'We're not out of the woods': How hospitals are looking out for their staffs' mental health

Psychiatric advanced practice nurse Alan "Tony" Amberg, MSN, APRN, is a familiar face at Chicago-based Northwestern Memorial Hospital. 

Mr. Amberg's job has always focused on mental health issues and reducing the stigma that surrounds them. These days he spends most of his time visiting healthcare workers at Northwestern to help ease or prevent mental stress associated with the COVID-19 pandemic. 

"People love Tony," said Maureen Slade, RN, vice president of operations at the hospital. "He's doing things like deep breathing to make sure nurses are calm, cared for." 

Across the U.S., hospitals and health systems are implementing initiatives similar to those at Northwestern to support employee morale and wellness. Organizations are not only addressing employees' current stress, but also preparing for a potential increase in mental stress and disorders among employees who have been on the front lines of the pandemic.

The need to support employee mental health

Healthcare workers are facing unprecedented circumstances. They are fighting a virus that is new and unpredictable, and they are seeing hospitals run short on basic supplies and equipment. They are also witnessing patients battle illness in isolation as family members and other loved ones are kept away for their safety.

Factors like these and others associated with the pandemic have the potential to threaten workers' mental health, suggests a study published March 23 in JAMA Network Open. The widely reported suicide of a New York physician on the front lines of COVID-19 also has highlighted the potential mental threat associated with the pandemic. 

Hospitals and health systems are aware of these negative effects, and some said they already are seeing upticks in employee reports of depression and anxiety or seeking mental health services related.  

Marra Ackerman, MD, director of the House Staff Mental Health Program & Student Mental Health Services at New York City-based NYU Langone Health, said her organization saw lower numbers of mental health referrals among front-line employees in the early stage of the pandemic, which she attributed to demands on people's time. But as the average number of COVID-19 patients decreases, the organization is seeing increased use of psychiatric services at its hospitals, Dr. Ackerman said. 

Edison, N.J.-based Hackensack Meridian Health reported that usage of the health system's employee assistance program, which provides mental health services, climbed from 11 percent last year to 15 percent solely in the first quarter of 2020.

What hospitals are doing to support employee well-being 

To support employee well-being, San Diego-based Scripps Health offers mindfulness practice sessions online through Skype, which employees have access to for stress reduction and management. 

Chicago-based Sinai Health System has expanded a program — initially designed to support workers who care for trauma patients in the emergency department — to all health system employees. Through the program, employees may speak with a behavioral health professional, or for those who prefer a more spiritual component, a chaplain.

At New Hyde Park, N.Y.-based Northwell Health, tents are set up outside healthcare facilities where employees can get refreshments and take a mental break and learn about the many behavioral health and well-being services the system offers their employees, said Curtis Reisinger, PhD, corporate director of Northwell Health's employee and family assistance program.

And at Hackensack (N.J.) Meridian Health, more than 100 behavioral healthcare workers staff a 24/7 support line for workers, and virtual group sessions focus on building resiliency among workers.

"It's difficult for us (as healthcare workers) to admit we need help ourselves," said Amy Frieman, MD, Hackensack Meridian Health's chief wellness officer. "We know we can't wait for our teams to come forward, and we really have to be proactive in recognizing the people in need."

Preparing for mental health after-effects 

While hospitals and health systems are working to address employees' needs now, they also are preparing for the issues workers could face later, as trauma associated with COVID-19 sets in. 

About a week ago, New York City-based NewYork-Presbyterian released a confidential online symptom tracker for employees to self-monitor issues they may be experiencing, such as sleep disturbance and mood disturbance, said Philip Wilner, MD, senior vice president and COO of the NewYork-Presbyterian Westchester Behavioral Health Center and professor of clinical psychiatry at Weill Cornell Medicine in New York City. Employees receive a score and are encouraged to continue using the tracker to monitor their mental state. When employees complete the tracker, they receive information about available resources for crisis management care and emotional support. 

As the health system prepares for more mental health issues that may surface among workers, the symptom tracker will help staff continue to self-identify if they develop symptoms, Dr. Wilner said.

At New York City-based Mount Sinai Health System, there is a new center, called the Mount Sinai Center for Stress, Resilience and Personal Growth, to address the psychosocial effect of COVID-19 on the mental health of employees. 

Deborah Marin, MD, professor of psychiatry at the Icahn School of Medicine at Mount Sinai and director of the Center for Spirituality and Health at Mount Sinai, is directing the new center. She said a large part of the center's first phase is engaging with Mount Sinai employees so they can use an app that allows them to monitor their health, find resources and participate in programs to increase their resilience. Ultimately, the center will work with the New York City more broadly to monitor community resources available for healthcare workers and city residents.  

"The whole purpose of the new center is to be as preemptive as possible," Dr. Marin said.

Dr. Wilner, with NewYork Presbyterian, and Ms. Slade, with Northwestern, said it's important to focus on ensuring adequate protections for workers and making them feel as comfortable as possible if there is a second wave of COVID-19.

"They know what was missing (previously in terms of equipment and supplies), and for them not to have anxiety symptoms, they have to have all of that in place," said Dr. Wilner. "That will prevent people from developing symptoms and mental illness. You have to have that in place to shore up their resilience."

Additionally, "consistency is the key" when it comes to preparing for a potential wave of new mental health issues among employees, according to Paul Berkowitz, MD, chairman of Sinai Health System's psychiatry and behavioral health department. 

"We as health systems need to continue to be available to caregivers, communicate, 'We continue to be here for you,'" he said. "We know this isn't going to be this light-switch effect and poof (employee mental stress related to the pandemic) disappears. There will continue to be stress and long-lasting effects. We need to continue to support caregivers throughout this process."

Dr. Reisinger, PhD, with Northwell Health, echoed Dr. Berkowitz: "We're not out of the woods yet."


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