health conditions or to disclose their own mental health conditions. Despite treating patients with similar conditions, we are generally reluctant to seek help for ourselves.
By aiming to improve our own conversations that we have around our own mental health and wellbeing, we can also aim to improve the care that we can ultimately deliver to our patients.
Mental health conditions are also often subject to stereotypes. Stereotypes are useful in some areas of life, enabling us to make decisions based on patterns that we may have seen before – and so while these may not necessarily always be right, they may not necessarily always be harmful, either. However, with regards to mental health, stereotyping may lead to a generalised response pattern, rather than a customised one.20 And given the obviously personal and widely differing natures of our mental health, it is clear that a generalised response based on a stereotype may not be the most helpful one. Stereotypes can also lead to characterisations of those affected as being completely defined by their condition, rather than recognising the ebbing and flowing nature of aspects of our mental – as with our physical – health.
Many factors may contribute to these feelings.22 These factors, according to the Director of the Institute of Healthcare Policy and Innovation in the University of Michigan, USA, have the ability to ‘lead to psychological symptoms’.3 These include the stress of caring for colleagues who one moment have worked alongside of us, and the next moment are critically ill from COVID‐19. Inevitably, some of these colleagues may pass away. The burden of caring for any patient who is acutely unwell is stressful – with this multiplied when there are multiple cases in rapid succession, with the potential to rapidly deteriorate. There is stress around the ability to provide adequate care, particularly when there are shortages in treatment devices such as ventilators, as well as concern about healthcare systems being inundated and pushed to breaking point. Given the changes in roles, stress can come from being allocated a different role in an area of clinical practice that we are less familiar with, as discussed. And finally, crucially, the lack of access to support services for managing these psychological symptoms is also a contributing factor.
The lack of suitable PPE can also cause significant stress. This stress may include a fear of contracting the virus through workplace, and a fear of transmitting it to family household members. These stresses led some clinicians to feeling that they needed to live away from their family during the pandemic, in turn bringing them additional stress through further straining their support network.
Moral injury, a term based initially on work within the military, may also occur when we have insufficient resources with which to care for critically unwell patients.23 The term describes our feelings of psychological distress when our actions, or lack of actions, lead to us violating our ethical or moral code.23 This can cause us to have negative thoughts about ourselves, and while it is not strictly a mental health condition, it may well affect our mental health.
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