High stress levels, burnout, absence from work, and strikes affecting the health and care workforce are symptoms of the current health systems. These are normal reactions to staff shortages, low pay, inadequate and unsafe working conditions, extraordinarily stressful environments, and a lack of needed workplace safeguards.
At least a quarter of health and care workers reported anxiety, depression, and burnout symptoms between January 2020 and April 2022. No significant reductions have been observed since 2022.
Expanding upon knowledge to address this threat to health systems, the WHO Health Workforce Department organized an April 26 technical consultation on protecting health and care workers’ mental health and well-being in Leuven, Belgium. Health workers affected by burnout testified to their personal experiences, and experts exchanged evidence-based tools, research, guidelines, good practices, and opportunities for alignment across existing national, regional, and global initiatives.
Globally, health and care workers are raising their voices on how workplace demands and resource gaps are impacting their mental health and well-being. During the technical consultation, Corey Feist, Chief Executive Officer of the Dr. Lorna Breen Heroes Foundation, called to mind his sister-in-law Dr. Lorna Breen, a New York City emergency room physician who died by suicide exactly at the height of the COVID-19 pandemic.
The landmark 2022 Dr. Lorna Breen Health Care Provider Protection Act in the United States, supporting health workers’ mental health and well-being, has funded $103 million across 44 organizations to implement evidence-informed strategies that reduce and prevent suicide, burnout, mental health conditions, and substance use disorders.
“Particularly following the COVID-19 pandemic, there is a moral obligation to address the long-standing crisis of burnout, exhaustion, and moral injury across the health sector by protecting decent work, improving the practice environment, and tackling the root causes of mental health problems in our workforce,” stated Jim Campbell, WHO Health Workforce Director.
Experts contributing to the consultation agreed that urgent collective action to address health system factors that lead to stress and burnout in the workforce is essential. The technical consultation builds upon national policy actions like the Dr. Lorna Breen Act, regional initiatives, cross-border studies that document evidence on the impact of organizational level change, and the Global Health and Care Worker Compact requested and approved by countries through the World Health Assembly.
Application of these recommendations within health systems and with appropriate policy action remains a challenge in most countries.
The expert consultation is part of a strategic partnership with the World Innovation Summit for Health (WISH) that focuses on operationalizing the recommendations of Our duty of care: A global call to action to protect the mental health of health and care workers. Demonstration sites have been launched at the health facility level in Spain and Qatar to apply evidence-based interventions and address organizational-level changes to better protect and support health and care workers.
Understanding resilience in healthcare settings
Resilience is a good starting point for hospitals, clinics, and medical practices looking to improve the well-being of healthcare workers. Resilience refers to the ability to manage physical and mental responses to difficult life events. By increasing resilience, healthcare workers are better able to deal with the stress and anxiety that comes with the job of safeguarding health and safety. When considering that doctors, surgeons, and nurses are expected to make life-saving decisions, resilience then becomes all the more important.
COVID-19 had a significant impact on the mental health and stress levels of healthcare workers. Research suggests that 93% of front-line medical workers were stressed, 86% were anxious, and over 75% reported frustration, exhaustion, burnout, and feelings of overwhelm.
Concerningly, only 13% received support in the form of behavioral health services.
Resilience is an important support strategy that can be used to equip healthcare providers to deal with their challenging work environment. A study shows that nurses with a higher resilience scale score had, on average, lower stress scores. The research suggests resilience is an important metric that can be used (in conjunction with other indicators) to assess the overall well-being of nurses and doctors.
The Importance of Peer-to-Peer Support
One of the best ways to change the stressful, high-pressured working environment that healthcare workers operate in is to establish peer-to-peer support programs. A study conducted by the National Institute of Health raised concern over bullying between nurses, which “begins well before nursing school and continues throughout a nurse’s career.”
Doctors and surgeons aren’t immune to a hostile work environment, which is often exacerbated by a hierarchical structure. Surveying approximately 44,000 doctors, researchers found that 51% of medical residents have experienced bullying.
