Mental Health Services Need to Harness Skills & Lessons Learned from Frontline Health Workers During the COVID Pandemic
frontline workers
Nurses are on the frontline of the COVID-19 response.

In the wake of COVID-19, both the needs and the skills of frontline healthcare workers need to be made integral to the design of global mental health services, said experts at a Wednesday webinar, sponsored by the Geneva-based Global Self-Care Federation (GSCF).    

While mental health issues have come more to the forefront during the COVID pandemic, including among WHO member states, much still needs to be done to ensure that countries build strong systems of mental health services at community level, while also recognizing the mental health needs of health care workers themselves, said Dr Fahmy Hanna, of the WHO Department of Mental Health and Substance Abuse, speaking at the session.  

Involving frontline health workers in building awareness can also help destigmatize mental health conditions, he added, during the panel discussion on ‘COVID-19 and Frontline Workers’. Healthworkers, who have undergone trial by fire during the pandemic, are well-placed to share testimonies about their own experiences and challenges at the frontlines, he added, saying:  

“It is key and evidence-based that sharing and involving those who are affected by mental health conditions through campaigns is an effective tool to reduce stigma.” 

Nurses as Leaders: From Bedside to Boardroom

Nurse treating a child at a medical center in Baghdad, Iraq

Nurses, as skilled professionals at the cornerstone of primary health care systems, can become movers and shakers in building better mental health services – if only given the chance, added Dr Michelle Acorn of the International Council of Nurses (ICN). 

“Nurses are the life, blood, and stewards of the health system and should be recognized for what  they are,” she said. “[Nurses] are the glue and connectors holding the healthcare system together.” 

Underpaid, and overworked, nurses have a range of skills from “bedsides to the boardroom” that need to be recognized and harnessed more effectively in mental health services and support to health care workers and the communities that they serve, said Acorn.

Too often, however, nurses are often left out of policy debates and choices – preventing them from becoming fully and actively engaged in leadership, governance, and decision-making, especially in issues around gender and inclusivity in health service provision. 

“They do the work but they’re kept at arm’s length, around the periphery or fringes, not being fully enabled or empowered to maximize their contributions or knowledge to support mental health and deliver safe, competent care,” she said.   

The pandemic has also profoundly impacted the mental and physical health of nurses themselves, she added, despite the fact that COVID-19 highlighted how critical nurses and other frontline workers have been in leading pandemic response.  

Global Shortage of Nurses Exacerbated by Pandemic 

The largest shortages of nurses are seen in some parts of Latin America, Africa, and Southeast Asia

Additionally, the global nursing shortage, the result of rising rates of mental distress, poor working conditions, personal protective equipment shortages, and more, has been further exacerbated by the pandemic.

An expected six-million shortfall of nurses  is likely to increase by more than 4 million  nurses retiring by 2030, with this influx caused by the cumulative influence of mass trauma from COVID-19, said Acorn.

In addition over 115,00 health workers have died as a result of contracting COVID-19, according to the WHO.

Acorn called this a “complex form of trauma with devastating consequences” that will cause millions to leave the nursing profession.  

“Trauma is like an iceberg – you can maybe see above the ice but you don’t know what’s below that iceberg.” 

She advocated for increased investments in nursing. “Investing in nursing is not actually a cost; it’s an investment in our future.” 

Self-Care of Patients and Providers is Necessary 

The pandemic has also highlighted the importance of ”self-care”, as complementary to formalized medical care, and this goes for mental health as much as for other areas of health, like diet, exercise and sleep, the panel experts underlined.  

“We need greater recognition, and for people to jump on the bandwagon [to recognize the importance of self care],” said Director-General of GSCF Judy Stenmark. “We need to really work together to demonstrate the value of self-care, particularly in terms of mental health.” 

For healthcare workers, who have devoted most of their time to the frontline response of the pandemic, caring for patients and communities, in addition to the needs of their family, there’s little time for them to focus on their own wellbeing. 

“How much time do we actually truly devote and prioritize to self-care?” asked  Acorn. 

Those with family members who are on the front lines can support their loved ones through continued social contact, support, and empathy, encouraging positive coping mechanisms as opposed to negative ones during these stressful situations, said Hanna.

This can include supporting positive self-care approaches, like meditation and physical exercise, and discouraging negative habits, like tobacco use or alcohol abuse, he said, observing:  

“You cannot take care of others until you really take care of yourself.” 

WHO Expands Mental Health Action with Member States    

In the wake of the COVID crisis, the May meeting of the World Health Assembly, the WHO’s member state governing body, included a dedicated discussion on the “mass trauma” triggered by the pandemic, in which member states agreed to extend WHO’s 2013-2020 Mental Health Action plan for another decade – including a bold new set of global targets for 2030, Hanna said.

The global 2030 targets include calls for:

  • Mental health to be integrated into primary health care services by 80% of countries – and increased mental health service coverage by 50% of countries;
  • 80% of countries with at least two national mental health promotion and prevention programmes;
  • 80% of countries with a system for mental health and psychosocial preparedness for emergencies;
Examples of WHO mental health resources during COVID-19

In addition, WHO has developed a range of new tools for primary care and self-care responses.  Those include a new  WHO guidance for healthcare workers and other COVID-19 responders, which supports front-line workers in providing mental health and psychological ”first aid” as part of their emergency response. 

Other guides have been developed to address groups that are often overlooked by the mental health community, such as older adults and their caregivers. 

A children’s storybook has also been produced for children ages 6 – 11 years to help them cope with COVID-related stressors. 

The recently-launched report, ‘Guidance on community mental health service: promoting person-centered and rights-based approaches’, featured over two-dozen peer-reviewed examples of mental health services around the world that have developed high quality and cost-effective alternative models of care, anchored in communities. These systems, which exist in countries ranging from the United Kingdom, to Myanmar, Kenya, Zimbabwe and India, rely heavily on front-line workers as well as peer support systems, and avoid compulsory hospitalization and forced medication, whereever possible. 

Hanna highlighted Zimbabwe’s Friendship Bench, as just one example, which utilizes the expertise of lay volunteers, often older women, to support people in distress with problem-solving interventions, provided under the guidance of other front-line health workers.  As its name implices, Friendship Bench is “an actual wooden bench, placed in front of some of the healthcare facilities and building on local resources in local communities in Harare, Zimbabwe,” said  Hanna.

“The guide provides simple solutions [like the Friendship Bench] and many others, that can be used by countries to scale-up.”

Image Credits: Public Services International/Madelline Romero, International Labor Organization/Flickr, WHO, GSCF.

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