I walk – PPE-clad – into a medical ward to see a patient. A seasoned manager I’ve known for years approaches me: “Jimporta nkellmek naqra please?” (“May I talk to you please?”). Without hesitation, I usher her into an office. She bursts out into tears and I haven’t even shut the door yet. COVID-19 doesn’t only hurt our patients and loved ones. It also hurts our indefatigable staff.

Haggard and clearly under pressure, the manager opens up. It’s not only COVID-19 but this is the cherry on the cake. Like all staff, she works tirelessly and ably in a team. She opens the floodgates, sharing her worries about seeing patients suffering, colleagues under pressure, her loved ones and other issues.

Like so many, she works diligently and conscientiously, burning the midnight oil and the candle at both ends. She is not the first colleague in crisis, asking for support. These ad hoc crisis sessions are on the rise and occur in every area, be it administration, medical school, pantries, community clinics, police departments, government offices, elderly residences… the list goes on and on.

These crises are visible for those who have eyes to see and for those who spare some compassion towards staff who valiantly perform their duty without lamenting. The workforce’s resilience and flexibility is being tested to the limit. These are not people who give up easily.

A fresh study carried out by Roehampton University, published in the British Journal of Psychiatry Open, echoes these concerns. The study showed that “in April last year, the number of workers with high levels of stress, anxiety and depression quadrupled, reaching a third of all staff”. These findings were described as “staggering”. Colleagues of all levels – 2,733 in all – comprised 2,365 women and 342 from ethnic minority backgrounds. Fourteen per cent had elevated levels of Post Traumatic Stress Disorder.  In the UK, the initial stressors were the lack of readily available good quality PPEs and inadequate readiness for a pandemic, together with the difficulties of getting up-to-date clinical information about COVID-19. These were described as key factors for poor mental health.

Similar to what we notice here, managers bore the brunt of worst mental health. These were five times as likely as other groups to report PTSD symptoms. Being female and single increased the risk of mental health issues while working on the frontline doubled the risk.

We must devise a strategy to cater for those who take care of others on the COVID-19 frontline- Mark Xuereb

Crucially, those who – like this Maltese manager – reported being able to share their stresses at work were up to 40 per cent less likely than others to have poor mental health. Ask the superb hospital chaplains who, like me, tread the wards and corridors. They also quietly support the staff in unison. Our sessions happen standing up and anywhere. Of course, there are counsellors’ rooms but these staff members are often too busy to even sit still. We need to reach them where they are. We need to support frontliners raw and on the frontline, just like a battle medic.

Psychologist and researcher James Gilleen explained that the UK study “is critical in providing the clearest picture yet on the traumatic psychological effects of the COVID-19 pandemic on the UK’s healthcare workers. While we’re not entirely shocked to discover that all mental health indicators deteriorated among healthcare workers, the extremely sharp increase in those that experienced severe symptoms of stress, anxiety, depression and PTSD is unprecedented and a serious cause for concern for NHS staff well-being”.

Suicide and self-harm is also an inevitable consequence.

“Mental health disorders are on a staggering rise and urgent action is needed to provide our healthcare workforce with the support, resources and management they need,” she added.

Locally, our colleagues, leaders and management are doing a lot to help address this crisis. We must do more to take care of those who take care of us – from top to bottom. As the pandemic’s evolution remains uncertain, we must – as mental health professionals – urgently devise a concerted national strategy to cater not only for patients and loved ones but also for those who take care of others on the frontline.

Long COVID-19 – described by the British Medical Journal as a cluster of relapsing and remitting symptoms including “profound fatigue, cough, breathlessness, muscle and body aches and chest heaviness or pressure, but also skin rashes, palpitations, fever, headache, diarrhoea and pins and needles” –  affected the equivalent of Malta’s population in the UK so far.

We urgently need local research on how COVID-19 and long COVID-19 is affecting our population and our frontliners. Research initiatives by the crisis team are underway. “Jimporta nkellmek naqra please” is what we should be assiduously asking staff – not the other way round.

Mark Xuereb, UK-trained crisis psychiatrist

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