The COVID-19 pandemic has pushed health-care systems across the world to the very brink. This is not just about lack of infrastructure but also about stretching healthcare workers to their limits. From having to make very difficult decisions, for example, regarding allotment of resources, to breaking bad news often to families of patients, health-care workers are under tremendous pressure. In this context, an Analysis published in The British Medical Journal compares the trauma faced by healthcare workers during the pandemic to that of a war situation and advocates giving them adequate support and counsel before, during and after the crisis.
The type of decisions health-care workers may have to take could range over allocating scant resources, balancing their own needs against those of patients, allotting time for family over the demands of duty and so on. All of these could result in “moral injury” – a term borrowed from military usage by the authors, referring to the psychological distress that results from actions that violate someone’s ethical or moral code.
The authors advocate that this can be prevented by preparing the personnel for what they are going to encounter, and providing enough support and encouragement during and after the crisis, in such a way that they do not take the route to mental illness and instead move towards post-traumatic growth.
Post-traumatic growth
Post-traumatic growth refers to positive changes in attitudes, beliefs and behaviour following traumatic life events. “It may present as being more able to cope with adversity in the future or feeling less anxious when thinking about future challenging events,” says Neil Greenberg, Professor of Defence Mental Health with King's College London and trauma lead at the Royal College of Psychiatrists, in an email to The Hindu. He is an author of the paper. He further adds, “This may come across as increased optimism, more positive mood and better coping when adversity strikes.”
Prof. Greenberg further explains, “Many people find it hard to talk about what did not ‘go right’ because they fear being judged or reprimanded... or they may feel a seething anger at their bosses for not supporting them which they do not speak about as they fear they may lose control and this might lead to problems at work.” He suggests that reflective practice sessions, by leaders who speak about what did not go right for them, may help people develop a meaningful narrative. “Best to do this either periodically as the crisis is ongoing or shortly afterwards as people are trying to make sense of what they have experienced,” he says.
Indian context
In India, for several reasons, including the early lapse into lockdowns, and perhaps the demography, the medical systems have not been stretched as much as the European systems.
However, here too, there is a chance that mental health issues may crop up. Chennai-based psychiatrist, Dr M. Suresh Kumar, currently Director of Psymed Hospital, who has worked internationally in public mental health, has this to say: “Young people are at the forefront of this fight, and many of them may not be adequately prepared to work under such circumstances… there is a chance of moral injury occurring.” He also points out that professionals such as doctors or nurses do not readily ask for help or reveal stress. They should be encouraged to speak out and be provided ongoing help rather than a one-time help. According to Dr Suresh Kumar, peer support is easier to accept. He adds, “Most important is to express appreciation of the service.”
