The global mental health crisis among healthcare workers

In any healthcare crisis, everyone turns to doctors and healthcare workers for support and relief. But during times such as the ongoing COVID-19 pandemic, doctors and healthcare workers are more vulnerable than many others. The economic impact of the current pandemic is already causing havoc around the world, yet the associated mental health impact is quickly rearing its ugly head. As evidenced by previous epidemics, such as the 2015 Ebola outbreak in West Africa and the 2003 SARS outbreak, the psychological impact can outweigh the impact of the infection itself in terms of the number and duration of people affected. How fast India can react and cope to save its medical fraternity is something which needs a proper debate and urgent action.

The following studies from around the world have caused alarm bells to go off among healthcare providers and policymakers:

• A study published in Lancet on the mental health outcomes among healthcare workers in China who are treating patients with COVID-19 showed that a considerable proportion of participants reported symptoms of depression (50.4%), anxiety (44.6%), insomnia (34.0%), and distress (71.5%)¹.
• In a study conducted in two tertiary institutions in Singapore, 14.5% participants screened positive for anxiety, 8.9% for depression, 6.6% for stress, and 7.7% for clinical concern of PTSD.²
• A University of Colorado’s Clinical and Translational Sciences Institute’s study on nurses determined that close to 50% of nurses will experience post-traumatic stress disorder when the COVID-19 pandemic is over. ³
• University of Rome researchers surveyed more than 1,300 healthcare providers working through Italy’s pandemic. The group found nearly half of them reported symptoms of PTSD. ⁴

Not surprisingly, studies in India only reflect this global trend:

• ⁵ A survey done among 2,355 ophthalmologists across the country by the L V Prasad Eye Institute, in collaboration with All India Ophthalmological Society and George Institute, has revealed that nearly one-third of the respondents were suffering from mild to severe depression. On top of that, 3.2% of them had suicidal and self-harm ideations.
• ⁶ A study published in the Indian Journal of Psychiatry states that out of 152 doctors interviewed in West Bengal during the pandemic, 34.9% were depressed and 39.5% and 32.9% were having anxiety and stress, respectively. Significant predictors for psychiatric morbidities included experience in the health sector, duty hours, use of protective measures, and altruistic coping.
• ⁷ A multinational, multi-center study on the psychological outcomes and associated physical symptoms among healthcare workers during the COVID-19 outbreak published in Science Direct reported that out of 426 healthcare workers from 5 tertiary hospitals in India, 12.4% reported depression, 17.1% anxiety and 7.3% PTSD.

Challenges

As is evident from the studies above, there is a global mental health crisis among the healthcare fraternity and the Indian healthcare worker is not immune to it. There is an urgent need at multiple levels to address the mental health issues of our workers. Some of the key challenges in the Indian context are as follows:

Call to action

Our failure to care for the mentally ill comes at a high cost; not only in economic terms, but in wasted human potential as well. It is important to address this at multiple levels:

Policy advocacy level:

• The conservative annual estimated cost on the government to implement the Mental Healthcare Act, 2017 would be Rs 94,073 crore, according to a study by the Indian Journal of Psychiatry . However, the actual current spending at 40 crores is barely a fraction of the figure. The total spending on mental health is only a meagre 0.05% of the total healthcare budget. Unfortunately, mental health, which is mostly an out-patient treatment. is not included in the flagship Ayushman Bharat Pradhan Mantri Jan Arogya Yojana program of the Government of India. It is important for the government to increase fund allocation to the National Mental Health Programme.
• The need of the hour is to create mass awareness about mental health through campaigns similar to Swach Mansikta Abhiyan. This will have a two-pronged strategy to both remove stigma pertaining to mental health while encouraging those suffering from it to access care.

It is of critical importance to take care of our healthcare workers during this crisis through the planning and development of an inclusive psychological support strategy.

• Implement an inclusive financial plan to ensure employees are not drastically affected. Health and life insurance planning will ensure healthcare workers who put their lives at risk are provided adequate financial protection.
• Ensure that staff are aware of where and how they can access mental health and psychosocial support services, and facilitate access to such services through helplines and online applications when required.
• Rotate workers from higher-stress to lower-stress functions. Partner inexperienced workers with their more experienced colleagues. The buddy system helps to provide support, monitor stress and reinforce safety procedures. Ensure that outreach personnel enter the community in pairs. Initiate, encourage and monitor work breaks.

