The second wave of coronavirus infections had pushed many frontline workers in India to a breaking point. Media reports have shown that an overwhelming number of healthcare workers sought psychological help to cope with the relentless demands of Covid-19, especially during the second surge.
Even as the surge subsides on the back of vaccines, the trauma could have lingering effects on this workforce. Readjusting to normalcy will therefore entail addressing not just the physical and economic aftershocks of the pandemic, but also the psychological.
Covid-19 has psychologically impacted all essential workers, not only healthcare workers. India was third in journalist deaths due to Covid-19, globally. Yet, they have not even been officially recognised as essential workers in India.
Several states have now declared them as “Covid warriors’’, but little has been done to ensure the physical and psychological safety of these first-hand witnesses and documenters of the crisis. Many journalists have left their jobs reporting burnout. The International Center for Journalists found that 38% of journalists they surveyed suffered from burnout and a third from dark and negative thoughts.
Despite these unsettling reports, this parallel health crisis has received little attention in India. Instead of planned strategy and guidelines, we have so far only seen an ad-hoc response. There is an urgent need for a multi-pronged response to the unfolding mental health crisis focussed on three aspects: prevention, de-stigmatisation and clinical support.
As a first step, organisations must try to make working conditions safer for the frontline workforce. During the first wave of the pandemic, police departments were left to their own devices to arrange for masks, sanitisers and Personal Protective Equipment kits. Neither the Union government nor the state governments (until much later) helped ensure this equipment reaches the personnel on duty.
About a fourth of Accredited Social Health Activist workers on Covid duty were not provided masks. In the International Center for Journalists survey quoted above, 30% of journalists said their organisations had not provided a single piece of protective equipment for field reporting.
The provision of proper protective gear is essential to make all frontline workers feel safer while performing their duties. In addition, ventilation in office and hospital buildings must be improved to limit the spread of the infection and mitigate the fear of contagion.
The safety protocol must look beyond just the physical safety aspect. Organisations should re-strategise their leave policies in order to prevent burnout among frontline workers. Last year, Kerala adopted a rotation system wherein healthcare workers were divided into three groups: the Covid-19 pool, off-duty pool and routine pool. Studies show that such staff rotation from jobs of higher pressure to lower pressure and vice-versa can help reduce stress among healthcare workers.
Given understaffing concerns in the healthcare sector, other strategies such as the curtailment of routine outpatient services and postponing elective surgeries can also help. Even in normal times, India has a shortage of health workers, with only one doctor for every 1,511 people and one nurse for every 670 people, well below World Health Organization’s minimum norms. The result of understaffing is indefinite long shifts and less to no leaves to recuperate. This puts an enormous toll on mental health.
Second, de-stigmatisation of both Covid-19 patients and mental health illnesses is crucial to counter this crisis. Awareness campaigns must be organised in public and private workplaces, in collaboration with mental health professionals, to counter stigma and provide guidance on mental health issues. Such campaigns can encourage open conversations about mental health and encourage frontline workers to seek support. They should also be used as a platform to give information on the support available in times of need.
Social media should also be leveraged to raise awareness among the general public. In the past social media platforms have proved effective in raising awareness on mental health issues. During Ebola, these were also used to help health workers form support groups to deal with challenges and stigma associated with their work.
The third leg of the strategy should focus on providing direct psychological and financial support. Mental health forums and helplines should be set up for early screening and distress management. Research shows that peer training in identifying burnout and delivering informal counselling as well as psychologically oriented meetings among the frontline staff and the team leaders have proved effective mental care strategies during previous epidemics.
Supporting frontline workforce
Group support sessions for health care workers can offer a safe place for people to describe how they are feeling and to share successful coping mechanisms. Individuals experiencing greater degrees of distress can be offered one-on-one support. Disha, a 24X7 telehealth helpline, and psychosocial support programme “Ottakalla oppamundu” set up by the Kerala government are good examples.
Such measures should be adopted as part of a long term strategy, especially for workers who deal with death and trauma in their regular professional lives such as the police and clinical staff.
Financial support in the form of insurance coverage and “risk allowances” can be given to make clinical support more accessible. The inclusion of mental illnesses in regular health insurance coverage, as recommended by Insurance Regulatory and Development Authority, is a good step in that direction.
Extending support related to finances and personal needs can bring about a sense of trust among frontline workers and help them stay motivated.
Many frontline workers are reportedly contemplating quitting their jobs to find alternative employment amid severe burnout. This can have dire consequences for a country such as India that is already facing a severe staff crunch in many essential services.
We need to make sure that frontline workers that took us through the pandemic get more support beyond the national applause they have been getting until now.
Nikita Kwatra is a Researcher and Sofia Imad is a Junior Fellow at IDFC Institute.