Mental well-being during a pandemic
Recurrent waves of the coronavirus disease 2019 (COVID-19) pandemic are having a huge impact on healthcare workers, and Medical Protection has called for more to be done to ensure medical professionals in Hong Kong have quick access to mental well-being support.
The consequences of the pandemic for clinicians extend beyond treating patients with COVID-19, although the effects of this alone should not be underestimated. Adapting to changing policies and new ways of working can be exhausting and challenging, bringing about new medicolegal risks and concerns for clinicians to navigate. For doctors, this is compounded by financial pressures, concerns about their own health, as well as the health of their loved ones. All these add stress on clinicians, many of whom may already be suffering from, or are at risk of, burnout.1 Working in the context of the ongoing pandemic, and the intensity of exposure to the human suffering this can entail, is a huge emotional strain and may be devastating for some.
The Medical Council of Hong Kong endorses the duties of physicians as outlined in the International Code of Medical Ethics, including that a physician shall seek appropriate care and attention if suffering from mental or physical illness.2 While it is indeed difficult for doctors to effectively provide care for others if they are not taking care of themselves, there are many reasons why doctors may struggle in accessing mental healthcare for themselves. These include a lack of knowledge of possible sources of support, concerns around professional implications, concerns around confidentiality, and intrinsic psychological barriers, such as shame.3 It is particularly important, therefore, that resources for mental well-being support for doctors are not only available, but also widely known, with access encouraged. It is more preferable for doctors to seek the help they require at an early stage, rather than later, when they may be in a significantly worse position.
Hong Kong has experienced several waves of COVID-19 interspersed with short periods of what may be called normality. As with managing the pandemic, we must think about the health of clinicians longitudinally, being alert to the present circumstances and planning for the future. The effects of different phases should be considered, and support offered to staff accordingly. During acute phases, the stress tends to be related to planning, concerns over personal safety, and exposure to suffering and distress. However, following the acute phase, when the pressures start to ease, is when exhaustion may set in.4 If clinicians are expected to be able to continue working through these cycles, it is essential that consideration is given to additional support required. Of course, even after the pandemic has eased, clinicians must be in a position to be able to go on providing healthcare to our communities.
Considerable research has been undertaken on supporting mental health of healthcare practitioners during the pandemic, and some helpful guidance has been produced.4-7 Some steps doctors can take include the following:
1. Know that stress at this time is normal, and appreciate the importance of managing your health at this time.
2. Try to take care of yourself. Consider which coping strategies are healthy and helpful to you as an individual, and look out for each other.
3. Do not ignore basic needs, such as eating, drinking and resting when possible.
4. Try to maintain social connections and sources of social support. Even though physical connectedness may be limited, it is important that social connectedness is not lost.
5. Those in leadership positions should acknowledge anxieties and concerns of colleagues, and assist in managing these.
In addition to providing medicolegal advice and support, Medical Protection has been offering its members support for their well-being through podcasts, workshops and an online resilience hub. This support has been offered both before and during the pandemic. In response to the challenges of the pandemic, we have delivered webinars on self-care, and have extended our free and confidential counselling service to all members. However, support across the profession is required. Mental health resources are limited in Hong Kong, where there are only 4.39 psychiatrists per 100,000 population. This is less than half the number recommended by the WHO.
My colleague, Dr Pallavi Bradshaw, Medicolegal Lead for Risk Prevention at Medical Protection, recently wrote about the need to support mental well-being: “...we hope employers, institutions and the authorities can work together as quickly as possible to ensure doctors in the public and private sector have access to the support they need and can continue to perform at their best for patients. Doctors should not suffer in silence.”
Patients and the wider public alike are grateful to the clinicians who are working tirelessly during the pandemic. At the very least, healthcare professionals should be able to access and receive the support they require, so that they can maintain their own health and well-being, and in turn provide the best possible care for their patients.
Members of Medical Protection can seek confidential counselling support free of charge. Details of the service can be found online: www.medicalprotection.org/hongkong/help-and-advice/counselling-service