With the pandemic entering its third year, many health-care workers are exhausted — facing long hours, limited breaks and staffing shortages.

For nurses, the work has been especially gruelling. “Nurses are the front line of everything,” said Eram Chhogala, an ER nurse in Toronto. “We’re the first face that you see when you come to the ER, the first person you interact with that will provide you with comfort.”

Some, like Chhogala herself, have even lost family members to COVID-19, but have continued to care for patients in spite of their own trauma. “I’ve lost my own dad to it, and it’s not easy to go into work sometimes,” she said.

“You see people who are on life-support, and I try to keep my head up.”

Health-care workers of all stripes have faced unprecedented challenges during the pandemic, navigating difficulties like overwhelmed hospitals, a growing backlog of surgeries and diagnostic exams, and the impact of the virus on their own lives.

But nurses are seeking mental health help more than any other front-line health-care profession, according to data provided to the Star by Ontario Health on its COVID front-line wellness program, which launched nearly two years ago in April 2020. Nurses and advocates say the data points to a need for accessible mental health services for a struggling workforce

“Of all the front line — fire, police and health care — nurses have the least availability and dollars to spend on mental health benefits,” said Cathryn Hoy, president of the Ontario Nurses’ Association.

Since May 2020, the COVID front-line wellness program has received 2,351 self-referrals from health-care workers seeking one-on-one counselling. Nearly half of those referrals — around 47 per cent — were from nurses, and 86 per cent of those seeking help identify as women.

“We saw very few physicians,” said Dr. Paul Kurdyak, a psychiatrist and clinical vice-president for Ontario’s Mental Health and Addictions Centre of Excellence, which helped launch the program. Other front-line workers accessing counselling include personal support workers, social workers, custodial workers and those in hospital administrative roles.

The program received renewed funding from the government last November, with a further $12.4 million injection — part of which will help keep it running for another two years. One of its unique hallmarks, Kurdyak said, was how rapidly it was set up and how quickly it offers one-on-one counselling to those reaching out for help in the health-care sector, as people are often otherwise met with lengthy wait lists.

While it initially operated on a pilot basis, data on usage of the program showed it’s been used by many, especially during peak COVID-19 waves, making the case for renewed funding. “We were able to demonstrate that we’re providing a useful service for the health-care sector,” Kurdyak said.

Previously released data by Mental Health Research Canada shows health-care workers, and nurses in particular, have been profoundly impacted by the pandemic. The average anxiety rating for nurses is up 50 per cent from pre-pandemic levels, MHRC data shows, and anxiety disorder diagnoses are more frequent among health-care workers.

Kurdyak said many accessing COVID front-line health-care mental health supports have benefited from a few counselling sessions, but a smaller percentage with pre-existing mental health issues were referred for external, longer-term help. He added this outcome shows how quick access to mental health care can prevent the worsening of someone’s health down the line.

“It just saves an individual a lot of heartache,” Kurdyak said.

Chhogala hasn’t accessed the program herself, but said she recognizes the importance of having supports in place. She and her colleagues, she said, are often heavily involved in patient care. During limits on visitations due to COVID-19, nurses have acted as the liaison between a patient and their family — a responsibility that is both emotional and difficult.

“We have people on life-support with families crying on the phone, and that’s not an easy thing to deal with,” Chhogala said.

More recently, protests near hospitals during which health-care workers have faced intimidation, have also been a cause for stress. But Chhogala noted nursing has always been a difficult profession, and that nurses have dealt with harassment in the workplace even before COVID-19. The pandemic, however, has exacerbated those issues.

Addressing the root causes of nursing shortages, as well as improving wages and providing additional protections would go a long way to improving the well-being of nurses, said Doris Grinspun, chief executive officer of the Registered Nurses’ Association of Ontario.

This includes the repeal of Bill 124, she said, which caps the wages of public employees, including nurses. The bill does not apply to police officers, firefighters and doctors, and Grinspun said she hopes the same exemption can be made for nurses.

“We need to treat nurses with the respect and dignity that they deserve, with the compensation that they deserve,” Grinspun said.

Whether Ontario’s mental health program for front-line health-care workers will continue beyond the next two years remains to be seen, but Chhogala said she hopes permanent, accessible support will be in place, as the trauma of the pandemic will likely linger for those working in health care.

“Nurses deserve more than just a few months of support,” she said. “They’ve done so much for everyone, for so long.”

Nadine Yousif is a Toronto-based reporter for the Star covering mental health. Follow her on Twitter: @nadineyousif_