Healthcare workers have been on the front lines of the COVID-19 pandemic, providing care to the sick at great personal risk. Most of the proposed policies to protect their health and safety have focused on access to high-quality personal protective equipment and other occupational safety needs. But authors of a recent Health Affairs blog post argue that a major component is being overlooked: behavioral health.
The article addresses concerns about the impact of sustained, acute psychological and moral distress on those working the front lines. It proposes a coordinated national strategy to identify, prevent, mitigate and manage post-traumatic stress disorder symptoms in healthcare workers.
WHAT'S THE IMPACT?
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The strategy encompasses three parts: prevention, treatment and managing long-term effects.
To encourage prevention, the Occupational Safety and Health Administration should convene industry stakeholders – hospitals, provider groups and payers – and behavioral health clinicians as soon as possible to rapidly develop an evidence-based critical incident stress mitigation standard for the industry and its workers, authors said.
Ideally, the standards would reflect best practices in stress reduction, such as required limits on work hours, mandatory paid days off, training and deployment of critical-stress-debriefing facilitators, the use of validated stress-monitoring tools in certain settings, the use of relaxation techniques, and peer support groups.
The treatment component focuses on building behavioral health-treatment capacity. To that end, the Department of Veterans Affairs – along with the U.S. Public Health Service, Department of Defense, and Department of Health and Human Services' Disaster Medical Assistance Teams – should partner with lead entities in the public and private sectors, such as integrated behavioral health networks and federally qualified health centers, to form a Coordinated Clinical Team of primary care and PTSD specialists throughout the country. This team would attempt to provide clinical evaluation and management services to each worker identified as being at elevated risk in the prevention stage.
The team would consist of community and private-practice clinicians with expertise in caring for patients with PTSD, but would be subject to change, based on the demand for clinical services, the availability of providers and funding levels.
To manage long-term effects the Coordinated Clinical Team would use the communication mechanisms developed in the treatment phase to provide guidance to community behavioral health providers on medication management and other interventions to manage the long-term complications of PTSD – such as cardiovascular disease, severe depression and anxiety, and substance use disorder.
THE LARGER TREND
While healthcare workers are at particular risk of behavioral health needs, due to the stressful nature of their jobs during the pandemic, people of all stripes are finding that isolation is putting strains on their mental health. According to Revel Health, more than 42% of Americans are reporting an overall mental health decline since the start of the global crisis.
Especially problematic is a severe shortage of mental health services, in rural areas in particular, due in part to mental health being treated as different from primary care in terms of reimbursement. The Centers for Medicare and Medicaid Services has ensured parity on copayments and cost-sharing for primary care services, but an equivalent framework for mental health treatment has yet to emerge.