You can keep Zoom, we prefer face-to-face counselling: health workers

Virtual medical and psychological consultations have become a standard practice since the emergence of the Covid-19 pandemic, but this new normal is yet to be embraced by some healthcare workers who clearly still prefer traditional face-to-face consultations. This has become evident at a Tygerberg Hospital pilot programme that provides psychological support to front-line workers, which only attracted support after it was it switched from virtual to a walk-in facility.

In an article that’s been published in the SA Medical Journal, researchers and clinicians from Tygerberg Hospital and Stellenbosch University noted that accessing emotional support during the pandemic had been difficult for many healthcare workers due to their hectic schedules and overwhelming clinical responsibilities. But it was barriers associated to virtual consultations that discouraged many healthcare workers from taking up counselling services.

Owing to the initial poor uptake of virtual services by front-line staff, the Covid-19 resiliency clinic was moved in-house and later offered to all staff. “It soon became apparent that, to overcome barriers to accessing care by front-line staff, the service needed to have greater on-site visibility,” wrote psychologist Erin Bröcker and colleagues.

Added to help-seeking barriers among health care workers is also fear of victimisation, a culture of silence, ingrained beliefs that self-care is selfish, work and time pressures, and a “trenches mentality” ... a culture of needing to be heroic and reluctance to approach providers who do not understand working in the trenches.

Bröcker said setting an up an on-site office close to a Covid-19 intensive care and high care unit not only added visibility to this essential service, but had a positive effect as more front-line staff reached out to the clinic.

“The increased on-site presence of clinic providers enabled networking and building of relationships with front-line staff, including doctors, nurses, physiotherapists, dietitians, technicians and administrative support staff. Through these relationships other front-line needs, such as providing psychosocial and spiritual support to patients and their families, were identified to alleviate the burden on staff, facilitate prompt support and implement resilience-bolstering strategies,” Bröcker noted.

Even though healthcare workers, who are often taught that they must cope even in adverse circumstances and must always put other people first, are known for neglecting their mental health, researchers said having these support services on-site has been linked to greater understanding of lived experiences and needs of front-line workers and their patients.

“They also had been described as very powerful interventions to strengthen existing coping mechanisms on how to manage stress and emotional distress. Making this kind of services visible to users, as opposed to virtual, built relationships and trust, making it a symbolic holding space of emotional reflection and allowed understanding between health care workers and patients,” they wrote.

Set up within the first six weeks of the Covid-19 outbreak by the department of psychiatry at Stellenbosch University, the clinic was supported by 11 volunteer psychiatrists and psychologists who offered both individual and group-based support. Embedded in it was a Covid-19 care team — which positively addressed ongoing stress, uncertainty and loss faced by health care workers, patients and their families during the pandemic.

One of the clinic staff had this to say: “I have been part of the clinic team for the past couple of months. The virtual sessions were new to me and I was not sure how this would impact on the client-therapist relationship and rapport building. And to my surprise, it was more effective than I thought it would be. I assisted with on-site individual and group sessions as well, which have also been a very meaningful and growing experience.”

“The front-line workers have been fighting this pandemic so hard and holding the pressure and pain does not come without a cost. To have been able to play even a small part in supporting them has been a tremendous privilege,” said another mental health specialist.

“Accessing emotional support during the pandemic has been difficult for many people because they have been so busy and at times overwhelmed by their clinical responsibilities. Accessing help can also be uncomfortable for healthcare providers who are taught that they must cope even in adverse circumstances and that they must always put other people first.

“Taking care of our mental health and getting support when we need it should become a part of our culture and our work community. These brief resiliency clinic interventions can be very powerful for helping people get perspective, to strengthen existing coping mechanisms and to learn new tools to manage stress and emotional distress,” said another clinic user.