|Year : 2020 | Volume
| Issue : 2 | Page : 98-101
Occupational mental health services for medical professionals: Relevance in the Indian context
Sanju George1, Nitin Gupta2
1 Rajagiri Centre of Behavioural Sciences and Research, Rajagiri College of Social Sciences (Autonomous), Kochi, Kerala, India
2 Gupta Mind Healing and Counselling Centre, Chandigarh, India
|Date of Submission||21-May-2020|
|Date of Decision||23-May-2020|
|Date of Acceptance||24-May-2020|
|Date of Web Publication||27-Jun-2020|
Prof. Sanju George
Rajagiri Centre of Behavioural Sciences and Research, Rajagiri College of Social Sciences (Autonomous), Rajagiri P. O., Kalamassery, Kochi - 683 104, Kerala
Source of Support: None, Conflict of Interest: None
Medical practitioners are often reluctant to acknowledge and seek timely help for their own mental health problems. If things are to improve, both medical professionals and policy makers alike need to “wake up.” In this article, we first look at why doctors (including medical students) are susceptible to mental health problems and why they are reluctant help seekers, and then discuss how an occupational mental health service for doctors can work in hospital settings. We focus on the need for occupational mental health services in medical settings in India and how they can be translated from theory into practice.
Keywords: Doctors, mental health, occupational mental health services
|How to cite this article:|
George S, Gupta N. Occupational mental health services for medical professionals: Relevance in the Indian context. Indian J Soc Psychiatry 2020;36:98-101
|How to cite this URL:|
George S, Gupta N. Occupational mental health services for medical professionals: Relevance in the Indian context. Indian J Soc Psychiatry [serial online] 2020 [cited 2020 Aug 8];36:98-101. Available from: http://www.indjsp.org/text.asp?2020/36/2/98/288102
The most tragic thing in the world is a sick doctor
– George Bernard Shaw
Unlike members of nonmedical professions, medical practitioners, in general, are reluctant to acknowledge and seek timely help for their own health problems; this aspect being more evident when it comes to their mental health problems. If things are to improve, both medical professionals and policymakers alike need to “wake up” to this aspect. In this paper, we discuss why doctors (including medical students) are susceptible to mental health problems, why they are reluctant help seekers, and how an occupational mental health service (to address these two issues of psychiatric problems and reluctance to seek treatment) can work in hospital settings. In the West, there exist reasonably robust care pathways for medical professionals to seek and receive help and support for their mental health problems. However, this aspect is, sadly, lacking in medical settings in Indian setup. Hence, we focus on the need for occupational mental health services (OMHS) in medical settings in India and how they can be translated from theory into practice.
It may be pertinent to mention that, for the sake of argument (but at the cost of oversimplification of the concept), medical students have been included in the category of “doctors” in this discussion. In addition, although the discussion will be limited to the medical profession, the principles being discussed will be equally applicable to the allied healthcare professions too.
The importance of mental health at workplace and the consequences of mental ill health (to the individual, workplace, and the society) have been acknowledged widely, both in theory and practice. In fact, mental health in the workplace has been gaining a lot of attention with the WHO declaring workplace mental health to be an integral part of the WHO Mental Health Action Plan 2013–2020. Hence, workplace mental health has been incorporated, to varying extents, even by Indian companies run within the government and by private sectors under the name of “occupational medicine.” However, mental health problems rarely get included, or even addressed, under the rubric of “occupational medicine.”
Research studies in India have largely focused on the Information and Technology sector where nearly 46% of working population in private sector reported occupational stress, with higher levels in private than in government sectors.,
There is a reasonable body of evidence that shows medical professionals being prone to suffer with mental health problems, such as depression, anxiety, addictions, stress, burnout, and suicide.,, Indian data from various parts of the country on resident doctors and practitioners of various disciplines have also reported the presence of significant levels of stress, anxiety, depression, and burnout.,,,,,,,,,,,,
Reasons abound as to why doctors are more prone to mental ill health. First and foremost, practice of medicine is very stressful. Other important individual- and workplace-related factors include workplace stress, inflexible and long hours of work, lack of close and supportive confidants, high personal, and professional expectations., In the Indian context, however, additional factors tend to operate unique to the government and private sector setup.
As can be seen from the aforementioned discussion, despite evidence that doctors are more prone to mental health problems, they remain very reluctant to acknowledge the presence of psychological difficulties. Even when they do acknowledge, they do not demonstrate timely help-seeking behavior from appropriate professionals. Some barriers to seeking help by the individual include stigma related to the diagnosis of mental illness in the individual; confidentiality issues; feelings of guilt and shame; concerns related to the potential impact on career; fears about negative response from colleagues and employer/s; mistrust from colleagues, employer/s, and regulatory bodies; and being unaware from where to seek help.
Medical profession is unlike many others in that doctors deal with people's (patients') lives. From this perspective, inadequate or delayed help/support/treatment can negatively impact on the quality of care and/or services they can potentially offer to their patients (i.e., doctors' duty of care, standards of performance, and ensuring basic minimum safety of patients) and on the training/supervision/peer-working for the present and future generations of doctors.
