American healthcare workers have been disproportionately impacted by the COVID-19 pandemic sweeping through the country. They have to treat the surge of patients under difficult conditions, all while trying to protect themselves and their families from infection. The psychological toll puts frontline workers at especially high risk for anxiety, depression, PTSD and suicide. Dr. Samuel McLean, an attending emergency physician at the University of North Carolina at Chapel Hill (UNC), and his wife Dr. Heather McLean, a pediatrician at Duke University Hospital, worked long hours and suffered from fatigue, stress, headaches, and coughs. In mid-March the whole family was tested for COVID-19 and both doctors and one of their sons tested positive.

All of the family recovered, fortunately, but it prompted Dr. Samuel McLean, who is also the Jeffrey Houpt Distinguished Investigator and director of the Institute for Trauma Recovery at UNC, to consider how to support his hard-working and overburdened colleagues. “People were a mess; there was the anxiety and fear of infecting loved ones and the burden of seeing so much sadness, which had a clear impact on mental health,” says McLean, whose research focuses on the effect of trauma on the brain. “But without a way to assess it, it was hard for hospital leadership to address the problem in a systematic, scalable way.” He came up with an idea to solve this problem: the Heroes Health initiative, an innovative online tool to promote self-care in the healthcare community. It helps healthcare workers self-monitor their mental well-being in the same way that they might monitor their blood pressure or other vital signs.

Addressing urgent mental health needs of frontline workers during the global pandemic

The Heroes Health app is available at no charge through Google Play and Apple’s App Store to any healthcare worker in the United States, with additional features for partnering healthcare institutions to provide their own resources and support. Healthcare workers who download the app to their iOS (Apple) or Android-compatible smartphones complete a brief mental health assessment weekly, answering questions like “over the past week, how often have you been bothered by feeling nervous, anxious, or on edge?” They can then access a summary of their mental well-being along with trends in their self-reported symptoms over time. The app also provides links to immediate support and mental health resources, emphasizing low-cost services.

Users who work for a participating institution can choose to share the data with their employer, who may suggest resources, but that is entirely voluntary. For employers, the app provides a way to track trends in staff morale and potentially intervene to support vulnerable essential workers, whether they are E.R. doctors, clerical staff, or building custodians.

McLean collaborated on the app with colleagues at UNC and Harvard Medical School, including co-principal investigators Ronald Kessler and Kerry Ressler. The team then reached out to Google to better understand what was possible with Google Cloud technology. Volunteers across Google provided engineering support to advance the project from study protocol to working app in two months by using Google Cloud’s Real-World Insights. This solution, which is Google’s deployment of the FDA’s MyStudies platform, is an open-source platform for building customized healthcare apps, studies, and clinical trials with minimal software development. The MyStudies platform is built to support HIPAA and 21 CFR part 11 requirements, but due to the flexibility in how the technology can be used, compliance is ultimately up to the customer. Participating healthcare customers, like the Heroes Health Initiative, maintain complete control over their data.

In July 2020 the program launched at UNC Health, the health system for UNC and its eleven affiliated hospitals. Since then, it has expanded its partnerships to include Cooper University Health Care in New Jersey, Jefferson Health in Pennsylvania, Grady Health System in Atlanta, Georgia, and Appalachian Regional Health Systems in North Carolina. Other institutions are also in the process of signing up. The UNC team secured funding from OneMind, a leading nonprofit for brain research, as well as the Rockefeller Foundation and Bank of America Foundation. OneMind also launched a grassroots GoFundMe campaign to expand and improve access to the app to benefit more healthcare workers.

At participating institutions, outreach teams have already made many hundreds of calls to healthcare workers who reached out through the Heroes Health app and reported mental health challenges in the face of the COVID pandemic. One outreach worker reports that “the interactions I have had with participating staff have been wonderful! Part of my goal is simply to normalize people taking time for themselves and taking care of their mental health. As an organization and in our culture that has always been a struggle for us.”

McLean agrees. Barriers such as stigma and a lack of knowledge regarding available resources lead too many healthcare workers to suffer in silence. “It can be hard for healthcare workers to distinguish between our own fatigue, stress, and illness,” he says. “We are very excited about the potential of the app to empower communities to care for one another.”

Individual healthcare workers across all 48 states have already used the app to keep track of their mental health and to help them connect to confidential mental health resources, which users can draw on whenever they need them, including discounted services from popular online providers like Talkspace and Headspace. In the longer term, Heroes Health can be deployed during future epidemics and disasters, or on an ongoing basis by healthcare organisations wishing to support their workers with the demands of their high-stakes jobs.

To read more about Heroes Health, check out their website. To get started building your own healthcare app or research study, explore here.