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Formal organizational supports

In a healthcare context, research demonstrates that practical and psychological support from the organization protect against adverse psychological outcomes in HCPs. These include access to tailored psychological interventions, family support, and positive recognition for employees.Current best practice guidelines for supporting HCPs’ mental health during outbreaks agree that education and training to increase employee awareness of coping skills and mental health issues, including potentially traumatic situations, is critical. 

HCPs described organizational and systemic barriers to accessing mental health support during our interviews. Many HCPs felt that their organizations did not care about their mental health and safety. A lack of open discussion and education regarding mental health in the workplace made it difficult to navigate available services. Overall, several organizational adjustments were identified from interviews to prevent, mitigate, and address workplace-related adverse mental health outcomes.

Research insights and recommendationsHCPs’ reportsStrategies for implementation
Support HCP mental health and well-being.

HCPs described increased expectations from their organizations to put work before their families and personal well-being. HCPs feltthat personal circumstances were overlooked and there was little flexibility from leadership to balance needs at work with their personal lives. This issue is not unique to the pandemic but was exacerbated by increased staffing shortages and work hours.

HCPs reported they left their position or profession after all other efforts to work within the system were exhausted. HCPs expressed positive attitudes toward the work they do, but many were no longer able or willing to navigate the unrelenting pressures and systemic/organizational barriers that contributed to poor mental health.
HCPs shared that they were often contacted to come in for work on their days off even though they already worked full-time hours. Many took the shifts but felt they were missing out on their family life. 

“You can keep asking but if I pick up anymore shifts, I’m not going to make it in for my own… I feel like I’m being asked all the time to put work ahead of my family.” (34HCP)
Verbally recognize employees’ contributions to demonstrate they are valued members of the team, which could improve retention. 

Provide flexible scheduling and time off for workers who are directly impacted or who have a family member impacted by a stressful event. It conveys a message of caring and compassion from the organization and allows HCPs to care for themselves or loved ones.

Place limits on overtime to ensure HCPs have enough time to care for themselves and spend time with loved ones.

Establish adequate sick leave and vacation policies to provide adequate time off to care for personal well-being.
Acknowledge adverse mental health outcomes are an occupational hazard for healthcare workers. Prioritize employee mental health as an organizational responsibility. 

HCPs felt that organizations provided insufficient superficial mental health supports. While organizations shared resources and provided coverage for mental health services in some instances, many HCPs reported that these supports were inaccessible (e.g., inadequate benefits, time restrictions, etc.). HCPs perceived that they were expected to care for their own mental health due to a lack of support from the organization.
Many HCPs felt their organizational culture did not support discussions about mental health and were responsible for their own well-being.

“There was a kind of culture of silence, of ‘We don’t want to talk about the things that are wrong because it opens us up to liability or litigation.’ So, [there was] pressure in terms of, ‘Don’t talk about that,’ or it’s not going to change, so why bother? Or ‘Sure, maybe you can access support…’ I feel like we’re kind of left on our own to figure things out.There’s not a lot of people who are checking in or that would be actually asking on a day-to-day basis, providing any kind of clinical supervision, or direction.” (306HCP)
Implement shared decision-making models to  enhance bidirectional communication and build respect for expertise of the interdisciplinary team.

Establish regular communication processes like town halls or informal meet and greets to communicate directly with senior leaders. 

Communicate your response to staff recommendations and suggestions made in meetings/town halls so HCPs feel heard. 
Be a visible accessible presence to demonstrate support of and interest in your employees’ work 

HCPs felt that leadership, especially senior leadership, was absent and inaccessible during the pandemic. As a result, many HCPs felt that leadership did not fully understand the reality of the challenges HCPs were facing and the stress associated with these circumstances. Policies and orders coming from higher up the chain of command reflected a lack of understanding of working conditions on units.
“I remember a night when a Staff Support Specialist did rounds and actually came by so that we could feel validated, like “Can I talk to you about what’s going on here?” And, “Can I talk to you about what we’re witnessing or what we’re experiencing?” To have someone who is actually checking in with us…I wish that my boss did that too.” (116HCP)To improve the quality of workplace mental health supports:

Track mental health wellness indicators of all staff to monitor mental health and well-being within the organization and determine areas of highest need.

Be aware of staff who may be particularly vulnerable (e.g., women, racialized individuals, etc.) and actively monitor their well-being. 

Offer trauma-informed and culturally competent mental health support.