Having looked at the “Why” or the need for an OMHS, we will now briefly discuss how this theoretical concept can be translated into practice in a medical setup.
As per the concept outlined above, an ideal situation would entail every hospital setting having an occupational health service (or department), with an in-built OMHS component. This could be via the hospital's own psychiatric service (consisting of psychiatrist/s and psychologist/s) or an externally “commissioned” service. For the success of OMHS, the key components are its availability, accessibility, and over-arching confidential nature of such a service. Apart from this, the specialist and the expert nature of psychological and/or psychiatric help that is on offer are equally important and lead to delivery of an ideal service. Nevertheless, where the presence of “restricted resources” limits offering of such an ideal service to the hospital's doctors (and allied healthcare professionals), at the very least, hospitals should be able to outsource/commission this service either in whole, or elements of it – i.e., a telephone helpline and care pathway for providing mental health screening, assessment, and treatment services.
There are encouraging initiatives in this regard that are operating in India, although on a small scale. Four of these are briefly alluded to here:
First, a project called “Hope” has been running since 2019 under the auspices of IMA, Kochi, offering mental health support to its doctor members and their families. This consists of a free confidential telephone help-line manned by psychiatrists, and a follow–on face-to-face consultation, where ever needed. Preliminary take-up of this service has been reported to be “encouraging.” Second, the IMA's national committee for emotional health and emotional well-being of medical students and doctors in India, since 2018, has also been running several campaigns with the overall aim of reducing mental health problems in medical students and doctors. However, to the best of our knowledge, this has not been formally evaluated. Third, Occupational Health Services were started in January 2018 at Mental Health Institute, Department of Psychiatry, Government Medical College and Hospital - 32, Chandigarh, for those individuals experiencing mental health issues that can impact/has impacted their functioning in the workplace, experiencing stress and mental health problems at work, facing stigma/discrimination at workplace due to mental illness, and facing stigma/discrimination at workplace due to disability arising related to mental illness. These individuals are managed by a team of consultant psychiatrists and clinical psychologists and provide regular longitudinal contact for the management of occupational dissatisfaction and stress, psychological morbidity, problems with coping, stigma, and disability. Since 2019, additional services on similar lines (Trainee Drop-In Centre) for undergraduate and postgraduate trainees of all disciplines were introduced by the same team and have been running successfully. These services are currently undergoing formal evaluation although preliminary evidence suggests “encouraging and positive” uptake (Personal Communication). Finally, we are aware of a student wellness clinic that runs at the All India Institute of Medical Science, Delhi, with input from psychiatrists and clinical psychologists. Nevertheless, it is not surprising that lack of awareness, resource limitations, and potentially competing interests are some of the factors that seem to be putting brakes on the rolling out of the above schemes on a larger scale.
Even where OMHS exist, conventionally and even contemporarily, because of resource starvation, the focus has tended to be on the treatment rather than on the prevention or promotion of emotional well-being of doctors and medical students. Hence, in our considered opinion, we call for a shift in such a “cultural” and “systemic” mind-set of the employers and related responsible bodies. They should aim to target and address issues that contribute to stress, burden, and mental illness such as a difficult and stressful work environment, extended and unsupported work-hours, lack of regular (or periodic) rest periods, “out-of-the-job” extra responsibilities, lack of “protected” learning time, nonsupportive (and/or critical) colleagues, nonsupportive mentors, absence of opportunities for career advancement, inflexible leave entitlements and arrangements, and an alien concept of work–life balance.
Whatever the precise structure and functions of such an OMHS, as highlighted earlier, it is crucial that medical students are able to avail this service too. The focus should be on mental health promotion and, where need be, early intervention. We cannot emphasize enough the efficacy of early intervention in achieving better outcomes for various psychological disorders (especially psychosis).
Despite the above discussion being limited to what hospitals and policymakers need to do in helping doctors with mental health problems, we in no way would like to suggest and imply that this is a one-way process and to absolve the individual doctors (and medical students) from their responsibility in this whole aspect. They too have a crucial responsibility to ensure promotion of their own psychological well-being and thereby prevent the development of psychological distress and/or mental illness. Furthermore, nowhere else is early intervention in the form of promotion of mental health as important as it is in the case of doctors, i.e., starting early in the medical career – as medical students. Early intervention can include the following: medical students, and practicing doctors, of course, should be aware (or be made aware) of what stress is, what its manifestations are, what can be done to prevent stress, and where to get help. Every medical student and doctor should be equipped with adequate de-stress strategies such as understanding one's own perspective (or how one views work and life, and events), making necessary changes (using the process of “cognitive re-framing”) for the better, and putting in place adequate positive coping strategies, including interests/passions outside work. William Osler, the Father of Modern Medicine, is credited with the saying: “The young doctor should look about early for an avocation, a pastime, that will take him away from patients, pills, and potions … No one is really happy or safe without one.”
