Healthcare workers fear mental health stigma

The Covid-19 pandemic has sparked a rise in mental health disorders worldwide,  with healthcare workers on the frontline among the most affected, yet those who take care of others are more likely to suffer in silence than to seek help for their own symptoms of anxiety, depression, stress and burnout.

The Healthcare Workers Care Network (HWCN) has found that 82% of the South African doctors, nurses and allied health professionals using its counselling services believe there is a stigma attached to healthcare workers asking for help with their own mental health.
The network was set up early in the pandemic by a number of healthcare professional bodies*, anticipating the added stresses on healthcare workers and aiming to provide mental health support through a 24-hour helpline and online counselling, individual and group support, and training. The services have reached almost 5 000 healthcare workers since April 2020, with an average of 175 calls to the helpline per month. 
A recent survey of the healthcare workers who used the services revealed high levels of reluctance to seek help for mental health challenges, and the reasons why.

For 80% of the healthcare workers, fear of judgement, by colleagues, managers and their profession, was the main reason for being unwilling or delaying finding support for their mental health concerns.

They fear being seen as incompetent, weak and unfit to do their jobs because of expectations that healthcare workers should be more resilient and better-equipped than the general public to deal with work stress and manage their own mental health.

Psychiatrist Dr Antoinette Miric, representing the SA Society of Psychiatrists (SASOP) on the HWCN convening body, said expectations that healthcare workers “shou
ld be able to fix themselves” are unrealistic, placing health professionals at risk, as well as their patients and the healthcare system as a whole.

“With a third of South Africans experiencing mental illness at some point in their lifetimes,  and mental disorders the leading cause of disability,  it is illogical to think that healthcare workers are exempt from mental health challenges. 
“Despite this, the stigma attached to mental health is magnified in the healthcare sector amid intense pressure to deliver, to be resilient, super-human even, and fear of showing any sign of weakness,” she said.

She said that healthcare workers who avoid seeking help are at risk of self-medicating, potentially leading to substance abuse and suicide.
“Healthcare workers are our first responders in a crisis like the pandemic, and they will be our guides and community allies on the road to recovery as the pandemic ends. We need to ensure that we support their mental health, wellbeing and resilience in order to ensure that our health system is strong, robust and resilient coming out of the pandemic and prepared for the next crisis,” Dr Miric said.

The respondents in the HWCN survey – a combination of doctors, nurses, support staff and allied professionals such as counsellors and social workers, in both the public and private sectors, spoke of expectations that they should be always in control and that their training should equip them to look after their own health.

Many commented that the perception of “How can you help others if you cannot help yourself?” made them reluctant to open up to colleagues or managers that they are struggling with their mental health or to seek professional help.
The healthcare workers feared that a mental health issue would make them seem incompetent or weak, a burden on co-workers, and that their credibility and competence would be questioned.

They revealed a need to “be seen as human beings behind the lab coat or uniform”, with one respondent saying that “there needs to be an understanding that despite our profession we are still human beings and need just as much, if not more, support, as we take on so much – we hold everyone but ourselves”.

“We need to highlight the humanity of the person in the lab coat or nursing uniform. We are humans first, with emotions and challenges as much as everyone else. Our qualifications and skills do not shield us from psychiatric illness, hence we are not immune and should not be viewed as ‘less than’ when we have challenges,” said another.

Dr Miric said the survey had highlighted the need to improve workplace support for mental health in the healthcare sector, with respondents calling for more education, awareness and open communication that acknowledged the challenges to mental health of working in healthcare.
“Healthcare professionals need to be reminded that they cannot pour from an empty cup, and that taking care of themselves enables them to serve others,” commented one respondent.

There is also a need to make support more easily accessible, greater awareness of the resources and services that are available, and to ensure confidence in the privacy and confidentiality of support services.

“The respondents were clear that mental health and seeking help in the healthcare professions needs to be normalized and made a part of everyday language and interactions in healthcare workplaces, through actions such as regular workplace wellness check-ins and mental health care a standard part of the ‘package of care’ for those in the caring professions.

“Mental illness needs to be treated the same as physical illness in terms of medical aid, disability and income protection insurance, and workplace policies such as sick leave benefits,” she said.

Operations Director of the South African Depression and Anxiety Group, Cassey Chambers said, “We know already that amongst healthcare workers, poor help-seeking behaviour exists where they are less likely to reach out for help or support due to stigma and fear. Through the HWCN, we are aiming to not only reduce the stigma associated with mental health but also to change the narrative and speak openly on accessing support when needed and being more aware of the warning signs.” 

* The HWCN network is a joint initiative of the South African Medical Association (SAMA), the SA Depression and Anxiety Group (SADAG), the SA Society of Psychiatrists (SASOP), and the SA Society of Anaesthetists (SASA), supported by the Psychological Society of SA (PsySSA). Visit www.healthcareworkerscarenetwork.org.za for more information. 


REFERENCES

World Health Organization (WHO). News release: COVID-19 pandemic triggers 25% increase in prevalence of anxiety and depression worldwide. 2 March 2022.  https://www.who.int/news/item/02-03-2022-covid-19-pandemic-triggers-25-increase-in-prevalence-of-anxiety-and-depression-worldwide

Herman AA, et al. The South African Stress and Health (SASH) Study: 12-month and lifetime prevalence of common mental disorders. SA Medical Journal, Vol 99, No. 5. 2009. http://www.samj.org.za/index.php/samj/article/view/3374

Carpenter B, et al. Disability, a priority area for health research in South Africa: an analysis of the burden of disease study 2017. Disability and Rehabilitation. Published online Nov 2021. DOI: 10.1080/09638288.2021.2000047