Oct 07, 2022
Mental Healthcare For Doctors In India
Arguably, it can be said that the medical profession is one of the most challenging professions across the globe. While there is a high degree of personal satisfaction involved, working in this profession also involves an extremely high threshold of responsibility and accountability. For the past several years, and especially in the recent pandemic-affected years, the mental health of healthcare workers has been a growing concern. This is primarily owing to the fact that the medical profession itself entails a number of stress factors which may adversely affect the physical, mental, and emotional well-being of such professionals in a number of ways.
This article aims to explore the mental condition of healthcare workers in India and the need for a new approach and corrective measures. Read on!
Major Mental Health Issues
Primarily, there are 3 primary mental health issues that usually tend to affect healthcare workers:
Stress- Stress can be defined as any type of change that causes physical, emotional, or psychological strain. In other words, stress is our body's response to anything that requires attention or action.
Depression- Depression is a mood disorder that causes a persistent feeling of sadness and loss of interest. Also called a major depressive disorder or clinical depression, it affects how we feel, think and behave and can lead to a variety of emotional and physical problems.
Burnout- Burnout is a reaction to prolonged or chronic job stress. It is characterized by three main dimensions: exhaustion, cynicism (less identification with the job), and feelings of reduced professional ability. More simply put, if an individual begins to feel exhausted, starts to hate his/her job, and begins to feel less capable at work, he/she is showing signs of burnout.
Common Causes Of Mental Problems In Healthcare Workers
Understaffing- Understaffing is one of the major issues faced by healthcare institutions in India- especially government medical institutions where the recruitment process is potentially incompetent, slow or corrupt. Understaffing in a healthcare centre essentially leads to ambiguity in work roles and additional workloads for healthcare workers who already have their plates full in their current rules. It also adds to operational management which creates further stress.
A lack of resources- A work environment that is lacking in the necessary resources, especially one that pertains to the invaluable commodity of human life can cause severe stress to professionals. It is important to keep a healthcare institution well-equipped with regard to the services being offered as well as potential contingencies.
Challenging patients and relatives- Medical professionals such as doctors and nurses, in addition to their usual work, also have to interact with patients, patients' families and relatives on a regular basis. While this is usually to consult or update the family on the condition of the patient, sometimes this interaction may also involve breaking the bad news of the deterioration or demise of a patient. In such cases, the patient’s family may often react in a violent or hysteric manner. Even if there is no fault of the doctor involved, they feel excessively stressed and guilty for the loss of their patient.
A lack of sufficient training or skills
Shift patterns- Erratic shift patterns and the lack of rest resulting from it often adds to the stress threshold of a doctor. Back-to-back shifts which together span over 20 hours is an inhumane but apparent necessity that plagues the medical profession.
Heavy workloads- Most roles in the medical sector usually involve consistently heavy workloads and strict deadlines that make work notoriously challenging and hard to keep up with. Moreover, there is no possibility of rushing through the work owing to the high standard of care and due diligence involved.
Long shifts- Long shifts, while unhealthy, are common in the medical profession and eventually lead to systematic sleep deprivation in healthcare workers. In 2010, the Supreme Court ruled that medical residents must now work for more than 12 hours at a stretch and more than 48 hours a week- this is yet to be implemented comprehensively as medical students and young medical professionals continue to be the subject of exploitation at work.
Unsociable hours- In addition to long shifts, medical professionals often have to observe unprecedented and unsociable work hours. Being called in on an emergency even on an off day is a common occurrence in government as well as private hospitals and health centres.
Poor working relationships- The work environment is an important factor that influences the way a doctor or nurse handles stress at the workplace. When there are poor working relationships, the overall job of the professional becomes significantly more tedious as compared to a scenario where the co-workers are on friendly terms.
Dealing with death- Regrettably, death is an inalienable part of a doctor’s work and even though one might encounter such patient deaths a few times in one’s career, it is difficult to cope each time. This is why in some Western healthcare institutions, counselling is made mandatory for a doctor after the demise of his/her patient in order to assist the professional in overcoming the setback.
The stress resulting from these factors further results in untoward consequences in junior doctors and other young medical professionals through:
Prescription errors or errors in patient care
Losing temper with patients/caregivers
Demonstrating an inability to give sufficient time/attention to their patients
Experiencing poor communication skills, and-
Feeling a lack of empathy for their seniors.
The Chandigarh Survey
Needless to say, the highly volatile situation created by the Covid-pandemic which spanned almost two years was an immensely difficult time for medical professionals across the globe and more so in India, where the doctor-patient ratio is largely inadequate, thanks to a growing population of 140 crores in the country where there a limited number of medical colleges.
One of the first surveys carried out on the subject was done by the Postgraduate Institute of Medical Education and Research in Chandigarh. The survey comprised questions pertaining to demographic and personal characteristics, substance use, depression, perceived stress, and burnout. The study was approved by the Ethics Committee of the institute, and participation in the survey was voluntary. Out of the 445 medical professionals who participated in the survey, 30.1% of individuals were found to have depression. Furthermore, it was found that 74 participants strongly believed ‘they were better off dead or of hurting themselves in some way’.