• The current pandemic is exerting enormous pressure on healthcare workers. It is perfectly normal for them to feel that pressure during their work. Stress and the feelings associated with it are by no means a reflection that you cannot do your job or that you are weak. Managing your mental health and psychosocial well-being during this time is as important as managing your physical health.
• Try and use helpful coping strategies, such as getting sufficient rest and respite during work or between shifts, eat sufficient and healthy food, engage in physical activity, and stay in contact with family and friends. Avoid using unhelpful coping strategies such as use of tobacco, alcohol or other drugs. In the long term, these can worsen your mental and physical well-being.

Conclusion

Good mental health is critical to overall wellbeing of individuals, societies and countries. Mental, emotional and behavioral disorders (MEBs) are a serious threat to a nation’s security and economy. The World Economic Forum estimated the direct and indirect costs due to mental illness will reach $30 trillion by 2030, according to its report “2011 in economics of NCDs projects global cost of mental illness.” It is important for India to come out of the COVID-19 crisis with more than a stronger economy and infrastructure. It needs to come out of the pandemic with a stronger healthcare workforce. Caring for our doctors, nurses and allied health professionals at this time of crisis is of paramount importance.

¹ Factors Associated With Mental Health Outcomes Among Health Care Workers Exposed to Coronavirus Disease 2019 Jianbo Lai, MSc,1 Simeng Ma, MSc,2 Ying Wang, MSc,2 Zhongxiang Cai, MD,2 Jianbo Hu, MSc,1 Ning Wei, MD,1 Jiang Wu, MD,3 Hui Du, MD,4 Tingting Chen, MD,5 Ruiting Li, MD,2 Huawei Tan, MD,2 Lijun Kang, MSc,2 Lihua Yao, MD,2 Manli Huang, MD,1 Huafen Wang, BD,6 Gaohua Wang, MD,2 Zhongchun Liu, MD,corresponding author2 and Shaohua Hu, MDcorresponding author1
² Psychological Impact of the COVID-19 Pandemic on Health Care Workers in Singapore Benjamin Y.Q. Tan, MD,* Nicholas W.S. Chew, MD,* Grace K.H. Lee, MD, Mingxue Jing, MD, Yihui Goh, MD, Leonard L.L. Yeo, MD, Ka Zhang, MD, Howe-Keat Chin, MD, Aftab Ahmad, MD, Faheem Ahmed Khan, MD, Ganesh Napolean Shanmugam, MBBCh, Bernard P.L. Chan, MD, Sibi Sunny, MD, Bharatendu Chandra, MD, Jonathan J.Y. Ong, MD, Prakash R. Paliwal, MD, Lily Y.H. Wong, BN, Renarebecca Sagayanathan, BSc, Jin Tao Chen, BN, Alison Ying Ying Ng, Dip, Hock Luen Teoh, MD, Cyrus S. Ho, MD, Roger C. Ho, MD, and Vijay K. Sharma, MD
³ https://www.theguardian.com/us-news/2020/may/15/us-nurses-doctors-mental-health-coronavirus
⁴ https://www.upi.com/Health_News/2020/05/28/Half-of-Italian-healthcare-workers-experienced-PTSD-during-COVID-19-outbreak/7111590673223/
⁵ https://www.thehindu.com/news/cities/Hyderabad/psychological-impact-of-pandemic-high-on-ophthalmologists-study/article31626676.ece
⁶ Chatterjee SS, Bhattacharyya R, Bhattacharyya S, Gupta S, Das S, Banerjee BB. Attitude, practice, behavior, and mental health impact of COVID-19 on doctors. Indian J Psychiatry 2020;62:257-65
⁷ A multinational, multicenter study on the psychological outcomes and associated physical symptoms amongst healthcare workers during COVID-19 outbreak
⁸ https://www.thehindubusinessline.com/news/national/huge-gap-in-indias-mental-health-budget/article30733494.ece#:~:text=The%20conservative%20annual%20estimated%20cost,a%20fraction%20of%20the%20figure.