PPE for your mind: a peer support initiative for health care workers

Peer support initiatives can help health professionals experiencing mental health and wellbeing challenges during the COVID‐19 pandemic and beyond

The coronavirus disease 2019 (COVID‐19) pandemic has placed the health care workforce under an unprecedented level of stress. No area of the health workforce is immune to COVID‐19‐related changes to usual work practices. The impact of this acute stress has occurred in the context of a health care profession that was already struggling with major work‐related challenges including anxiety, depression, secondary trauma, compassion fatigue and burnout. Importantly, these issues may have been exacerbated by the COVID‐19 pandemic due to the direct consequences of health care workers being infected, and the indirect consequences of the economic impact on their families and friends, the rigours of lockdown and the adverse effects on health and wellbeing felt across all aspects of society.

Numerous studies have investigated the mental health burden in health care workers, including the landmark 2019 Beyond Blue national survey of the mental health of doctors and medical students.1 The survey found that levels of psychological distress were up to 12 times higher in doctors under the age of 30 years compared with age‐matched individuals in other professions. Most importantly, it revealed that 1 in 50 doctors had attempted suicide in their lifetime and female doctors had a twofold higher rate of suicide compared with other female professionals. High levels of emotional exhaustion and cynicism have also been reported.2 However, how and whether health professionals are adequately supported remains questionable. As Dr Geoff Toogood, Founder of CrazySocks4Docs, recently said, “the time for action is now”.3

Organic responses to the pandemic

The pandemic has provided an opportunity for practitioners across a range of disciplines to make connections with each other to share information and provide mutual support. This previously unimaginable level of connectedness has been enabled by the social media revolution. Examples include the Pandemic Kindness Movement (https://aci.health.nsw.gov.au/covid-19/kindness) and the Hand‐n‐Hand peer support network for health care workers (https://www.handnhand.org.au). Hand‐n‐Hand, originally an idea from a stage one psychiatry registrar, quickly developed a strong online presence through Facebook (https://www.facebook.com/groups/HandnHandAU), WhatsApp and Twitter. It became apparent that peer support was regarded by many as a missing but necessary element in the health workforce. The provision of such a service was an undertaking deemed essential by those leading the Hand‐n‐Hand initiative.

Why peer support?

Peer support is a pre‐clinical intervention, defined as a way of giving and receiving support based on respect, shared responsibility and mutual agreement.5 It is essential that peer support is conducted between peers who are at similar career stages and ideally are in similar or related specialties and disciplines, thus removing the hierarchical and interdisciplinary challenges that may be experienced by health care workers. Effective peer support can only occur between participants who consider each other as equals. This is how peer support differs from mentoring and supervision, which are traditionally based on a hierarchy and involve providing advice and teaching to more junior colleagues. Peer support is not about being an advocate for colleagues or acting on behalf of colleagues, and above all, it is not about providing therapy or a clinical intervention.4,5

The concept of peer support is not new, originating in the early 1970s as a means for former patients with mental health diagnoses to discuss common problems resulting from their treatment.6 Although not formally called peer support, a key feature of Alcoholics Anonymous and Narcotics Anonymous is the principle of people supporting each other through common experiences and becoming empowered to overcome their hardships.6 Peer support can occur in isolation for those needing additional support during challenging times (such as COVID‐19). It can also complement treatment modalities for those who have a diagnosed physical or mental health condition.

Until recently, the concept of medical practitioners engaging in peer support has not been widely embraced by the medical profession. There are relatively few peer support programs for the health care workforce compared with people with a lived experience of psychosocial and mental health challenges. Programs that are available for health care workers have not been evaluated or focus mainly on one‐off peer support rather than long term engagement. A summary of programs available for health care workers is provided in the Box. We contend that the COVID‐19 pandemic has provided a unique opportunity for health care professionals to improve wellbeing within the health care workforce, address persisting mental health stigma and related help‐seeking behaviour, and embrace initiatives to address these issues.

