S08 – Supporting Health Care Workers’ Mental Health During the COVID-19 Pandemic: Recognizing Institution-Specific Culture and Challenges to Inform Program Design

S08 – Supporting Health Care Workers’ Mental Health During the COVID-19 Pandemic: Recognizing Institution-Specific Culture and Challenges to Inform Program Design

Saturday, Oct. 29
14:30 – 15:30 (1 hr)
Meeting Room: Birchwood Ballroom (Mezzanine)
Kathleen Sheehan*, MD, DPhil, FRCPC; Rima Styra, MD; Mary Preisman, MD; Mary Elliott, MD; Suze Berkhout, MD, PhD

CanMEDS Roles:

  1. Collaborator
  2. Leader
  3. Health Advocate

At the end of this session, participants will be able to: 1) Discuss the challenges in developing and evaluating mental health support programs for health care workers (HCWs); 2) Compare and contrast different types of HCW mental health programs developed at Canadian institutions during the COVID-19 pandemic; and 3) Assess the individual, institutional, and systemic factors that may affect HCWs’ mental health at their hospital or workplace.

Through the multiple waves of the COVID-19 pandemic, there has been growing concern about the mental health of health care workers (HCWs). Research suggests heightened levels of anxiety, depression, insomnia, and burnout. Increasingly, hospitals are developing programs to support the mental health and well-being of their staff; however, there is limited evidence to guide the development of these programs. In this symposium, presenter one will summarize current literature on the topic of mental health support programs for HCWs (5 minutes). Following this, presenter two will share the results of a large multisite study that investigated how work during the 2003 SARS outbreak impacted the psychological response of HCWs to the COVID-19 pandemic (10 minutes). Three presenters will then discuss the mental health support programs they helped develop at each of their institutions. They will provide data on implementation and evaluation, demonstrating the impact of their programs. This will enable attendees to better understand what type of program may be useful for different hospital cultures and challenges. Presenter three will present on Mount Sinai Hospital’s Resilience Coaching program (10 minutes). Presenter four will outline the CREATE (Compassion, Resilience, and Team Building) model, implemented at the Princess Margaret Cancer Centre (10 minutes). Presenter five will discuss the UHN CARES (coping and resilience for employees and staff) program, rolled out across four sites of the University Health Network (10 minutes). The final 15 minutes will be for attendees to ask the presenters any questions.

S08a – Hearing from Health Care Workers During the COVID-19 Pandemic
Rima Styra, MD

At the end of this session, participants will be able to: 1) Discuss the different types of distress facing health care workers during the COVID-19 pandemic; 2) Appreciate the impact of having worked during the SARS outbreak on psychological response during the COVID-19 pandemic; and 3) Compare different types of distress faced by health care workers.

The psychological impact on health care workers (HCWs) dealing with the COVID-19 pandemic was explored, including how previous work during the 2003 severe acute respiratory syndrome (SARS) outbreak affected the psychological response of clinical and non-clinical HCWs.

Methods: A cross-sectional, multicentred hospital online survey of HCWs in the Greater Toronto Area was conducted. Mental health outcomes of HCWs were assessed, using the Impact of Events-Revised scale (IES-R), Generalized Anxiety Disorder scale (GAD-7), and Patient Health Questionnaire (PHQ-9), as well as a questionnaire adapted from previous SARS work.

