We Need to Prioritize Mental Health for Healthcare Workers

(Posted on Tuesday, June 29, 2021)

KEY POINTS

• Between 35 and 54 percent of nurses and doctors were already experiencing burnout before the pandemic.
• During the pandemic, healthcare workers had to work with a lack of protective equipment and faced many instances of moral injury on the job.
• Roughly 3 in 10 healthcare workers have weighed leaving their profession. Some fear stigma or losing licensure by seeking mental health care.
• Removing stigma can be a first step toward getting healthcare workers the mental health support they need.

Healthcare workers were already under immense strain prior to the pandemic. A report by the National Academy of Medicine in October 2019 found that between 35 and 54 percent of nurses and doctors experience burnout. Among medical students and residents, the percentage is as high as 60 percent.

Burnout can lead to symptoms of depression, substance abuse, and suicide. In the United States, approximately one doctor was dying of suicide every day. According to a 2018 literature review of physician suicide, the suicide rate among physicians is 28 to 40 per 100,000, more than double that in the general population.

An analysis by Ohio State University College of Nursing and The American Journal of Critical Care found that a majority of critical-care nurses scored themselves low on physical and mental health status even before the pandemic began. Survey results collected from August 2018 to August 2019 found 61% of more than 700 critical care nurses rated their physical health a score of five or lower out of a possible 10, while 51% reported their mental health with a score of five or lower.

Compounding this crisis is the fact that many healthcare workers are discouraged from seeking mental healthcare for fear of risking their medical licensing or malpractice insurance. In one survey, around 1 in 15 surgeons cited recent suicidal thoughts, but more than 60 percent were deterred from seeking out mental health care because of concerns that it might affect their license.

Physicians face intense levels of scrutiny when disclosing any form of mental health treatment to state licensing boards. This goes against the recommendation of the American Medical Association. Early treatment of mental health issues is so critical, licensure applications should be amended to remove broad questions regarding mental health history and focus on a clinician’s ability to function.

Lack of protection for healthcare workers

An ongoing pandemic in which healthcare workers were under-resourced, unprotected, overwhelmed, and traumatized by the lack of effective leadership and ambivalence of the public, has only worsened and amplified this already precarious mental health crisis. According to a survey conducted in April 2020, nearly half of participating healthcare workers experienced serious psychiatric symptoms as a result of the COVID-19 pandemic. Two-thirds of participants reported some level of clinical anxiety and nearly a fifth reported moderate to severe depressive symptoms, while 17% met the criteria for posttraumatic stress disorder. A prior history of mental health disorders increased the likelihood of COVID-19-related psychiatric distress, though many without a prior history of mental health disorders also reported experiencing anxiety and depression.

When COVID-19 patients first filled our hospitals, we knew so little about how the virus was transmitted, how severe the symptoms could be, or even how to care for patients. Due to inadequate pandemic planning and supply chain issues, there was simply not enough PPE available to keep healthcare workers safe. This created an immediate uncontrollable stressor for doctors and nurses working in hospitals, who were updating their wills and end-of-life directives while concurrently worrying about infecting their families, loved ones, or roommates. Emergency Physician and asthmatic Brittany Bankhead-Kendall told The New Yorker she felt so vulnerable “Whenever I got coughed on, it felt like a death sentence…every day I thought, this could be the end.”

Moral injury

In addition to fearing for their own lives, while working long and chaotic shifts. Doctors and nurses were experiencing the traumatizing moral injury of not being able to provide high-quality care and healing to patients through factors they could not control. The lack of effective treatments, ICU beds, and ventilators in the early days of the pandemic meant mass casualties were a frequent occurrence. The ongoing death toll from COVID-19 is astronomical by anyone’s standards. So many physicians consider medicine a calling rather than a career path; they push themselves through years of schooling, grueling work hours, and take on significant financial debt, motivated by a desire to help people.

Megan Brunson, a night-shift nurse in Dallas echoed these sentiments to The Washington Post. “Most of us got into this to save lives. But when death is blowing around you like a tornado and you can’t make a dent in any of it, it makes you question whether you’re making any difference.”

As if these layers of stress and trauma were not enough to cope with, healthcare workers also had to endure the moral trauma of inaction by global leaders and ambivalence by some members of the public towards the virus. In return for risking their lives, U.S. healthcare workers watched former President Trump ignore science and mock others for protecting themselves while wearing masks, stoking the flames of division at a time when unity was essential to save lives.

Sharon Griswold, an emergency room doctor in Pennsylvania told The Washington Post, “You feel expendable. You can’t help thinking about how this country sent us to the front lines with none of the equipment needed for the battle.”

Doctors and nurses have also felt a deep sense of betrayal and hypocrisy from the public during the pandemic. Public tributes such as the nightly cheering and clapping and hero-worship were juxtaposed with a refusal to wear masks and take other public health precautions. As pandemic isolation fatigue set in and thousands flouted warnings and traveled over the holiday period, healthcare workers witnessed the tangible impact as hospitals were once more overwhelmed with COVID-19 patients during the winter surge.

Healthcare workers leaving the profession

The burden of all this trauma will lead to an exodus of healthcare workers. According to a Washington Post-Kaiser Family Foundation poll, roughly 3 in 10 healthcare workers have weighed leaving their profession. Losses to the medical workforce could mean dire consequences for an already strained U.S. healthcare system, as years of training are needed to produce a single doctor or nurse. Many burdened by student loans will not even have the option of quitting but will suffer from festering, unaddressed mental wounds unless urgent action is taken. Medical workers should not feel like their only option to preserve their mental health is quitting.

Mental healthcare solutions for medical workers

Solutions begin with removing obstacles to accessing mental healthcare resources for medical workers by removing the culture of stigma and shame in workplaces. Lorna Breen, an emergency room doctor in New York, died by suicide in April 2020. In the months since, her sister and brother-in-law, Jennifer and Corey Feist, have strived to prevent further deaths by creating mental health resources for health workers. Corey Feist, who is also the CEO of the University of Virginia Physicians Group, penned an op-ed for Modern Healthcare decrying the neglect of physicians’ mental health.

“Traditionally, clinicians have dealt with the trauma of their experiences away from the workplace and alone. We saw this in my sister-in-law when Lorna often talked about the importance of maintaining a stiff upper lip … The old approach of telling clinicians to maintain a stiff upper lip and download meditation apps for stress relief is not the antidote,” writes Feist.

Jennifer and Corey Feist created a foundation in Dr. Breen’s name and got a bipartisan bill called the Dr. Lorna Breen Health Care Provider Protection Act introduced in the Senate. Some recommendations from the legislation were included in the American Rescue Plan relief bill, including $140 million allotted for medical training, hospital programs, and a mental health awareness campaign. Feist also found through extensive polling that “complex and cumbersome electronic health record systems and other administrative inefficiencies” were also “a chief culprit of burnout.” Physicians report spending on average one to two hours a night inputting patient data instead of resting after a long shift.

We should be listening to those in the medical community about what they need to process the ongoing trauma of COVID-19 and to reform the problematic workplace culture that contributed to this mental health crisis. Then we should be swiftly delivering those initiatives with the same priority given to other COVID-19 interventions.