Ahead of the World Mental Health Day last week, over 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 a subject often discussed in hushed tones due to the stigma attached to the condition. It gets worse if the victim is a healthcare provider. Yet, the reality on the ground is that there are more cases of undiagnosed mental illness among healthcare providers. Indeed, mental illness is a silent epidemic among the health practitioners even as one in every four Kenyans (About 11.5 million) live with the condition.
But what causes mental illness among the healthcare providers? The answer may be multi-factorial. First, the rigorous training at the medical school is not for the faint-hearted and many end up depressed due to inherent issues related to this training. The situation may be exacerbated by the unfriendly working conditions under which most healthcare providers work. Often, doctors take it hard when they lose patients that would otherwise have survived due to many reasons beyond their reach. These factors and many others, including genetic predisposition, are a major contributor of moral injury.
A study by Dr Clare Gerada published in BJPSych London bulletin finds that major risk factors for suicide across all populations are depression and substance misuse, both of which are also common in doctors who take their own life.
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“It is not just mental illness that predisposes doctors to kill 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.
Some sick doctors deliberately concealed their problems and pretended to go to work daily rather than seek medical attention. Families need to be aware of mental illness and help doctors to seek treatment.
Healthcare providers suffer in silence because their own patients consider them as demi-gods who are not as vulnerable as their clients. Fears abound that disclosure of a mental health condition can result in job loss or disciplinary measures from the professional regulator. Then there is the fear of loss of confidentiality resulting from the possibility of the issue being known by colleagues. A major cause of concern is the fact that doctors find it difficult to treat their own colleagues and this does not augur well for the overall care and health seeking behaviour of healthcare providers with mental illness.
This worrying trend must be addressed as a matter of urgency 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 behooves employers in the medical profession to lead from the front by putting in place concerted efforts aimed at reducing the stigma of mental illness among their workforce, thus enabling 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.
Dr Abeid is the acting CEO, The Nairobi Hospital