Behavioral Health for the Front Line: Lessons from the Covid-19 Pandemic

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O’Hayer, C. V., Nobleza, D. N., Inch, S., Rene, R., Capparella, L., Vergare, M., & Lauriello, J. (2021). Behavioral Health for the Front Line: Lessons from the Covid-19 Pandemic. NEJM Catalyst Innovations in Care Delivery, 2(3). https://doi.org/10.1056/CAT.21.0109


A large, university-based health system reorganized and expanded its behavioral health services to respond to the special needs of health care workers, students, faculty, patients,and caregivers across the Covid-19 pandemic. While patient services did not require much structural change, mental health support for employees, specifically frontline health care workers, required significant development. The Department of Psychiatry and Human Behavior, along with HR, launched a wide variety of mental health offerings at different levels of engagement beginning in March 2020. They adopted a four-tiered “pyramid” approach, with self-care resources (Tier 1) at the base; Tier 2 programs to teach supervisors how to support their employees; Tier 3 programs for peer support; and professional therapy at Tier 4. Most of the program development efforts targeted Tiers 1and 3. Tier 1 self-care resources were well used, but Tier 3 group and individual support programs struggled with scheduling issues. They relaunched several programs in summer2020 by moving scheduling responsibility to team leaders and managers, who were better able to determine the needs of their employees and the best times for everyone to gather.They adapted the programs to large-group and workshop formats. They established behavioral health liaisons for larger teams and departments to coordinate requests for services. They created four specialty targeted partnerships with the cancer center, the student counseling center, a new assisted coping program for health care providers, and institutional leadership, which has adopted mental health and wellness as a top priority.