Medical Professionals In Rural Areas
Even today, the quality and extent of healthcare services available in urban India and rural India bear stark contrast with each other. The infrastructure is severely lacking, professionals are often insincere and another overall standard of services that can be availed is average at best and sub-par at worst. Though the existing infrastructural setup for providing health care in rural India is on the right track, the qualitative and quantitative availability of primary health care facilities is far less than the defined norms by the World Health Organization. Union Ministry of Health and Family Welfare figure of 2005 suggests a shortfall of 12% for sub-centres (existing 146,026), 16% for Primary Health Centers (PHCs) (existing 23,236) and 50% for Community Health Centers (CHCs) (existing 3346) than prescribed norms with 49.7%, 78% and 91.5% of sub-centres, PHCs and CHCs located in government buildings and rest in non-government buildings respectively requiring a figure of 60,762, 2948 and 205 additional buildings for sub centers, PHCs and CHCs respectively.
Usually, the experiences of a medical professional working in rural India is characterised by the following:
caring for patients in a context of uncertainty, fear, and anxiety;
practical solutions through improvising and being resourceful;
gaining community trust and cooperation;
adapting to unrelenting pressures; and-
reaffirming commitments.
This was especially highlighted during the Covid-19 pandemic, during which rural doctors felt largely underprepared to tackle community transmission and manage patients who contracted the virus. The uncertainty from feeling isolated, in terms of access to credible information and resources, left doctors with feelings of fear and anxiety, and a sense of not being in control as multiple problems were encountered. These feelings were exacerbated by a lack of personal protective equipment (PPE), limited COVID?19 testing, rapid system changes, possible COVID-19-positive patients turning up unexpectedly, and the flood of media exposure. The scenario was a repeated for a second time Despite the coping strategies, the longer?term impacts on rural doctors and their adaptive resources are causes for concern. In fact, the lack of support for doctors and other medical professionals in some areas is truly alarming and warrants thorough introspection.
Violence Against Medical Professionals
For government hospitals and primary health centres across the country, particularly in West Bengal and Maharashtra, violence by patients’ relatives, local goons, political leaders and even police has been reported. Here, money is not the reason but anxiety, but long waiting periods, non-availability of crucial investigations, inordinate delay in referral, and unhygienic and extremely crowded conditions in the emergency and other wards are some of the reasons given. To make matters worse, the electronic and print media also do not have a real understanding of the challenges faced by doctors.
A true reflection of the prevalent times would be the results of a study by the Indian Medical Association (IMA) which reports that 75 per cent of doctors in India have faced violence at some point of time in their life, and most of the time, it is verbal abuse. Emergency and ICU are the most violent venues and visiting hours are the most violent time. Therefore, for the average doctor who is treating several patients in a single day or shift, the consequences of having to work in constant fear of violence can be devastating for mental health and the overall welfare of the professional.
A Guide To Mental Health For Doctors
Developing A Support System
Develop a support system of well-wishes from among family members, friends and peers who have similar mindsets and goals in life. Stay in touch with them via phone calls, texts or other channels. Remember, to receive support one must also be willing to lend support to others. Having people to rely on ensures that you will undergo significantly less stress in a critical situation.
Remain Hydrated
Drink a sufficient amount of water every day. With proper hydration, a law student may enjoy an improved mood and other mental health benefits.
Getting The Required Shut-Eye
Despite the hectic schedule, find the time to get sufficient rest- at least seven to eight hours of sleep each night. That will make sure you wake up feeling refreshed and ready to tackle any challenges that come your way.
Staying As Active As Possible
Exercising regularly is important to combat anxiety and depression. Furthermore, make a habit to attend social events and take advantage of any opportunities to build friendships. This ensures that medical professionals can stay active, grow their support network, and develop meaningful relationships with others.
Do Not Hesitate To Seek Help
Even if you are remotely concerned about how you have been feeling lately, reach out to a professional. Confiding in your friends or family is always good but at the end of the day, one must remember that they are not qualified to provide any real help. A professional will help you understand what you are going through and exactly how you can remedy that to the benefit of your mental health.
Conclusion
In conclusion, it may be reiterated that a significantly higher proportion of doctors in India experience a number of mental health ailments such as severe stress, depression and burnout. It is important now more than ever to rectify the institutional deficiencies and administrative shortcomings and establish a sustainable support system for doctors and nurses who have high-stress work profiles and hectic schedules. Moreover, at the institute level, there must be a screening of professionals' mental health at regular intervals and there must be a provision for conducting regular stress management workshops. In addition to this, primary health care in India needs to be re-evaluated as a matter of priority which warrants immediate and concrete reforms, otherwise, this tug of war between growth and human resource development remains will continue forever.
As a developing country with the world’s second highest population, medical professionals have always been, and continue to remain, a formidable asset in our journey towards advancement and mental health is an important element in their well-being and competence.