Physician Mental Health During COVID-19: A Call to Action

The stress of health care professionals (HCPs) is surging during the COVID-19 pandemic. We need resources for our own care so we can perform well in our care of patients. It is a painful irony that, at this time of surging HCP distress, the Colorado Physician Health Program (CPHP), the peer assistance organization to which Colorado physicians have turned for 34 years for confidential assessment and treatment monitoring, is under serious threat.

As early as this past March, we were seeing reports about mental health outcomes among health care workers in Wuhan. In June, the published results of a survey of HCPs in New York demonstrated that psychological symptoms were common, with 57% of respondents reporting acute stress, 48% endorsing depressive symptoms, and 33% acknowledging anxiety symptoms. Lack of control, fear of transmitting COVID-19 to family, and fear for the health of family and friends were the most upsetting stressors, each endorsed by over 70% of respondents. The survey found that, while physical exercise was the most common coping strategy (59%), the majority of participants (51%) expressed interest in one or more proposed mental health wellness activities, especially online self-guided counseling with access to an individual therapist (33%) and individual counseling (28%).

Reports of HCP distress highlight the difficulties of working with critically ill and dying patients who are isolated from the support of their families, the fear of becoming ill or transmitting the virus to loved ones, concerns about access to personal protective equipment (PPE), and a sense of lack of control or uncertainty. An additional concern has been moral injury, which comprises the feelings of anxiety, helplessness, or outrage that occur when HCPs feel unable to surmount inequities or deficiencies in the health care system, such as when shortages of PPE or other resources force HCPs to make decisions that are contrary to their commitment to healing and awareness of how the deeply rooted structural racism in our society has made people of color especially vulnerable to the pandemic.

A pre-pandemic video from Dr. Z, who is best known for his satirical raps about health care, is a profoundly serious six-minute lesson that defines moral injury and its roots in a broken health care system. The problems discussed in the video have been amplified during the pandemic. A guidance document on moral injury in the pandemic by APA’s Committee on the Psychiatric Dimensions of Disaster is a must-read for physicians, administrators, and other leaders. It asserts, “Moral injury is associated with strong feelings of shame and guilt and with intense self-condemnation and a shattered core sense of self.” It highlights the circumstances in the current crisis that may lead to moral injury and introduces three tiers of interventions that health care systems may implement to reduce risk for such injury.

Although the literature on moral injury is primarily focused on situations in which HCPs must make treatment decisions that are counter to their moral commitment to provide the best possible care to patients, it is showing up in a unique way right now in Colorado health care. The Colorado Department of Regulatory Agencies (DORA), the state entity that oversees all the licensing boards including the medical board, has awarded the peer health contract to Peer Assistance Services instead of CPHP. For background about CPHP and the importance of a confidential peer health program for physicians, physician assistants, and medical trainees, please read my Psychiatric News column “ ‘Safe Haven’ Is Integral to Physician Wellness” (see Psychiatric News).

At the time of this writing, CPHP has appealed DORA’s decision and is simultaneously encouraging a public education campaign about the vital importance of confidential treatment of physicians by other physicians in order to keep the medical workforce healthy and our patients safe. CPHP’s campaign includes a website that outlines key issues and calls us to action, www.PatientSafetyColorado.com. While the potential loss of confidential peer assistance is unique to Colorado at this moment, this may be the canary that warns other states about an erosion of protections for physicians who seek help for mental health issues. District branch leadership across the country would do well to monitor the situation in their own states.

In addition to protecting our physician health programs, there are other ways we can work to improve the mental health of our health care workforce during the pandemic. Some institutions, such as Rush University in Chicago, have responded by creating innovative pandemic wellness programs for their workforce. The Rush program includes Wellness Rounds, a Wellness Consult Service, onsite confidential counseling, and a crisis response algorithm.

As psychiatrists, we are in the best position to attend to the mental health of our health care colleagues. Whether through leadership in our institutions, our clinical activities, or activism to protect our physician health programs, we are the definitive spokespeople for the power of prevention and treatment of emotional distress. ■

APA’s document, “Moral Injury During the Covid-19 Pandemic,” is posted here.

“Creating Wellness in a Pandemic: A Practical Framework for Health Systems Responding to Covid-19” is posted here.