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Psychiatry and Behavioral Health

Envisioning the Future of Well-Being Efforts for Health Care Workers—Successes and Lessons Learned From the COVID-19 Pandemic

To identify the key insights or developments described in this article

1 Credit CME

JAMA Psychiatry

Published Online: July 26, 2023

Special Communication

Article Information and Disclosures

Christina Mangurian, MD, MAS^1,2,3,4;

Elizabeth Fitelson, MD⁵;

Michael Devlin, MD^5,6;

Margo Pumar, MD¹;

Elissa Epel, PhD¹;

Priya Dahiya, BA¹;

Laurel E. S. Mayer, MD^5,6;

Maga Jackson-Triche, MD, MSHS¹

Author Affiliations

¹Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco
²Department of Biostatistics and Epidemiology, University of California, San Francisco, San Francisco
³UCSF Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, San Francisco, California
⁴Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco
⁵Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
⁶New York State Psychiatric Institute, New York

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Abstract

Importance The National Academy of Medicine’s National Plan for Health Workforce Well-Being provides recommendations for supporting the mental health and well-being of health care workers. This article aims to guide implementation of National Academy of Medicine recommendations by describing 2 programs at Columbia University Irving Medical Center and the University of California, San Francisco (UCSF), designed early in the COVID-19 pandemic to respond to the behavioral health needs of the health care workforce. The development of these programs, their similarities and differences, and the key lessons learned are discussed.

Observations The well-being programs, CopeColumbia and UCSF Cope, shared key elements. Both efforts were led by their respective departments of psychiatry and used similar frameworks. Teams created strategic cross-university partnerships to share difficulties and successes across both programs. Moreover, both programs addressed compounding stressors of racial and political unrest, evaluated program components, and created resources for employee self-management. CopeColumbia and UCSF Cope differed in approaches to identifying high-risk employees and formal assessment and treatment pathways. From the authors’ experience implementing these programs and having knowledge regarding health care workforce burnout, this article offers recommendations for the development of well-being programs. These include structural changes and resources to promote group and individual well-being emphasizing equity and justice, intentional involvement of psychiatry on well-being leadership teams, and bold efforts to destigmatize mental health care alongside clear paths to mental health treatment.

Conclusions and Relevance The impact of the COVID-19 pandemic revealed a need for institutions to support the mental health and emotional well-being of health care workers. By outlining the development and implementation of 2 well-being programs in large academic health care settings and making recommendations to promote workforce well-being, it is the authors’ hope that leaders will be empowered to carry forward critical changes. Most importantly, implementing plans now will provide the resilience needed both for the long shadow of the pandemic and future crises.

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Article Information

Accepted for Publication: May 3, 2023.

Published Online: July 26, 2023. doi:10.1001/jamapsychiatry.2023.2355

Corresponding Author: Christina Mangurian, MD, MAS, Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, S-224H, Box 0410, 513 Parnassus Ave, San Francisco, CA 94143 (christina.mangurian@ucsf.edu).

Author Contributions: Drs Jackson-Triche and Mayer had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Drs Mangurian and Fitelson are considered co–first authors. Drs Mayer and Jackson-Triche are considered co–senior authors.

Concept and design: Mangurian, Fitelson, Devlin, Pumar, Epel, Mayer, Jackson-Triche.

Acquisition, analysis, or interpretation of data: Devlin, Dahiya, Jackson-Triche.

Drafting of the manuscript: Mangurian, Fitelson, Pumar, Mayer, Jackson-Triche.

Critical revision of the manuscript for important intellectual content: Mangurian, Fitelson, Devlin, Epel, Dahiya, Mayer, Jackson-Triche.

Statistical analysis: Jackson-Triche.

Administrative, technical, or material support: Mangurian, Fitelson, Pumar, Dahiya, Jackson-Triche.

Supervision: Mangurian, Fitelson, Epel, Mayer.

Conflict of Interest Disclosures: Dr Mangurian reported receiving grants from National Institutes of Mental Health, the Department of Defense, Genentech, United Health Group, Gilead, the Doris Duke Charitable Foundation, and the California Health Care Foundation outside the submitted work. Dr Epel reported being a consultant for Meru Health, a digital mental health company, outside the submitted work. No other disclosures were reported.

Additional Contributions: We thank all of the talented and committed faculty and staff at University of California, San Francisco, and Columbia University who helped devote their expertise, time, and energy to support our people during this crisis. The CopeColumbia team would specifically like to acknowledge the leadership and guidance of Lourival Baptista-Neto, MD, and Claude Mellins, PhD (Columbia University). Beyond usual salary, financial compensation was not received for these contributions.

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 credit toward the CME of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.