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A burned out workforce and overwhelmed healthcare system could spell lasting trouble for nations. MoMo Productions/Getty Images
  • Mental health professionals weigh in on the tremendous toll the pandemic has had on the healthcare workforce, and what that might mean for our future.
  • Women in this field who were under age 60 and worked more than 40 hours a week were more likely to experience mental health symptoms, a study finds.
  • One psychologist said the world is at a critical point to address the mental health pandemic unfolding in the traumatized workforce.

The COVID-19 pandemic has taken a significant toll on the mental and physical health of physicians, nurses, and other healthcare workers around the world.

As many as 1 in 4 medical doctors in Italy have experienced symptoms of anxiety and 1 in 5 have reported depression both in June and December 2020, according to a recent study.

Being female, younger than 60 years old, and working over 40 hours a week also made it more likely for doctors to experience anxiety and depression or report mental health symptoms.

These statistics are just a small peek at the toll that COVID-19 has taken on the mental health of healthcare workers around the world.

Steven C. Hayes, foundation professor of psychology at the University of Nevada, and originator of acceptance and commitment therapy (ACT), said the world is at a critical point to address the mental health pandemic unfolding in the traumatized workforce.

“I think if we mishandle this moment, we will face years of trouble going forward in dealing with many sectors of our society who have been asked to do more and more but without necessarily being given the psychological tools to do it in a healthy way,” he told Healthline.

Anxiety, depression, mood changes, and social withdrawal are among the many mental health symptoms healthcare professionals have experienced over the pandemic.

Dr. Wizdom Powell, director of the Health Disparities Institute at the University of Connecticut and associate professor of psychiatry said anxiety would be at the top of the symptoms list, followed by fear, worry, and the feeling of being on edge.

“We’re also seeing post-traumatic stress disorder (PTSD)-like symptoms and also depression because those emotions kind of interlace one another. As a psychologist, I see a newer form of depression presented in the clinic: depression mixed with some anxiety,” Powell said.

Powell said asking healthcare workers to look past their own or families’ needs during the pandemic was a tremendous burden, and this has led her to observe firsthand a different type of burnout.

“The disconnection from the day-to-day work, the sense of watching your body from the outside and watching it all take place… [W]hat I’m observing is them feeling a little bit frayed at the edges, while at the same time so motivated to stay in the firefight,” she said.

Meanwhile, Hayes highlighted the challenges of dealing with people who may be confrontational.

“If you have a person screaming at you that they’re not going to wear a mask, nobody is going to be filled with positive emotions and peaceful thoughts,” he said.

So, what will it truly mean to have a workforce that’s sick, tired, and burned out?

Almost 1 in 5 healthcare workers in the United States — or approximately 18 percent — have quit their jobs since February 2020, according to a survey by the global private data intelligence company, Morning Consult.

A Washington Post-Kaiser Family Foundation poll also found that 3 in 10 U.S. healthcare workers were considering leaving their profession. Almost 6 in 10 said that stress from the pandemic had harmed their mental health.

The situation is no different in other countries either.

Thirty-two percent of U.K. doctors are now reportedly considering early retirement — a figure which has doubled since June 2020.

In light of this data, keeping up with the rising demand from a dwindling workforce will be one of the biggest challenges to both fighting the coronavirus and for the continuity of healthcare services.

“What that says to me is that we have a mental health crisis — a shadow pandemic — around mental and behavioral health. If we don’t rise up to address [this], we’re going to find ourselves with a sick and tired workforce. And that can’t be good for any global economy,” said Powell.

She added this would be not just a blow to the competence of the healthcare workforce but also to nations themselves.

Powell underscored that this loss won’t stem from people having physical symptoms like a cough or fever.

“It will be because we have failed to see to the emotional wounds that lie beneath those physical,” she said.

“If we don’t take care of this shadow pandemic, the mental health of not just our healthcare workers but of our population [will deteriorate], and we will find ourselves at a place where we have lost more members of our labor force than we can count,” she stressed.

“If we lose even a single one of [healthcare workers] to depression, anxiety, PTSD, [or] suicide, we are putting ourselves at such a disadvantage in this fight. More importantly, we’re losing critical members of our human family who devoted so much of themselves to ensure that we all can heal, grow, and thrive.”
— Dr. Wizdom Powell

Powell acknowledged that not every healthcare worker will have had the same experiences throughout the pandemic.

While those working in COVID-19 wards and especially those stationed at infectious or respiratory disease clinics have “taken the brunt of the hits, or at least the biological and the viral risks,” the remainders have tried to be of service in other ways, said Powell.

For Powell and many healthcare workers not directly on the front lines, this has led to feelings of guilt or shame. But these feelings, while natural, can be difficult to process.

“I often feel a little bit of guilt around not being in that position. So, it drives me, actually, to want to do more in the ways that I can serve,” she said.

“For those of us who work in healing professions, we often are much more externally motivated, meaning we want to serve. We come to these professions with a pure intention to be a part of the healing ecosystem,” she said. “And then we face moments like these when we realized that healers also need healing.”

For the many people around the world, the pandemic and hospitalizations have been something to watch on the news, read or hear about, rather than experience first-hand. This can make it difficult for frontline workers to interact with people who haven’t seen the devastation of the pandemic.

