Supporting healthcare workers during COVID-19

When the COVID-19 pandemic reached Australia, many psychologists wondered what they could contribute to the psychological response. As a psychologist working in a public health service there were several options, including working directly with people who are COVID-19 positive and their families. But a group of us had a specific question – what could psychologists within a public health service offer their healthcare colleagues?

During a public health emergency, healthcare workers have additional psychological vulnerabilities, particularly those working directly with people who are or suspected of being COVID-19 positive. Evidence from past emergency contexts and emerging research from China regarding COVID-19 showed that exposure to an epidemic is associated with mental health consequences for healthcare workers, including high psychological distress, burnout, post-traumatic stress, increased alcohol and other drug use; and these effects are being seen two years post-recovery (Chen et al., 2020; Lai et al., 2020; Maunder et al., 2006). Contributing factors include high patient and family distress, ethically compromising clinical decisions, and unrelenting work conditions.

One identified mediating factor is the perceived adequacy of support and training throughout all response phases (Maunder, 2006). While resilience is the rule, not the exception, natural resilience could be enabled by basic mental health and psychosocial supports provided at work to staff during the COVID-19 pandemic (Inter-Agency Standing Committee, 2020). This highlighted a need for a customised psychological support service embeddedwithinthe health service.

An evidence-based support framework

In response, the Mental Health and Psychosocial Support (MHPSS) Advisory was formally commenced in April 2020 and staffed by psychologists with clinical expertise in disaster and emergency situations, redeployed from within the health service. The MHPSS Advisory focused on meeting the needs of staff based on the International mental health and psychosocial support intervention pyramid (Inter-Agency Standing Committee, 2020), with psychologists using their clinical expertise to deliver the full range of interventions.

An in-house psychology service has benefits that include being a proactive and responsive psychological service embedded within teams. This allows a focus on team interventions that strengthens the team structure and its psychological culture by supporting managers to embed psychological skills in practice. Such a psychological approach is shown to have a positive influence on staff wellbeing (Brooks et al., 2018).

As employees of the same health service, an in-house psychology service holds insight into the clinical realities of working in a public health service; can be more easily adapted for a public health service, and is accepted by staff and teams.

Measuring the impact

For the MHPSS Advisory, interventions focused on capacity building within the leadership structure to help these leaders become more attuned to the psychological needs of their staff and to support them to provide psychological first aid directly. A training on the psychological response to public health emergencies and psychological first aid was developed and delivered across 23 sites, reaching 237 managers and clinical leaders across the service within the first eight weeks. Using a Likert scale from 1 to 5 (where 5 is Excellent/Very Satisfied) respondents rated the overall quality of trainers (4.3), quality of content (4.1), and satisfaction with the training (4.0).

Favourable comments included the organisational focus of the training, the relevance of the training beyond the pandemic, and that the training should have occurred earlier to better support leaders in their role.

Training packages were also developed for clinical and non-clinical staff on skills to manage patient and family distress; and on self-care for non-clinical staff, an often forgotten group of workers. A suite of written resources that could be utilised at work were developed to provide information on psychological concepts to help normalise reactions and psychological skills to maintain psychological wellbeing. Examples of developed material included, Recognising Burnout; Stigma; Impact of Multiple Deaths in Critical Care; Moral Distress; Self-Compassion; and Grounding Strategies.

Staff and managers have been overwhelmingly positive about the role of the MHPSS Advisory in both its support to managers and leaders during an already stressful time and providing an extra level of embedded support to the staff.

Maintaining support

Psychologists are well-placed to support healthcare workers in public health services through embedding a psychologically and trauma-informed culture and providing clinical psychological interventions at a systems and individual level. A psychological response in a public health service reduces the psychological risk factors for healthcare workers associated with work during and after COVID-19, ensuring a healthy workforce.

The first author can be contacted at [email protected]