This blog post originally appeared on the SAGE Journals Blog

A critical part of the public health response

By Matthew Walton, Esther Murray and Mike Christian

We asked this question ourselves many times, as we worked as front line medics, psychological support staff and leaders in the heart of the outbreak in London. We shared what we learned in our recent article “Mental health care for medical staff and affiliated healthcare workers during the COVID-19 pandemic”.

Dr Mike Christian, an author of the article, has had first-hand experience treating SARS patients in 2003, dealing with other outbreaks working in conflict zones and responding to terrorism incidents. We started looking at what worked and what did not in previous outbreaks, as well as other crisis situations or disasters in the literature. Many stressors and patterns of reactions in staff were similar to what we see today in the COVID-19 pandemic. Common stressors emerged such as fears of catching the virus, spreading it to family, treating ill colleagues and rapidly deteriorating patients as well as new stressors, such as PPE shortages and having to make triage decisions in civilian settings – who lives and who dies if resources are scarce? Existing stressors were exacerbated, such as pre-existing mental health issues, workload and shift working, as an already stretched workforce is stretched further. We also noted secondary stressors, such as the socio-economic impacts on staff and their families from ‘lockdown’ restrictions. Quarantine too, carries a unique burden of stress - loneliness, guilt and apprehension to return back to work.

Not all staff react equally in a disaster and there is a spectrum of negative impacts including ‘moral injury’, PTSD, depression, anxiety and burnout; the list goes on. However, crucially important is to understand that it is not all bad. Meaning and growth can be found in these situations, new leaders can be born, teams can bond with great purpose, and most of all, many profound psychological reactions will be normal. Most people will recover after having what is considered a normal reaction to an abnormal situation.

So, how can we help? At an organizational level, immediately reflecting on the pre-existing stressors for staff is essential, before addressing the new ones. Do not underestimate the influence an organizational environment has on staff mental health. Practical and tangible interventions were preferred in previous outbreaks, such as provision of food and drink, adequate PPE, housing and transport. Clear communication from visible ‘on the ground’ management was valued, as well as frank information about risk and uncertainty. Provision of psychological support was most successful if in comfortable settings and if senior staff used the support too.

Leaders of teams must first focus on being a ‘good leader’. Crisis leadership strategies include communicating clearly, empowering others and acting with humanity and humility. Leaders need confidence to pursue what is truly right, while acknowledging the difficulties of ‘living through’ the pandemic themselves. Colleagues can look for warning signs of distress in their peers and be open to listening, laughing and crying with them. Individuals can draw on the strategies that have worked for them in the past and be proud of their important societal role.

We are now entering the most difficult part of this pandemic: the adrenaline has worn off, the ‘crisis’ is subsiding, but the challenges remain with no short-term end in sight. Staff are tired, many of the normal avenues to ‘re-energize’ have been closed and family and friends are disconnected. Supporting the mental health of these individuals is a critical part of the public health response. This will remain the case for many years as we work to find a resolution for the pandemic and then move into the recovery phase. Our paper provides guidance on how to help healthcare workers cope. Leaders at all levels of healthcare organizations will find this a valuable resource.

About

Matthew Walton MA (Cantab) MB BChir DiMM. Matthew is a Doctor working in A+E and intensive care in London. He has studied infectious diseases at Cambridge University and has focussed most of his medical career on promoting public campaigns to support frontline staff wellbeing and resilience. Matthew is an amateur filmmaker and has had his work screened at the Barbican, Model United Nations and on the BBC. Recently he has created the ‘Resilience’ film series that features in a national training program to support healthcare worker mental health and is currently working on further initiatives with NHS Education for Scotland.

Esther Murray. Esther has been a health psychologist for 12 years, initially working in cardiac care both in service improvement and psychological interventions for patients, later going on to a career in academia at Barts and the London School of Medicine and Dentistry. She currently researches moral injury and the psychological wellbeing of healthcare professionals.

Mike Christian MD, MSc (Public Health), FRCPC is a senior healthcare sector leader with nearly 30 years of experience and a strong track record of high-performance. He specialisms include critical care, infectious diseases, military, aviation and pre-hospital medicine. He has enjoyed a diverse range of roles, including Chief Safety Officer for a large multi-site Hospital System, Medical Director of Critical Care Response Teams in Canada, and Director (Founding Board) of Ontario Agency for Health Protection & Promotion. In 2016, he moved to the UK for a sabbatical with London’s Air Ambulance. Having decided to remain in the UK, he served as Clinical Lead for an Air Ambulance in the counties and subsequently was recruited to join London's Air Ambulance's senior team for a period of two years to lead on the delivery of key objectives within their research strategy.