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28 maart 2020

Managing mental health challenges faced by healthcare workers during covid-19 pandemic - BMJ

Bron: 26-3-2020; https://doi.org/10.1136/bmj.m1211
By: Greenberg et al.

Establish measures for healthcare managers to protect mental health of healthcare workers having to make morally challenging decisions


  • Healthcare workers are at increased risk of moral injury and mental health problems if dealing with covid-19
  • Managers should be proactive in maintaining mental health of staff
  • Managers must be honest about the possible challenging situations that lie ahead
  • Provide regular contact / discussion sessions to prevent mental injury
  • After the crisis: monitor closely for mental health problems and provide professional support when necessary. 


  • Due to covid19 healthcare professionals will: be in an unprecedented situation, have to make impossible decisions and work under extreme pressures. Which might lead to moral difficulties and mental stress.
  • Moral injury (term originated in the military) is the psychological distress resulting from actions which violate someone’s moral or ethical code. It is not a mental disease but can lead to negative thoughts and therefore mental health issues.
  • The repetitive character of challenging situations for which you are not prepared or in which you are not able to give the best you can (due to lack of resources, personnel or time) may lead to severe feelings of guilt.
  • It can however be prevented by proper support
  • Early support:
    • Prepare healthcare workers (HW) for upcoming moral dilemmas.
    • Do not give HW false reassurance but full and frank assessment of what lies ahead. 
    • Provide the possibility to discuss the morally challenging decisions in a group so HW can make sense of what is happening and discuss the emotional and social challenges. Those HW who continuously avoid or are to busy for these meetings are probably most in need for them. Consider professional mental health support. 
    • Support from colleagues and managers protects from mental injury. 
    • Single session psychological debriefing approaches should not be used as they may cause additional harm.
    • Supportive supervisors protect mental health. However, also supervisors can be harmed. Managers should be closely monitored as well. 
  • After care:
    • After the crisis make time to reflect on and learn from the extraordinary difficult situations to create a meaningful rather than traumatic narrative.
    • Active mental health monitoring and seek professional mental health support if needed
  • These are extraordinary times. There is a pressing need to ensure that the tasks ahead do not cause long lasting damage to healthcare staff. They will be the heroes of the day, but we will need them for tomorrow.