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During the 2003 SARS outbreak, health care workers had concerns about infecting others and experienced stigma because they were in close contact with sick patients. A new study in JAMA looked at the mental health of 1,257 health care workers attending to COVID-19 patients in China since COVID-19 is our current concern. A large percentage reported depression, anxiety, insomnia, and distress. Findings suggest that these health care workers are at a significant risk of developing mental illness and we need to be aware of this risk.

Caroline Artley, LCSW-C, believes the fear of transmitting COVID-19 to other patients and family is a concern, along with loss of safety precautions, rapidly changing protocols, re-assignment away from one's trained specialty, and the needs to treat all patients as though they may carry the virus.

What Artley learned from interacting with healthcare workers is they are tasked with coping with their trauma while still living it out. She explains, “Psychological trauma occurs neurobiologically when an individual experiences either a life-threatening situation or endures prolonged exposure to threats to safety. With the knowledge that the public has no guarantee of when the coronavirus crisis will end, our healthcare workers may fall into both categories. They learn from day one in their education that following safety precautions is essential to both their health and the health of their patients. This standard is so ingrained in their training, beliefs, and habits that they don't even need to think twice in order to execute. But when supplies ran low, their safety and security was shaken. Facing an illness that is not well-known, knowing there is no cure, without the basic measures of safety, thrust our healthcare workers into what their nervous system interprets as a life-threatening situation. The consequences of repeatedly calling on survival mechanisms in the brain include depression, anxiety, insomnia, and distress.”

Saundra Dalton-Smith MD, notes that physicians, nurses, and healthcare professionals are trained to mask their emotions which has a negative impact on anyone’s mental health. Because they want to avoid projecting fears onto patients, they become skilled at stuffing emotions. Dalton-Smith explains, “As an internist with over 20 years of clinical medical experience, I've experienced the toll this can have on many areas of life. Now with the current COVID-19 healthcare crisis, healthcare workers have the added stress of fear about taking a disease we have no cure for back home to their families due to the lack of adequate personal protective equipment (PPE). Many are working longer shifts than normal, further straining their mental and physical capacity to the limits.” 

Many experts speak about the COVID-19 crisis as a war which makes clear that psychological trauma is almost a given. Psychologist Dr Clinton Moore notes that healthcare workers are on the front lines of what could be a long battle and are faced with tough life-or-death decisions for which many may not be prepared. Moore says “they now may find themselves moving into the role of triage. While this role is familiar to those health care workers that were stationed in emergency departments, the scale of the current crisis means many other nurses and doctors may suddenly find themselves having to deal with overwhelming choices such as who gets the ventilator. This type of traumatic environment would be likely to stress even the most seasoned health care veterans.”

Since healthcare professionals are fighting a unique war, Kailyn Bobb, PsyD, director of Psychotherapy at Clarity Clinic in Chicago wonders if we can learn something from the military on how best to support our health care providers. Bobb comments, “Our service members have directly experienced threats of death to themselves and those around them, worked tireless hours with little to no end in sight, and yet, they continue to move forward with resilience, power, and a refusal to give up. Mental health providers and the community can learn a tremendous amount from how the military cares for one another during times of unfathomable difficulties to best support our health care providers on the medical front line fighting for the safety and lives of people.”

What’s clear to everyone is the need to become proactive in addressing the special mental health needs of healthcare professionals.  They cannot care for us if we do not care for them and the short and long term consequences affect everyone.