Coronavirus: how should occupational health support its mental health effects?

As organisations and the government step up measures to reduce the spread of the Covid-19 coronavirus, Professor Neil Greenberg, in association with SOM (the Society of Occupational Medicine), offers some advice on how occupational health professionals should support the mental health of employees, and of themselves, in these difficult times.

Over recent weeks, it is likely that most occupational health professionals (OHPs) will be inundated with requests for decisions on whether employees are fit to come to work and what the ever-changing government advice means for an organisation and its workforce.

It is likely that OHPs will experience pressure from employees to stay at home as well as pressure from managers to bring them into work. Should the OHP make the wrong decision, this may lead to unnecessary exposure of vulnerable individuals to the Covid-19 coronavirus with consequential loss of life as well as damaging organisational reputation. It is also likely that OHPs will experience an increase in abusive emails and phone calls from individuals who are not in agreement with advice they have received.

Professional isolation is a routine occupational hazard for many OHPs. As a result, during any healthcare crisis, such as the current Covid-19 pandemic, OHPs may be exposed to substantially increased work levels as well as having to make challenging decisions in the face of great uncertainty.

This information  will hopefully provide helpful information to help OHPs navigate their way through the currently unsettled waters.

Advice you can provide to staff who are worried

1. Ensure that you rely on trusted authorities such as NHS or PHE for information about the pandemic and what to do. Whilst it is understandable that people will want to watch some media reporting of the crisis, people who find their anxiety levels increase when they do so should very much limit their exposure to such information. In an uncertain time, people should try to ‘stick to the known facts’ rather than focus on speculation and possibly unhelpful stories of dismay or sorrow.
2. Ensure that you proactively reach other to other people and check on how they are doing. Share your own concerns with them; that may in turn help them to share their concerns with you. If you must isolate yourself physically, there is a wide range of ways to keep in touch using phones, WhatsApp, Skype or similar. Physical isolation should not mean social isolation. Do not wait for other people to contact you; make a distinct effort to be more in touch than usual.
3. Whilst you might feel that there is currently ‘no point’ in sticking to a healthy lifestyle, in fact it is now more important than every to do so. We know that a healthier body makes it more likely you will have a healthier mind. So, this is the time to get more sleep, eat better food, drink less alcohol and smoke less and exercise more regularly.
4. If you do get to the point of feeling unable to cope, reach out to someone for help. Just because there will many people who have physical health difficulties during the current crisis, it does not mean that those in a mental health crisis should not be cared for too.
5. Make use of trusted sources of information to bolster your mental resilience. Have a look at the NHS Every Mind Matters website which provides a range of information and tools that you might find useful. The Mental Health Foundation have some information which is specific to the current outbreak.

Advice on supporting people to stay well while self-isolating 

1. You should advise people who self-isolate to stay connected to their usual social network. Furthermore, they should try to keep to their usual routine as much as possible. When limiting physical social contact, people should stay connected via e-mail, social media, video conference and telephone.
2. Furthermore, those in isolation should try to keep to their usual routine as much as possible. This should mean working as much as they can, and this is best done through liaison with their line manager.
3. People who self-isolate should be advised to pay attention to their own needs and feelings and to engage in healthy activities that they enjoy and find relaxing. Encourage them to exercise regularly, keep to regular sleep routines, eat healthy food and limit unhealthy behaviours such as the use of excessive alcohol, smoking or gambling.
4. You should advise isolating individuals to keep repeated exposure to a never-ending stream of news to a minimum. This can cause anyone to feel anxious or distressed. Instead advise them to seek information from trusted sources such as the NHS website. They should also avoid listening to or following rumours that make them feel uncomfortable.

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The use of remote consultations

1. During the Covid-19 pandemic it is very likely that you will be asked to minimise your contact with others. If you do not have experience of conducting remote consultations, then you should get up to speed with doing so in terms of the practicalities and working out what technology will help.
2. Remote consultations can be carried out via telephone calls, Skype, WhatsApp or similar platforms.
3. When using a remote connection, consideration should be given to any potential limitations of the medium used and clinicians should continue to meet their obligations in Good Medical Practice. Furthermore, pay attention to your immediate environment and ensure that patients can only see you working in a professional environment.

Keeping yourself psychologically healthy

1. Make sure you follow the advice you are giving others about staying connected with your social networks, limiting over exposure to news articles, adhering to a healthy lifestyle and so on.
2. Should you have a dilemma about what decisions to make, reach out to your colleagues and share your concerns. Where ambiguity continues to exist, return to the official government advice and apply it to the best of your ability.
3. Before the crisis reaches its peak, reflect on the potential moral dilemmas you may face in terms of your decision making. They may be no easy answers and you should not feel that the burden of the crisis is on your shoulders alone. The current crisis is likely to force many healthcare professionals to have to make tough decisions, be they about life and death or about the success, or failure, of a business and the consequential impact on the lives its employees.
4. If you find that you are ruminating over decisions to be made or those you have made, once again share them with a colleague. Remember that there might be no right answer and it is not helpful to beat yourself up if the reasonable decision you make turns out to have an undesirable outcome.