We rapidly assessed the need for and then designed, implemented, and evaluated the UHN CARES program to support the mental health of healthcare workers’ (HCW) during the COVID19 pandemic. It greatly impacted HCW at our institution and we received extraordinarily positive feedback from both service users and care providers. We demonstrated use of a quality improvement approach to develop an impactful mental health support program, guided by a logic model that other institutions could modify and adapt for their own context. As an external reviewer commented, UHN CARES included “components that reflect an ideal mental health system of care…” – incorporating needs assessment with service user input, ongoing quantitative and qualitative evaluation, flexible care options, low-barrier self-referral options and online tools, and triaging to ensure rapid response to those identify safety concerns with minimal delay from referral to assessment.

Objectives: Mental health concerns, including anxiety and depression, have been voiced by health care workers (HCW) throughout the COVID-19 pandemic. However, little is known about the impact of programs designed to improve HCW well-being. At University Health Network (UHN), we rapidly implemented and evaluated a program to support the mental health of our HCW.

Methods: Taking a quality improvement approach, we conducted a needs assessment and then created and evaluated the provision of individual psychological support through a modified stepped-care model, and team-based supports. These included: unit visits, online self-management resources, access to online support groups, and self-referral for individual care from a psychologist or psychiatrist. We used ongoing mixed methods evaluation, with quantitative and qualitative analysis, to improve program quality.

Results: The program ran from April 2020 to June 2023. The needs assessment demonstrated the effect of individual-level and institutional-level challenges on HCW wellbeing. Approximately 500 team visits occurred. There were over 12,000 hits to our intranet webpage. More than 220 people self-referred for individual psychological or psychiatric care, with over 1550 appointments provided. The mean wait-time from referral to initial appointment was 5 days. The majority had at least moderate symptoms of depression and anxiety at referral, with over 20% expressing thoughts of self-harm or suicide. Post-care user feedback indicated that the program was effective and valued. Interviews were also conducted with care providers, affording a unique opportunity to explore the impact of providing mental health care to colleagues in this type of model.

Conclusions: The development of a high-quality HCW mental health support program was feasible, effective, and highly valued. Using frequent feedback from multiple perspectives and stakeholders, this program was adjusted to meet HCW mental health needs as the pandemic evolved.

Berkhout, S. G., Sheehan, K. A., & Abbey, S. E. (2021). Individual-and institutional-level concerns of health care workers in Canada during the COVID-19 pandemic: a qualitative analysis. JAMA Network Open, 4(7), e2118425-e2118425.

Dhuper, M., Ruttan, L., MacGillvray, L., McKay, M., Li, A., Stewart, D., … & Schulz-Quach, C. (2022). Future public health emergencies and disasters: sustainability and insights into support programs for healthcare providers. BMC psychiatry, 22(1), 664.

Berkhout, S. G., Billings, J., Abou Seif, N., Singleton, D., Stein, H., Hegarty, S., … & Sheehan, K. (2022). Shared sources and mechanisms of healthcare worker distress in COVID-19: a comparative qualitative study in Canada and the UK. European journal of psychotraumatology, 13(2), 2107810.

Sheehan, K. A., Schulz-Quach, C., Ruttan, L. A., MacGillivray, L., McKay, M. S., Seto, A., … & Berkhout, S. G. (2023). “Don’t Just Study our Distress, Do Something”: Implementing and Evaluating a Modified Stepped-Care Model for Health Care Worker Mental Health During the COVID-19 Pandemic. The Canadian Journal of Psychiatry, 68(1), 43-53.

Berkhout, S. G., Abbey, S., & Sheehan, K. A. (2023). Burnout and distress among health care workers during COVID-19: can we offer more than band-aid solutions?. Canadian Journal of Cardiology.