By: Retna Mustika Indah

The outbreak of coronavirus disease 2019 (COVID-19), which started in China in December 2019, has proliferated in other Europe, America, Australia, Africa, and Asian countries, including Indonesia. In addition to endangering human health and consequently causing deaths, COVID-19 imposes irreversible psychological impacts on human societies. It is natural for individuals to feel fear, sadness, and anxiety during a crisis. Indeed, fear of the virus is spreading even faster than the virus itself. In this COVID-19 conjuncture, people can be fearful about becoming ill and dying, losing livelihoods and loved ones, and being socially excluded. People who test positive for COVID-19 must cope with anxiety about their condition, physical discomfort, separation from loved ones, isolation, and possible stigma. Those who have loved ones affected by COVID-19 are facing worry and separation.1 Many people worldwide are suffering from loss of livelihoods and opportunities. Some people turn to alcohol, drugs, and potentially addictive behaviors such as gaming, shopping online, internet, or eating disorders.2-7 Domestic violence has increased. Finally, people experiencing the death of a family member due to COVID-19 may not have the opportunity to be physically present in their last moments or to hold a proper funeral ceremony, which may disrupt the grieving process.8 At the press conference of The 5th ASEAN Health Ministers Meeting (AHMM) on May 2022, The Director for Mental Health, Ministry of Health Republic of Indonesia, highlighted that this COVID-19 pandemic had increased the prevalence of mental health disorders to 1-2 fold compared to before the pandemic, and affected various groups of the population.9 In many pandemic episodes, the general population and the healthcare workers who are more at risk for infection and transmission also present similar psychological distress.10-12 Frontline workers such as doctors, nurses, and ambulance drivers, are exposed to additional stress during the COVID-19 pandemic. They experience stigmatization, higher demands during work, and fear of spreading COVID-19 to their families, not to mention the physical strain they have to endure while wearing protective equipment and the physical isolation to which they have to submit themselves to protect their families.

It cannot be denied that many countries have no adequate healthcare system and infrastructure to deal with the pandemic situation.13, 14 The shortage of healthcare workers is aggravated by high mortality among those treating COVID-19 patients15, resulting in higher work-load and longer working hours for the remaining personnel, especially when the number of COVID-19 patients continues to increase. Moreover, similar to other countries, there is a lack of personal protective equipment (PPE) for healthcare workers on duty. This shortage is worsened by the public’s panic buying and stockpiling of medical-grade PPE.13, 14 Other than that, the number of hospitals, bed capacities, and supporting facilities to treat COVID-19 patients, such as negative pressure wards and Intensive Care Unit rooms, are lacking and also not evenly distributed in Indonesia.13 The lack of facilities puts healthcare workers in a difficult position, where they must decide to whom treatments should be given.16 The abovementioned issues might explain why healthcare workers in Indonesia are more prone to adverse mental health symptoms than the general population.

Several interventions have been implemented to support the healthcare workers in minimizing the impact of the COVID-19 pandemic on their mental health. Some focus areas, such as training the healthcare workers and strengthening the logistics and supply chain, should be prioritized and require a relentless commitment. Knowledge regarding the infection causing the pandemic and its prevention was deemed important to reduce the worries of healthcare workers.17 Updated information, including infection guidelines, hospital procedures, and even operation of common medical protective equipment should be well provided and reachable. Online platforms that are growing rapidly nowadays make it more possible to achieve this goal. After taking serious attention to the infrastructure and facility, psychosocial intervention might play important role in supporting the mental health of healthcare workers. Lesson learned from the previous pandemic; psychosocial training can improve resilience to pandemic-related stress.18, 19 Mental health consultants or peer group support and offered assistance to healthcare workers may help the healthcare workers to adapt to the stresses created by the epidemic.17 Some cases might require therapy and rehabilitation, however, studies found that Cognitive Behavioural Therapy20-22 and music therapy23 were effective to relieve specific mental symptoms such as stress, depression, PTSD, anxiety, behavioral changes, or psychotic symptoms.

Besides the psychosocial intervention, organizational support during the pandemic is important. One effective support to create better environments during the pandemic is an adjustment of working hours.24 Some hospital staff in several cities with a high burden of COVID-19 in Indonesia work for 2 weeks and have the following week off. Some local governments even provided accommodation for the health workers during the peak of the COVID-19 cases. These policies were implemented to prevent transmission from healthcare workers to their environment. Reorganizing the area in the hospital to provide space for healthcare workers to relax, shower, receive emotional support, and reenergize with snacks and beverages is expected by the employees since they are exposed to the stress of using the full protective equipment and dealing with the mortality and emergence of COVID-19 patients.

Taking care of the mental health of healthcare workers directly affects their ability to fully serve their patients. We should take this moment to strengthen our healthcare system, especially mental health services. In the near future, it will be mandatory to establish psycho-logical treatment guidelines and launch the program to improve psychological resilience among healthcare workers. Finally, all the programs put in place so far faced resistance on the part of healthcare workers in admitting psychological difficulties. We believe online promotion and awareness campaigns to minimize psychological stigma should also be implemented in both the planning and the execution phases of a psychological intervention program.


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