How are countries supporting the mental health and wellbeing of their health workforce?

Cross-Country Analysis

How are countries supporting the mental health and wellbeing of their health workforce?

Providing appropriate emotional, financial and practical support to protect health workers’ mental health and wellbeing and enable them to do their job are crucial to delivering an effective COVID-19 response.

Health workers have been at the forefront of treating and caring for large numbers of severely ill and dying patients during the COVID-19 pandemic. They are at risk not only of becoming infected by the virus themselves, but also experiencing anxiety, stress, trauma and other mental health problems. This may lead to burnout and force staff to take sick leave or leave their profession altogether. Moreover, many countries are in lockdown with schools closed and transport reduced, which may create practical barriers to continuing work. But what support measures to address these issues have countries put in place so far?

Using data extracted from the COVID-19 Health Systems Response Monitor (HSRM) (up to 12 May 2020) we summarize the initiatives put in place outside of clinical settings to support health workers (Table 1). We do not consider measures implemented in clinical settings, such as personal protective equipment (covered in a previous thematic analysis) working time limits or mandatory rest periods. A forthcoming post will look in more detail at how countries are supporting their workforce with financial compensation.

Table 1. Measures taken to support health workers during the COVID-19 outbreak outside of clinical settings

Notes:+ These include financial measures beyond usual payments or salaries for health workers, including bonuses and pay rises for COVID-19 related work; ++ These include practical measures such as provision of free accommodation, transport or parking.

Most countries have put in place special measures to support the mental health of health workers, often through helplines and remote counselling 

Table 1 shows that 21 countries have adopted special measures to support the mental health of health and social care workers during the COVID-19 crisis. 

In many countries, this support is provided through newly established helplines that health, and oftentimes social care workers, can call to access psychological support from trained professionals and/or to receive referrals to additional mental health services. These helplines are sometimes organised at the national level (e.g. IsraelMaltaRomania, the United Kingdom) and/or by professional associations for specific professions (e.g. FranceIrelandLatviaPoland, the United Kingdom). In Hungary and Croatia, helplines are run by universities and schools of public health. Apps and online services are available in some countries (e.g. Romania, the United Kingdom) to provide guidance and support for hours when helplines are not staffed.

In Ireland, Norway and the United Kingdom, specific guidelines for promoting mental health and wellbeing have been issued, targeting both health workers themselves and employers. These are in addition to more general guidelines for mental health support that were available pre-crisis. 

Remote counselling sessions with psychiatrists or psychologists are provided in some countries (e.g. FinlandItaly, Malta, Kyrgyzstanthe Russian Federation and the United Kingdom) for COVID-19 related stress management, burnout prevention and other mental health support. Norway has also established a buddy-system whereby health professionals can talk to a matched peer, while mindfulness sessions are being offered to hospital workers in Malta.  

In Stockholm, Sweden’s rules for accessing 24-hour mental health support have been relaxed for the duration of the crisis, with health workers now able to access help directly without a referral from their manager. 

Childcare facilities are provided for health care workers in several countries where schools are closed  

Childcare facilities and schools have remained open to provide childcare for health workers where these institutions have been otherwise closed in several countries (AustriaBelgiumDenmark, France, Germany, Malta, the Netherlands, Norway, Portugal and the United Kingdom) and Vilnius Municipality, Lithuania. In Ireland, health workers who cannot find childcare are to be allowed to stay home to mind their children and be paid. Romania meanwhile is paying allowances for childcare during the crisis for health workers where another parent cannot take paid leave. 

In the absence of a national childcare scheme for health care workers in Israel, some hospitals and universities have organised childcare (ages 3+) for their workers.

A number of countries, predominantly in Eastern and Southern Europe, have provided additional financial support and compensation to health workers 

Thirteen countries reported providing additional financial support and compensation to health care workers involved in the COVID-19 response. This generally took the form of one-time bonus payments (Bosnia and HerzegovinaGreece, Germany, Hungary, Kyrgyzstan, Romania, the Russian Federation) or monthly bonus payments for the duration of the crisis (Albania, Bulgaria, Latvia) from the central government. In Kyrgyzstan, the bonus amount varies according to profession, with doctors paid the highest amount. In Greece, Latvia and the Russia Federation, the bonus amount is set as a proportion (50%, and between 20-50%, and 20–100% respectively) of the regular monthly wage. 

In Armenia and Estonia, bonus payments for staff have been paid by individual hospitals. In Germany, long-term care workers were paid a bonus by the labour union ver.di and the Federal Association of Employers in the Care Industry (BVAP). Some German states (e.g. Bavaria) have also given health workers a bonus in addition to that provided by the central government.

Health care professionals working with COVID-19 patients have been granted a temporary salary increase in Belarus and Lithuania for the duration of the crisis, set as a percentage of their usual monthly salaries. 

In general, financial support and compensation has been provided in countries in the East and South of the region, potentially reflecting lower, pre-existing salary levels. 

Other practical support measures such as free transport and accommodation have been put in place in some countries 

Some countries have put in place other practical support measures for health workers. For example, Romania and Mater Dei, the main hospital in Malta, have offered free accommodation for health workers isolating from their families during the pandemic. The Medical Association of Malta has also provided financial support primarily to junior doctors renting privately. In Hungary and some parts of the UK, health workers have been given free access to public transport, while NHS workers in London can hire bikes for free from a city-wide cycle scheme. In the City of Helsinki, Finland health workers have been granted free parking near health facilities. Meanwhile, in Denmark, COVID-19 has been recognised as a work-related injury for health care staff, enabling them to access associated benefits.  

Policy lessons and implications

Countries have introduced a variety of measures outside of clinical settings to support and value health workers and enable them to do their job during the COVID-19 pandemic. These range from mental health and wellbeing support initiatives, to providing bonuses and temporary salary increases, as well as practical measures such as childcare provision and free transport and accommodation. 

These measures are crucial to enable the health workforce to deliver an effective crisis response. However, many are temporary. Beyond the crisis period, providing appropriate long-term mental health support, adequate salaries and other compensation should be recognised as core components of developing a sustainable health workforce.

Gemma A Williams, Giada Scarpetti, Claudia B Maier