Hospital governance, mental health, and bioethics in the COVID-19 syndemic

Abstract

This article analyzed the institutional responses of public mental health governance adopted by a
public university hospital during the COVID-19 syndemic, with an emphasis on the bioethical models
underpinning organizational decisions in response to workers’ psychological distress. This was an
observational, descriptive-exploratory study with a mixed-methods, longitudinal, and retrospective
approach, conducted between 2017 and 2021 in Alagoas, Brazil. A total of 765 records of sick leave
due to mental disorders were analyzed, and interviews were conducted with managers. Data were
subjected to statistical and thematic analyses. There was no significant increase in sick leave, with
a higher incidence among workers with intermediate levels of contact. The analysis revealed ethical
dilemmas, such as the suspension of elective surgeries. Governance responses were predominantly
guided by bioethical principlism, balancing autonomy, justice, beneficence, and non-maleficence. The
adoption of a bioethical model integrated with institutional strategies emerged as a protective factor
for mental health and contributed to an ethical and humanized response to the health crisis.