MSU – Mount Sinai Hospital – University Health Network Academic Medical Organization
Caring for Our Physicians and TeamUHN During the COVID-19 Pandemic: Rapid Delivery and Evaluation of the Multi-Component Mental Health Support Program
Mental health concerns, including anxiety, depression, insomnia, and burnout, have been increasingly voiced by health care workers (HCW) as the COVID-19 pandemic has progressed (Tsamakis et al. 2020; Lai et al. 2020). Despite well documented mental health challenges during this and past pandemics, there is limited knowledge about how to best support HCW during these challenging times (Muller et al. 2020).
In response, we rapidly designed and implemented UHN CARES (Coping and Resilience for Employees and Staff) in April 2020, an innovative stepped care model of mental health supports for HCW. The UHN CARES program provides several levels of care, with people initially self-triaging based on their needs. Care can then be“stepped up” and “stepped down” in terms of intensity, depending on symptoms. The program design includes a qualitative needs assessment and mixed-methods program evaluation, which has been used to modify the program over the course of the pandemic. Step 1 consists of self-directed mental health supports designed by psychologists and psychiatrists addressing a range of concerns identified in the needs assessment phase; Step 2 provides access to group-based interventions delivered online. Steps 3 and 4 provide individual mental health care by psychologists or psychiatrists. In addition, we developed“Team CARES”, a proactive outreach service bringing targeted supports and resources to highly impacted areas (e.g. intensive care units, COVID wards). We have also created“Supporting the Supporters, providing peer-based support to other HCW who are themselves in support roles during the pandemic, such as wellness leads and spiritual care services.
The needs assessment identified a number of sources of distress amongst HCW. Importantly, it demonstrated the intersections of individual-level and institutional or structural-level challenges and how these impact HCW wellbeing of during the pandemic. As of November 30, 2021, the curated online resources have received more than 12,000 webpage views. 173 individuals have self-referred to the program for individual support, and we have undertaken more than 400 engagements with teams across UHN, providing debriefing, support, and resource provision to clinical teams. When they self-refer to CARES, most HCW are struggling with moderate to severe anxiety and depression, as assessed by intake PHQ-9 and GAD-7 scales. Nearly 20% report suicidal ideation at the time of referral and these individuals are supported with crisis planning and assessment by a CARES psychiatrist within the same day. The average time from self-referral to first appointment is four days. CARES has been highly valued by those receiving support, as evidenced by quantitative and qualitative evaluation data.
“[Reaching out] was so much easier because it bypassed the barrier of all the time waiting… I guess this eliminated the red tape. And that I’m definitely very appreciative for, and I think that’s one of the biggest benefits. Along with the fact that its UHN employees helping UHN employees. So, that way we can get through everything together.” (CARES service user)
“Before I accessed the UHN Cares program, I felt so lost and helpless in life. I had lost my purpose and sense of direction. After receiving the UHN Cares support, I finally feel happy with myself and my life since March 2020. I truly believe this is 100% because of this program. I feel happier at work to do my job and happier in my home life. I will be forever grateful for this program.” (CARES service user)
Our knowledge translation activities have been many and varied:
- Needs Assessment publication, JAMA Open (Berkhout et al. 2021)
- Invited presenters at “Race Against the Clock: Mental Health Researchers Stand Up to COVID-19″, which showcased COVID19 research to parliamentarians, organized by Research Canada
- Presentations at UHN Transplant program and Centre for Mental Health Grand Rounds
- Presentations on wellness issues in the pandemic for incoming internal medicine residents
- Consultation to the Department of Medicine at Women’s College Hospital to support wellness initiatives for their team
- Consultation with the Aga Khan University Hospital in Nairobi
- Invited presentations at the annual meetings of the Canadian Psychiatric Association (CPA) and the Academy of Consult-Liaison Psychiatry (ACLP)
- Research presentations to the UHN community through the Wilson Centre Reznick Research Day and research rounds
Mental Health and Well-Being
Primary Project Lead for Contact
Secondary Project Lead for Contact
Suze Berkhout, Kathleen Sheehan