US Pharm. 2022;47(5)18-22.
ABSTRACT: The impact of the coronavirus disease 2019 has substantially affected the mental health of today’s society. The negative sequela of the pandemic has been skewed towards healthcare workers (HCW), including pharmacists. This article aims to summarize key consi-derations for supporting and maintaining the mental health of HCW to enable them to provide high-quality care for their patients.
The coronavirus disease 2019 (COVID-19) pandemic has evolved as one of the most impactful events that has negatively influenced mental health.1 To date, the pandemic continues to spread worldwide, requiring nations to demand restrictions on social activities to evade further sequela. As such, the result of enforcing quarantine, keeping children home from school, isolating from large societal events, and refraining from travel has drastically impacted the mental health of today’s society.2 Moreover, healthcare workers (HCW) are impacted to a greater extent. While attempting to cope with the drastic societal shifts and emotional stressors that impact the whole nation, HCW also must face the tragic impact of COVID-19 in their day-to-day job. With a larger volume of patients, the need to quickly adapt to the rapid changes and challenges of patients with COVID-19, staffing and supply shortages, among other issues, COVID-19 has extremely taxed HCW and the healthcare system.3
Despite the extreme challenges, more than ever during the COVID-19 pandemic, it is critical to maintain an adequate mental health state for HCW. In particular, pharmacists in both hospital- and community-based settings are frontline HCW with vital duties to uphold during the COVID-19 pandemic. Given the continued flux of this crisis with an unknown end, it is crucial that HCW perform at their full potential and maintain this work ethic for a prolonged time interval.
Multiple studies have been conducted during the COVID-19 pandemic that have shed light on the burden of mental health issues among HCW. A single-center, cross-sectional survey using various validated screening tools for mental health conditions demonstrated that frontline HCW are 1.4 times more likely to experience fear and twice as much anxiety and depression compared with their nonclinical counterparts.4 Comparatively, another cross-sectional study conducted in China observed that nurses, women, frontline HCW, and those working in Wuhan during the pandemic reported more severe degrees of mental health symptoms than other HCW. Depression, anxiety, insomnia, and distress were identified at greater frequency among frontline HCW who engaged in direct diagnosis, treatment, and care of patients with COVID-19.5 Although these studies do not specify or isolate the impact of COVID-19 on pharmacists’ mental health, pharmacists are considered frontline HCW and are subject to the same stressors as the HCW identified in these studies.
Numerous factors contribute to elevated stress among HCW, including heavy workloads, long shifts, a high pace, moral conflicts, and workplace-related bullying or lack of emotional or psychosocial support.6 In a systematic review and meta-analysis analyzing risk factors for mental health issues during the COVID-19 pandemic, females, nurses, and frontline HCW experienced the highest incidence of depression and anxiety.7 Frontline HCW are particularly susceptible to the negative mental health impact of the COVID-19 pandemic due to the difficulty in balancing the duty of caring for their patients with concerns about their own well-being and that of their friends and family. Frontline workers have been independently associated with more severe depression, anxiety, and insomnia.5
The distress, however, carries over to all aspects of the healthcare field, from management positions in mitigating staff shortages, pharmacist drug shortages, and technician staff managing increases in workload due to higher patient volume and acuity. In a survey of 1,362 pharmacists, nearly half were concerned about mental health (41%), well-being of their colleagues (41%), and professional burnout (41%), driven by workload (82.9%), incomplete information and uncertainty (66.8%), and scarcity of resources (58.9%).8 FIGURE 1 outlines the various mental health manifestations of COVID-19 on HCW.
The resultant psychological distress that healthcare employees experience from the COVID-19 pandemic has been shown to lead to burnout, depression, anxiety, sleeping disorders, and other metal health illnesses.9 Mental Health America conducted a national survey with 1,119 HCW respondents, including direct patient care staff (30%), nurses (22%), pharmacists (19%), physicians (7%), and others. Stress was the most frequently reported symptom among 93% of respondents, accompanied by increased emotional exhaustion (82%), difficulty sleeping (70%), physical exhaustion (68%), and work-related dread (63%).10 Other alarming features included changes in appetite (57%); physical symptoms of stress such as headache or stomachache (56%); questioning their career path (55%); compassion fatigue (52%); and heightened awareness, worry, or attention to being exposed to COVID-19 (52%). When asked about emotional support, 39% indicated they felt inadequate emotional support.10 This highlights the substantial physical, mental, and emotional distress that over 50% of HCW are experiencing secondary to the pandemic and the fundamental need to develop strategies, resources, and tools to support vital HCW.
Strategies to Mitigate the Mental Health Impact of COVID-19
Prioritizing the mental health and well-being of employees should be a primary goal of institutional leadership, as preserving employees’ health and well-being are crucial to maintaining essential healthcare services for patients. Leadership should aim to maintain current infrastructure while ensuring additional support measures are in place during these critical times.
