Implementing a mental health support system for health workers, trainees, and students

Volume 11 Issue 7 July, 2021

Invited Article

Health workers, students, and trainees in the health sector work, learn and train for long hours in unpredictable situations, constantly dealing with mortality/morbidity in an emotionally loaded environment. As expected, mental health issues are common among them. Current pandemic situation has brought to surface many latent mental health challenges among the people. But, seeking psychiatric and psychological help is still a taboo, though this is changing gradually. We present some implementation ideas for promoting mental health in health workers in the health sector, especially front-line workers, students, and trainees.

“… during […], I went through a dark phase. Family and friends were around me and yet I felt alone. I lost interest in work, could not sleep, […]. Took me a while to realise that I was in despair. I thought I could handle things myself. But I was sliding into an abyss and didn’t even know it. Seeking professional help never occurred to me at all. A good friend and mentor suggested [to seek professional help], which I did, and it helped… Many of us, especially in healthcare, do not seek help until it is too late. Why? Isn’t it sad that, we, in the health profession, know that a stitch in time saves nine and yet mostly we don’t act for ourselves and others until late, for health issues…especially mental health” [Paraphrased personal communication by a post-graduate trainee to R.A (Author Two)]

Health care system has many small teams, each with few people from different backgrounds, who interact regularly. Long hours spent working together gives us opportunities to monitor the mental and physical well-being of our co-workers. Sharing experiences and providing support could go a long way. But, at present, there is mostly an unpleasant hush-hush or gossip around anyone facing mental health issues. This must change. Working and learning environment should be a safe and non-judgmental space for honest conversations. Team members can be trained to be empathetic to co-workers. Those with ‘lived experience’ can be trained to be part of a mental health peer support system to promote mental well-being at the workplace. This will be a sustainable approach.

We need to establish a non-judgmental and privacy-informed support framework to seek help or refer someone. Ideally, this should be independent and flexible. The team should have motivated multidisciplinary personnel from clinical and administrative sections with judicious powers to help those in need. Some of the trained peer workers with ‘lived experience’ of mental health issues, should be included to help co-design a good support system as they can improve accessibility and utilization. We should formalize and implement guidelines for timely action when issues are suspected in self or among co-workers. These guidelines may be locally developed, but it is better if they are developed at national or regional level with local adaptation.

We can integrate knowledge about these guidelines and support pathways during orientation programs at the workplace and institutions. We must propagate a culture of seeking help from trained experts only and to avoid self-medication or prescriptions for ‘friends’ or ‘self’ without a proper assessment by an expert. We speak about the mental health aspects of working in a highly stressful environment but there is no follow up training or support on how to self-care or help those in need. This knowledge should be spirally integrated in the training and teaching pathways. A robust support system may be in place and yet underutilized. This requires effort from the end-users. We must practice self-reflection and monitoring of oneself and of co-workers. Identifying a troubled student colleague and helping them to seek support should be as important as identifying and eliciting any number of eponymous signs during clinical rotations. These skills are useful in personal life as well. We must contextualize and implement this multifaceted approach. For this to succeed, we must systematically weed out the stigma attached to mental health issues. As a start, we can actively monitor the mental well-being of ourselves and co-workers by looking out for each other. When in doubt about someone’s mental health, we can start asking a simple question, “Are you okay?” and support them to seek professional help. We must actively involve ourselves in the design, implementation, and utilization of this support system for promoting mental well-being of self and our co-workers.

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