Implement on call services that are available immediately following a potentially traumatic exposure to support affected employees.

Allocate funds for staff to develop their own mental health wellness initiatives. 

To increase access and accessibility of mental health supports:

Extend health benefits to include mental health supports for all staff, part-time, and casual employees to reduce barriers to accessing services.

Hire a psychologist to be available at no extra cost IN the workplace to reduce access barriers like time and financial restrictions.

Create a centralized place (e.g., organizational website) for HCPs to locate and access mental health supports to make it easier for them to navigate services.

Assemble a team dedicated to helping HCPs navigate internal and external mental health services and resources.

Ensure mental health benefits include short-term and long-term coverage so HCPs can access services for as long as they need.

Support spiritual care by including formal mental health supports or on-site chaplains who offer “spirituality-integrated holistic person-centered care.”

To improve mental health literacy among staff:

Teach HCPs self-care and self-compassion to equip them with tools that mitigate poor mental health outcomes.

Embed mental health literacy in team communication processes to support HCPs. For example, team managers and supervisors can include mental health check-ins in team huddles and in debriefs following critical incidents.
Commit to building a trauma-informed organization.

Efforts to mitigate and address mental health in the workplace should be trauma-informed due to the nature of the role and HCPs’ increased risk of exposure to potentially traumatic situations.

“If you want us to be able to care for people in the utmost fashion… then guess what? You need to provide a way to do that because if you don’t give people the mental health part of it, you’re not going to be able to have them do it physically…If you keep putting them in a situation, and putting them in a situation, and you don’t actually discuss it with them or allow them to come down from it, then they’re going to be traumatized.” (40HCP)
Create a safe environment. Model trauma-informed behaviour and communication when interacting with staff. 

Create emotional safety by embodying the principles of trauma-informed care:  

• demonstrate trustworthiness and transparency.
• emphasize collaboration and mutually beneficial solutions.
• actively encourage people to share observations and recommendations.  
• be attentive to power and privilege differentials that can prevent key information from being shared.
• acknowledge mistakes and strive to repair and learn from them. 

For example: 

• Demonstrate respect for employees.
• Empathetically engage with employees.
• Prioritize rapport-building between leadership and employees.
• Take time to listen to employees’ concerns and challenges.
• Allow employees to take an active role in developing initiatives that work well for them.

Train leadership on how to recognize and respond to the signs and symptoms of trauma.
Take visible action to protect employees’ physical safety. 

During the pandemic, HCPs reported increased incidences of violence and conflict from the public, patients, and patients’ families. Despite this increased risk, HCPs felt their organizations did not support and protect them. Enforcement of harassment and violence policy was left to frontline staff instead of management or senior leadership.
HCPs described instances of abuse and harassment from patients and families prior to and during the pandemic. While there are protocols in place, HCPs said they are often ignored as it has become an accepted part of the role.

“Technically, our health authorities tolerate no abuse of any kind. But it’s such a milquetoast statement because of course we do… We’ve let it slip in some areas then we let it slip in almost every area. Go work in emerg. You will be [called] every slur under the sun.” (103HCP)
Enforce harassment policies with patients and families in the workplace to visibly promote HCP workplace safety.

Value employee health and safety at the same level as patients to demonstrate that the organization cares for HCPs.

Track incidents of staff related harassment or violence as an organizational wellness indicator.

Ensure security is available to assist with aggressive visitors or patients to remove this responsibility from HCPs and protect their safety.
Promote mental health through education and acknowledging the stressors involved in providing healthcare. 

Few HCPs reported having any training to respond to mental health hazards associated with their role. HCPs also reported difficulty balancing their mental health needs with patient care needs.
The majority of HCPs stated they received little to no workplace training to maintain their own mental health, and often did not know how or where to access services. (25 Segments)

“There has been no training since school…like little tools/learning mechanisms to keep yourself sane during these times, right? And if it wasn’t for me doing my own stuff, doing my own meditation, and looking for my own therapist, I wouldn’t have those tools.” (159HCP)
Hold discussions on moral injury and trauma in the workplace to reduce risk of adverse mental health outcomes.

Provide diverse mental health services to be inclusive and increase ability to access resources (e.g., in-service counselling, online counselling, counselling during work hours, etc.)

Teach HCPs about coping strategies that can be used in and outside of the workplace to mitigate poor mental health outcomes.

Integrate mental health training into educational curriculums to build recognition of the importance of practicing self-care and self-compassion prior to entering the field.