Preparedness is key, and policies and procedures for addressing mental health concerns of employees and a referral pathway should be established and readily available for healthcare employees if/when needed. Institutions should offer mental health and psychosocial support, including staff access to free telehealth sessions with licensed psychologists or therapists. Institutions should provide psychological first-aid training to their healthcare staff to ensure they are equipped with the tools to manage not only their own healthcare needs but also the needs of their colleagues. HCW with families report feeling significant stress and anxiety about the challenges with childcare during the pandemic. Between virtual home schooling or absences due to COVID-19 exposures, the often-unexpected absences or illnesses can place significant distress on the healthcare employee. Leaders should work with employees to best accommodate these situations, including facilitating a work-from-home day when possible while ensuring all employees are made aware of institutional childcare services if applicable.
An essential step in preserving the mental health of employees is creating a culture of open communication.11 Managers, coordinators, and all leaders should encourage staff to speak openly about their worries and provide a platform for frequent check-ins to inform them how management is actively addressing their concerns. Creating an environment of open communication enables staff to express their concerns, ask questions, and request additional support or assistance when needed. Leaders should integrate stress-management strategies and education on psychosocial support services into staff meetings to ensure the workforce is informed and to make their needs heard. Importantly, leaders should be proactive in encouraging conversation about mental health needs and create an atmosphere free of stigma, coercion, and fear of being removed from their duties or other negative consequences. Employees do not expect leaders to have all the answers, but listening and understanding requests makes the employees feel acknowledged and ensures their voice will be heard as a part of the larger organizational response to battling pandemic challenges.5 Frequent communication about the ever-changing policies and procedures that accompany the pandemic is important to ensure that staff is well-informed with the most up-to-date information, especially in the case of a COVID-19 exposure.
A large proportion of the stress and anxiety of front-line HCW managing patients with COVID-19 received inadequate personal protective equipment (PPE) and other resources needed to manage the pandemic. Institutions should ensure staff is adequately provided the necessary resources, PPE, and staff to care for patients and provide prompt, frequent communication when resources are limited, and strategies to overcome shortages. Pharmacists and technicians working in high-risk areas or those directly caring for patients should be provided the necessary PPE and resources to safely provide essential care. Leadership should also model the appropriate mask wearing and PPE. Pharmacists managing drug shortages can be stressed given the unpredictable supplies of high volume–usage medications. Leadership and team members should work as a united front to ensure key stakeholders are apprised of shortages and assisting those on drug-shortage task forces in finding the best suitable alternatives.
Frequent one-on-one interaction with frontline staff was identified as an important component of reassuring HCW directly caring for COVID-19 patients.12 Walking the units on a weekly or biweekly basis can be a strong demonstration of leadership support and helps raise morale. The power of simple and genuine expressions of gratitude to convey thanks for the commitment of HCW in overcoming the immense challenges faced in this pandemic cannot be overstated. This can be in the form of small treats, meals or snacks, gift bags, gift cards, or any small symbol of appreciation. Honoring HCW serves to reinforce compassion and overcome the distress and fear faced from risking their lives to help those infected with the deadly virus.12,13
An example of improved mental health support by an institution during the COVID-19 is the Princess Margaret Cancer Centre and its development and implementation of the CREATE program—Compassion, REsilience, And TEam-building.14 This program is a proactive, team-based intervention involving integration of the essential elements of psychological first aid and adaptive coping strategies into daily workflows for frontline interdisciplinary HCW and oncology teams. The program trained a group of psychosocial coaches (PSCs), and these support teams were made available to provide team support during acute destabilizing situations and extended to ongoing challenges, such as grief or distress after a traumatic event. The PSCs provided psychological first aid by addressing patients’ emotional needs, providing calming strategies, serving as institutional advocates to the HCW, providing resources, and focusing on cultivating resilience. PSCs were paired with clinical managers to enhance engagement within hospital teams and support managers in addressing their teams’ emotional concerns. CREATE was reportedly well received by participants and as a valued entity for HCW and leadership, with demonstrations of appreciation for the institution for its development and implementation. The CREATE program can serve as a model for organizations looking for strategies to optimize the mental health support delivered to employees.14
