COVID-19: The mental health impacts of working on the healthcare frontline

Australia is grappling with the two challenges of containing the COVID-19 pandemic and addressing the economic and mental health effects of sustained lockdowns. Poorer mental health is predicted to be a consequence of living with restrictions, and health programs to deal with the “mental health fallout” of the pandemic are emerging.

There’s increasing concern about the mental health of healthcare workers during the pandemic.

Due to the high-pressure, high-stakes, high-intensity and high-workload environment that exists in healthcare organisations, health workers experience higher rates of mental illness when compared with people in other occupations.

Thus the pandemic has thrown a “perfect storm” of additional mental health threats at healthcare workers, including:

• increased risk exposure
• intensified work pressures
• uncertainty, along with the social restrictions faced by all community members.

Our study of frontline health workers conducted from August to October 2020, during the second wave of the pandemic, identified the significant psychosocial disruption experienced by frontline healthcare workers.

This is the largest multi-professional survey on the topic, and it included frontline healthcare workers in primary and secondary care. With 7846 complete responses, we identified a high prevalence of mental health symptoms, including:

• anxiety (59.8%)
• burnout (as measured by emotional exhaustion) (70.9%)
• depression (57.3%).

World's largest study of frontline healthcare workers during 2020’s second wave reports some remarkable insights. https://t.co/hNgSFBaRz4#MentalHealth pic.twitter.com/JNDPB7pPZ1

— Monash Medicine, Nursing and Health Sciences (@Monash_FMNHS) 13 September, 2021

Fewer than one in 10 participants sought professional help for mental health symptoms.

Overall, our findings indicate that workplace strategies are needed to both prevent and actively address mental health illnesses experienced by frontline healthcare workers.

More crisis preparation and planning needed

Increased workloads, lack of role clarity, or having to change work role or area during the pandemic, as well as concerns about personal protective equipment (PPE), organisational leadership and communication were all identified as major workplace challenges by frontline healthcare workers. Importantly, these are also all issues that can be addressed with sufficient crisis preparation and planning.

Cultural and societal factors also contribute to adverse mental health effects.

For example, the fear of being blamed for contracting the COVID-19 virus by colleagues was a predictor for poor mental health.

Healthcare workers also worried about letting down colleagues if they needed to quarantine due to exposure to the virus.

Believing the community was afraid healthcare workers would spread the virus was also a significant predictor for anxiety, post-traumatic stress disorder (PTSD), emotional exhaustion and depersonalisation.

Measures to prevent mental health harms and support the psychological wellbeing of all workers, but especially healthcare workers, are ... vital as we move towards a ‘new normal’ state of living with COVID or as we encounter future crises.

But feeling valued by the community was an independent factor for experiencing fewer mental health symptoms – making it a potential target for interventions to help protect healthcare workers.

The COVID-19 pandemic has shone a light on the fact that healthcare resources are finite, and crises have the very real capacity to disrupt and prevent the delivery of optimal care.

There’s increasing attention to the concept of “moral distress” experienced by healthcare workers, which may occur when healthcare workers must deliver care that goes against their beliefs – for example, in preventing families from being with their loved ones when in hospital. Many healthcare workers wrote in our survey about the distress of families saying goodbye to loved ones using a phone or iPad.

Additionally, moral distress may occur when healthcare workers are providing care that’s contrary to the way they’ve been trained, perhaps through rationing of healthcare resources.

The issue of moral distress is important not just because of the ethical dilemmas it generates, but because moral distress is associated with adverse mental health outcomes in frontline healthcare workers.

Moving towards the new normal

While there’s increasing pressure to open our economy and our borders, our recent article pointed to the need to consider how “living with COVID-19” affects frontline health workers.

Many healthcare workers want an end to the current restrictions affecting the lives and livelihoods of thousands of Australians on the east coast; however, they also want to be able to work in a safe environment, and within a healthcare system that has the resources to cope with this and future crisis events.

Measures to prevent mental health harms, and to support the psychological wellbeing of all workers, but especially healthcare workers, are therefore vital as we move towards a “new normal” state of living with COVID, or as we encounter future crises.

Poor mental health of clinicians affects not only the individual, but has implications for quality of care, patient safety, workforce retention and engagement.

Although many other factors, including lockdown restrictions, social disconnection and media coverage, have also likely contributed to the high prevalence of mental health symptoms in frontline healthcare workers, workplace factors cannot be ignored. Workplaces need to intervene and prevent mental health issues, and in doing so ensure our most precious asset in the face of a crisis – the healthcare workforce – is valued and supported.

This article was co-authored with Karen Willis, Professor of Public Health at Victoria University.