Mental health during COVID-19 outbreak: who takes care of health professionals?

This article was exclusively written for The European Sting by Ms. Jacqueline Ahrens, 4^th year Brazilian student at the medical school of Ingá University Center. She is affiliated to the International Federation of Medical Students Associations (IFMSA), cordial partner of The Sting. The opinions expressed in this piece belong strictly to the writer and do not necessarily reflect IFMSA’s view on the topic, nor The European Sting’s one.

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During pandemics, it is common for health professionals, research scientists and hospital administrators to use most of their efforts fighting the pathogen, in order to understand the pathophysiological mechanisms involved and propose measures to prevent, contain and treat the disease, mitigating its biological risk. In these situations, both at the individual and the collective level, the psychological and psychiatric implications tend to be underestimated and neglected. Under this prism, such implications might generate gaps in coping strategies and increase the burden of associated diseases.¹ Health professionals, especially those working in hospitals with confirmed or suspected cases of COVID-19, are vulnerable to both high risks: infection itself and mental health problems. They may also experience fear of contagion and spreading this virus to their families, friends and others. Even though some protocols for doctors have been established, most health professionals working in this pandemic are not trained to provide mental health care. In addition, vast majority of cases these workers do not receive this specialized care. Studies carried out mainly among nurses and doctors revealed high rates of anxiety and stress symptoms, as well as prevalence to mental disorders, such as post-traumatic stress. Although actions are aimed at helping infected and quarantined patients, along with the general population and some specific groups, some of that are left out. This way, strategies to include health professionals directly exposed to the pathogen and with high levels of stress should be developed. Focusing on COVID-19, Xiang et al. (2020), suggested that three main factors should be considered for the developing mental health strategies:

1. establishment of multidisciplinary mental health teams by authorities at regional and national level (including psychiatrists, psychiatric nurses, clinical psychologists and other mental health professionals);
2. clear communication with regular and accurate updates on the COVID-19 outbreak both for health professionals and for patients;
3. provide safe psychological counseling services (for example, via electronic devices or apps).

Before that approaches to support health care professionals can be developed, it is critical to understand their specific sources of anxiety and fear. The best way to do it is by asking. A study, involving 69 individuals in the USA, conducted eight listening sessions with groups of doctors, nurses, advanced clinicians, residents and fellows during the first week of the COVID-19 pandemic.² The questions were about three main concerns: what health care professionals were most concerned about, what messaging and behaviors they needed from their leaders, and what other tangible sources of support they believed would be most helpful for them.  These discussions centered on some sources of anxiety, that health professionals organized into five requests: listen to me, protect me, prepare me, support me and take care of me.² In this perspective, it is crucial to expand research investments and strategic actions aimed at mental health in parallel to those focused on treating infectious outbreaks worldwide. After all, health professionals are also frightened and are in need of psychological or psychiatric assistance. References

1. Ornell, F et al. ‘‘Pandemic fear’’ and COVID-19: mental health burden and strategies. Braz. J Psychiatry. 2020 [access in 2020 apr. 21]. Available from: http://www.scielo.br/pdf/rbp/2020nahead/1516-4446-rbp-1516444620200008.pdf.
2. Shanafelt, T; Ripp, J; Trockel, M. Understanding and Addressing Sources of Anxiety Among Health Care Professionals During the COVID-19 Pandemic. JAMA. Published online April 7, 2020 [access in 2020 apr. 22]. Available from: https://jamanetwork.com/journals/jama/article-abstract/2764380.
3. Xiang, YT et al. Timely mental health care for the 2019 novel coronavirus outbreak is urgently needed. Lancet Psychiatry. V. 7, march 2020 [access in 2020 apr. 21]. Available from: https://www.thelancet.com/action/showPdf?pii=S2215-0366%2820%2930046-8.
4. World Health Organization. Mental Health and Psychosocial Considerations During COVID19 Outbreak [access in 2020 apr. 21]. Available from: https://www.who.int/docs/default-source/coronaviruse/mental-health-considerations.pdf.

About the author Jacqueline Ahrens, Brazilian student, 4^th year in medical school of Ingá University Center (Uningá) of Maringá – Paraná. Founding member of the local committee of International Federation of Medical Student’s Associations of Brazil (IFMSA Brazil-Uningá) and of the Academic Center, and also member of Medical Clinic – Urgency and Emergency Academic League (LACMUE). This student articulated herself with the objective of reporting a current problem that is happening in the world.