Resilience through mutual support

During the pandemic the Department’s faculty members have been on the frontline of the battle to protect the mental health of healthcare workers. Drawing on knowledge gained during the SARS outbreak, they’ve spent the past year developing strategies and supports to help health care workers endure the mental health impacts of the pandemic.

“SARS taught us that we will experience a mental health impact, but the length of time and intensity of this pandemic led to so many unprecedented outcomes, many of which we are still struggling to understand,” says Dr. Mary Preisman. Dr. Mary Preisman and Dr. Ben Rosen are psychiatrists at Sinai Health, whose duties include supporting their colleagues’ mental wellbeing.

As the Physician-in-Chief at the Centre for Addiction and Mental Health (CAMH), Dr. Vicky Stergiopoulos has also witnessed the impact of long-term stress on health care workers. “With COVID-19 we saw absenteeism, frontline staff leaving hospitals for other sectors, and experienced staff shortages we did not have an opportunity to see during SARS. We’ve seen high rates of burnout among frontline staff, especially nursing staff.”

As the pandemic has progressed, the nature of the stress health care workers experience has changed. Dr. Rima Styra of UHN has studied the mental health impacts of SARS and COVID-19. She notes that the arrival of vaccines alleviated many of the initial concerns regarding infection and severe symptoms.

“However, workers in areas where they were more likely to interact with patients with COVID-19, such as the Intensive Care Unit (ICU) or COVID-19 unit, continued to experience high levels of distress,” says Dr. Styra. “The long hours of work and moral distress experienced during COVID-19 has added to the burnout that many healthcare professionals had already been speaking about prior to the pandemic.”

“Many health care workers have experienced an increase in workload, uncertainty, redeployment, and moral distress in their roles,” says Dr. Rosen. “Early pandemic fears around infection and transmission evolved into the devastation of watching isolation and suffering, and ultimately to fatigue and distress.”

At Sinai Health, doctors responded to this adversity with an initiative called Resilience Coaching.

“Mental health clinicians in our department identified areas of need within our hospital where staff were experiencing high levels of stress and strain and used our skills in various modalities of psychotherapy to provide peer support,” explains Dr. Preisman.

Distinct from clinical care, coaching provides an opportunity for expression of emotion, problem solving, and support.

“Beginning in the Emergency Department and ICU at Sinai Health and expanding to almost every other clinical area, Resilience Coaching has been received as an important acknowledgement of the impact of COVID-19 and the intense work done in health care on the mental health of health care workers,” says Dr. Rosen.

At CAMH, a number of strategies have been employed. An easy-to-access mental health support self-referral portal was quickly developed and launched to serve frontline heath care workers across the region. Health workers were assessed by a psychologist and were offered a range of supports, from counseling, to therapy to psychiatric care as needed.

“We used frequent communication, providing the latest in COVID-19 news as it affects our hospital, offered free meals periodically, and recognized staff by profiling staff excellence on our intranet,” says Dr. Stergiopoulos.

CAMH also collaborated with ECHO Ontario Mental Health to develop workshops on coping with COVID-19 that have reached health care workers nationally.

Throughout the pandemic, healthcare workers also took the initiative to care for themselves and each other. Dr Styra’s research has revealed some of the key behaviours they found helpful. They leveraged their family and social support, used digital means to stay connected, and spoke openly with friends and co-workers.

“Healthcare workers identified that support from their families, friends and colleagues played a major role in protecting their mental health,” says Dr. Styra. “Those who worked together as teams or who had strong collegial bonds found these connections to be a highly valuable source of support. Time away from the hospital environment and engaging in creative activities provided much needed time for rest and healing.”

Dr. Preisman and Dr. Rosen are hopeful that the lessons of the pandemic will lead to better support for healthcare workers on an ongoing basis.

“The mental health of healthcare workers has been overlooked in the past and hopefully, the COVID-19 pandemic will be the wedge that drives forward the need to address this,” says Dr. Rosen. “Working in healthcare is stressful in general even in the absence of a pandemic and healthcare workers are vulnerable to burnout. Having strategies for combatting burnout is important for healthcare workers personally and for healthcare organizations.”

While the crisis has demonstrated the vulnerability of healthcare workers, it has also demonstrated their capacity for resilience and heroism. The SARS pandemic also offers some clues that health care workers will endure the stresses of COVID-19 although some might suffer longerterm effects.

“Healthcare providers who had worked during SARS have not experienced worse mental health impacts than their colleagues who had not been exposed to a previous outbreak,” says Dr. Styra, “This speaks to the possible benefits of experience and the long-term resilience of healthcare workers. From my ownperspective, I have seen that healthcare workers are overall resilient and rise to the challenge of caring for their patients in the most difficult situations.”

This last sentiment is one her colleagues echo. All of them have seen healthcare workers rise to the challenge of caring for their patients in the most difficult situations and taken away important lessons in adversity and how it can be overcome

“Personally, I will take away strategies and approaches to managing volatility, uncertainty, complexity and ambiguity, says Dr. Stergiopoulos, “And I will reflect on this unique experience as an opportunity to see the best in myself and those around me.”