A global need: addressing the mental health of healthcare workers

TThe World Health Organization defines mental health as a state of mental well-being in which people cope well with the various stresses of life, can realize their potential, work productively and productively, and contribute to society. By that standard, health care workers are in a lot of trouble.

While no group or profession is immune to mental health challenges, healthcare workers face excessive stress and burnout, putting them at greater risk of anxiety, depression, insomnia, PTSD, or suicide. These stressors and risk factors are heightened in public health emergencies, particularly in low- and middle-income countries, where the ratio of health workers to the public can be low.

I am a humanitarian health worker implementing programs on five continents, and what my colleagues and I at Project HOPE, an international health and humanitarian aid organization, see time and time again is how widespread and difficult mental health challenges are among this population. Yet there is also hope for a future with less stigma and more support for this essential workforce.


Even before the Covid-19 pandemic, doctors and nurses were more likely than the general public to die by suicide. Health workers who worked in emergency departments in Hong Kong during the 2003 SARS outbreak reported severe persistent mental distress several months after the peak of the disease. After health workers who worked in West Africa during the 2013-2016 Ebola epidemic returned home, many described symptoms of isolation, depression, stigma, interpersonal difficulties and high levels of stress.

In recent years, we have learned more about vicarious trauma, or post-traumatic stress, and how often it is experienced by healthcare professionals who have been empathically involved with patients who are enduring primary trauma.


The Covid-19 pandemic has taken a heavy toll on mental health around the world, especially among healthcare workers. Forced to put themselves and their loved ones at risk day in and day out to care for their patients, healthcare workers did not have the luxury of taking time off or working from home. All the while dealing with the trauma of witnessing significant loss—not only the loss of those they cared for, but loss within their own family and community. In one study, more than half of those responding to the coronavirus reported experiencing mental health problems.

The problem has been compounded by a global health workforce shortage, which has left far too many health systems understaffed and underfunded. The remaining staff must manage large volumes of patients without adequate support. In developing countries and rural communities, where resources are still limited, this is particularly problematic and contributes to the rise of infectious diseases, reduced life expectancy and increased maternal and infant mortality.

And in places like Afghanistan, Ethiopia, Haiti and Ukraine, health workers are on the front lines of more than just the Covid-19 pandemic.

Across all continents, mental health remains one of the most misunderstood and neglected areas of public health. While barriers to treatment include lack of funding and trained health professionals, social stigma and shame surrounding mental health are often the biggest barriers to care. This is especially true for healthcare workers who often take on the responsibility of caring without being able to take a moment to take care of themselves. Doctors, nurses and other healthcare professionals may also be particularly likely to suffer in silence because they are concerned about confidentiality and its potential impact on their careers.

One place I’m finding help for healthcare workers is a training series developed by NYC Health + Hospitals called Healing, Education, Resilience and Opportunity for New York’s Frontline Workforce (HERO-NY). Its aim is not only to equip healthcare professionals with the tools to manage their own mental health, but also to break down stigmas that might prevent them from managing or acknowledging it. In five modules, the program teaches healthcare professionals how to identify common stress and trauma responses, implement self-care and stress management strategies, and seek support.

Resilience Training Program in India
A trainer leads a program for healthcare workers in India. The program, called Healing, Education, Resilience and Opportunity for New York’s Frontline Workforce, was developed by NYC Health + Hospitals. Courtesy of Project HOPE

My colleagues at Project HOPE and I have adapted and implemented the program in multiple languages ​​and cultural contexts, reaching more than 60,000 health workers and 400 health facilities in 35 countries around the world. We are now expanding it to conflict zones in Colombia, Ethiopia, Syria and Yemen.

A future with less stigma associated with mental illness will require taking responsibility from individual healthcare professionals to recognize and manage their mental health challenges on their own. While there can be value in teaching people self-care and coping skills such as acceptance, active coping, mindfulness and positive framing, it is up to healthcare leaders and decision makers to increase the psychological resilience of healthcare workers and prioritize their needs. At the workplace culture level, this includes normalizing discussions about employee mental health and establishing screening and prevention programs, so that employees can not only voice their needs, but also have ways to get their needs met in the long term.

What is needed at a systemic level is to continue to implement evidence-based programs that reduce the emotional and mental burden on health care workers. The United Nations Strategy on Covid-19 and the need for mental health action suggests that the implementation of several systematic actions by national decision-makers will help to minimize and address the overall mental health consequences of the pandemic. These include:

  • apply a whole-of-community approach to promoting, protecting and caring for mental health
  • ensure widespread availability of mental health and psychosocial support
  • supporting recovery from Covid-19 by building mental health services for the future

Health workers are the backbone of any nation’s well-being, whether they are working in a small rural clinic, a mobile medical unit reaching displaced communities affected by conflict and war, or in a large hospital emergency room. As conflict, natural disasters and infectious diseases become more common, the need for mental health services will become more common, making it necessary to invest in support for frontline health workers. The health of the world depends on it.

Rawan Hamadeh is a program director at Project HOPE.

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