Mental health providers also are facing psychological and financial strains during the COVID-19 pandemic

The psychological toll of the COVID-19 pandemic has received much attention as cases of depression, anxiety and loneliness – especially among children – have raised concerns among mental health providers.

The American Academy of Pediatrics is among several organizations that have called on government officials to address the growing crisis. Other health professionals have urged the American Medical Association to declare a national emergency.

However, far less attention has been paid to the way the pandemic has affected those providing care.

A new study at the University of Pennsylvania highlights the stress that mental health professionals face in Philadelphia as they try to meet the needs of patients while dealing with their psychological and financial stress.

The study’s lead author, Brianna Last, said the researchers noted a worrying trend of significant fatigue, secondary fatigue – a condition caused by treating patients who have gone through traumatic experiences – and financial stress.

“Delays in licensing exams, the ability to open up to private clinics as well as increased expenses and the need to juggle their children’s care with their work during the pandemic have added to the financial pressures they are already facing,” Last said.

Specifically, the researchers sought to understand how the pandemic has exacerbated these pre-existing challenges and affected the ability of caregivers to care for young people with PTSD.

The study surveyed 49 general mental health physicians from 16 clinics in Philadelphia. About a third of them were independent contractors, and nearly half reported wanting a paid job.

Before the pandemic, many mental health clinics reduced staffing, hours and employer-provided health benefits, which led to more doctors working as independent contractors in exchange for the service, Last said. Since these service providers are only paid for their face-to-face hours, they face more unpredictable income and fewer opportunities for professional advancement. The pandemic has only exacerbated this problem.

At the same time, providers are seeing more patients undergo major shocks and face their own economic struggles, according to Last.

In general, financial and work-related stress was high among the study participants. Medical education debt was a major concern. 37 of the physicians reported having education debt, 38% of whom owed at least $100,000.

Last year, 29% of physicians said the costs of care limited their ability to care for their mental health. However, 22% of them met the criteria for symptoms of secondary stress.

The researchers also found that educational debt was negatively associated with the use of trauma-focused cognitive behavioral therapy, an evidence-based treatment approach that has been shown to be effective for children affected by trauma.

However, senior study author Renad Beds stressed that the study was not designed to show a cause-and-effect relationship between religion and providers’ abilities to use evidence-based interventions.

The researchers said the findings raise concerns that the stress of providing care in under-resourced clinical settings interferes with efforts to incorporate scientific evidence into mental health care. This should be a wake-up call alerting people to the financial investment and measures needed to support existing mental health professionals and expand the workforce.

This could include job training programs that offer free tuition to public college graduates, increased Medicaid provider payments, more stable employment, and greater peer support to reduce burnout, they said.

“We are in a global health crisis, and there are not enough providers to meet the needs,” said Beds, founder and director of the Center for Applied Science in Pennsylvania. “Although we have a massive workforce, I am very concerned about their ability to provide high-quality care both in Philadelphia and nationwide.”

All clinicians surveyed in the study were trained in trauma-focused cognitive behavioral therapy. The study was published online in Psychiatric Services.


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