Although institutional efforts can assist in adjusting workplace stressors and burn out, pharmacists must consider implementing their own personal strategies to improve their well-being. There are various guidance documents set forth by national societies, medical organizations, and so forth that provide credible recommendations on how HCW can personally cope with the stress of COVID-19 (see TABLE 1). Universally, one of the most simple, important interventions each HCW can easily implement into their day-to-day routine is self-care. Finding an activity that is both stress-relieving and personally fulfilling is the cornerstone technique to maintain a sense of normalcy during challenging times. Whether it is exercise, reading, walking, or listening to music, any engaging activity that pharmacists can schedule on their calendar will help revive mental health. This should be implemented in both the workday routine and outside of working hours. It is important to schedule short timeouts in the workday for basic bodily care and refreshment as well as longer breaks for relaxation and stress management.11
Outside of direct patient care for patients with COVID-19, the dissemination of information regarding COVID-19 on social media is a major source of stress to HCW and society. While it is important to stay updated, the large propagation of false or negative information throughout the Internet is enough to overwhelm HCWs and reignite the same fear and anxiety that are brought about in the workplace. Strategies such as limiting social media usage, filtering newsfeeds to eliminate information about COVID-19, and only referring to reputable sources for updated information can assist in maintaining a healthy mindset.15
Although a majority of recommendations have been focused on frontline HCW who work on-site, HCW with remote positions are vulnerable to the same anxiety, stress, and high working demand as those with on-site jobs. For individuals with work-from-home positions, it is just as important to maintain a sense of normalcy and separate the working mindset from home. Strategies to minimize stress in a work-from-home position include creating a defined working schedule with strict end times to prevent working all day. Allotting time for a lunch break, sitting near a window, and getting dressed as if one is going into work are also strategies to assist getting in the working mindset while at home. Of all, the most important is setting a boundary to define when the workday is complete, which helps pharmacists and other HCW maintain a healthy work-life balance.16
In those with preexisting mental health conditions, additional support and assistance are needed to maintain well-being during an international infectious disease outbreak. The American Society of Health-System Pharmacists provides valuable resources for individuals with mental health conditions trying to emotionally handle the stressors of the COVID-19 pandemic.17 One such resource is the Substance Abuse and Mental Health Services Administration organization, which provides invaluable access to support services over the phone and via the Internet for individuals coping with a national disaster. It aids in building resilience in those with mental health conditions by providing continued support and preventative services to recover from hardships that are out of one’s control, such as the COVID-19 pandemic.18
Pharmacists remain vital contributors to the successful delivery of healthcare throughout the COVID-19 pandemic. To continue to best serve patients, pharmacists must take time to evaluate their own mental health for signs of burnout and overall psychological burden. A key point to remember is that stress is a normal reaction to a worldwide infectious disease outbreak. It is most important to anticipate stress and take the appropriate steps to minimize the effects of stress on the mind and body. Attempts to keep a normal routine, partaking in enjoyable activities, seeking support from colleagues and family, and developing stress-reducing strategies will help keep a well-equipped workforce. Pharmacy managers should maintain regular and frequent communication with their employees to ensure that adequate resources and support are being provided. There is a great need to address the mental health of HCW during the continuous hardships being faced by the COVID-19 pandemic. Pharmacy organizations should prioritize the development of guidance documents and solutions to improve the well-being of pharmacists and other HCW during the COVID-19 pandemic and future international infectious disease outbreaks.
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10. Mental Health America. The mental health of healthcare workers in COVID-19. https://mhanational.org/mental-health-healthcare-workers-covid-19. Accessed February 2, 2022.
11. National Center for PTSD. Managing healthcare workers’ stress associated with the COVID-19 virus outbreak. March 2020. www.ptsd.va.gov/covid/COVID19ManagingStressHCW032020.pdf. Accessed February 2, 2022.
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14. Shapiro GK, Schulz-Quach C, Matthew A, et al. An institutional model for health care workers’ mental health during Covid-19. NEJM Catalyst. March 12, 2021. https://catalyst.nejm.org/doi/full/10.1056/CAT.20.0684. Accessed April 21, 2022.
15. Center for the Study of Traumatic Stress; Department of Psychiatry. Supporting families of healthcare workers exposed to COVID-19.www.cstsonline.org/assets/media/documents/CSTS_FS_Supporting_Families_of_Healthcare_Workers_Exposed_COVID19.pdf. Accessed February 21, 2022.
16. Canadian Pharmacists Association. Supporting pharmacists’ mental health and wellness during COVID-19. May 1, 2020. www.pharmacists.ca/cpha-ca/assets/File/cpha-on-the-issues/SupportPharmacistMentalHealth_EN.pdf. Accessed March 18, 2022.
17. American Society of Health-System Pharmacists. Tips for taking care of yourself during COVID-19. https://wellbeing.ashp.org/resources/tips-for-taking-care-of-yourself?loginreturnUrl=SSOCheckOnly. Accessed March 18, 2022.
18. Substance Abuse and Mental Health Services Administration. Disaster preparedness, response, and recovery. www.samhsa.gov/disaster-prepareness. Accessed March 18, 2022.
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