Mental health and resilience: protecting the person behind the professional

"Right now, there are many walking wounded among doctors and allied health practitioners," says clinical psychologist Dr Colinda Linde. "It's hardly surprising during such unprecedented times and with so many stressors and challenges in the workplace. They've never had to deal with being so overworked in a health system that's been so over-stretched. They have not been trained for the constant death and daily ICU work with seriously ill patients for months on end. There are even physiotherapists and specialists, who rarely work in ICU, who now have to deal with this.

Healthcare professionals are currently trying to cope with the same issues as their patients: deaths of people close to them; financial struggles for their practices and families; fear of themselves or loved ones becoming ill; the uncertainty about how ill they could become as the course of COVID-19 is so unpredictable. High uncertainty means high anxiety. This is why, across medical disciplines, we currently find professionals who are bravely trying to manage ill and traumatised people while managing their own trauma and concerns. All of these issues add to their already high stress levels, which could have serious consequences on their mental and physical wellbeing."

Protecting the metal health and wellbeing of the healthcare workforce is becoming a global priority

A recent article published in Frontiers, Prioritizing the Mental Health and Well-Being of Healthcare Workers: An Urgent Global Public Health Priority, acknowledges the stressors, burdens and psychological needs of the healthcare workforce across health systems and disciplines. It also calls for renewed efforts to mitigate these challenges among those working on the frontlines during public health emergencies, such as the COVID-19 pandemic.

With healthcare workers being exhausted, stressed, and at high risk for physical and mental illness, top South African medical, clinical and professional associations have banded together to bring them much-needed support and care. The Healthcare Workers Care Network (HWCN) is a nationwide healthcare worker support network that offers all healthcare workers across the public and private sectors free support, pro bono therapy, resources, training and psycho-education.

Discovery is leading the way with their Discovery Doctor Resilience Suite. It is a free, exclusive range of resources and products that have been designed to support the personal wellness of South African doctors during the COVID-19 pandemic. "Doctors have free access to Healthy Company," explains Dr Maurice Goodman who is the Chief Medical Officer at Discovery Health. "This is a digitally enabled, comprehensive, fully integrated personal assistance programme that focuses on physical, emotional and financial wellbeing as well as providing legal support, on a personal and small business level. In addition, doctors with a valid HPCSA (MP/IN number) are also invited to join Vitality Active Rewards for Doctors (VARD) free of charge." Watch a video for more information about VARD.

Resilience in the healthcare profession

"Resilience," explains Dr Linde, "Is associated with realistic optimism - an ability to balance out negative and positive things in situations, circumstances and people. It's also about the courage to explore opportunities and find gifts in adversity, instead of being stuck in risk and failure. It's linked to a belief that the future will be better than the past or present.

This is not only about thinking positively - the cult of happiness," she adds, "It's about feeling that you have the power to make good things happen, even in very tough conditions. A lot of people who go into the helping professions have this mindset, and it keeps them going even when times are tough. But eventually, the sheer volume of trauma and the inability to help or save lives do take their toll."

Watch out for compassion fatigue

Compassion fatigue is not a new phenomenon in the field of caregivers and healthcare workers, says Dr Linde. "However, it's far more prevalent right now. This is mainly due to the heavy workload, the intensity of working without a break for well over a year and the fact that everyone's in the same position of loss, uncertainty and situational anxiety, which need to be managed in addition to jobs."

Compassion fatigue sets in due to burnout and total fatigue, she explains. It goes through three stages:

• Physical exhaustion that doesn't seem to recover, even after a day or weekend off
• Self-doubt, second guessing and questioning whether you are making any difference (this is more prevalent in women)
• Detachment, cynicism and lack of emotional control

Physician, heal thyself

Dr Linde speaks directly to healthcare workers when she gives this advice: Follow your own good advice to patients about self-care, finding good support and getting enough rest. She highlights that it is important that you:

Take breaks to save lives. If you are a healthcare professional with impaired mental functioning and you are making critical (life and death) decisions, your exhaustion or cynicism could easily result in missing an important piece of information, as well as regret in future. So prioritise downtime - regularly.

Monitor your capacity. Bear in mind that you only have a certain capacity for the amount of bad news and contact with patients and peers you can absorb, and only a certain amount of hours you are awake. Even if your capacity may historically have been higher, it still has a limit. When you notice that you are starting to behave quite differently, something may be amiss. It includes these signs:

• You're detached instead of your usual chatty self
• You're abusing alcohol, medicine, sugar or carbohydrates every day
• You're angry and you have unusual outbursts
• You feel like all your empathy is used up or you're forgetting things far more than usual

Get peer support. This is about supporting your colleagues (and getting their support for you) as opposed to 'telling on them' when you notice signs that something is wrong. Prevention is better than cure: as soon as you see a pattern emerging where either you or your healthcare professional colleagues are not themselves (see the examples above) be sure to bring it to their attention.

Discovery Health offers much-needed support

"It's very important to seek help because, now more than ever, taking care of your mental and physical wellbeing needs to be prioritised", says Dr Goodman. "Discovery Health cares deeply about the health of doctors, especially when it comes to building resilience and protecting mental wellness."

Discovery's Young Doctor Mental Health Helpline provides a free telephonic 24-hour, all-year counselling service for all medical students and interns. It also provides nationwide referrals and crisis intervention where needed.

Call 0800 323 323 to find out more about Discovery's Young Doctor Mental Health helpline

Healthy Company also offers 24-hour telephonic support for doctors as well as face-to-face counselling services, trauma counselling and appointments for emergencies. Dr Goodman adds, "This is one way for Discovery Health to support doctors during and beyond the COVID-19 pandemic - by providing relevant and much-needed support that can really make a difference during these challenging times."

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