- Rohini Rajeev
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CODE 'Non-Existent' - Why Medical Professionals Need a Mental Health Contingency Plan and Fast
Barely two months ago I had written an article mentioning a young lady from suburban Mumbai, who had ended her life by jumping off the balcony. She left behind two children, no older than 6, who don't yet know how to mourn and a husband in deep disbelief. Another precious life was lost last month in Bengaluru, almost the exact same way. I was told by those who knew them, that they were both fighting a pre-existing psychological condition. One more in Chennai just yesterday, sent a wave of commiseration and shock across the nation… the deceased this time was a medical student attending to Covid patients. This is but the tip of the iceberg. According to an article that appeared in the The Print (April 2020), India's Covid 19 lockdown has taken several hundred lives so far to death by suicide alone…
A period of lockdown is hard for all of us in general. When we are forced to huddle together and figure out ways to deal with what is being thrown at us, often we do not look beyond the surface. We find it easier to get frustrated than to try harder to find that silver lining shining from within… the one that shows us how lucky we are… how we are in a much better place than a million others across the globe… We have a place to call home, a family that is safe and with us, a healthy body and an unimpaired mind. And yet… we despair and feel dispirited. It is time to stop.
Time to stop and think of those who would like to despair but cannot because a patient is waiting and needs their complete, unfrazzled attention. Think of those who would like to nestle closely together with their family but cannot because the Emergency Room does not close during lockdowns. Those who would like to feel safe and stay home but cannot because the medical profession is an inter-dependant one, from the technicians to the para-medics, from the receptionists to HR, from the nurses to the physicians, for a hospital to operate, everyone must do their part. And operate…it must. It is time we think of them…the health care workers whose profession demands nothing less than a pound of flesh from them…Time to realize that every time there is a global health crisis, we are not on the frontline…they are. This article is to bring to light something that goes unnoticed about them, the physicians in particular, and what they go through… to humanise those who are either glorified or demonised, simply for doing their job.
More often than not, we choose our line of work. The medical profession while being a noble one, comes with a price. Doctors are faced with hard decisions, have to be the ones who convey bad news most of the time, see pain and anxiety almost on a daily basis, and leaving out the armed forces, understand mortality better than any other profession. Being a healer is a wonderful thing, but the wounds that are inflicted upon their souls due to years of tacit emotions and tireless work leaves deep scars. If constant exposure to trauma and stress was not enough, the risks of this profession are augmented by marked effects outside of work; long hours, difficult family relationships, work–life balance that leaves much to be desired and so on, to say the least. The scars lie deep and thick, under layers of other things, that being able to tread through them becomes hard, unless the Doctors reach out and ask for help themselves. Unfortunately, the stigma associated with mental illness and seeking psychological help is felt sharply in the world of medical professionals.
Stigma against seeking help is second only admitting that they might need help. Doctors internally debate the insecurity they feel and fear appearing less than perfect. They are terrified of being vulnerable in front of a third person, dread a breach of confidentiality and assume the worst. These medical practitioners also worry that a disclosure about mental fatigue or psychological concerns may impact their medical licence. As a result, they choose to either self-medicate or indulge in substance or alcohol abuse; and worst still, inflict self-injury. Undiagnosed and untreated neurosis accompanied by intense anger or frustration takes its toll. Just the thought that suddenly one day the ritualistic self-injury will cease to provide them with the momentary sense of calm they seek and would then lead to Deliberate Self-Harm, is terrifying.
The suicidal rate across the globe is the highest among the medicos (Ventriglio et al., 2020). Statistics from India are equally disturbing, if not higher. And today when the world is at crossroads, these masked warriors struggle even more. The acute CoVid outbreak has only increased the psychological distress among the doctors and nurses involved in frontline work. The inability to take time off, the acknowledgement that the pandemic is real, insomnia, self-quarantining themselves from those they love so as to not put them at risk as well… reasons aplenty, but one result…burn out. Burn out combined with a sense of being trapped causes long-term loss of pleasure, feelings of inadequacy and an extreme sense of hopelessness (Lai et al.,2020). In other words, Major Depression. If not addressed, this could turn catastrophic for the medical fraternity.
