Doctors and depression: the Covid fallout

A hospital worker, in PPE mask and gown, sits exhausted in a corridor
The pressures of the coronavirus crisis on hospital staff is creating a mental health crisis in the NHS. Photo credit: Alberto Giuliani / CC BY-SA 4.0

Depression, mild or chronic, is widespread, but no one who saw the first press briefing by a doctors’ group last week could doubt that the pandemic has scarred the mental health of everyone who has looked after Covid patients. Watching health professionals quietly describe their daily experience was illuminating. The haunted faces and exhausted voices ground down by almost a year of Covid left everyone in no doubt that a decade of under-staffing and under-funding the NHS has had devastating consequences.

Behind the daily statistics about hospital admissions and deaths, we saw the human face of staff on the frontline, their uncomplaining voices cracking with despair as they revealed harrowing shifts. Doctors and all hospital workers constantly leant on to do more with less and less; to give up their annual leave, their breaks and pressured into working ever longer shifts. 

Staff have been drained and traumatised by what they have seen and have to do. They have comforted people while choking back tears telling loved ones the worst. This has taken its toll. It has left some 50% of staff in intensive care units (ICUs) unable to cope, suffering post-traumatic stress disorder (PTSD), and deep depression along with family, personal and professional problems. For some, catching Covid has left them without housing, and in poverty.

We may have glimpsed the horror of Covid on the news but how can anyone understand how big the mental health crisis is without doctors telling it like it is? It isn’t that staff aren’t offered resilience and wellbeing training, mindfulness or yoga. But who can leave patients when the ward is under-staffed, and emergencies are piling up, or when you are holding the hand of a dying, isolated person? 

Dreading the next day

Many have no chance either to look after themselves and families properly as they arrive home exhausted and dreading the next day. Some give up: problem drinking, severe depression, suicide and PTSD afflict health workers too as the British Medical Journal confirmed.

In underlining Covid’s impact on themselves, the doctors were talking about the need to invest in mental health services. The ‘long-term Covid’ effects are not just about physical disabilities. We will all suffer if mental health recovery plans are not addressed now.

The question of investment in mental health care highlights so many inter-linked issues about the future funding, training and staffing of the NHS; and about how to escape lockdown.

We have all heard that children’s mental health would be improved by returning to school. But the dots aren’t joined up: if children are simultaneously Covid’s route into the home, returning to school without adequate testing is not sensible. We can learn from other countries’ evidence on quarantining and masking.

France insists children mask up. Germany is Covid-testing twice a week nursery and school staff: a positive fast test (result in 20 minutes, like a pregnancy test) leads to an immediate PCR test. Test and trace in many EU countries is immediate, extensive and effective. That helps explains lower death rates and why current infection rates per 100,000 people have dipped well below 100.  But they too recognise the need to address the long-term mental health of frontline workers. 

Everyone wants more investment in health care, but leaving charities to fill the gap in funding for crucial public services baffles European public health policymakers. But they are not above reproach and have been sharply criticised over failings in procuring sufficient vaccines and over a lack of transparency over where public money is going

So this week, members of the European Parliament are holding a hearing with the chief executives of pharmaceutical companies involved in the vaccine rollout. At the same time, they stress that the EU recovery plan must invest for the future, alleviate the social impact of the Covid crisis and address its traumatic effects.

As we all tussle with an exit from lockdowns, we must abandon our sticking plaster approach to NHS funding, such as, for example, health passports. 

Doctors compelled to go public and ask for appropriate investment for mental health recovery are doing us all a favour. We should appreciate them as a rare resource: it takes years to qualify as a doctor. We can’t afford to see them burn out. After its well-publicised failings on track and trace, is the government really doing its best for its people and if it isn’t, what do we want to see? Listening to those doctors’ voices, it would seem that the first step must be to look into the eyes of those caring for us and seek their advice.

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