World Mental Health Day 2020. Protecting the mental health of the global health workforce during COVID-19: Lessons learned from the Ebola outbreak

News article 9 Oct 2020
Bernadette Thomas a Community Health Worker from Bonthe District of Sierra Leone poses next to a photo exhibition about the challenges she and her colleagues face in the course of their work.

As we approach a second wave of COVID-19 researchers are looking at what can be learnt from countries affected by the Ebola outbreak in order to better safeguard the mental health of health care workers in the UK and across the globe.

A recent report by researchers from the ARISE consortium  and REDRESS project has outlined some of the psychological challenges faced by health staff in crisis situations, and the importance of early support and intervention to protect mental health and wellbeing.

Psychological support for health workers should be built into the COVID-19 response and subsequent emergency responses, the report published in the British Medical Journal has said.

In Sierra Leone and Liberia COVID-19 is the latest in a range of shocks to the health system which have included war and the Ebola outbreak. Researchers believe health systems around the world can learn from their experiences.

After the Ebola outbreak health care workers were provided with a range of interventions to support their mental health, as well as helping to identify and design the kinds of support they felt they needed.

In Sierra Leone informal WhatsApp groups were established as safe spaces where colleagues could share feelings and seek guidance.

During the Ebola outbreak, in both Sierra Leone and Liberia, psychological first aid and self-care and wellness workshops were offered to some health care workers. Many reflected on how the outbreak had resulted in them revisiting previous traumas, emphasising how new stressors can trigger previously unresolved psychological injuries.

Both Sierra Leone and Liberia have included mental health protection as part of their current emergency response to COVID-19, with Liberia including that it “recognises the need to ensure duty of care through the protection of all responders from chronic stress, poor mental health and psychological distress during the response”.

Other suggestions in the paper include ensuring mandatory rest periods to prevent burn out, and the creation of ‘de-stress zones’ – spaces health workers can go at the end of shift before returning home.

In times of national and global crises health care workers are often some of the worst affected. Coping with these stresses and shocks can often lead to incredible resilience, but for some it can cause lasting psychological injury.

While much planning has been done around system resilience, often the long-term psychological wellbeing of those working on the front line is not considered. This is a worrying oversight as health care workers are central to how our health systems manage crises and respond to shocks.

The COVID-19 pandemic is set to continue for some time. We must urgently share learning on how to protect the mental health of our global health workforce, and work with staff to design the support that will best aid them.

“In Liverpool we are facing a second wave of COVID-19 and additional restrictions. The strain and stress for health care workers is clear, including many of my dear colleagues from LSTM, who are key to the Liverpool response. This isn’t the first-time health systems have been strained in this manner, and there is a lot we can learn from other contexts, such as Sierra Leone and Liberia” (Professor Sally Theobald, LSTM)

“In Sierra Leone, we saw the devastating effects of a pandemic on the mental health of healthcare workers who were expected to be on the frontline with little protection. During this COVID-19 pandemic, health care workers are once again are at the forefront of the fight, armed with the knowledge from past experiences and new learnings. Therefore, in this pandemic response we have seen the inclusion of mental health and wellbeing discourse for health care workers from the start of crises planning and need to continue to invest in this.” (Dr. Bintu Mansaray, ARISE & ARISE safeguarding lead, College of Medicine and Allied Health Sciences, Freetown, Sierra Leone.)

Read the full report published by the British Medical Journal (BMJ): Psychological resilience, fragility and the health workforce: lessons on pandemic preparedness from Liberia and Sierra Leone


Launched in January 2019 and funded by UK Research and Innovation’s Global Challenges Research Fund, the research consortium consists of ten partners from a range of backgrounds and disciplines. ARISE is led by the Liverpool School of Tropical Medicine (LSTM).

ARISE aims to catalyse change in approaches to enhancing accountability and improving the health and wellbeing of poor, marginalised people living in informal urban settlements. Developing approaches to support mental health and well-being is key in ARISE.

ARISE currently works in Bangladesh, India, Kenya and Sierra Leone.


REDRESS project (Reducing the Burden of Severe stigmatising skin diseases in Liberia) is a relatively new project funded by the National Institute for Health Research innovation in Global Health Transformation  fund, is led by the Liverpool School of Tropical Medicine (LSTM).

REDRESS will use a person-centred approach to evaluate, develop and adapt health systems interventions for the management of Severe Stigmatising Skin Diseases to generate learning for other settings in sub-Saharan Africa.

Supporting mental health and well-being and psycho-social support through a person centred approach is at the heart of REDRESS.