Results: Among 3,852 HCWs, moderate to severe scores for symptoms of post-traumatic stress disorder (PTSD; 50.2%), anxiety (24.6%), and depression (31.5%) were observed. Work during the 2003 SARS outbreak was reported by 1,116 respondents (29.1%), who did not have higher scores for PTSD, depression, or anxiety symptoms, compared to those who had not worked during the 2003 outbreak. Multivariable logistic regression analysis showed nonclinical HCWs during this pandemic were at higher risk of anxiety (odds ratio [OR] 1.68; 95% confidence interval [CI] 1.19 to 2.15, P = 0.01) and depressive symptoms (OR 2.03; 95%CI 1.34 to 3.07, P < 0.001). HCWs using hypnotics (OR 2.55; 95%CI 1.61 to 4.03, P < 0.001) and those who cared for only 2 to 5 patients with COVID-19 (OR 1.59; 95%CI 1.06 to 2.38, P = 0.01) were at higher risk of moderate to severe symptoms of PTSD. In addition, deterioration in sleep was associated with symptoms of PTSD (OR 4.68; 95%CI 3.74 to 6.30, P < 0.001), anxiety (OR 3.09; 95%CI 2.11 to 4.53, P < 0.001), and depression (OR 5.07; 95%CI 3.48 to 7.39, P < 0.001).

Conclusion: Psychological distress was observed in both clinical and nonclinical HCWs, with no impact from previous SARS work experience.


  1. Styra R, Hawryluck L, Mc Geer A, et al. Surviving SARS and living through COVID-19: healthcare worker mental health outcomes and insights for coping. PLoS One 2021;16(11):e0258893.
  2. Albott CS, Wozniak JR, McGlinch BP, et al. Battle buddies: rapid deployment of a psychological resilience intervention for health care workers during the coronavirus disease 2019 pandemic. Anesth Analg 2020;131(1):43-54.

S08b – Resilience Coaching During The COVID-19 Pandemic: A Model Implemented at Sinai Health
Mary Preisman, MD

At the end of this session, participants will be able to: 1) Discuss the concept of resilience coaching; 2) Appreciate the elements of resilience coaching; and 3) Apply resilience coaching to their setting.

At Sinai Health, the department of psychiatry developed a staff support program called “resilience coaching” to provide adaptive, collegial mental health support to hospital staff during the COVID-19 pandemic. The program is rooted in extensive in-house experience researching and providing support to colleagues during previous SARS and H1N1 epidemics, as well as in the relational practice of consultation-liaison psychiatry. Resilience coaching leverages the power of relationships to facilitate coping and adaptation. It is distinct from clinical care, with coaches drawing from diverse psychotherapeutic skills and applying them to evolving situations. Coaching may include leading mindfulness exercises in a group, providing support to an individual one-on-one, or leading a discussion about a challenging patient. Coaching skills include active listening, validation, and providing psychoeducation. Coaches can also help facilitate access to clinical mental health support for staff when necessary. A recent qualitative evaluation of resilience coaching highlighted staff appreciation for the intervention’s fostering of collegial relationships and the time and space to decompress at work. Challenges included scheduling and access to coaching for staff with multiple unit affiliations. Resilience coaches were also interviewed as part of the evaluation. They reported positive feelings about being able to provide collegial support and finding meaning in the work, alongside challenges related to meeting needs and providing support when they were experiencing personal burnout.


  1. Rosen B, Preisman M, Hunter J, et al. Applying psychotherapeutic principles to bolster resilience among health care workers during the COVID-19 pandemic. Am J Psychother 2020;73:144-8.
  2. Shapiro J, Galowitz P. Peer support for clinicians: a programmatic approach. Acad Med 2016;91:1200-4.

S08c – CREATE (Compassion, Resilience, and Team Building): Proactive Pandemic Support for Health Care Teams
Mary Elliott, MD

At the end of this session, participants will be able to: 1) Discuss how previous work can inform the implementation of a new program to support the well-being of health care workers (HCWs) during the COVID-19 pandemic; 2) Appreciate the benefits of a proactive team-based approach to supporting HCWs; and 3) Discuss the needs addressed by this type of program.

Previous resiliency work done at Princess Margaret Cancer Centre was used as the foundation to develop and deploy CREATE (Compassion, Resilience and Team Building) in response to the need for a rapid and institutionally integrated approach to supporting the mental health of health care workers (HCWs) during COVID-19.

