The mental health challenges faced by healthcare workers
Understanding resilience in healthcare settings
Preventative strategies for mental health
Responsive interventions for mental health crises
Case studies: successful mental health programs in healthcare
Conclusion
References
Further reading
The unique challenges associated with healthcare place a large burden of stress upon healthcare workers. This has necessitated the study and application of preventative and intervention strategies for mental health. This article will explore some of these strategies alongside providing case studies of where they have been implemented.
Female Doctor In Face Mask Wearing Scrubs Under Pressure In Busy Hospital During Health Pandemic. Image Credit: Southworks/Shutterstock.com
The mental health challenges faced by healthcare workers
Mental health is an aspect of a person's wellbeing related to their psychological and emotional state. Much like physical health, mental health is an important aspect for individuals to be able to recognize and manage. Challenges to mental health can arise from personal life or work and are important topics to discuss.
The healthcare field is associated with several unique challenges. For healthcare professionals, working hours are often long and may not be the typical 9-5 work week. These long and unsocial hours lead to difficulties in achieving a work-life balance, which may put a strain on relationships or lead to difficulties in childcare.1
Further to the described issues with standard work times, the so-called "Core Work Stressors" also add further challenges to the job. These are the aspects of everyday work that cause stress, such as a fear of making mistakes that could harm patients, patient deaths, and difficulties in dealing with patients and their families. 1
These unique and multifaceted challenges make stress management in healthcare a challenge. This has been seen in a range of healthcare workers, where over 70% of nurses have reported being stressed, and around 30% of physicians report experiencing high stress. 2,3
Mental health issues have been observed at significantly high rates among healthcare workers, such as high levels of anxiety. 4 A global meta-analysis has also shown similarly high rates of mental health issues. 5
This study suggested nearly half of healthcare workers worldwide had mental health issues during the COVID-19 pandemic. The assessed mental health problems included post-traumatic stress disorder, anxiety, depression, and distress. Post-traumatic stress disorder was reported as the most common among these mental health issues. 5
Compassion Fatigue in Healthcare Professionals
Understanding resilience in healthcare settings
In the context of healthcare, resilience is the capability of the individual to react and deal with stress suitably. 6 Healthcare workers perform roles that are critical to patient's health and safety. The ability to execute their actions to the highest standard is crucial. Stress can impact decision-making, and the unique challenges of healthcare may lead to many potential stressors. 7
Healthcare worker resilience is of the utmost importance, allowing for correct and efficient decision-making. A study has shown an association between higher resilience scale scores (a tool to rate resiliency) and lower total mean scores of stress and psychological wellbeing in nurses. 6
This association suggests that increased healthcare worker resilience may be protective against stress in the workplace. Potentially preventing the appearance of mental health issues and increasing the mental and emotional wellbeing of the workers.
Preventative strategies for mental health
Preventative strategies for mental health may be approached at both the organizational and individual levels. This offers both blanket strategies to protect and nourish healthcare worker resilience, alongside allowing individuals to be proactive in stress management.
Organizational approaches to fostering healthcare worker resilience may arise in the form of stress management training, such as the Stress Management and Resiliency Training (SMART) program explored by Dosset et al., 8
The SMART program combines meditation techniques, the promotion of a healthy lifestyle, traditional stress management techniques, plus cognitive reappraisal and adaptive coping skills (derived from various psychology practices). This approach showed positive effects on physical health, mental health, and job satisfaction whilst decreasing perceived stress. 8
As mentioned earlier, the work-life balance aspect of healthcare work is difficult to manage. Some approaches for increasing healthcare worker resilience seek to amend this through advanced scheduling of time off, allowing for a set time for healthcare workers to relax. 9
Individuals may also adopt practices to aid stress management in healthcare, such as meditation, as seen in the Mindfulness-Based Stress Reduction program. This program uses "mindfulness and loving kindness meditation". 10
A study utilizing the Mindfulness-Based Stress Reduction program has shown a significant reduction in perceived stress, anxiety, burnout, and depression through the use of such a program among nurses. 10
Responsive interventions for mental health crises
While preventative strategies are important for healthcare workers to avert mental health crises potentially, intervention strategies should also be in place. Mental health interventions for healthcare workers can come in many forms. Digital platforms, for example, including websites and mobile applications, can provide easily accessible information for overcoming stress reactions. 11
Professional physician wearing white coat talking to mature woman signing medical paper at appointment visit in clinic. Image Credit: Ground Picture/Shutterstock.com
Emergency telephone helplines are also commonly used tools. Acting as a psychological intervention, with the opportunity for the caller to receive further psychiatric consultation. These helplines have been demonstrated to be easily duplicatable across organizations and are used extensively in stressful situations. 12
As mentioned, counseling is an option for mental health intervention. Counseling and referral to other mental health services is often offered by healthcare organizations to workers. Psychological Support delivered by occupational health support personnel to healthcare workers has been shown to reduce distress and improve quality of life significantly. 13
Peer support programs are also valuable interventions in the face of mental health crises. Peer-to-peer conversations around mental health and stress have been shown to affect psychosocial outcomes positively. 14 A study surrounding such a scheme determined that training managers in such a manner suggested that it may help mitigate burnout of healthcare staff. 15
Case studies: successful mental health programs in healthcare
Case studies discussing best practices to promote healthcare worker wellbeing are valuable tools for organizations to reflect on to improve implementation. The Yorkshire and the Humber Senior Psychological Wellbeing Practitioner Network is a support program put in place in the larger Yorkshire and the Humber Mental Health Clinical Network. 16
The Yorkshire and the Humber Senior Psychological Wellbeing Practitioner Network has implemented a number of measures in the wider clinics, such as the inclusion of wellbeing in supervision contracts and establishing "wellbeing champions". Wellbeing activities, for instance, tabletop yoga and breaks from the desk when working, are also implemented. 16
The practices implemented by the Yorkshire and the Humber Senior Psychological Wellbeing Practitioner Network have received positive qualitative feedback, with individuals in the program now presenting about the initiative to other Improving Access to Psychological Therapies providers. 16
Conclusion
Mental health is as important as physical health among healthcare workers. Strategies to support resilience, such as mindful mediation, seeking greater work-life balance, alongside interventions like counseling and emergency helplines when mental health issues arise, are crucial to supporting mental health. Individuals should also advocate for organizations to increase support for mental health in healthcare.
