Even before the arrival of COVID-19, health care workers have been one of the most-strained and least-supported workforces in the nation. From vicarious trauma through patients’ lives to direct trauma from injuries and other traumatic situations unfolding in the clinic or the hospital, health care workers experience an unquantifiable burden of trauma as an inescapable part of their jobs. Despite this burden, a desperate lack of support structures has left health workers to muddle through these challenges on their own, contributing to the burnout crisis. When the coronavirus pandemic arrived, Mental Health America (MHA) knew that we could no longer afford to postpone action. A recent series of webinars by MHA highlighted new intervention, outreach, and skills training efforts to fortify health care workers.

“It’s no secret that the impact of COVID-19 on frontline health care workers has been devastating,” said Jenny Sanchez, director of grants management and projects for MHA’s national office. “Many supports have been focused on doctors and nurses, and not always the support workers, such as certified nursing assistants, or other professionals, such as maintenance and janitorial staff and food workers. Additionally, many health care workers are wary of seeking help because they fear retaliation in licensing or credentialing, or because they know too many providers in their networks and there’s a lack of trust there.”

The latter is especially a problem in more rural areas, where more limited mental health support facilities increase the chances that health workers may run into people they know if they seek local in-person care. While social stigma for mental health has lessened, it remains a powerful enough force to deter many workers from seeing a mental health professional.

Shellie Aune, speaking of the project run by MHA of Montana, described a program that established an anonymous long-distance support system through a telephone line. This system eliminated many common barriers to rural mental health programs, such as transportation and a desire for anonymity, while unintentionally extending the program’s reach even beyond its intended population. “We had the majority of all our callers’ calls come from Montana. We also have had callers outside of Montana, which we never turn away. Due to a nationwide trend to eliminate their drop-in centers, maybe they cannot get hold of their therapist, their counselor, family member, friend, you name it. Some just call in because that social piece has been eliminated. So they call in and, ‘I just needed someone to say goodnight to.’ We get those callers.”

The Montana program’s call centers were not designed to be crisis lines, although they had far more callers in crisis than they anticipated. Instead, the resource was designed to stabilize callers and bring them back to baseline to enable them to carry on with basic functionality, ranging from going to work to feeding themselves. Overwhelmingly, callers reported a high level of satisfaction with their experience with the support line.

In contrast to the in-the-moment support of the Montana program, MHA’s Los Angeles group continued their project teaching longer-term resiliency skills. “One of the areas we wanted to work in was for people who were health care workers to help them deal with the trauma they had been through and to fortify them against the trauma that would be coming up,” said Christina Miller of MHALA.

By providing resiliency and coping skills, the MHALA program was designed to teach emotional regulation techniques that could be more useful in situations where calling an instant helpline may not be an option. Still, in turn, this program lacked the capacity to provide more critical care support. Despite these differences and the demographic disparities of urban vs rural populations, the fear of facing stigma remained a significant problem across both programs.

Luther Richert of MHALA explained, “This really surprised me and made me realize that we’ve got a lot of work to do on the health care lines. There was a lot of fear and anxiety and stigma about participating in mental health services. People really felt that it would be held against them if their colleagues or their administrators knew that they were going to be there, so anonymity was very high on the list of something that they would value.”

“We were originally going to do a lot of this in person, but we decided that doing it remotely would be a benefit,” Miller concluded. As with the Montana program, this remote model also facilitated much greater reach than would be possible with in-person programs.

In Montgomery, the MHA program focused on collating existing resources to make them as easy to use as possible for their target population of health care workers. The handbook that resulted from their program was also highly reviewed by people who made use of this effort, with nearly 90% of people saying that it helped them deal with their mental and emotional well-being. “This 45-page handbook is written at a low literacy level, and it’s simple and easy to read. It’s easy to follow. It’s an interactive self-motivating guide to help someone decide if they need to contact a medical professional or if they need to learn new coping skills,” Julie Waters of Montgomery MHA explained. The handbook was distributed in interested clinics and hospitals to directly reach the health care workers this program was designed to help while still allowing a level of anonymity. This model blended the focus on training longer-term skills such as the MHALA program with the instant care of the Montana model by helping the user decide which type of help they need and then aiding them in getting that help.

Ultimately, the main challenge each program reported was the short time frame to which these projects were restricted as a result of the grant that funded them. While the programs were able to make significant differences for their target populations, and every program reported meeting and exceeding their service goals, the 90-day time frame imposed on each meant that many were winding down just as they felt they were fully functional. Between the short time frame and the wide variety of different models used to help their target demographic, one thing is clear: a greater breadth of long-term mental health support programs for health care workers across the country is critically important. As every local MHA spokesperson said of their programs, our work has just begun.

To learn more about these initiatives, view the first MHA webinar here and the second here.