How to Promote Wellbeing. Rachel K. Thomas
within the existing hospital system of many countries, the stresses of work are also related to the infrastructure that we are working within. They may be due to a range of factors, including excessive workloads, a workplace culture that is unsupportive of lowering stress at work, and other aspects of the overall work environment.
In times of crisis, efforts to expand the healthcare system lead to increases in these stresses. Doctors being moved to areas of practice where they have lesser familiarity working in – some even returning from retirement – leads to increases in stress. Inadequate personal protective equipment (PPE) and staffing rotas lead to clinicians being put in positions that can harm not only their own health but that of their patients, too. There is often an ‘all systems go’ approach to handling crises, while the ‘recovery’ or ‘debrief’ phases of such times are often viewed as being less important. After periods at war, the returned servicemen and women have current practice guidelines for debriefing techniques.5 Given their exposure to death and suffering during their work, it is well recognised that some kind of support will benefit them once they return. We, as clinicians, are also constantly surrounded by death and suffering and may be physically and mentally stretched beyond our coping resources. We are trained to manage both patients and our feelings about their health in times of crisis, but perhaps current practice guidelines should afford us similar support. Reflecting on the support offered in corporate environments may highlight that mental health education and stress management support is offered more extensively there, too, than it is for healthcare professionals.
Our conversations on wellbeing and mental health need to start focussing more on organisational change. However, since organisational change tends to evolve slowly, it may be useful for us to ‘put on our own oxygen mask first’, as the airline safety videos so aptly phrase it, and learn a few techniques that may help ourselves to relieve the situation on a personal level, until the required systemic changes are eventually implemented. Part of this ‘top down’ change can begin with a ‘bottom up’ approach: learning and implementing techniques on a personal level will contribute to the required attitude and institutional changes further up in the system.
It may well be that, given the significant burden of mental health across the globe, our global approach to how it is managed needs to be reviewed. Whether it is increased education in school systems or increased access to telehealth resources – there are multiple avenues for improvement. Maybe the most effective remedies will prove to be institutional as well as personal; only time will tell. In the meantime, however, we clinicians tend to, by necessity, be practical and solution focused. We also tend to appreciate an approach with different and complementary prongs – a multi‐disciplinary team approach. While reflecting on greater policy change, it makes sense to reflect not only on some of the wide issues relating to our wellbeing, but also on some of the solutions.
Problem factor: Accessing resources
The issue of the lack of adequate resources for mental health and wellbeing is universal. Across the globe 70% of the general population with a mental illness do not receive any treatment from trained healthcare staff (Figure 1.1).6 The reasons for this are multiple and complex; however, they include:
Ignorance of presenting signs and symptoms
Ignorance of treatment access pathways
Perception around mental health
Concerns about being discriminated against.2
Figure 1.1 Around 7 in 10 of the general population across the globe with a mental illness do not receive any treatment from trained healthcare staff.6
Approximately one‐third of global adult disability is due to issues surrounding mental health.2 So sobering are these statistics that bodies such as the WHO have responded with ‘Mental Health Action Plan’ directives.2 These include:
More effective leadership and governance for mental health
The provision of comprehensive, integrated mental health and social care services in community‐based settings
Implementation of strategies for promotion and prevention
Strengthened information systems, evidence, and research.7
As mentioned, evidence suggests that it may take almost a decade for treatment to begin for depression after depressed symptoms have first appeared.2 There is also evidence that delays in health professionals seeking treatment are greater than those of the general population. Hence the statistics for us and our colleagues could clearly be improved.
There are a range of different care options for mental health. While traditional face‐to‐face consultations with a trained clinician are key in some cases, there are a range of other, potentially more accessible treatment options that may be suitable in some cases. Some may include telemedicine, or complementary and alternative treatments. While some of these are in relative infancy, their potential is promising. Internet‐based cognitive behavioural therapy programmes aim to teach both cognitive skills – such as identifying depressogenic biases in how information is being processed – and behavioural skills, such as strategies to solve problems.
A range of factors may delay clinicians
accessing mental health and wellbeing resources.
Clinicians also may delay access to care due to concerns around confidentiality.8 There are other factors affecting how and why we access support in the way we do, as we will cover in the coming chapters.
Problem factor: Multiple potential impacts on individual mental health
The biopsychosocial (BPS) model framework is used to explore how a mental health condition has arisen.9 The BPS model outlines the broad scope of areas that impact on our mental health, and systematically shows their inter‐connections. According to this framework, there are various interconnected components that contribute to mental health conditions. These include the biological, the psychological, and the social. It shows that social parameters, the surrounding personality, and our emotional tone, as well as many other aspects all influence our mental health.10
Some factors include (Figure 1.2):
Biological: age, genetics, gender, disability, co‐morbid disease
Psychological: beliefs, attitudes, self‐perception, self‐esteem, coping skills
Social: friendships, occupation, employment, family relationships, social support systems, socioeconomics.
Figure 1.2 The biopsychosocial model indicates the interconnectedness between biological, psychological, and social factors that influence mental health.
Some of these aspects are modifiable; for example coping skills are highly modifiable.
Neurobiology and genomics research provide strong evidence on the complexity of the expression of mental health conditions. A simple, linear cause and effect model rarely, if ever, can explain a