We feel that the medical profession has a core responsibility to its practitioners in protecting the mental health and promoting the well-being of its members. While one waits for core policy changes and universal OMHS for doctors, we call for uptake of some our suggestions in the form of development of pilot/s service/s. Without further delay, alongside large-scale plans to address the above, we also advocate the need to run awareness programs for doctors and medical students to help reduce the stigma of mental health in our profession.
The need of the hour is to understand and address the various psychosocial aspects related to OMHS, and we have tried to make the reader aware of same.
No one is useless in this world who lightens the burden of another.
– Charles Dickens.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Mavroforou A, Giannoukas A, Michalodimitrakis E. Alcohol and drug abuse among doctors. Med Law 2006;25:611-25.
Schernhammer ES, Colditz GA. Suicide rates among physicians: A quantitative and gender assessment (meta-analysis). Am J Psychiatry 2004;161:2295-302.
Imo UO. Burnout and psychiatric morbidity among doctors in the UK: A systematic literature review of prevalence and associated factors. BJPsych Bull 2017;41:197-204.
Bhugra D, Bhui KS, Gupta KR. Burnout and stress among doctors and dentists in North India. Int J Cult Health 2008;1:24-9.
Gandhi K, Sahni N, Padhy SK, Mathew PJ. Comparison of stress and burnout among anaesthesia and surgical residents in a tertiary care teaching hospital in North India. J Post grad Med 2018;64:145-9.
Grover S, Sahoo S, Bhalla A, Avasthi A. Psychological problems and burnout among medical professionals of a tertiary care hospital of North India: A cross-sectional study. Indian J Psychiatry 2018;60:175-88.
] [Full text]
Jugale PV, Mallaiah P, Krishnamurthy A, Sangha R. Burnout and work engagement among dental practitioners in Bangalore City: A cross-sectional study. J Clin Diagn Res 2016;10:ZC63-7.
Kulkarni S, Dagli N, Duraiswamy P, Desai H, Vyas H, Baroudi K. Stress and professional burnout among newly graduated dentists. J Int Soc Prev Community Dent 2016;6:535-41.
Langade D, Modi PD, Sidhwa YF, Hishikar NA, Gharpure AS, Wankhade K, et al
. Burnout syndrome among medical practitioners across India: A questionnaire-based survey. Cureus 2016;8:e771.
Nandi M, Hazra A, Sarkar S, Mondal R, Ghosal MK. Stress and its risk factors in medical students: An observational study from a medical college in India. Indian J Med Sci 2012;66:1-2. [Full text]
Ratnakaran B, Prabhakaran A, Karunakaran V. Prevalence of burnout and its correlates among residents in a tertiary medical centre in Kerala, India: A cross-sectional study. J Postgrad Med 2016;62:157-61.
] [Full text]
Shetty A, Shetty A, Hegde MN, Narasimhan D, Shetty S. Stress and burnout assessment among post graduate dental students. Nitte Univ J Health Sci 2015;5:31-6.
Shetty SH, Assem Y, Khedekar RG, Asha S, Arora M. Indian orthopaedic surgeons are less burned out than their Western colleagues. J Arthrosc Joint Surg 2017;4:1-7.
Swami MK, Mathur DM, Pushp BK. Emotional intelligence, perceived stress and burnout among resident doctors: An assessment of the relationship. Natl Med J India 2013;26:210-3.
Dave S, Parikh M, Vankar G, Valipay SK. Depression, anxiety and stress among resident doctors of a teaching hospital. Indian J Soc Psychiatry 2018;34:163-71. [Full text]
Saini NK, Agrawal S, Bhasin SK, Bhatia MS, Sharma AK. Prevalence of stress among resident doctors working in Medical Colleges of Delhi. Indian J Public Health 2010;54:219-23.
] [Full text]
Kroenke K, Spitzer RL, Williams JB, Monahan PO, Löwe B. Anxiety disorders in primary care: Prevalence, impairment, comorbidity, and detection. Ann Intern Med 2007;146:317-25.
Firth-Cozens J. A perspective on stress and depression. In: Cox J, King J, Hutchinson A, McAvoy P, editors. Understanding Doctors' Performance. Oxford: Radcliffe Publishing; 2006. p. 22-5.
Grover S. Physician burnout: Are we taking care of ourselves enough! J Mental Health Hum Behave 2018;23:76-7.
George S, Deshpande S, Kallivayalil RA. Are specialist treatment services needed for doctors with mental health problems? Indian J Psychol Med 2020;42:105-7. [Full text]
George S, Menon V, Sameed S, Hazzein A, Haneesh MM, Rahman J, et al
. The establishment and short-term evaluation of a specialist and confidential service for doctors with mental health difficulties in India. Asian J Psychiatr 2019;44:65-7.
George S, Gerada C. Stressed GPs: A call for action. Br J Gen Pract 2019;69:116-7.
Richards K, Austin A, Allen K, Schmidt U. Early intervention services for non-psychotic mental health disorders: A scoping review protocol. BMJ Open 2019;9:e033656.