The Hand‐n‐Hand initiative

Hand‐n‐Hand peer support includes the collective expertise of psychiatrists, general practitioners, nurses and allied health practitioners with a background in mental health to establish an effective system of peer support. The initiative was launched in March 2020 via social media and gained traction through Twitter and Facebook channels. Over 400 health care workers signed up to the dedicated Facebook group within the first 24 hours, suggesting a strong need for collegial support. Hand‐n‐Hand now offers a number of services for all sectors of the workforce (hospital care, community services and primary care), tailored to suit the various disciplines. In the Hand–n‐Hand model, peer support initiatives are offered to those requesting assistance following a triage process to ensure that peer support as opposed to clinical care is the most appropriate intervention.

Hand‐n‐Hand has rapidly evolved since its inception. One‐off guided support sessions on COVID‐19 and the mental health response are offered by senior clinicians, either in the form of a webinar or small group discussion. There is also a dedicated triage manager — an experienced psychiatrist who provides a triage service for all health care workers signing up to receive peer support. Those seeking help can opt for one‐on‐one or small group peer support. There is also the option for participants to select with whom they would like to be grouped (members of the same discipline, same specialty and/or same level of seniority). While peer support workers do not provide a clinical intervention, they must have experience with collegial support. If volunteers do not have experience in either of these fields, Hand‐n‐Hand in partnership with the Black Dog Institute has developed training materials and implemented a buddy system whereby volunteers can learn through example. Volunteer peer supporters are also offered fortnightly opportunities to discuss challenges with senior clinicians from the Hand‐n‐Hand team to ensure all members are well supported during this process.

Currently, Hand‐n‐Hand has seen health care workers reach out from all states and territories across Australia and New Zealand for support. A range of health professions and specialties has sought help from the Hand‐n‐Hand team, and the type of support requested has been similarly varied. There have also been requests from specialty colleges to assist with wellbeing programs for trainees and fellows. Service evaluation remains in the preliminary stages and will require prospective follow‐up over the coming months.

Future directions

To ensure universal access to the service, the Hand‐n‐Hand team has liaised with a number of stakeholders including individual health services, the Pandemic Kindness Movement and the #MindingCOVID writing group. Pilot initiatives are in various stages of development for doctors‐in‐training in a number of hospitals across the country to provide access to a local peer support service. The #MindingCOVID writing group has also contributed significantly to the provision of education materials on peer support, compassion fatigue, burnout and vicarious trauma which have been distributed to the Hand‐n‐Hand and Pandemic Kindness Movement. Furthermore, Hand‐n‐Hand has been involved in The Essential Network initiative as an official partner with the Black Dog Institute (https://www.blackdoginstitute.org.au/ten/).

Through funding granted by the federal government, Hand‐n‐Hand has partnered with the Black Dog Institute to develop a service that not only provides peer support but also facilitates peer support‐related education and training across Australia and New Zealand. Training modules (via Zoom during COVID‐19 restrictions) have been developed in conjunction with the Black Dog Institute and will be available to individual health services, as well as any health care worker interested in receiving this education. A pilot workshop to train peer support facilitators has been conducted with a group of senior medical consultants. After preliminary talks with the Australian Medical Students’ Association, a facilitator training and peer support system will be offered to medical students. This will provide support to medical students as well as a template for peer support as a whole‐of‐profession career practice.

COVID‐19 and beyond

The advent of COVID‐19 has highlighted emotional wellbeing challenges faced by health practitioners and remains an issue that many of us feel needs to be addressed. There is a role for increased support for health care workers now and into the future. Services are required for all levels of clinical need, from online self‐help modules to specialist psychiatric intervention. The peer support model developed by Hand‐n‐Hand has a unique and important role that we contend should continue post‐pandemic and be incorporated into routine health care practice. Further work to expand this model of care and provide a more comprehensive service is vital to ensure our colleagues in the health care sector receive appropriate assistance during times of adversity.