-based programs that reduce the emotional and mental burden on health care workers. A policy brief by the United Nations on Covid-19 and the need for action on mental health suggests that the implementation of several systemic actions by national decision-makers will help minimize and address the mental health consequences of the pandemic in general. These include:

• applying a whole-of-society approach to promote, protect, and care for mental health
• ensuring widespread availability of emergency mental health and psychosocial support
• supporting recovery from Covid-19 by building mental health services for the future

Health workers are the backbone of every nation’s well-being, whether they’re working in a small clinic in a rural community, a mobile medical unit reaching displaced communities beset by conflict and war, or at a large-scale hospital emergency room. As conflict, natural disasters, and infectious diseases become more common, so will the need for mental health services, making it essential to invest in supporting frontline health workers. Global health depends on it.

Rawan Hamadeh is a program officer at Project HOPE.