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Beneath the PPE: Mental Health Impacts of COVID-19 on Healthcare Workers

Malaysia has endured the battle of COVID-19 for close to two years now. As the national vaccination rate reaches 75% as of 2nd November 2021[1], the fog over our economic and social activities appear to be lifting. The rakyat are slowly returning to work and malls are once again a gathering place for weekends. 

However, the mental fog in our healthcare workers is not as easily dispersed. The mental state of doctors, nurses, and healthcare workers alike might have sustained unintended consequences from this long arduous fight to flatten the curve. 

Source: Bernama via New Straits Times

Medical Burnout

The Ministry of Health’s (MOH) Institute for Health Behavioural Research surveyed 6616 healthcare workers across the nation to find out the state of mental health among medical personnel. 

About 14.2% of frontline health workers suffered severe mental disorders during the COVID-19 pandemic[2].

Donning their personal protective equipment (PPE) and a strict face, healthcare workers are keenly aware that a single mistake in judgement call may put their patients at risk. This expectation incurs additional stress on healthcare workers at the start of the pandemic when they are tossed into a chaotic whirlwind, trying tirelessly to save lives against a novel and deadly virus.

Once I reach home, I just lie down on my bed. At this stage there are many unexpected things—those big numbers of late night admissions, working late night… you just need to prepare for all kinds of possibilities. – A dietician who is involved in setting up quarantine and low risk treatment centres[3].

Acute fatigue seems to underlie these symptoms. With uncertainty on the trajectory of pandemic after the first wave, 39.1% of healthcare workers experienced workplace burnout. But more worrying is that 53.1% of them cited burnout in their personal life[3]

Source: New Straits Times

Juggling Work And Family

The prolonged working hours (60 hours per week or more) has taken a toll on healthcare workers’ personal life and their families are facing the brunt of it. Longer working hours means shorter family time, especially for those who are posted out-station.

I miss my family so much. I feel sad not being able to be around them for important occasions, such as my sister’s engagement two weeks ago. When the third wave first hit, it was very stressful as we had limited manpower. We were drained mentally, physically and even emotionally. – Dr Shaz, 28, stationed at Lahad Datu, 400km away from her family in Kota Kinabalu[4].

Workers who receive inadequate childcare support and workplace psychological support are particularly at risk of mental distress. Balancing work-family becomes particularly challenging with children under the belt.

We have our own struggle at home with these home schooling (due to COVID-19). Both of us are working, kids need to be sent to their grandparents, homework keeps coming through those WhatsApp groups everyday leaving us feeling even more hopeless. I cannot help but feel very guilty. – A specialist doctor with a working spouse and schooling kids[3].

Source: The Star

Not In A Good State

A survey was conducted across government hospitals in Selangor. Among the 1050 government hospital doctors surveyed, 10% reported experiencing severe levels of depression, 11.33% severe anxiety, and 6.48% experiencing severe stress[5]. Work demands are highly correlated with doctors’ mental state. Those who reported a high emotional demand from work showed a higher risk of depression, anxiety, and stress. 

Prolonged exposure in a high tension working environment also means doctors are less capable of detaching themselves from the emotional burden and more prone to psychological distress[5].

Certain states in Malaysia recorded higher numbers of mental health issues among their healthcare professionals. This is the case for Kelantan where non-frontline healthcare providers (eg. those that are not in direct contact with COVID-19 patients) reported a greater level of depressive symptoms (37.7%) as compared to their frontline colleagues (27.5%)[6].

Source: Jabatan Kesihatan Negeri Johor via Code Blue

Though this may come as a surprise, it is not hard to imagine a staff shortage situation where non-frontline staff have to be deployed to frontline positions.

Currently, both government and private hospital staff are out there working in places such as CACs (Covid-19 Assessment Centres) and all of them are feeling the strain. Many of them have to contend with staff shortages as they have to replace their colleagues who are under quarantine. – Dr Sharifa Ezat, who is attached to the Faculty of Medicine at Universiti Kebangsaan Malaysia (UKM)[7].

Shifting working environments with the lack of appropriate training and experience may trigger anxiety, stress and depression in non-frontline workers especially with an increased patient load.

Medical Personnel Also Need Mental Health Support

In light of recent mental health statistics, Health Director-General Tan Sri Dr Noor Hisham announced that healthcare workers involved in combating COVID-19 will be granted unrecorded leave with the approval of respective department heads[8]

The Ministry of Health also deployed Mental Health and Psychosocial Support Services (MHPSS) to low-risk treatment and quarantine centres to provide counselling and intervention for staff and patients alike[8]. MHPSS is formed by a core team medical officer, counsellor, and paramedic that underwent Psychological First Aid (PFA) training[9].

