It is no surprise that the current COVID-19 pandemic has had huge implications for mental wellbeing worldwide. Dr Sara Sreih, Medicolegal Consultant at Medical Protection, takes stock of the issue
COVID-19 isn’t going anywhere soon – maybe not ever – but the constant waves of infection that are affecting countries around the world are having a cumulatively damaging effect on people’s wellbeing. And this is no different for healthcare staff.
In Hong Kong we have called for more access to mental wellbeing support for all medical professionals. It isn’t just the virus itself causing a strain: changing policies and adaptations to new ways of working have been exhausting, and they bring about their own challenges and new medicolegal risks.
For doctors this is compounded by financial pressures, and concerns about their own health, and the health of their loved ones. All this adds increased stress on clinicians, many of whom may already be suffering from, or are at risk of, burnout. We are concerned that working in the context of the ongoing pandemic, and the intensity of exposure to the human suffering that this can entail, is a huge emotional strain and may be devastating for some.
The Medical Council of Hong Kong endorses the duties of physicians as outlined in the International Code of Medical Ethics, including that a physician shall seek appropriate care and attention if suffering from mental or physical illness. Indeed it is difficult for doctors to effectively care for others if not taking care of themselves. There are many reasons why doctors may struggle to access mental healthcare for themselves; these include a lack of knowledge of possible sources of support, concerns around professional implications, concerns around confidentiality and intrinsic psychological barriers, such as shame. It is particularly important therefore that resources for mental wellbeing support for doctors are not only available but also widely known and access encouraged. It is more preferable for doctors to seek the help they require at an early stage, rather than later, when the doctor may be in a significantly worse position.
Hong Kong has experienced several waves of the virus interspersed with short periods of what may be called normality. As with managing the pandemic, we must think about the health of clinicians longitudinally, being alert to the present circumstances and planning for the future. The effects of the different phases should be considered, and support offered to staff accordingly. During the acute phases, the stress tends to be related to planning, concerns over personal safety and exposure to suffering and distress. However following the acute phase, when the pressures start to ease, is when exhaustion may set in.. If clinicians are expected to be able to continue working through these cycles, it is essential that consideration is given to additional support required.
There is considerable research being undertaken and some helpful guidance has been produced.   Some steps doctors can take include the following:
- Know that stress at this time is normal, and appreciate the importance of managing your health at this time.
- Try to take care of yourself, consider which coping strategies are healthy and helpful to you as an individual, and look out for each other.
- Do not ignore basic needs, such as eating, drinking, and resting when possible.
- Try to maintain social connections and sources of social support; even though physical connectedness may be limited, it is important that social connectedness is not lost.
- Those in leadership positions should acknowledge anxieties and concerns of colleagues, and assist in managing these.
As well as providing medicolegal advice and support, Medical Protection has been offering members support for their wellbeing through podcasts, workshops and an online resilience hub. This support has been offered both before and during the onset of the pandemic. In response to the challenges of the pandemic, we have delivered webinars on self-care, and have extended our free and confidential counselling service to all members. However, support across the profession is required. Mental health resources are limited in Hong Kong, where there are only 4.39 psychiatrists per 100,000 population. This is less than half the number recommended by the World Health Organisation.
Patients and the wider public alike are grateful to the clinicians who are working so tirelessly during the pandemic. At the very least healthcare professionals should be able to access and receive the support that they require, so that they are able to maintain their own health and wellbeing, and in turn provide the best possible care for their patients.
Members of Medical Protection can seek confidential counselling support free of charge.
 Lemaire & Wallace, 2017 https://www.bmj.com/content/358/bmj.j3360.full
 Code of Professional Conduct, Hong Kong Medical Council
 Brooks et al, 2011 https://www.tandfonline.com/doi/abs/10.3109/09638237.2010.541300
 Williams, Murray, Neal, Kemp, A Discussion Document: Top ten messages for supporting healthcare staff during the COVID-19 pandemic, 2020
 Williams & Kemp, Caring for healthcare practitioners, BJPsych Advances 2019
 WHO, Mental health and psychosocial considerations during the COVID-19 pandemic 2020; Williams, Murray, Neal, Kemp, A Discussion Document: Top ten messages for supporting healthcare staff during the COVID-19 pandemic, 2020
 NHS Clinical Leaders Network, Enhancing mental health resilience and anticipating treatment provision of mental health conditions for frontline Healthcare workers involved in caring for patients during the COVID-19 pandemic, A call for action