Methods: CREATE is a proactive team-based supportive intervention delivered at the point of care by psychosocial coaches (PSCs) to multidisciplinary frontline oncology HCWs. Quantitative administrative data and qualitative process data were recorded by PSCs during the first pandemic wave, from March 27 to June 19, 2020. Thirteen PSCs and clinical managers were paired to support 27 HCW teams.

Results: HCW team needs that were addressed by PSCs were categorized into four themes: 1) physical (14.5%), 2) social (28.4%), 3) psychological (46.2%), and 4) spiritual (10.9%). The emotional tone expressed within the teams became more positive over time, suggesting a reduction in team-level distress and an increase in team resilience. CREATE was perceived as valuable by PSCs, HCWs, and hospital leadership.

Discussion: CREATE is a team-based approach that can be rapidly adopted and delivered by institutions. The unique strengths of CREATE include that it is proactive; is tailored, collaborative, and responsive to HCW needs; is embedded into the workflows of health care teams; and uses existing psychosocial staff for rapid deployment. Future research is needed to evaluate longer-term effects and establish the most ‘active ingredients’ that contribute to the effectiveness of the intervention.


  1. Elliott M, Macedo A, Escaf M. Building Resilience within Institutions Together with Employees (BRITE): preliminary experience with implementation in an academic cancer centre. Healthc Manage Forum 2021;34:107-14. doi:10.1177/0840470420981595
  2. Shapiro GK, Schulz-Quach C, Matthew A, et al. An institutional model for health care workers during COVID-19. NEJM Catalyst 2021. DOI: 10.1056/CAT.20.0684

S08d – “Don’t Just Study Our Distress; Do Something”: Implementing and Evaluating a Modified Stepped-Care Model for Hospital Workers’ Mental Health During the COVID-19 Pandemic
Suze Berkhout, MD, PhD

At the end of this session, participants will be able to: 1) Discuss the application of stepped-care models to support health care workers (HCWs) during the COVID-19 pandemic; 2) Apply a quality improvement approach to program development and evaluation; and 3) Appreciate the individual and institutional concerns of HCWs during the pandemic.

Objective: Faced with the challenge of providing mental health support to over 21,000 health care workers (HCWs) at multiple sites during the COVID-19 pandemic, we used a quality improvement approach to develop, implement, and evaluate a modified stepped-care model and proactive team outreach program to support HCWs’ mental health at the University Health Network (UHN).

Methods: The CARES program included online resources focused on psychoeducation and self-management, access to online support and psychotherapeutic groups, and self-referral for individual care from a psychologist or psychiatrist. Team support was provided through proactive and requested visits to inpatient units. Mixed-methods evaluation, combining quantitative and qualitative analysis, was used to improve program quality.

Results: The program is ongoing and we present data up to November 30, 2021. We have done more than 400 team outreach visits. There were over 12,000 hits to the UHN’s COVID mental health intranet webpage and 166 people self-referred for individual psychological or psychiatric care. The mean wait time from referral to initial appointment was 5.4 days. Most had moderate to severe symptoms of depression and anxiety at referral, with over 20% expressing thoughts of self-harm or suicide. Post-care user feedback indicated that the program is effective and valued.

Conclusions: The development of a high-quality internal HCW mental health support program is feasible, effective, and highly valued. By using early and frequent feedback from multiple perspectives and stakeholders to address demand and implement changes responsively, the program was adjusted to meet HCW mental health needs as the pandemic itself has evolved.


  1. Berkhout SG, Sheehan KA, Abbey SE. Individual- and institutional-level concerns of health care workers in Canada during the COVID-19 pandemic: a qualitative analysis. JAMA Network Open 2021;7:e2118425.
  2. Mellins CA, Mayer LES, Glasofer DR, et al. Supporting the well-being of health care providers during the COVID-19 pandemic: The CopeColumbia response. Gen Hosp Psychiatry 2020;67:62-9.