By Hannah Zhihan Jiang

Healthcare workers (HCWs) say targeted programmes to destigmatise mental illnesses and support mental health among HCWs after the COVID-19 pandemic is needed more than ever. They stress the need to debunk the stereotype that HCWs are strong heroes who don’t need mental health support. 

Under #Healthcareheroes, the South African Department of Health in 2020 and 2021 posted videos honouring HCWs who fought on the frontline of the COVID-19 pandemic. 

While they appreciate the gratitude, HCWs say branding them as “heroes or heroines” reinforces the stigma of healthcare workers being invincible. It legitimises the stressful, sometimes traumatic, day-to-day work and discourages them from seeking mental health help. 

“Because when you say, hero, you make us seem like Superman. Nobody knows what Superman eats. Nobody knows who takes care of them, who takes care of Superman’s kids. It’s just about the work that he does for the community, and that’s really degrading,” says Dr Zolelwa Sifumba, an advocate for health workers’ mental health and a former frontline doctor from 2017 to 2020. 

Healthcare workers scared to be vulnerable

The Healthcare Workers Care Network (HWCN) was established during the COVID-19 pandemic, offering HCWs free mental health support and pro bono therapy across the public and private sectors. They surveyed 85 healthcare workers in 2022, 91% of whom agreed that healthcare workers are reluctant to seek mental health support. 83% of the participants say there is a stigma attached to healthcare workers accessing help for their mental health. 

More than half of the respondents chose “fear of judgement/criticism from colleagues or the profession” and “time constraints” as the reasons for healthcare workers’ reluctance to seek support.

At the 2023 South Africa Mental Health Conference, Dr Antoinette Miric, one of the founders of HWCN, presented studies across different professionals in the healthcare industry. The studies found that 59% of doctors in KwaZulu-Natal (2020), 67% of rural doctors (2021) and 67.7% of psych registrars (2022) in South Africa reported feeling burnout. 

Healthcare workers at risk of substance abuse

The barriers to healthcare workers seeking mental health help have serious consequences. Cassey Chambers, operations director at South African Depression and Anxiety Group (SADAG), says HCWs are at high risk of substance abuse. On one hand, due to long working hours, they resort to alcohol and pills to quickly “switch off” and rest when they have a break. On the other hand, they self-diagnose, self-medicate and self-treat fearing their colleagues would find out about their mental health conditions. 

“They are writing their own scripts but not necessarily practising that self-care: not going to a therapist, not looking after their mental health,” says Chambers.

SADAG was one of the founders of the Healthcare Workers Care Network. Chambers observed that some doctors using the counselling service preferred to get therapy from a therapist who was in a different province so they would not “bump into each other at a conference or in a hospital.”

Dr Tshepile Tlali graduated from medical school in 2017 and was in internship and community service programmes from 2018 to 2020. Now an Anatomical Pathology registrar, Tlali says he felt consistent burnout as a medical student and a frontline doctor. He felt embarrassed and guilty to ask for leave as other colleagues would have to complete his work. He says fears of being labelled “incompetent” makes it challenging to be vulnerable and transparent about one’s mental health conditions.  

“I don’t have a fever, but I’m just extremely tired. I cannot focus on my memory. I’m not performing at my optimum standard at work. And I now decide I’m taking two weeks off on sick leave. In my mind, I’m just thinking, ‘Oh, my gosh! They probably think I’m so incompetent. They probably think I’m so weak. I’m not the only person who’s suffering. All of us have the same kind of workload,’ ” says Tlali. 

Tlali is now seeing a therapist, but he says it feels impossible to recover from the burnout he experienced unless he takes three months off to rest, which is not possible without a pay cut. 

Confidentiality concerns with Employee Assistance Program

Healthcare workers in public facilities could raise their health and wellness concerns through the Employee Assistance Program (EAP). However, researchers found health workers rarely use the program due to privacy and confidentiality concerns, according to a presentation by the Foundation of Professional Development (FPD) during the 2023 Mental Health Conference. 

HCWs are scared that if they raise complaints through EAP, their managers will know about it, says Tsholofelo Malepe, a mental health training officer at FPD. 

Dr Sifumba experienced it herself. She graduated in 2017 and utilised EAP about five times during her community service in 2020 at St. Andrew’s Hospital in KwaZulu-Natal. Sifumba contracted multidrug-resistant tuberculosis as a medical student and survived a car accident after a 36-hour shift during community service. She has battled depression and anxiety since being a medical student.

Sifumba says she had an issue with one of her supervisors and consulted EAP in 2020. She says her supervisor eventually was made aware of her complaints. 

As for her mental health, EAP advised her to seek external psychological counselling. She says her medical aid covered some of the expenses, and she had to cover the rest herself.

“You first have to find time to go there. And usually, if you’re a junior doctor, you’re having your ward round. And time is a bit of an issue sometimes. You also have to be brave enough, because you’re not sure if this is going to be fed back to your medical manager, or to somebody who is above you. That can maybe make your life more difficult,” says Sifumba.

Studies conducted on the utilisation of EAP are scarce. One study in 2015 surveyed 100 out of 1877 employees at Polokwane Tertiary Hospital. It found that the utilisation rate of EAP services was very low (8%) and that 63% of the employees were not aware of the services within their own department. 15% of the respondents indicated they thought the EAP staff would discuss their cases with other employees. 

Proactive mental health intervention needed 

FPD suggested incorporating more proactive mental health intervention in clinical settings. One recommendation is to appoint mental health champions to facilitate discussions on workplace challenges such as toxic leadership, peer pressure and impossible workloads.

They also advised employers to expand the usage of digital mental health tools to reduce the stigma and visibility to others of the assessment. 

Managers should be trained to identify early signs of mental health issues and include quick check-ins for mental health issues during weekly or monthly meetings. 

In August 2020, the National Department of Health published a Strategy to protect the health and safety of health workers in the face of the COVID-19 pandemic. The strategy says the government would promote mental health of healthcare workers through daily check-in strategies, psychological first aid to recognise a colleague in distress and react immediately and appropriate referral.

Sifumba, however, says she never saw the implementation of the strategy before she left frontline work at the end of 2020. She says her friends remaining in clinical work still complain about the same issues now. 

“I think it’s amazing that the strategy exists. But it’s time for implementation now. It’s not enough to have it written down somewhere.” —— Health-e News