Nightmares, exhaustion and burnout: health workers describe the emotional toll of life on the frontline

By Tamaryn Nelson, Amnesty International’s Researcher on the Right to Health

“I called my therapist once in the middle of the chaos, but I felt I couldn't speak. It’s like opening a dam - if I let my feelings out, I don’t know if I’ll be able to hold them in again.”

This is what  Annalisa*, a care home worker in Italy, told Amnesty International about the toll the pandemic has taken on her mental health. Like many health workers around the world,  Annalisa has put her own wellbeing on hold throughout the pandemic.

But even during the peak of the crisis, when  Annalisa was preoccupied by immediate challenges like PPE shortages, she felt  the severity of the psychological impact. Annalisa said she developed a stammer and had nightmares, but staff shortages made it difficult to take time off.

I couldn't take it anymore. But I had to wait for [...] colleagues who had caught the disease to be able to return, so that there was a minimum of coverage. I did not want to abandon a sinking ship.
Annalisa*

The right to the highest attainable standard of mental health is enshrined in international law, but globally relatively few people have access to quality mental health services. The World Health Organization says that in low- and middle-income countries, more than 75% of people with mental, neurological and substance use disorders receive no treatment at all.

COVID-19 has exacerbated the problem - a recent WHO survey found that the pandemic has disrupted or halted critical mental health services in 93% of countries worldwide. Meanwhile, demand is increasing. Although everyone has felt the psychological impact of the pandemic, many health workers have been exposed to trauma on a daily basis and need extra support.

During dozens of interviews with health workers, Amnesty has heard time and again how PPE shortages and grueling hours pose mental as well as physical health risks. Health workers who are expected to go to work without adequate protection feel undervalued, demoralized and angry. But given the low pay and precarious contracts that are endemic in parts of the sector, many have little choice but to carry on.

Sarah*, who works in a  care home in the UK, said she had joined a union after finding out that agency workers brought in to cover shifts were being paid more than the other staff. She was angry about what she calls “poverty wages”, and the fact that care home workers were coming in to work unwell because they only get statutory sick pay . Sarah spoke about the psychological impact the isolation had on the residents of the care home:

It broke my heart. Because family is the right of the residents. They want to be happy at the end of their lives. But they were just staying in their rooms all the time.
Sarah*

So when Sarah’s manager called her on her day off and asked her to come in, she agreed.

“I felt exhausted, but I was thinking about residents. Who is going to attend them? Probably agency workers. But when you are permanent you know your residents’ needs.”

Laly*, a home care worker in France, said the French government underestimates the strain the pandemic has put on people in her profession. Health workers who visit patients in their homes were excluded from France’s bonus scheme until August; although the bonus has now been extended, Laly is angry about the low pay and poor conditions.

Many people are burned out, they have depression
Laly*

She points out that many in her sector are effectively paid below minimum wage, and that the vast majority are women. Laly said she sometimes works from 6 am to 9pm with just an hour’s break, helping vulnerable people shower, use the toilet, eat, and dress. Despite this, Laly said her company did not initially provide workers with masks; Laly was eventually given masks by nurses who lived nearby. Laly worries that if there is a second spike, many home care workers will resign:

“Many people are burned out, they have depression ... If we really get into a second wave, it's going to pose a real problem for the authorities, because there are a lot of home care workers who are going to go on medical leave. Despite their dedication, they will not go back to working like that.”

Many health workers Amnesty spoke to said they felt demoralised by the inequalities they saw in decisions about PPE. Ronald*, a hospital pharmacist in Indonesia, said he was left without adequate protection and support when pharmaceutical workers were reclassified as “non-medical personnel” - even though pharmacists also have direct contact with COVID-19 patients.

My body has not healed completely. It has affected my breathing, sinuses and I am fatigued
Tshepo*

Tshepo*, a radiographer from South Africa, contracted COVID-19 after going to work without adequate PPE; radiographers were not considered a “high risk” group despite coming into contact with COVID-19 patients daily, and were not provided with N-95 masks until April. Tshepo also expressed concern about the lack of rehabilitation for staff who had contracted the virus, and stressed that the trauma of being diagnosed with a potentially deadly illness has lasting consequences:

“My body has not healed completely. It has affected my breathing, sinuses and I am fatigued. We should go through physiotherapy to assist with healing, and counselling for the trauma.”

Seven months into the pandemic, it’s high time that governments start giving proper consideration to the wellbeing of health workers.

There are many practical steps that managers of health care facilities can take. They should rotate workers from higher-stress to lower-stress functions; partner inexperienced workers with more experienced colleagues; and initiate, encourage and monitor work breaks. There needs to be flexibility for workers who are directly impacted by the virus, and all staff should be given information about how to access mental health services.

If health workers aren't safe, neither are we

The dedication of health workers is humbling, but calling them “heroes” ignores the fact that these are human beings; and no human being makes it unscathed through months of proximity to death and illness, gruelingly long hours and minimal pay.

On World Mental Health Day, there needs to be a global effort to protect health workers and address the full range of challenges the pandemic has posed for their lives and wellbeing. We all owe a great debt to people like Annalisa, Sarah, Laly, Ronald and Tshepo, and it’s time for governments to take concrete action to show how much they are valued. If health workers are not safe, neither are we.

*All names have been changed to protect identities