UHN CARES: Individual and Team Level Supports for Hospital Workers During the COVID-19 Pandemic

Background: During the COVID19 pandemic, there has been growing concern of its impact on healthcare worker (HCW) mental health. However, there is limited evidence to guide the development and provision of mental health support to workers during these highly stressful times. Led primarily by our consultation-liaison psychiatry team, we rapidly developed and implemented a program to deliver both individual and team-level support for HCW at the University Health Network (UHN) in Toronto, Canada. This complements existing corporate wellness programs promoting resilience and mental and physical health. Methods: To support individuals, we developed a modified stepped care model. As it was not feasible nor appropriate to screen all workers for mental health issues, we decided to provide several steps of care to which people effectively “self-triaged” based on their needs. This included online self-management resources (brochures, infographic and videos), virtual group care (e.g. mindfulness groups), as well as individual counselling and psychiatric care from psychologists and psychiatrists respectively. To support teams, we implemented a mix of proactive and reactive outreach, conducting drop-in visits to higher stress units (e.g. COVID units and ICU) and requested in-services to other teams as needed. In parallel, we have been using a mixed methods approach to conduct needs assessment and program evaluation. Results: To date, over the last 10 months, our online resources, including group therapy information, have had over 2000 page views. We have had 109 referrals for individual psychological or psychiatric care. Over half of those individuals have moderate to severe anxiety and depressive symptoms at the time of referral and approximately 15% present with safety concerns. Our mean time from referral to first appointment is four days and people receive, on average, four sessions of individual support. Feedback surveys and interviews (n=37) have shown a high level of satisfaction with services and improvement in symptoms. Although the program is run locally, most HCWs feel that clinicians’ awareness of hospital context and culture is advantageous during care and have no concerns about confidentiality. In addition, our team supports have provided nearly 300 engagements on different units, with the majority (n=190) being proactive outreach. Discussion: Wellness promotion programs do not fully meet the increased mental health needs of HCW during the COVID19 pandemic. We have developed a high quality support program which is feasible, sustainable, and valued by teams and individuals within our institution. Ongoing needs assessment and evaluation, using different methods, enables us to adapt to the needs of HCWs as the pandemic evolves.