Prioritising the mental health of doctors in hospital

Human beings take great pride in their minds, which has unravelled the deepest mysteries of the universe and is the cause of the exponential progress of civilisation. Hindu scriptures underline the profundity of mind in our lives, declaring singularly ‘’ i.e., ‘mind is the wheel of worldly life’. Therefore, protecting the mind from disturbances or dysfunction is paramount. Mental health is integral to our well-being and is fundamental to living a productive and fulfilling life. After the coronavirus pandemic, mental health issues have shot up globally and brought mental health under focus. The World Health Organization (WHO) reports that one in every eight people in the world lives with a mental disorder.[1] Approximately 60% of the world population is employed, and 15% of working-age adults have a mental disorder at any point in time.[2] As a result, the impact of mental health disorders in the workplace has become a matter of urgent concern. The consequences of mental disorders in the workplace are manifold, ranging from reduced productivity to interpersonal difficulties, poor job satisfaction and emotional distress stemming from stigma and discrimination. These factors, in turn, can contribute to future relapses. Conversely, work-related issues, such as poor control over working hours, bullying, lack of work-life balance, fear of losing jobs and sustained stress, can precipitate mental health challenges. Globally, an estimated 12 billion work days are lost every year due to depression and anxiety alone, amounting to 1 trillion US dollars lost in productivity. Given this backdrop, the theme of World Mental Health Day 2024, ‘It is Time to Prioritise Mental Health at the Workplace’, is very apt as there is a rise in mental health challenges. India has the highest number of suicides worldwide. According to the National Crime Records Bureau, ‘1.71 lakh people died by suicide in 2022, resulting in a suicide rate of a staggering 12.4%’. Depression was the most common underlying cause of suicide. The National Mental Health Survey of India (2015–2016) has reported a 13.7% lifetime prevalence of mental morbidity in India, with a current prevalence of 10.6% and depression occurs in 5% of the population.[3] A recent survey by the National Medical Commission[4] revealed that 28% of undergraduate and 15% of post-graduate medical students have mental disorders. In comparison, according to an e-mail survey in a premium medical institute in India, there is some degree of burnout in 90% of doctors, depression in 30% and suicidal ideation in 16%.[5] Research shows that doctors are more vulnerable in the formative years of their career and appear to develop resilience over time. Nurses, too, have similar problems and 50% of nurses do not have any mental health support. Healthcare providers, especially nurses and doctors, are in a catch-22 situation; they are expected to look after their health but do not have time for it, their professional work spills over into their personal sphere. The nature of medical work including long working hours, regular critical decision-making, exposure to human suffering, and rising unemployment put mental strength and resilience to the test. The Internet, disintegrating joint families, and violence against doctors are significant reasons that have eroded the balancing factor in doctors’ lives. Furthermore, cutthroat competition, increasing materialism and pressure to meet commercial targets to justify unrealistic corporate packages are stressful. There is a need to tame unbridled material pursuits and simplify needs to promote a stress-free life. Referring to the WHO’s guidelines for the organisational, managerial and individual measures to facilitate workplace mental health, Dr Ajay Swaroop, Chairman of Sir Ganga Ram Hospital, highlighted the farsightedness of the Founder of Sir Ganga Ram Hospital to inculcate a tradition of treating all the employees as a part of the family to generate support among staff. He appreciated the consultants’ combine of the hospital, a space for consultants to meet, relax, unwind and discuss anything from politics to professional to personal. With space for TV’s, carom, literature and computers, as well as dining and refreshments, everybody can relax in their style, stealing a few moments from their busy work lives. An atmosphere of camaraderie, mentoring of the juniors and focus on excellence in work goes a long way in managing day-to-day hassles and promoting mental well-being. Interdepartmental and interpersonal interaction is encouraged at similar forums for residents, nurses, and paramedical staff. Similar forums for medical residents, nurses and paramedical staff encourage interpersonal and interdepartmental mingling. This is energised by the organisation of sociocultural, musical, sports and culinary events that include a mango party in summer! The magazine of Ganga Ram Institute of Postgraduate Medical Education and Research emphasizes the importance of destressing by publishing only nonacademic material. In the past several decades, ground-breaking advancements in behavioural and neuroscience research have deepened our understanding of the workings of the mind, offering hope and relief to millions suffering from mental disorders through the discovery of pharmacological and psychological treatments. However, health issues, especially psychiatric issues, are highly stigmatising among medical professionals, and a point of deep concern is that they avoid seeking help for their mental health problems and suffer silently. Help-seeking is at a dismal low, from 13% to 36%, with serious consequences for clinical decision-making, career, and life. With a suicide rate 2–7 times that of the general population,[6] the mental health of doctors demands immediate attention. It is said that organisational commitment to mental health by following the mental health policy and laws of the place, an open and supportive work atmosphere, protection of fundamental human rights and enabling initiatives for those suffering from mental health issues to return as productive individuals go a long way in strengthening mental health at work. The Chairman lauded the tradition of easy approachability and receptivity of Sir Ganga Ram Hospital Management, which includes doctors for a well-rounded perception of various issues. Significantly, the lack of commercial targets and peer pressure for either departments or individual consultants reflects the broad, humane perspective of management, the only ambition being to enhance patient care and learning in every way possible. Most importantly, it is creditable that psychological and psychiatric consultations are not stigmatised in hospital. Employees are encouraged by colleagues and seniors to seek professional help whenever required, and the treatment of mentally ill medical professionals is facilitated, rarely with interdepartmental collaboration. At the same time, rehabilitation at work is expected to be a routine matter as far as possible. Confidentiality is assured in these matters, and this is where the attitude of an organisation to mental health matters stands out. It is expressed in the quality of help received by the person with mental health problem. As is the current reality, a hospital mental well-being programme is imperative in all healthcare establishments. The Institute of Psychiatry and Behavioural Sciences in Sir Ganga Ram Hospital regularly organises the programmes to improve mental health literacy and promote the mental wellbeing of hospital doctors, nurses, paramedics and office staff and this includes programmes on stress management, resilience, relationships and mindfulness as well as the early identification of mental health issues. An annual Mental Health Walk is organised for hospital employees to open up a conversation about mental health and erode the self-stigma about help-seeking for mental health issues. In conclusion, responsibility for health, physical or mental, rests with the individual. A persistent effort to understand the ways of one's mind is central to maintaining mental well-being under all circumstances. One must educate oneself about mental health and take help, when required, from family, friends, fellow workers or mental health professionals. Lastly, it cannot be overstated how important it is to have a work-life balance, to have a passion and to have a life beyond Medicine to relax and connect to oneself and others. This mantra serves as a vital tool for coping with stress and fostering psychological wellbeing.