The healthcare profession can be taxing on one’s mental health at the best of times, especially among those that have recently joined the profession. The decision making involved in a patient’s care knowing that they impact your patient’s life significantly, the expectations from patients and their families, and recently the ever-growing worry about patients or relatives becoming violent are just some of the reasons.
With that existing scenario, in came the new COVID-19 pandemic that posed an even higher demand from healthcare workers. The constant rise in number of cases and deaths, the initial lack of any specific treatment plans or vaccines, the closure of entire hospitals, the extensive global media coverage, increased workload, inadequate PPE, feeling unsupported, long working hours, fear of exposure to the virus and the risk of infecting loved ones, staying away from one’s support systems, and the stigma of being a healthcare worker were just some of the initial issues faced by healthcare workers. Working among these risk factors increases the risk of physical, emotional, and psychological distress.
Different research studies have been conducted around the world to learn the effects of the pandemic on healthcare workers. Reviews of these studies found that the prevalence of anxiety, depression, and stress among HCWs ranged from 24.1%, 12.1%, and 29.8% respectively to 67.55%, 55.89%, and 62.99%, respectively. Those HCWs working at the front-line, nurses, female HCWs, younger HCWs, and those in areas with higher infection rates reported more severe symptoms than other HCWs. The concerns and subject of worry changed depending on the age of the HCW. There was no significant difference in levels of distress between those HCWs in hospital departments associated with covid patients and those in other hospital departments. Additionally, most studies found nurses to be more stressed and depressed than doctors which could be explained by their increased proximity to the patients and thus playing the role of confidante as well.
Many healthcare workers were being asked to stay home by their families for their own safety, but they had to battle their own feelings of being torn between the wellbeing of their families and that of their patients. Elderly healthcare workers were found to have the additional burden of fatigue leading to increased stress.
Talking to friends, colleagues, and clients who were HCWs, the feeling of helplessness was palpable – some were losing young patients with no comorbidities and saving the elderly patient with multiple comorbidities, some patients seemed to be doing well and then crashed for no apparent reason. HCWs are trained to be in control of their situation as best as can be, but with COVID, there often appeared to be no logic at all initially. How do you control something which appears illogical? As time went by, HCWs acquired more knowledge about covid and how one can protect oneself – this enhanced the sense of control over their environment and treatment. The advent of the vaccines earlier this year was a huge boost to this. However, to date, many HCWs are still having trouble falling asleep or maintaining sleep.
Continuing to work with the intense pressure that in spite of taking all precautions, one could catch the virus anytime or worse still pass it on to a loved one who may be more susceptible can cause a range of emotions from anxiety to fear to depression. The sudden reversal to a patient can cause frustration, feelings of helplessness, and adjustment issues. Additionally, almost every HCW has known some colleague who has lost their battle to COVID while fighting with them to the end – this has been hard on many.In addition to all this, HCWs also had to adjust to the online world the same as the rest of the world. But some HCWs couldn’t work online: their work had to be in person. But this also came with its own adjustments – PPE, changing their clinic environments to reduce the associated risk for themselves and their patients, reduced patient in flow, etc.
The PPE reduced their ability to connect with patients. New patients invariably don’t know what their doctor looks like. I remember a client of mine at the start of the first wave telling me that I was the first person who he had ‘seen’ (albeit online) while in hospital and felt calmer just being able to see a face. He had been extremely agitated and upset about being in the hospital with the “white suits” as without being able to see their faces to connect with them he felt “nobody was around”.
To help patients deal with their own mental health concerns, HCWs adapted their roles to also spend time with patients and listen to their issues. Not having been trained to handle to work with these emotional concerns, this new role often added to their own emotional burden. For example, another client of mine told me about how she lost her entire family to COVID within a matter of days, and couldn’t sleep unless someone held her hand. Because of her emotional state, either the staff sister or the doctor would go whenever possible to hold her hand till she fell asleep. This meant their short breaks for self-care were also difficult to come by, but it’s a choice many HCWs made.
Since COVID began, mental health professionals across the nation felt the need to be there for others. From this desire sprang up a number of volunteer groups, crisis helplines, free/ low-cost therapy and counselling sessions, group sessions, and support groups for different populations, including specialized ones for HCWs in view of the unique challenges they faced. However, one issue that arose from this was the mental health professionals experiencing burnout themselves. Guilt at not doing enough or being there for everyone led to increased hours, lower pay, and oftentimes lack of appreciation. However, this led to increased support among the community with everyone coming together to support each other.
Research indicates that when HCWs felt supported, they had decreased anxiety and stress levels as well as increased self-efficacy. The highest stress protector was found to be knowing one’s family was safe. Additionally, an Indian study found that positive factors such as family and friends being proud and supportive of the HCW, validation and recognition from patients, colleagues, and hospital authorities, positive role models, positive caretaking experiences, along with the understanding and acceptance of the possibility of getting infected were found to be morale boosting.
As a healthcare system, we should have regular screening of all HCWs to evaluate for stress, anxiety, and depression so that they can receive timely therapy/ counselling. However, for this we also need to reduce the stigma surrounding mental health and improve our existing mental healthcare system which is in dire need of more qualified professionals to work with a population of our size.
At our hospital, we set up a helpline for our HCWs to get counselling services, our covid and ICU teams had regular debriefing sessions with their seniors, work was being validation and recognised, regular knowledge sharing sessions were held, adequate PPE given to all HCWs, among other motivators and I firmly believe this has helped to some extent.
Of course, as always, there is lots more to be done, but everything starts with recognising the concerns and taking the first steps in a positive direction.
By Ritika Aggarwal Mehta, Consultant Psychologist, Jaslok Hospital
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