Mental health: Medics also cry

Ahead of the World Mental Health Day, more than 300 healthcare providers converged at The Nairobi Hospital for the first Annual Moral Injury Symposium. The forum discussed various aspects of mental health, with a rich menu of presentations from Prof Lukoye Atwoli, Mary Sirima, Dr Mucheru Wang’ombe and Michael Onyango, among others.

In Kenya and the rest of Africa, mental illness is often discussed in hushed tones due to the stigma attached to it. It gets worse if the victim is a healthcare provider. Yet, the reality on the ground is that there are more cases of mental illness among healthcare providers than the patients they see. Indeed, mental illness is a silent epidemic among health practitioners even as one in four Kenyans (about 11.5 million) live with the condition.

But what causes mental illness among healthcare providers? First, the rigorous training at medical school is not for the faint-hearted and many end up depressed soon after graduation. The situation is exacerbated by the unfriendly conditions under which most healthcare providers work. Often times, doctors lose patients that would otherwise have survived due to lack of basic tools of trade at the workplace.

Such losses are difficult to comprehend and leave practitioners with low self-esteem and regrets, a major contributor to moral injury.

A study by Dr Clare Gerada published in BJPSych London bulletin finds that major risk factors for completed suicide across all populations are depression and substance misuse, both of which are also common in doctors who take their own lives.

“It is not just mental illness that predisposes doctors to killing themselves. Suicide is also linked to how doctors are treated, how they treat themselves, unique issues related to their job and a system where doctors with mental illness are handled through an adversarial rather than treatment system”, she writes. “This equates to personal, professional and institutional stigma, which doctors face when trying to access care and also once in treatment. Stigma is one of the most important barriers for doctors trying to be treated”.

A similar scenario is mirrored in a study by Henderson and others titled Shame! Self-stigmatisation as an obstacle to sick doctors returning to work: a qualitative study, published in the British Medical Journal. It finds that most doctors out of work with mental illness felt guilty, shamed and fearful. Doctors feel a dreadful sense of personal failure and inadequacy if they struggle to keep working and despair can be sudden and overwhelming.

The researchers describe an overwhelming stigmatisation that mentally ill doctors were exposed to by friends, family and peers, which left them isolated and sad. Some sick doctors deliberately concealed their problems, and pretended to go to work each day rather than admit to their families that they are unwell.

That medical practitioners are not keen on seeking the same services they render to their patients is an open secret. Undoubtedly, stigma plays a key role. Fears abound that disclosure of a mental health condition can result in job loss or disciplinary measures from the professional regulator.  Then there is also the fear of loss of confidentiality resulting from the possibility of the issue being known by other colleagues.  It is also noteworthy that healthcare providers suffer in silence because their own patients consider them as demi-gods who are not as vulnerable as their clients.

A major cause of concern is the fact that doctors find it difficult to treat their own colleagues, to the extent of feeling embarrassed.

This worrying trend must be addressed urgently to save the medical profession. To begin with, many systemic issues that cause dissatisfaction among the practitioners must be tackled, including allowing them to maintain a sensible work–life balance, taking cognisance of the basic needs of staff who sacrifice their lives to save those of patients.

Secondly, it behoves employers in the medical profession to lead from the front by making concerted efforts to reduce the stigma of mental illness among their workforce. This will enable them to seek timely medical intervention and confidential support services.  We must be our brothers’ keepers. Above all, it is imperative that we offer our staff the same compassion that they are expected to give to their patients.

Acting CEO, The Nairobi Hospital