Source: Bernama via The Star

Despite the government’s effort, a bigger stigma of mental health remains unaddressed.

There is a lot of resistance towards seeking help as mental illness is seen as something you can handle on your own or bounce back from. – Dr Nicholas Pang, deputy director of Hospital Universiti Malaysia Sabah[10].

Seeking psychiatric assistance is yet to be normalised, especially in states where psychiatric service remains scarce. Healthcare workers are as vulnerable as normal folks to fall for this stigmatization.

It’s a major issue in Sabah in general. People think you can sort it out yourself whereas no one would actually tell someone with diabetes or high blood pressure to do so. – Dr. Nicholas Pang[10].

It has been said that almost all public hospitals in the country have a counselling unit made available for healthcare staff[11]. However, even with the ubiquity of such services, most frontliners simply could not carve out the time for a counselling session when they could not even get time for shut-eyes.

Source: The Sun Daily

The collaboration of MOH’s Crisis Preparedness and Response Center and Mercy Malaysia is seen as a welcomed sign[12]. A hotline has been set up to receive and refer cases to relevant bodies so that psychosocial and mental health services can be coordinated. If you are or know any healthcare worker suffering from mental distress, do not hesitate to dial the hotline 03-29359935.

Alternatively, you can reach out to our network of changemakers who are ready to listen:

  1. MIASA provides support to patients and carers through their hotline 1-800-820066, which operates 7 days a week, 24 hours a day. Callers will be provided with the option to speak in either English or Bahasa Malaysia.
  2. Thrive Well is a social enterprise with a mission to  expand trauma-informed community mental health services to individuals, communities and organisations. They provide counselling,  psychotherapy, and mental health screening upon appointment here
  3. Talian Kasih is a 24-hours hotline operated by the Ministry of Women, Family, and Community Development that responds to community crises and provides inquiry on counselling and social welfare. Phone: 15999 or WhatsApp: +60192615999
  4. MMHA is a non-profit non-government organisation that provides community psychological support services and training. They can be reached via the helpline +603 2780 6803 which operates on weekdays 9am to 9pm.
  5. Befrienders is a not-for-profit organisation providing emotional support 24 hours a day, 7 days a week, to people who are lonely, in distress, in despair, and having suicidal thoughts – without charge. They can be reached by hotline 03-76272929.

Explore Our Sources:

  1. Ministry of Heath Malaysia (2021, October 29). COVID-19 Cases in Malaysia. COVIDNOW. Link.
  2. Institute for Health Behavioural Research (IHBR). (2020). Psychological Effects of Coronavirus Disease 20219 (COVID-19) amongst Healthcare Workers. Ministry of Health Malaysia. Link.
  3. Nurhanis Syazni Roslan et al. (2021). Burnout Prevalence and Its Associated Factors among Malaysian Healthcare Workers during COVID-19 Pandemic: An Embedded Mixed-Method Study. Healthcare. Link.
  4. Yuen, MK. (2020). Away from home to fight Covid-19. The Star. Link.
  5. Mohd Fadhli Mohd Fauzi et al. (2020). Doctors’ Mental Health in the Midst of COVID-19 Pandemic: The Roles of Work Demands and Recovery Experiences. International Journal of Environmental Research and Public Health. Link.
  6. Mohd Noor Norhayati, Ruhana Che Yusof & Mohd Yacob Azman. (2021). Depressive symptoms among frontline and non-frontline healthcare providers in response to the COVID-19 pandemic in Kelantan, Malaysia: A cross sectional study. PLOS ONE. Link.
  7. Bernama. (2021). Is fatigue setting in for Malaysia’s healthcare workers? The Sun Daily. Link.
  8. Bernama. (2021). Health DG: Health Ministry aims to prevent burnout among healthcare workers. The Star. Link.
  9. Mental Health, Substance Abuse and Violence Injury Prevention Sector (MeSVIPP) Disease Control Division. (2020). SOP MHPSS for COVID-19 Response in Quarantine Stations. Ministry of Health Malaysia. Link.
  10. Fong, D.R. (2021). Fear and shame prevent mentally ill Sabahans from getting help. Free Malaysia Today (FMT). Link.
  11. Between the Lines. (2020). Battling the beast within: The psychological trauma of Covid-19. Malaysiakini. Link.
  12. Hassandarvish, M. (2020). Mercy Malaysia, Health Ministry start free mental health hotline to ease Covid-19 lockdown emotional trauma. Malay Mail. Link.
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