Helen L. Coons, Ph.D.,
Winnifred M. Hunter, Ph.D.,
Steven J. Berkowitz, M.D.,
Rachel A. Davis, M.D.,
Brian A. Rothberg, MD,
& C. Neill Epperson, M.D.
Department of Psychiatry,
University of Colorado School of Medicine
Anschutz Medical Campus, Aurora, Colorado
The COVID-19 pandemic continues to have profound personal, public health and economic consequences worldwide. Since its onset, health care providers have worked tirelessly to treat adults and children facing this complex condition, and are consequently at increased risk for acute and long-term mental health conditions. Starting in late March, 2020, the Department of Psychiatry, University of Colorado School of Medicine, has launched COVID-19 related wellness programs for health care workers and staff across disciplines and medical settings. The services are designed to support colleagues in health care, promote their physical, emotional and relational well-being, and reduce their risk for adverse mental health issues. With funding from department, institutional, health system, philanthropic, state and federal sources, our interprofessional faculty and staff offer a range of wellness programs including the following examples:
Team Support Sessions: Zoom-based team support sessions are available to clinical groups as well as hospital leadership teams across Colorado. Sessions are scheduled with units or teams on an “as needed” basis, on a regular schedule or following a critical event. The hour-long, interactive support sessions are also available throughout the week to accommodate different shifts. Faculty facilitators work with team leaders to tailor the COVID-19 related sessions which focus on concrete strategies to support health and well-being now and in the future. The 85 plus team support sessions offered since late March 2020 have supported more than 450 individuals, and have been very well received by colleagues across disciplines in both inpatient and outpatient settings. Participants benefitted from hearing their colleagues’ concerns and coping strategies, felt less isolated, and appreciated the opportunity to focus on their own health and well-being.
COVID-19 Support Groups: Zoom-based support groups have been offered throughout the week for faculty, residents, staff and health professions students. Additional groups have focused on grief, mindfulness strategies and eating related issues during the pandemic.
Well-Being Support Line: Faculty and staff are available to individuals who call into a confidential support line to discuss COVID-19 related concerns. The support line is staffed from 8 am to 8 pm seven days/week.
Faculty and Staff Mental Health Services: A focused program was established with support from the institution and the department to address the mental health needs of (>10,000) faculty and staff across the Anschutz Medical Campus which is comprised of primary hospital affiliates— University of Colorado Hospital, Children’s Hospital Colorado and University of Colorado Schools of Public Health, Pharmacy, Dentistry, Graduate Sciences and College of Nursing. Clinical services are provided by Psychiatrists, Psychologists and Social Workers.
Past the Pandemic: With Department of Psychiatry support and grants from federal and state agencies, an interdisciplinary team of experts in disaster relief and trauma response have created and delivered a novel eight-session series on coping during COVID-19. Past the Pandemic is designed for health care providers. Colleagues across disciplines may attend individual virtual modules or the entire series. Sessions to date have included health care providers primarily from Colorado but also neighboring Wyoming. State agencies are now requesting that other state employees (e.g., teachers, child welfare workers, etc.) attend or have their own version of Past the Pandemic.
Mind the Brain: Mental Health in the Time of COVID-19: This series includes written materials and podcasts on a range of topics bridging the mind and the brain during COVID-19. Topics have focused on the pandemic, how it contributes to psychosocial distress for various populations and how biological factors such as the microbiome, neurodevelopment, immune and stress systems may impact risk and resilience for psychiatric conditions, substance misuse or behavioral health concerns more generally. Topics have included the impact of the pandemic on motherhood and mental health, sleep, our microbiome, mindful alcohol use, behavioral activation and depression, the adolescent brain and need for autonomy, risk for suicide, anxiety during cancer treatment, disordered eating and obsessive compulsive disorder. The podcast will soon provide continuing medical education credits and can be found at https://medschool.cuanschutz.edu/psychiatry/covid-19-support/mind-the-brain.
COVID-19 Web-Resources: The Department of Psychiatry also created a special home page on our website for COVID-19 related mental health and coping resources. Articles, informational flyers on health and well-being, and links to other reputable information are organized for health care providers, health professions students, faculty and staff, patients, parents and other populations. See https://medschool.cuanschutz.edu/psychiatry/covid-19-support. Examples of resources specifically for health care providers include Health Care Provider Well-Being During COVID-19 https://www.ucdenver.edu/docs/librariesprovider45/covid-19-support/health-care-provider-well-being.pdf and Tips to Improve Sleep for health Care Providers During COVID-19 https://medschool.cuanschutz.edu/docs/librariesprovider45/covid-19-support/tips-to-improve-sleep-for-health-care-providers-during-covid-19.pdf?sfvrsn=70bdecb9_2
During this tragic public health crisis, we have worked with hospital-based healthcare providers who bear a tremendous burden caring for very ill patients under highly stressful circumstances. A range of themes have emerged while working with colleagues across our COVID-19 related well-being services. Consistent with concerns identified during focus groups at Stanford University School of Medicine (Shanafelt, Ripp & Trockel, 2020), providers routinely share their fears of exposure to COVID-19 and risks for their family members. Individuals also speak of their cognitive overload and exhaustion related to shifts on new units or teams, rapidly changing treatment regimens and safety protocols, frequent codes and deaths, and working long hours. Colleagues also express their sadness about the limitations imposed on interpersonal interactions while caring for patients with COVID-19 when they are gowned in extensive PPE. And many share their frustration educating and caring for families and discussing end of life issues of those hospitalized by phone or on zoom. Others are sad and/or distressed by the socioeconomic and health disparities among hospitalized individuals with COVID-19.
Health care workers also routinely share challenges managing their family and friends’ frequent requests for up-to-date information on the pandemic. Caregiving responsibilities are also stressful for individuals with young children, ill relatives and/or elderly parents at home. Others sometimes feel that non-health care providers don’t always understand their highly stressful work situation and consequently feel isolated. Many also share their own and our collective sadness or grief that work, home and community are different without familiar connections, contacts and the ability to readily plan visits, events, travel, school, etc.
As the pandemic continues across the US and other countries around the world, health care providers also acknowledge their anticipatory anxiety about the ongoing uncertainty and stress of additional surges. At the same time, colleagues also readily share positive experiences in the midst of COVID-19 such as taking outstanding care of ill patients and their families, learning new clinical skills and competencies, their flexibility during this crisis, feeling more valued by their health systems and some communities, and coping well during a highly stressful time of ongoing uncertainty.
We hope that this short summary of COVID-19 related wellness services is helpful and are available to discuss these and other programs with your health care teams or leadership. In addition, see https://www.apa.org/topics/covid-19/trauma-health-providers for examples of health care worker well-being programs launched at other US Schools of Medicine and hospital systems. For additional information, contact Helen L. Coons, Ph.D., ABPP, President Elect, Society for Health Psychology, and Associate Professor, Department of Psychiatry, CUSOM, Anschutz Medical Campus, Aurora, Colorado at Helen.Coons@cuanschutz.edu.
Shanafelt, T., Ripp, J., & Trockel, M.(2020). Understanding and Addressing Sources of Anxiety Among Health Care Professionals During the COVID-19 Pandemic. JAMA.