Most medical professionals, especially those working in emergency departments, go into the profession with the knowledge that they will face confronting and traumatic situations, from treating severe wounds to victims of extreme and/or long-term abuse. However, the relentless months-long influx of covid-19 patients is having a serious impact on the mental health of those charged with treating them.
Not only are frontline healthcare workers often dealing with patients who are unlikely to survive the virus, but they are also fearful of contracting the virus themselves and possibly transmitting the virus to their loved ones. These fears were compounded by the shortage of personal protective equipment (PPE) and lower staffing levels owing to those who had to take time off to recover from the virus or shield themselves.
The World Health Organisation (WHO) reported that about 10% of infections globally are among healthcare workers.
Persistently dealing with Covid-19 patients adds a whole new layer of stress and emotional trauma to an already stressful job. If left untreated, that stress and emotional trauma could leave a deep and lasting scar on the individual’s mental health.
According to Mind, some of the causes of Post-Traumatic Stress Disorder include: seeing other people hurt or killed (including in the course of your job), doing a job where you repeatedly see distressing images or hear details of traumatic events, being diagnosed with a life-threatening condition, losing someone close to you in particularly upsetting circumstances, or any other event in which you fear for your life.
Many healthcare workers, working on the wards throughout or for part of the coronavirus pandemic, will likely be able to resonate with one or more of those possible causes. Similarly, many frontline healthcare workers will likely experience symptoms of post-traumatic stress, such as flashbacks, nightmares, panic, lack of concentration, self-blame, and so on.
In a 2013 study of 549 hospital staff responding to the Beijing SARS (severe acute respiratory syndrome) outbreak, 10% of hospital staff reported experiencing symptoms of PTSD.
For most, these will go away. It’s when they persist for at least a month that PTSD is clinically diagnosed.
Many frontline workers have faced ethical and personal safety dilemmas at some point during the pandemic, perhaps feeling like they were out of their depth, being redeployed, or the lack of PPE. Many healthcare workers were redeployed from outpatient care, physiotherapy, sexual health clinics, and so on, onto the wards and were suddenly dealing with life and death situations – something some healthcare workers hadn’t done for many years.
Some healthcare workers were forced to make decisions about which patients would and wouldn’t receive ventilators and other treatments that were in short supply. Not only that, but they had to inform the family members over the phone, as they weren’t permitted into the hospital.
Situations like this can cause moral injury. Moral injury is not a mental health condition; it is an inner psychological conflict that has been linked with PTSD, depression, and suicidality. Moral injury is associated with feelings of guilt, shame, or loss of trust in oneself or others.
Who will be most impacted?
Mental Health does not discriminate. That being said, a 2002 review of 59 studies into the health worker response to outbreaks such as MERS (Middle East respiratory syndrome), Ebola, bird flu, and swine flu found that female members of staff, those with less work experience, and those with infected family members were more prone to acute stress disorder or PTSD.
As mentioned, mental health does not discriminate. If you are a male emergency room doctor with 40 years’ experience and no infected family members, you may or may not experience mental health repercussions. If you are a female doctor straight out of medical school, with multiple family members deemed to be high risk or fighting the virus, you may or may not experience mental health repercussions.
What Can You Do?
First, it’s important to understand that everyone copes differently with stress and distress. Some will want to talk through what has happened, while others will want to shift their focus to other things once their workday has ended.
There are different schools of thought regarding the idea of ‘debriefing’ at the end of each day or week and the impacts on mental health. Some research suggests that it is not a healthy way of coping and can actually increase the likelihood of PTSD symptoms, while others suggest it is a way of spotting those who need extra support and showing staff that it is okay to reach out.
The NHS has set up online support groups, e-learning focusing on mindfulness and mental wellbeing, and has redeployed many NHS psychologists to various wards to support the frontline staff.
It can be helpful to focus on and differentiate between the things that you can control and the things that you can’t control, especially at work. Many of us try to control the outcome of things that are just not possible to control and this can lead to increased stress and anxiety levels.
Activities such as meditation, mindfulness, running, and journaling can be immensely helpful ways of processing your thoughts and the events of working on the wards. Meditation and mindfulness don’t need to be done sitting still with your eyes closed; running or walking alone without listening to music or a podcast can be considered active meditation.
If you’d like professional therapeutic support to help you process your experiences of the pandemic then get in touch with us by calling 020 8673 4545 or emailing [email protected] We have face-to-face appointments available at our centres in Clapham and Tooting, seven days a week, as well sessions via phone or online video.