The Covid-19 fallout: An imminent mental health epidemic among health workers
During the Severe Acute Respiratory Syndrome (Sars) outbreak of 2003, a high prevalence of depression, anxiety, post-traumatic stress disorder (PTSD), and sleep disorders were noted among health care workers.
Nearly a decade later, similar mental health conditions were reported by health care workers who volunteered in the West African Ebola outbreak, and nearly two-thirds of the medical staff during the initial stages of the Middle-East Respiratory Syndrome (Mers) outbreak reported PTSD-like symptoms, according to various studies.
The occupational burnout
During the Covid-19 pandemic, a systematic review across 21 countries found a high prevalence of moderate depression, anxiety, and PTSD among health care workers. Understanding that frontline health workers — who take public health emergencies head-on — are vulnerable to poor mental health doesn’t require hard evidence, but historical insight and a bit of common sense. However, this understanding has been slow to percolate into the Indian health policy arena.
The vulnerability to poor mental health is not an exclusive feature of pandemics and disasters. Even when adjusting for age, sex, relationship status, and the number of working hours, physicians are at an increased risk for occupational burnout compared to other working individuals.
However, these aren’t the greatest of concerns. Some psychiatrists have presented anecdotes about how the number of people — not working in health care — seeking help for their mental health didn’t rise during the pandemic. One could ascribe this to factors such as a general lack of awareness about mental health, the associated stigma, and the health services disruption caused by Covid-19.
Again, the situation with health care workers is even more grim. Evidence indicates alarmingly low help-seeking behaviour among public health workers who perceive themselves to be affected with probable mental health conditions.
This has been attributed to a range of factors, including stigma, potentially deleterious career implications, poor social support, and job-related constraints. The situation among Covid-19 warriors is likely to be worse, given India’s manpower shortage and the disruption of the already frail mental health care infrastructure.
And these are the first of many, since a large chunk of the mental illness burden could present over the long-term, possibly much after the pandemic has subsided.
Little systematic attention has gone into the mental health of health care workers in India, and the pandemic has not significantly altered this tendency. However, with the pandemic now appearing to be receding, it is high time India pulled up its socks. The immediate post-pandemic period is likely to be crucial in inculcating mental health resilience among health care providers, while engendering a cultural shift in mental health care.
The economics of mental health
The economic justification is compelling enough to galvanise us into action, for not investing enough in the mental health of health workers is a potentially disastrous health policy decision. Such considerations become more acute in the Indian context, which is plagued by perennial human resource shortages and poor general health infrastructure.
Moreover, mental health investments promise high returns. Some estimates indicate that every dollar spent on evidence-based care for depression and anxiety returns $5. Such returns are likely to be higher when directed towards health care workers, who in turn cater for the population’s health, creating a positive domino effect. Further, as a developing nation, even small additional investments in mental health are likely to yield large gains in terms of improved mental health of the whole population.
Responsiveness towards people is one of the major intrinsic goals of health systems — a yardstick to measure the performance of health systems. The responsiveness towards the needs of health care providers must, therefore, become part of the goal-performance framework.
All hands on deck
For this to happen, the health care provider needs to find a more emphatic voice in matters of decision-making at all levels, beyond just matters concerning their remuneration and professional regulation.
In the Indian context, various approaches of self-care, psycho-social support, and stigma-reduction for health care workers must be incorporated as part of the organisational culture of health care institutions, be it through policy or legislative instruments.
Pan-sector advocacy, in which every segment of the health care sector contributes to the improved mental health of healthcare workers, is imperative. There is simply no alternative to strengthening the general health care system in the public sector.
Developing countries such as India are looking at a significant shortfall of health human resources over this decade. Let us not ignore another disaster in the making.
Dr Soham D Bhaduri is a physician, health policy expert, and chief editor of The Indian Practitioner
The views expressed are personal