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During public health complex emergencies (CE), healthcare workers play a crucial role in mitigating its impact. This work can also be rewarding as it reminds health professionals about their mission and purpose.  
Just like “a perfect storm,” CE disrupts the fabric of community life, overwhelms the infrastructure and resources, and the responders are subjected to the same ailments as their patients (Cherepanov, 2019). When responding to international CEs, humanitarians accumulated a great deal of experience dealing with extreme work stresses. This experience offers a valuable insight into the psychological challenges the frontline healthcare workers face during the pandemic and the best practices for managing them. Here are some of them:
The most common and bothersome feeling reported by both providers and patients during a CE is anger. Providers can become targets of anger and hostility from those they are trying to help. The provider’s anger is often misdirected at self, peers, managers, and administration who are part of the solution. This anger substitutes helplessness, sadness, fear, and recognizing these underlying feelings can help manage them more effectively. 
Severe stresses and the sheer volume of work can lead to emotional over-engagement and produce persistent cognitive distortions or fantasies, acting upon which compromises care, increases risks for both patients and providers, and leads to burnout. With the Rescuer, Superman fantasies previously described in helping professions, acting upon Helper fantasy involves judging the meaning and the value of their work by expressed appreciation. It leaves providers emotionally vulnerable and dependent on external approval (Cherepanov, 2019)
Also, accumulated fatigue and exposure to mass mortality can change life’s perceived value and increase reckless, risk-taking, and even suicidal behaviors ( Elwafaii, 2020). It means that suicide risk in the frontline health workers during the pandemic response is real and must be taken very seriously. The self-care module has become a golden standard of burnout prevention in helping professions. It has been credited with encouraging helpers to pay attention to their personal needs and includes recommendations about taking time for oneself through meditation, mindfulness, and grounding exercises (Kollack, 2006). However, during the training and private conversations, some responders expressed ambivalence about adopting the self-care approach.
In the heat of the response, self-care may seem like a diversion from focusing on patients’ needs. It can leave responders feeling like they are not trusted to decide when and how to attend to personal needs. Besides, prioritizing self-care can be negatively perceived by peers and put others at a disadvantage.
Instead, self-awareness helps realize the available choices and empowers responders to reclaim control over their own life and decision-making. It ensures the awareness of one’s limits and needs and empowers making informed decisions about safety and the self-care strategies that are most appropriate for the professional role and situation (Cherepanov, 2019).
Peer support is recognized as the approach of choice during CE. It makes peers feel noticed, understood, supported, and validated, and spares them from a necessity to explain the outsiders the nature of their work. It does not substitute professional MH support in case of a higher level of needs, and MH providers can assist with psychoeducation, facilitating peer supports, and raising self-awareness.
Interestingly, many responders shared that being called a hero made them uncomfortable because they had to navigate intractable moral dilemmas and make difficult decisions. In this context, being called a hero was experienced as dubious praise that only added additional pressure and expectations.
Humanitarian experience suggests that the re-entry or return to normality may be the most challenging phase of the disaster response. Responders may need additional peer support when dealing with re-adjustment associated with depression, low energy, increased conflicts at home and work, loss of meaning of life, and suicidal thoughts. 
The COVID-19 response has demonstrated that fostering peer supports, changing organizational culture, addressing self-awareness within a training and supervisory context, and strengthening managers’ support are essential parts of disaster preparedness. It also revealed that more research is needed to identify the most effective supports for healthcare responders.

Reference Article

Cherepanov, E. (2020). Responding to the Psychological Needs of Health Workers During Pandemic: Ten Lessons From Humanitarian Work. Disaster Medicine and Public Health Preparedness, 1-7. doi:10.1017/dmp.2020.356

Discussion Questions

  1. Are MH professionals well equipped to provide support to the first responders during CE? What expertise and skills are needed?
  2. What are the most effective strategies for psychological support and suicide prevention among frontline providers? 
  3. Are healthcare institutions doing enough to acknowledge and support their personnel and, especially, managers?
  4. How can we assure that the responders have access to support during re-entry?

About the Author

Elena Cherepanov, PhD, LMHC has extensive humanitarian work experience and is on the faculty of the Graduate School of Psychology and Counseling at Cambridge College (Boston MA) and. Her interests mainly concern global and refugee mental health, multicultural integrated care, and community-based interventions. Dr. Cherepanov can be contacted at elena.cherepanov@yahoo.com. Twitter Handle: @Echer02

References Cited

Cherepanov, E. (2019). Ethics for Global Mental Health: From Good Intentions to Humanitarian Accountability. New York: Routledge. doi: 10.4324/9781351175746 

Elwafaii, O. (2020). Why are COVID-19 doctors committing suicide? CGTN. 2020. https://newsus.cgtn.co/ew/020-04-2/hy-are-COVID-19-doctors-committing-suicide--Q4yi8yhYB/ndex.html/.

Kollack, I. (2006). The concept of self-care. In: Kim HS, Kollak I, eds. Nursing Theories: Conceptual and Philosophical Foundations. New York: Springer Publishing Company; 2006:45.

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