Intended for healthcare professionals


Managing mental health challenges faced by healthcare workers during covid-19 pandemic

BMJ 2020; 368 doi: (Published 26 March 2020) Cite this as: BMJ 2020;368:m1211

Read our latest coverage of the coronavirus outbreak

  1. Neil Greenberg, professor of defence mental health1,
  2. Mary Docherty, consultant liaison psychiatrist2,
  3. Sam Gnanapragasam, NIHR academic clinical fellow in psychiatry2,
  4. Simon Wessely, regius professor of psychiatry1
  1. 1NIHR Health Protection Research Unit in Emergency Preparedness and Response, King’s College London, London, UK
  2. 2South London and the Maudsley NHS Trust, London, UK
  1. Correspondence to: N Greenberg neil.greenberg{at}

Neil Greenberg and colleagues set out measures that healthcare managers need to put in place to protect the mental health of healthcare staff having to make morally challenging decisions

The covid-19 pandemic is likely to put healthcare professionals across the world in an unprecedented situation, having to make impossible decisions and work under extreme pressures. These decisions may include how to allocate scant resources to equally needy patients, how to balance their own physical and mental healthcare needs with those of patients, how to align their desire and duty to patients with those to family and friends, and how to provide care for all severely unwell patients with constrained or inadequate resources. This may cause some to experience moral injury or mental health problems.

Moral injury

Moral injury, a term that originated in the military, can be defined as the psychological distress that results from actions, or the lack of them, which violate someone’s moral or ethical code.1 Unlike formal mental health conditions such as depression or post-traumatic stress disorder, moral injury is not a mental illness. But those who develop moral injuries are likely to experience negative thoughts about themselves or others (for example, “I am a terrible person” or “My bosses don’t care about people’s lives”) as well as intense feelings of shame, guilt, or disgust. These symptoms can contribute to the development of mental health difficulties, including depression, post-traumatic stress disorder, and even suicidal ideation.2 Equally, some people who have to contend with significant challenges, moral or traumatic, experience a degree of post-traumatic growth,3 a term used to describe a bolstering of psychological resilience, esteem, outlook, and values after exposure to highly challenging situations. Whether someone develops a psychological injury or experiences psychological growth is likely to be influenced by the way that they are supported …

View Full Text