References
1. Rink LC, Oyesanya TO, Adair KC, Humphreys JC, Silva SG, Sexton JB. Stressors Among Healthcare Workers: A Summative Content Analysis. Glob Qual Nurs Res. 2023;10. doi:10.1177/23333936231161127
2. American Nurses Foundation. COVID-19 impact assessment survey—The second year. American Nurses Association Enterprise. https://www.nursingworld.org/practice-policy/work-environment/health-safety/disaster-preparedness/coronavirus/what-you-need-to-know/covid-19-impact-assessment-survey---the-second-year/. Published 2022.
3. Linzer M, Stillman M, Brown R, et al. Preliminary Report: US Physician Stress During the Early Days of the COVID-19 Pandemic. Mayo Clin Proc Innov Qual Outcomes. 2021;5(1):127-136. doi:10.1016/j.mayocpiqo.2021.01.005
4. Xiao H, Zhang Y, Kong D, Li S, Yang N. The effects of social support on sleep quality of medical staff treating patients with coronavirus disease 2019(COVID-19) in January and February 2020 in China. Med Sci Monit. 2020;26:1-8. doi:10.12659/MSM.923549
5. Saragih ID, Tonapa SI, Saragih IS, et al. Global prevalence of mental health problems among healthcare workers during the Covid-19 pandemic: A systematic review and meta-analysis. Int J Nurs Stud. 2021;121:104002. doi:10.1016/j.ijnurstu.2021.104002
6. Sheikhrabori A, Peyrovi H, Khankeh H. The Main Features of Resilience in Healthcare Providers: A Scoping Review. Med J Islam Repub Iran. 2022;36(1). doi:10.47176/mjiri.36.3
7. Porcelli AJ, Delgado MR. Stress and decision making: effects on valuation, learning, and risk-taking. Curr Opin Behav Sci. 2017;14:33-39. doi:10.1016/j.cobeha.2016.11.015
8. Dossett ML, Needles EW, Nittoli CE, Mehta DH. Stress Management and Resiliency Training for Healthcare Professionals. J Occup Environ Med. 2021;63(1):64-68. doi:10.1097/JOM.0000000000002071
9. Lebares CC, Greenberg AL, Ascher NL, et al. Exploration of Individual and System-Level Wellbeing Initiatives at an Academic Surgical Residency Program: A Mixed-Methods Study. JAMA Netw Open. 2021;4(1):1-12. doi:10.1001/jamanetworkopen.2020.32676
10. dos Santos TM, Kozasa EH, Carmagnani IS, Tanaka LH, Lacerda SS, Nogueira-Martins LA. Positive Effects of a Stress Reduction Program Based on Mindfulness Meditation in Brazilian Nursing Professionals: Qualitative and Quantitative Evaluation. EXPLORE. 2016;12(2):90-99. doi:10.1016/j.explore.2015.12.005
11. Zaçe D, Hoxhaj I, Orfino A, Viteritti AM, Janiri L, Di Pietro ML. Interventions to address mental health issues in healthcare workers during infectious disease outbreaks: A systematic review. J Psychiatr Res. 2021;136(November 2020):319-333. doi:10.1016/j.jpsychires.2021.02.019
12. Geoffroy PA, Le Goanvic V, Sabbagh O, et al. Psychological Support System for Hospital Workers During the Covid-19 Outbreak: Rapid Design and Implementation of the Covid-Psy Hotline. Front Psychiatry. 2020;11(May):1-8. doi:10.3389/fpsyt.2020.00511
13. Dalmasso G, Di Prinzio RR, Gilardi F, et al. Effectiveness of psychological support to healthcare workers by the occupational health service: a pilot experience. Healthc. 2021;9(6):1-9. doi:10.3390/healthcare9060732
14. White S, Foster R, Marks J, et al. The effectiveness of one-to-one peer support in mental health services: a systematic review and meta-analysis. BMC Psychiatry. 2020;20(1):1-20. doi:10.1186/s12888-020-02923-3
15. Simms L, Ottman KE, Griffith JL, et al. Psychosocial Peer Support to Address Mental Health and Burnout of Health Care Workers Affected by COVID-19: A Qualitative Evaluation. Int J Environ Res Public Health. 2023;20(5):4536. doi:10.3390/ijerph20054536
16. NHS. Promoting wellbeing in the workforce: Yorkshire and the Humber Senior Psychological Wellbeing Practitioner Network. https://www.england.nhs.uk/mental-health/case-studies/staff-mental-health-and-wellbeing-case-studies/promoting-wellbeing-in-the-workforce-yorkshire-and-the-humber-senior-psychological-wellbeing-practitioner-network/. Published 2023.
Further Reading
Telephone therapy reduces mental health symptoms in refugee children