Legislation Addresses COVID-related PTSD Among Health Care Workers

Doctors, nurses and other first responders risked their lives fighting COVID-19. Now their mental and emotional health could be compromised because of their service

New Jersey’s unprecedented fight against the coronavirus pandemic is expected to take a heavy toll on those working its front lines, with studies suggesting that at least half — and possibly almost all — health care workers face some form of stress or emotional trauma.

As a result, Garden State lawmakers are seeking to help identify and treat PTSD, or post-traumatic stress disorder, among the hundreds of thousands of health care workers, first responders and other frontline employees who have battled COVID-19. Their family members would also be eligible for some services.

On Monday the Senate Health and Human Services Committee unanimously approved three bipartisan pandemic-related PTSD bills. One measure would establish a 24/7 hotline for support and referrals; another creates a PTSD screening process to be administered as part of a doctor’s office visit; the third calls for a public awareness campaign on the issue and available services.

“Heroes need help, too,” said Sen. Anthony M. Bucco (R-Morris), the lead sponsor on all three bills. “A silent struggle with PTSD or depression can turn deadly without the proper support. These initiatives will help ensure that our hospital workers, first responders and their families have access to the mental health services they need to cope with the crushing trauma and stress they have endured as a result of this epidemic.”

Manifestations of PTSD

PTSD involves the physical manifestations of a stressful and traumatic event in the past and can show up as trouble sleeping, anxiety, depression, avoiding certain people and places or trouble with daily activities, according to the U.S. Veteran’s Administration. It is often associated with combat or survival situations, domestic violence or other abuse but can also be triggered by exposure to death or suffering, as well as an inability to effectively respond.

This could certainly describe the situation for many health care workers in the Garden State. For weeks on end, hospitals faced a crush of extremely sick patients in March and April and significant numbers of deaths; several hospitals were forced to bring in refrigerated trailers to provide additional morgue space.

While the virus is now spreading more slowly, and hospitalizations have declined significantly, nearly 800 patients remain in acute-care facilities. Close to 177,000 New Jerseyans have been diagnosed with COVID-19 since March, including at least 13,700 who have died.

Nursing-home workers, who faced severe shortages in staffing and protective gear, experienced similar strains — and without the same level of public and government support provided to hospitals, according to long-term-care advocates. While fewer nursing homes are dealing with active infections now, cases continue to climb at these facilities, where more than 37,300 residents and staff have tested positive for the virus.

Experts have expressed growing concerns in recent years about stress, anxiety and other mental health concerns among doctors and health care providers, with burnout affecting as many as half of clinicians. The pandemic has clearly exacerbated the situation. Nearly two-thirds of health care workers or family members reported stress or other concerns in a Kaiser Family Foundation poll published in late April. More than half of all adults reported the same symptoms, the nonprofit research group found.

The Iranian angle

And more recently, researchers at a medical school in Iran questioned 311 health care workers from a hospital in Tehran that was the epicenter of that city’s COVID-19 response. According to a news report last week, 88% of participants had severe PTSD and 12% had moderate PTSD scores; none of them showed mild PTSD, or no impact at all.

This result “indicates the depth and severity of the psychological impact of the current crisis on the medical staff,” the Tehran Times wrote. “The study concluded that the serious spread of traumatic psychiatric symptoms in the current situation can lead to damage to the health system. While serious effort is necessary for many areas, spending time and money on the mental health of at-risk patients as well as society as a whole is a necessity.”

The New Jersey proposals do not address the cost of any programs, and the legislation faces several more votes before it can be presented to Gov. Phil Murphy for his signature; Assembly versions of the bills have yet to receive a hearing. Championed in the Senate by Bucco, as well as Sens. Vin Gopal (D-Monmouth) and Troy Singleton (D-Burlington), the measures were also supported by representatives for the state’s hospitals and nursing homes.

The bills focus on several aspects of addressing PTSD:

  • S-2447 would create a toll-free hotline, operated 24/7 by trained staff, to provide support and referral information to first responders, health care workers and other frontline employees and their families who have concerns about PTSD related to their role in the COVID-19 response. It would also require the state Department of Human Services, which oversees community mental health services, to develop a system to track those with severe symptoms to ensure they receive care.
  • S-2490 calls for health care facilities to establish a procedure to screen first responders, health care staff and other frontline COVID-response workers for PTSD symptoms as part of a non-emergency visit to the doctor. The screenings — which would be optional — would be developed by the DHS or based on an established model. If individuals are found likely to have PTSD, the bill calls for the screening facility to assist them with referrals and provide a link to certain state resources.
  • S-2492 would require the DHS to launch a public awareness campaign around these PTSD services, with billboards, transit ads and media outreach targeting the same group of first responders, health care employees and other frontline COVID-19 workers and their families. The message would be designed to educate the public about the connection between the coronavirus and behavioral health issues — including things like substance abuse — advertise the PTSD hotline and screening programs and provide tips to help alleviate stress.