“Because we’ve been in this virtual environment, it’s almost as if we can pretend sometimes that we’re watching a movie. It’s all on TV, and we’re not touching people, and physically most of us are still isolated. So, it really has this almost surreal feeling,” she said.

However, Powell said this has led to people behaving “as if nothing has happened and it’s business as usual.”

She likened it to the cult movie “Titanic,” where the violinists continue to play on deck as the ship sinks.

“I do not want to be one of those violinists. And I really think we should all be the person on the deck screaming at the top of our lungs ‘Iceberg!'” she said.

Just around May in the spring, COVID-19 cases were in a decisive fall in the United States. However, as the situation in the U.K. showed, the Delta variant brought along hospitalizations, inundating facilities with patients.

Powell said the surge in cases dealt a blow to the confidence of healthcare workers and the capacity of the health system to recover.

“What I know to be true is that our competence and capacity to move through this pandemic to come out on the other side was shaken by Delta. We thought we had reached a point in this pandemic. We were on a down slope, closing in on herd immunity, perhaps.”
— Dr. Wizdom Powell

Apart from maxing out the capacities of hospitals, new waves of cases and hospitalizations from the Delta variant also diminished the hope and optimism of frontline workers.

Calling it a perfect storm of morale dampening, Powell said Delta had come at a precarious time when healthcare workers were trying to mobilize public interest and commitment to getting vaccinated.

“I can’t imagine that in the midst of this, that we have that same level of radical optimism that we had when we all took the first jab of the vaccine, when we felt that we were coming together as a global community to fight back against this virus,” she said.

Powell said she’s seeing this driving many out of healthcare professions, bringing a wave of resignations.

“That is the quitting I’m worried about,” — not the quitting from family demands or the vaccine or testing mandates, she said.

It’s too early to talk about an end to the COVID-19 pandemic, but its effects on mental health are already evident.

“I think the [biggest] issue is that many of [the frontline workers] have been traumatized. They’re going to be dealing with the ramifications of that for years. So we’re also going to be dealing with the ramifications for years of having a badly traumatized workforce,” said Dr. James Jackson, psychologist and director of long-term outcomes at the ICU Recovery Center at Vanderbilt University Medical Center.

Jackson said the associated trauma of being on the front lines may also go on to affect workers’ productivity, lead to absenteeism, and lower their ability to tolerate stress.

“[Healthcare workers] are wounded; they’re bruised. Some of them are experiencing that dynamic of a whiplash. We’ve got quite a crisis brewing.”
— Dr. James Jackson

Powell suggested mental health days off for companies or designating no meeting days when possible to help workers re-energize and retreat.

She stressed that these moments were crucial for reinvigorating workers and for creative ideation, which are requisites for sustaining any global economy.

Forming alliances with others, and building relationships, teamwork, and cooperation will also be crucial, added Hayes.

And if this is not enough motivation, the financial costs can be a strong enough driving force for companies and institutions, said Powell.

Burnout is estimated to cost the United States between $125 billion and $190 billion annually in healthcare costs, according to the Harvard Business School.

Hayes said it was high time for the current healthcare model to change, as evident by the state of the overwhelmed healthcare technicians and providers.

One good thing to come out of the COVID-19 pandemic, however, has been the rise of telemedicine, according to Powell.

“We have an opportunity to reimagine healthcare delivery with the onset of tele-behavioral health services. People can now access those services from their homes and in ways that we couldn’t before. We have some tools at our disposal, we also have digital technology, and can deliver support to our health system workers in real-time,” said Powell.

Powell also said healthcare workers need to realize that they can only help their colleagues if they take care of their own mental health first.

“It has meant for me, paying either more attention to my own well-being and making sure that I take time to self-care, and giving myself radical permission to do so, which I think is a challenge,” she said.

One way we can help is by changing the discourse around healthcare workers’ mental health.

“Often, when we talk about healthcare workers and their experiences, we talk about them in a very [distant] way like we’re not a part of the same community that we’re actually seeking to understand more about,” said Powell.

To achieve this, health systems, leaders, and policymakers could start by baking in structural moments of self-care for workers because it’s highly unlikely that workers themselves will seek those moments out.

But Powell underlined that taking care of the mental, emotional, and psychosocial well-being of healthcare workers was not solely an issue for legislative leaders and policymakers to solve.

“As a human family, we have to recognize that we are asking more of our healthcare leaders and workers than we’re willing to do ourselves,” she said.

Hayes said he believes part of the solution lay in helping people be more psychologically flexible.

“If anybody has gotten through this year of COVID-19 without realizing that it’s hard to be human, [they should know that it is] just like working on our skills at the gym, that we want to work on our strength and our flexibility. We need to be doing that not just when we’re suffering but before the time when those skills are needed,” he said.

Getting people to focus on what’s really important intrinsically and by choice — not driven by feelings of guilt, shame, or others’ expectations or by force — will be key, according to Hayes.

But he pointed out there will be challenges in doing that.

“In the modern world, you have a constant invitation to take these normative concepts of anxiety disorders, depressive disorders, burnout syndrome, and climb inside that category,” he said. “Very often people are asked to rely more and more on medications to view themselves as having a disorder rather than responding in a natural way to what is a very stressful and difficult situation.”