CORRESPONDENCE

A call to action: Promoting mental wellbeing in South African healthcare workers

To the Editor: Healthcare workers are exposed to significant occupational stress.^[1-4] Systematic reviews suggest that organisational as well as individual interventions may help to reduce burnout and build resilience.^[5-7] There is emerging evidence of the impact of the COVID-19 pandemic on the wellbeing of frontline workers. ^[8,9]Literature reviewing the impact of previous emergencies has highlighted the need for a proactive approach to promoting mental wellbeing and preventing mental ill-health.^[10-13] Current evidence suggests that a trauma-informed model with psychological first aid as the initial intervention is beneficial,^[14-16] with an emphasis on compassionate leadership, good self-care, and creating an environment that facilitates access to support and mental health interventions for those who need it.^[17] The aim is to build and sustain resilience. These measures need to be continuous throughout all phases of the pandemic.

While South Africa (SA) had some time to prepare for the pandemic, anticipatory anxiety and other heightened emotional states were initially evident among healthcare workers.^[18] Now, as COVID-19 caseloads and healthcare worker infections increase, we can expect that ongoing unremitting stress will increase the risk of distress, burnout and moral injury, as well as specific psychiatric disorders.

A national initiative, the Healthcare Worker Care Network, was launched on 3 June. This initiative is a partnership between South African Depression and Anxiety Group, the South African Medical Association (SAMA), the South African Society of Psychiatrists and the South African Society of Anaesthesiologists, and is supported by the Psychological Association of South Africa. The project has taken a two-pronged approach:

• The first prong is preventive and has involved training leaders in effective proactive measures to improve staff wellbeing. As of 14 July 2020, 1 035 people had attended these sessions.

• The second prong is the provision of counselling. As of 14 July, 592 mental health professionals nationally had volunteered to assist with this. Requests for help can be made in a secure and confidential manner through the SAMA website, the Vula or EMG applications, a dedicated helpline (0800212121), or the project website (https://www.healthcareworkerscarenetwork.org.za).

The anticipated impact of the pandemic on the wellbeing of healthcare workers is likely to be an added burden on an already stressed population.^[19,20] We should be doing everything we can to mitigate this and to build resilience in our frontline workers.

More than ever, leadership needs to be clear, informative, and supportive. More than ever, frontline workers need to practise good self-care for the benefit of their patients, their families and themselves.

This is an opportunity to build a more compassionate and healthy healthcare system. So, the call to action is to:

• Leaders in the SA healthcare system: Do all you can to create an enabling environment for healthcare workers to provide clinical care in this difficult time, learn how to support your teams, develop compassionate leadership skills, and practise good self-care yourselves.

• Individual healthcare workers and other workers in the frontline: Pace yourselves, develop healthy self-care strategies, and have the courage to reach out for help. It is available.

• Psychiatrists, psychologists and other allied health professionals: Join this effort to make a difference and play a valuable role in the pandemic and beyond.

Rita Thorn, on behalf of the Healthcare Worker Care Network

Department of Psychiatry, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg rita.thom@wits.ac.za

References

1. Dubale BW, Friedman LE, Chemali Z, et al. Systematic review of burnout among healthcare providers in sub-Saharan Africa. BMC Public Health 2019;19(1):1247. https://doi.org/10.1186/s12889-019-7566-7        [ Links ]

2. Elshaer NSM, Moustafa MSA, Aiad MW, et al. Job stress and burnout syndrome among critical care healthcare workers. Alexandria Med J 2018;54(3):273-277. https://doi.org/10.1016/j.ajme.2017.06.004        [ Links ]

3. Sirsawy U, Steinberg W, Raubenheimer J. Levels of burnout among registrars and medical officers working at Bloemfontein public healthcare facilities in 2013. S Afr Fam Pract 2016;58(6):213-218. https://doi.org/10.1080/20786190.2016.1198088        [ Links ]

4. Dutheil F, Aubert C, Pereira B, et al. Suicide among physicians and health-care workers: A systematic review and meta-analysis. PLoS ONE 2019;14(12):e0226361. https://doi.org/10.1371/journal.pone.0226361        [ Links ]

5. Ruotsalainen J, Serra C, Marine A, et al. Systematic review of interventions for reducing occupational stress in health care workers. Scand J Work Environ Health 2008;34(3):169-178. https://doi.org/10.5271/sjweh.12403        [ Links ]