The integration of mental health services in our basic health care system should not remain a proposal and an afterthought. While it is true that in China and across the world, including India, local and national mental health institutions have put into position psychological assistance services using mediums like the telephone, internet and application-based counselling in response to the COVID-19 outbreak and the resultant anxiety(Lai et al, 2020), this not the norm in the absence of a pandemic. Even then, evidence-based mental health evaluation and interventions directed at front-line health care workers are relatively hard to find. It is time, now more than ever, for the Government and with them the medical schools and hospital managements to emphasize the need for psychological help among doctors and para medics and normalize it for their students and staff. They have a responsibility as any other non-medical corporation, to provide proactive measures to promote physical and emotional wellbeing within their communities and organizations.
May marks Mental Health Month in the United States. This is often the time when awareness campaigns and efforts to combat stigma associated with mental health gain momentum and thanks to social media, these attempts trickle down to other countries as well. Maybe this May, in 2020, could mark an additional focus and set the pace for the promotion of mental health and positive, supportive psychology… Not just to the healthcare consumers across the world but to the healthcare providers as well. Especially in India.
Listed below are a few pointers for Psychological Self-Care.
Here is what you can do…
1. Sleep right. Eight hours are essential. However, even if you do not get that many hours right now, make sure the quality of sleep you get is good. Avoid screen time 15 minutes before hitting the sack. Set the space by turning off bright lights and if possible, making the room cooler (like a turn down service). Empty your bladder before turning in. Recognise your ‘Sheep'- if its music, prayer, books, meditation or simply cuddling with your partner/kids/object of comfort. Bio sleep (the one suited to your personality and natural sleepiness) is most important. An owl can't sleep before 10 pm and a Lark can't stay up after. Maintaining a routine is also critical to lasting health benefits of sleep. Well rested equals better mood.
2. Avoid an overdose of the uppers (mood and energy elevating food) and the downers (food that makes your tired and low in energy). Understand what you consume apart from just coffee and alcohol… caffeine is present in several other everyday things we eat/drink chocolates, pain medication, cola, energy drinks … there is a list. Remember… too much of a good thing is never as good.
3. Practice progressive relaxation. Tighten you muscles, one area at a time and relax. From top to toe.
4. Put things in perspective. Try to find out what your stress triggers are. If possible, note them down. Write down what scares you and what is the worst that can happen and what is the best that should happen. I would also suggest making a list with the names of people in your life you could count on in case specific things go wrong. This helps you prepare, not catastrophize and stay positive.
5. Get up and get going. Exercise in any form is extremely useful to combat stress and anxiety. It could be fast walking (at present, inside the house), online guided work outs or yoga. Find out what works for you and try to schedule in 30 minutes at least a few times in a week. Assign yourself a partner… TIP: A child can be a compelling partner and would love to boss you around and refuse to take no for an answer.
6. Do not self-medicate. That never easing headache, unreasonable indigestion or that unbearable back ache… they are signals being sent by your body. Stop and pay attention. Maybe it's time to reverse the role… maybe now is when the caregiver in you needs to be cared for…it's okay to admit it. Do not abuse your access to medication and try to solve all your problems yourself by popping a pill. Strength is in self-awareness and understanding your limitations.
7. Surround yourself with what you love…be it family, pets, music, plants…remember your home is your refuge. And if you are a frontline worker and you are worried about your safety and the safety of those closest to you… then take heart… worry will not get you anywhere. Your kindness will be repaid to you in ways that you cannot imagine, may not be in the means you understand or during times that you desire…but it will. Such is the power of good deeds done.
8. Reach out. Even Heads of Governments have trusted advisors. Reaching out for help will not make you look small. There are two kinds of people who can help you when you are upset and need to lean on someone for solace and support. The first category comprises of friends/partner/parent/sibling/child/well-read, genuine spiritual leader/your teacher and the second category- a mental health professional. Figure out who can help you best and talk to them. Heed to their advice if it sounds safe and doable. Please reach out to a professional talk therapist if you long for genuine, non-judgemental support, cathartic relief and professional psychological analysis and counselling.
Things will get better and this too shall pass… until then, hold on. Please don't let go.
Note. I am sharing the link to the Crowdsourced list of Mental Health Professionals from all over India compiled by iCall, the telephonic and email based counselling service provided by my college, the Tata Institute of Social Sciences, Mumbai. Please feel free to add to this list if you wish to recommend a professional and also share the link with your friends and family…you never know who might need it.
-Rohini Kesavan Rajeev Senior Counselling Psychologist & Doctoral Researcher