The burden of care
Trailblazing services protect the mental health of healthcare workers during the pandemic
Over the course of the COVID-19 pandemic, health care workers (HCWs) have faced serious challenges to their mental health as they’ve shouldered the emotional and physical burden of providing care in adverse circumstances. The Department has previously covered the work our faculty members have done to help ease this burden and provide support to HCWs on the front lines. Now, Dr. Judith Laposa, one of the architects of the trailblazing mental health supports created at the Centre for Addiction and Mental Health (CAMH), has presented her work at the Association for Behavioral and Cognitive Therapies international conference in the hope that it will empower others to protect the mental health of HCWs. We spoke to her about the impacts of the pandemic and sharing her work with the world.
How has the ongoing stress of the pandemic impacted the lives of HCWs?
JL: HCWs have spoken of increases in symptoms of stress, anxiety and depression during the pandemic, and studies have backed up these reports.
COVID placed unique pressures on HCWs. In the beginning of the pandemic, there was uncertainty about the degree of risk from exposure to COVID. Many HCWs were asked to do duties outside of their normal roles and felt unequipped to cope. It was frustrating and discouraging to see some members of the public flouting healthcare guidelines, and a second wave of demoralization occurred when anti-vaccination protests were held. Some HCWs felt they could not take time off to recuperate due to staff shortages and burnout; they worried their absence would make their colleagues’ jobs even harder.
Moral distress came up frequently as the pandemic progressed. Situations such as having to leave patients alone while they died from COVID, since family visits were not allowed, caused intense anguish among HCWs.
What role did you play in the creation of CAMH’s support programs?
JL: I wore many hats in this initiative, including developing the assessment and enhanced coping treatment protocols and the project’s evaluation framework, training staff in the treatment protocol, assessing and treating HCWs, leading weekly clinical consultation sessions, and researching the outcomes at the local and provincial level. Implementation of the project involved a large, highly dedicated multidisciplinary team including psychology, social work, nursing, psychiatry, and occupational therapy, and I am thrilled and grateful to work with such an outstanding team. I was fortunate to have the support and expertise of many colleagues, including Dr. Vicky Stergiopoulos, Physician-in-Chief at CAMH and Vice-Chair, Clinical Programs & Innovation in the Department, who served as a co-Investigator for the program, and Natalie Quick, a senior manager and occupational therapist at CAMH who managed the HCW support program.
CAMH launched a HCW initiative very early in the pandemic, to support the Toronto region, and then collaborated with the Centre of Excellence and other hospitals to support expansion across the province.
How did you go about developing assessment and treatment programs without previous examples to guide you?
JL: When the pandemic hit in March 2020, I was one of a group of staff who assembled website links about coping skills for the general public, and for healthcare workers, that were put up on the CAMH website very quickly. This was a great starting point. I also turned to the literature on mental health needs for HCWs working in other pandemics and contagious disease outbreaks and reflected on core treatment strategies that we use in our Cognitive Behavioural Therapy (CBT) treatments in the CAMH Mood and Anxiety service. I am proud that CAMH made this initiative a priority, and that it has been supported at all levels of management/leadership.
Describe the programs you developed.
JL: The program begins with an assessment interview, after which several treatment options are available, including medication and psychotherapy. Having different treatment options has allowed us to be flexible while still offering standardized, high-quality care. I developed an enhanced coping skills brief intervention of 4-6 therapy sessions, which is the most accessed type of treatment. At CAMH this treatment has significantly decreased anxiety, depression, and stress among our HCWs. It created improvements across various occupational settings, professions, and mental health challenges.
It was challenging to assemble the program quickly, and to be offering clinical service for a source of stress that my clinician team and I were also facing. We also needed to respond to evolving mental health impacts. For example, trouble with anxiety and managing uncertainty was common in the start of the pandemic, whereas depression, burnout, and moral distress became more prominent as the months wore on.
What has the feedback been from HCWs who have participated in the programs?
JL: Gratitude. HCWs were profoundly grateful to have rapid access to high caliber treatment, and they were very appreciative of their therapists. We have seen over 400 HWCs through our program. 98% of HCWs agreed that the services provided were of high quality, 94% agreed that the treatment helped them deal more effectively with their life challenges.
How does it feel to be asked to share your findings with a wider audience? How do you hope the lessons you’ve learned will be applied going forward?
JL: We gathered data to evaluate our work from the beginning, and it was very gratifying to be able to present this at a major conference. I hope that the strong positive results will lead to continued funding and access for mental health services for HCWs. HCWs play an essential role in our ongoing COVID-19 response, and it is crucial for the functioning of our health care systems that they receive access to mental health supports.
