In many countries, large-scale initiatives are under way to pay tribute and thank health personnel for their heroic work in the diagnosis, care, and follow-up of patients during the COVID-19 pandemic.
These expressions of gratitude and admiration are undoubtedly an important source of motivation for health personnel, but true support goes beyond just applause. Comprehensive protection for health personnel consists of both physical measures to prevent contagion as well as protection for their mental health and quality of life. In the current circumstances, health personnel are not only coping with the social changes and emotional stress that we all face. They are also faced with exposure to the illness, extreme workloads, moral dilemmas, and an unpredictable work environment that changes from one day to the next. And as if that were not enough, sadly, in addition to putting their lives at risk by taking care of those who are ill, health personnel are also faced with violence and stigma resulting from unfounded fears among the population.
Lessons from past epidemics
We have to learn from previous epidemics. Just as with COVID-19, during the severe acute respiratory syndrome (SARS) epidemic, the health personnel who had to be quarantined experienced serious mental health effects, including acute stress disorders, depression, alcohol abuse, and symptoms of post-traumatic stress even as long as three years after the event. This is being corroborated in the current pandemic: preliminary studies in China show high levels of mental health problems among nursing and front-line health personnel that include depression, anxiety, insomnia, and anguish.
What are the needs of health personnel?
They themselves are telling us in straightforward terms:
Listen to me, protect me, prepare me, support me, and care for me.
- Having access to adequate personal protective equipment.
- Being exposed to COVID-19 at work and bringing the infection home to their families.
- Not having rapid access to diagnostic tests if they develop symptoms of COVID-19 and the associated fear of spreading the infection in their workplace.
- Uncertainty as to whether their employer will take care of their personal and family needs if they get infected.
- Being able to get someone to care for their children when they are working extra hours and schools are closed.
- Being able to depend on support for their other personal and family needs (food, water, shelter, transport) that increase in proportion to the extra hours they have to work.
- Being able to provide competent clinical care if they are transferred to another care area (for example, moving from general care to the intensive care unit).
- Lack of access to current information and communications.
What should the authorities do?
The psychiatrist Jessica Gold puts it bluntly: “The mental health of health personnel cannot be an afterthought when facing the pandemic.”
There are steps that can be taken right now. At the institutional level, it is essential to have the protective equipment, adequate training, supplies, and other elements necessary for the clinical care required, as well as an occupational health plan updated to meet emerging needs. Mental health measures can be adopted for prevention (support for stress reduction, provision of comprehensive care and of educational materials), real-time support (hotlines, crisis support), and treatment (telepsychiatry for therapy, and medication if necessary). Health teams should have promotion and prevention programs available to them that include break periods, space to connect virtually with their families, access to green areas and opportunities for physical activity, adequate food and nutrition, and relaxation exercises (when possible), among other services.
Some hospitals have established psycho-social support groups for all staff, with priority given to emergency, intensive care, and hospitalization units. These teams have access to virtual consultations 24 hours a day, as well as to weekly support group meetings. It is also important to include hospital administrative and security staff in these programs, since they also are exposed to high stress levels and demanding working conditions. And it is necessary to have a “radar” in place to identify best mental health practices that continue to emerge as countries acquire more experience during the pandemic.
Governments can provide regulation, information, and development of national protocols, support their implementation, and monitor compliance to ensure optimal working conditions. It is also critical to begin monitoring and researching the effect of the pandemic on health personnel. Working collaboratively will be very important in this regard. For example, in Chile, an international team led by the University of Chile’s School of Medicine was established to research the effects of the coronavirus pandemic on the mental health of health workers in more than 20 countries.
Ensuring and maintaining effective human resources in health care during this crisis requires measures to support health personnel so that they can perform to their full potential over a prolonged period of time. This refers not only to the acute phase of the pandemic but also to the many problems that arise in the medium and long term, when “normality” has returned. As a final thought, the current crisis, paradoxically, presents an opportunity to finally and seriously intervene in health systems to improve conditions for the talented and dedicated people who work in them.
“Will the new normal better provide for the physical safety and emotional support of the health care workforce in the future? Excellent medical care is not possible without a physically and psychologically safe and healthy labor force.”
Do you know of examples of public policies to care for the mental health of health personnel in your country? Leave us a comment or mention us at @BIDgente
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