Working in an already stressful environment, workplace bullying can compound the stressors that negatively impact mental health. This contributes to physicians:
Feeling burned out
Performing poorly in their job function
Experiencing depression and other mental health illnesses
Seeking employment elsewhere and increasing staff turnover
Healthcare professionals need to support one another to foster a positive work environment. Peer support programs provide a platform for doctors and nurses to open up about experiences, share insights, and receive and provide meaningful support.
Peer support programs have proven to be effective by encouraging open communication about the challenges healthcare providers face. By listening to and sharing their stories, they can promote a culture of empathy. Experts recommend initially ushering in peer support programs within the context of team-building activities. This helps colleagues build a stronger rapport and create new bonds.
Other positives from a peer support program include a boost in morale and an increase in patient outcomes. Doctors and nurses are better able to collaborate, and in an environment where everyone feels valued and supported, teamwork improves, and burnout rates decrease.
Addressing a mental health crisis
While support strategies are essential to maintaining a positive work environment for healthcare workers, hospitals and medical centers need intervention strategies in place. The recommended approach is to have various tools and methods at hand to ensure medical practitioners can obtain help in a way that’s most suitable and practical for them.
Some suggested methods include:
Digital platforms
Emergency helplines
One-to-one counseling
There are several applications to using digital tools for providing mental health care. Mobile applications, websites with information, discussion forums, and video-first platforms allow healthcare workers to access resources from the comfort and safety of their own homes.
Emergency hotlines are particularly effective at providing care due to the anonymity of the caller. Telephone helplines connect doctors and nurses with industry professionals and, in many cases, are available 24/7. Not only are these easy to set up, they have a high success rate and are particularly valuable in a crisis.
Offering individual therapy is another intervention available for healthcare workers. Many healthcare practitioners might be hesitant to consult with an in-house specialist, and so many hospitals use a referral system to other practices in the area.
Having regular, routine counseling and mental health support goes a long way to improving a physician’s stress levels, anxiety, and overall well-being. This has a direct correlation to the quality of care they provide.
Case studies: Successful support strategies in healthcare
Two case studies stand out as providing best practices to incorporate mental health support for healthcare workers. With different approaches to promoting mental health and well-being:
The Yorkshire and the Humber Senior Psychological Well-being Practitioner Network and
The Keck Medicine of USC Peer Program.
These case studies share valuable insights into the relevant tools hospitals and medical centers have at their disposal to improve employee wellness and, thus, patient care.
The Yorkshire and the Humber Senior Psychological well-being Practitioner Network is an online forum that enables healthcare professionals to share ideas, support one another, and establish best practices. Thanks to the knowledge-sharing on this platform, organizations have started to codify well-being initiatives into employee contracts. Other stand-out ideas include establishing well-being champions and implementing activities like tabletop yoga and desk breaks.
The Keck Medicine of USC Peer Support Program believes that talking to a peer, even for 15 minutes, can significantly improve mental health. Allowing colleagues to talk and process a traumatic or negative experience is a strong step toward healing.
The program aims to provide a safe space for staff to deal with difficult events and general stress associated with their job function. Since launching in 2021, they have trained approximately 57 “peer supporters” who provide wellness resources to over 500 healthcare professionals.
Conclusion
COVID-19 highlighted the importance of caring for the caregiver. Healthcare providers work in highly stressful environments that often lead to anxiety, burnout, and other mental health challenges. In addition to this, the hierarchical structure of the medical fraternity can often reinforce a culture of bullying or intimidation among nurses and doctors.
Prioritizing the mental health of healthcare workers is a moral and practical imperative for the sustainability of health systems worldwide. Addressing these challenges requires comprehensive strategies that include resilience training, peer-to-peer support programs, and accessible intervention tools like digital platforms, helplines, and counseling services.
Case studies such as the Yorkshire and the Humber Network and the Keck Medicine Peer Support Program underscore the potential for innovative approaches to create supportive environments where healthcare professionals can thrive.
By fostering resilience, encouraging open communication, and providing diverse mental health resources, hospitals, and medical centers can improve staff well-being, reduce turnover, and enhance patient care. The path forward calls for collective action—combining organizational change, policy support, and individual empowerment—to ensure a healthier, more sustainable future for healthcare workers and the communities they serve.