6. Ruotsalainen JH, Verbeek JH, Marine A, et al. Preventing occupational stress in healthcare workers. Cochrane Database Syst Rev 2015, Issue 4. Art. No.: CD002892. https://doi.org/10.1002/14651858.cd002892.pub5        [ Links ]

7. Mortali M, Moutier C. Facilitating help-seeking behavior among medical trainees and physicians using the interactive screening program. J Med Regul 2018;104(2):27-36. https://doi.org/10.30770/2572-1852-104.2.27        [ Links ]

8. Spoorthy MS, Pratapa SK, Mahant S. Mental health problems faced by healthcare workers due to the COVID-19 pandemic - a review. Asian J Psychiatry 2020;51:102119 . https://doi.org/10.1016/j.ajp.2020.102119        [ Links ]

9. Gold JA. Covid-19: Adverse mental health outcomes for healthcare workers. BMJ 2020;369:m1815.https://doi.org/10.1136/bmj.m1815        [ Links ]

10. Maunder R. The experience of the 2003 SARS outbreak as a traumatic stress among frontline healthcare workers in Toronto: Lessons learned. Philos Trans R Soc Lond B Biol Sci 2004;359(1447):1117-1125. https://doi.org/10.1098/rstb.2004.1483        [ Links ]

11. Maunder RG, Leszcz M, Adam MA, et al. Applying the lessons of SARS to pandemic influenza: An evidence-based approach to mitigating the stress experienced by healthcare workers. Can J Public Health 2008; 99(6):486-488. https://doi.org/10.1007/bf03403782        [ Links ]

12. Brooks SK, Dunn R, Amlöt R, et al. A systematic, thematic review of social and occupational factors associated with psychological outcomes in healthcare employees during an infectious disease outbreak. J Occup Environ Med 2018;60(3):248-257. https://doi.org/10.1097/jom.0000000000001235        [ Links ]

13. Brooks SK, Rubin GJ, Greenberg N. Traumatic stress within disaster-exposed occupations: Overview of the literature and suggestions for the management of traumatic stress in the workplace. Br Med Bull 2019;129(1):25-34. https://doi.org/10.1093/bmb/ldy040        [ Links ]

14. Greenberg N, Docherty M, Gnanapragasam S, et al. Managing mental health challenges faced by healthcare workers during COVID-19 pandemic. BMJ 2020;368:m1211. https://doi.org/10.1136/bmj.m1211        [ Links ]

15. De Sousa A, Mohandas E, Javed A. Psychological interventions during COVID-19: Challenges for low and middle income countries. Asian J Psychiatry 2020;51:102128. https://doi.org/10.1016/j.ajp.2020.102128        [ Links ]

16. Inter-Agency Standing Committee (IASC). Interim Briefing Note: Addressing mental health and psychosocial aspects of COVID-19 outbreak. Last updated February 2020. https://interagencystandingcommittee.org/system/files/2020-03/IASC%20Interim%20Briefing%20Note%20on%20COVID-19%20Outbreak%20Readiness%20and%20Response%20Operations%20-%20 MHPSS_0.pdf (accessed 19 May 2020).         [ Links ]

17. Agency for Clinical Innovation. Pandemic Kindness Movement. 2020. https://www.aci.health.nsw.gov.au/covid-19/kindness (accessed 19 May 2020).         [ Links ]

18. Dalwai M. EMGuidance health care professional COVID-19 survey. 10 April 2020. https://public.tableau.com/profile/mohammed.dalwai#!/vizhome/Survey_Extract_6Aprilv2/COVID-19andtheHCPsstory (accessed 10 May 2020).         [ Links ]

19. Khamisa N, Peltzer K, Ilic D, et al. Effect of personal and work stress on burnout, job satisfaction and general health of hospital nurses in South Africa. Health SA 2017;22:252-258. https://doi.org/10.1016/j.hsag.2016.10.001        [ Links ]

20. Liebenberg AR, Coetzee JF, Conradie HH, et al. Burnout among rural hospital doctors in the Western Cape: Comparison with previous South African studies. Afr J Prim Health Care Fam Med 2018;10(1):a1568. https://doi.org/10.4102/phcfm.v10i1.1568        [ Links ]