September 3, 2020 | By Zixiang (George) Zhou, Associate, Bridge Consulting | Image source: Xinhua News Agency
- In addition to measures led by the Chinese government, China’s response to mental health challenges among frontline health workers throughout the COVID-19 pandemic has also involved Chinese philanthropic organizations and private companies, which have both taken noteworthy measures.
- The case of China offers insights and lessons — both the good and the bad — on addressing mental health challenges among COVID-19 frontline health workers.
You may wonder why you should care about the mental health of COVID-19 frontline health workers in China. The reason is simple: when the worst of the crisis is over, the time will come to reflect on these experiences. As one of the first countries that brought the COVID-19 pandemic under control, China is evaluating its response to the COVID-19 pandemic. This piece offers a glimpse of this evaluation, and it is our hope that you will find China’s experience and lessons learned useful.
How Severe Was the Mental Health Challenge?
Since the containment of the COVID-19 outbreak in China, numerous Chinese institutions have conducted large-scale surveys and studies on the mental health of frontline health workers, in order to understand this issue and draw lessons for the future.
Studies on the mental health conditions during China’s initial response to COVID-19 have shown that many frontline health workers suffered from various mental health issues such as anxiety, depression, insomnia. The pandemic has also left a mental scar on many frontline health workers with conditions such as post‐traumatic stress disorder (PTSD).
- According to Lu Lin, an academician of the Chinese Academy of Sciences and an expert advising the Chinese government, the incidence rate of mild to severe anxiety, depression, insomnia, and various other mental health problems among Chinese COVID-19 frontline health workers could be as high as 50 percent.
- A study published in the medical journal The Lancet revealed that up to one-sixth of the Chinese frontline health workers surveyed between February 17 and 24 reported mental health challenges.
- Another survey also showed that frontline health workers in the city of Wuhan experienced somatization, showing symptoms such as shaking hands or feet (26.8 percent), numbness and/or stabbing pain in hands and feet (32.1 percent), and stomachache and indigestion (52.6 percent), and only 8.5 percent of them could sleep well often.
Potential Impact on the Profession at Large
In addition to the immediate impact the mental health challenges described above would have on frontline health workers, this issue could also have a lasting impact on these health workers and health worker as a profession. According to a March survey of 9,785 Chinese health workers working in 25 different Chinese provinces, for instance, more than 20 percent of surveyed health workers would not become a health worker if they could choose again and another 25 percent were not sure.
China already had a serious shortage of health workers before the pandemic, with a need for millions more in the coming decades. The shortage of health workers is not just a Chinese problem. The World Health Organization (WHO) predicted a projected shortfall of 18 million health workers primarily in low- and lower-middle-income countries by 2030. Deteriorating mental health conditions among health workers will make it harder for China and the rest of the world to attract, train, and deploy more health workers.
What Caused the Mental Health Issues Among Health Workers?
Some of the underlying causes of mental health challenges among health workers that have surfaced because of the COVID-19 pandemic include:
- Overwork. The same March survey cited above shows 84.4 percent of frontline health workers believe their workload almost doubled during this period of time and 6 percent of them believe their workload have been quadrupled.
- Fear and Discrimination. Beyond the very real fear of a highly infectious virus like SARS-CoV-2 (the virus that causes COVID-19), the danger faced by health workers also incited discrimination against them. A Chinese government report in early March estimated that more than 3,000 health workers had been infected with COVID-19 in Hubei province alone, and there have been numerous reports of discriminatory behaviors against Chinese frontline health workers.
- Shortage of PPE. At the beginning of the COVID-19 pandemic in China, a shortage of PPE forced hospitals in Wuhan to solicit direct donations from the public, and health workers in the city of Wuhan openly expressed their concerns and frustrations with the situation.
Other long-existing, systemic issues also played a significant role:
- Unbalanced and Underdeveloped Healthcare System. The Chinese healthcare system is unbalanced and underdeveloped for its massive population, and health workers are often trapped in underfunded, inefficient healthcare systems while being underpaid and overworked.
- Gender Inequality. Female frontline health workers’ needs were often trivialized or even ignored. Attention has been called to gender inequality issues such as the shortage of female hygiene products available for female health workers sent to Hubei and PPE designed to fit men instead of women.
- Underappreciation. A general underappreciation of nursing staff has also been a problem, despite the essential role they play in the care for patients. Like in many other countries, nurses in China are often under-compensated, and often treated with less respect by patients, the public, and other health workers.
What Has China Done to Address These?
Governments, philanthropic organizations, and private companies in China were swift in taking measures aimed at addressing mental health challenges among health workers.
Government Response. The Chinese government took the lead early on in the pandemic to address issues concerning the mental health of frontline health workers. As early as February 4, China’s National Health Commission set up a psychological assistance services expert working group that was sent to Wuhan to formulate plans to help frontline health workers address mental health challenges. Since February, the central government has issued numerous guidelines to protect the mental and physical health of health workers. These guidelines make a call for relevant government agencies and medical facilities to:
- Increase efforts to protect health workers against COVID-19 and other dangers;
- Ensure frontline health workers can get sufficient rest;
- Provide psychological counseling and other mental health services to health workers;
- Give frontline health workers increased stipends and/or other financial assistance;
- Crack down on discrimination against health workers and their family members;
- Provide care for family members left unattended by frontline health workers.
Local governments across China quickly followed suit and issued more specific measures detailing how they would achieve these objectives.
Building on these short-term measures, some effort has also been made to address underlying, systematic issues. Proposals have been submitted by representatives to the Chinese National People’s Congress calling for reforms such as revamping China’s public health and healthcare system and giving health workers better compensation and greater respect. The Chinese public and media in China have also called on the government and healthcare industry to address the issue of gender inequality that surfaced during the pandemic and take active measures to empower female health workers.
Philanthropic organizations. Although the Chinese government took the leading role in responding to the mental health challenges facing Chinese frontline health workers, Chinese philanthropic organizations also stepped in to fill gaps in important ways.
- Financing. Chinese philanthropic organizations also provided financial assistance to support frontline health workers. Tencent Foundation set up a fund with more than CNY 1.5 billion (~USD 216 million) to fight the COVID-19 pandemic, with a fifth set aside to provide assistance to the frontline health workers who have contributed to the fight against COVID-19 and their families. Of note, Tencent Foundation also donated CNY 6 million (~USD 864,000) to two leading Chinese mental health research institutes to fund psychological interventions serving frontline health workers.
- Goods. For example, according to a Chinese media report, of the 42,600 Chinese health workers sent to Hubei province and the city of Wuhan as of March 8, 2020, at least 28,000 were women. A shortage of daily necessities, especially female hygiene products, quickly emerged. Local volunteers and community organizers used Chinese social media platforms to raise awareness of this issue, and they raised funds as well as donations of female hygiene products which were then distributed among female frontline health workers in Hubei.
- Services. As soon as the severity of the crisis became apparent in January, Alipay Foundation started pulling together mental health experts across China’s leading universities and mental health institutions, and launched an on-demand online wellness therapy platform. According to a media report, by the end of May, over 400 volunteer counselors had already provided free mental health services to more than 500 frontline health workers, over more than 7,000 sessions.
Private Companies. Chinese private companies also participated in a number of ways. While some contributed through philanthropic organizations set up by them, as in the case of Tencent and Alipay, other companies donated directly to Chinese government charities to facilitate the care of frontline health workers. Companies in other industries also provided support for frontline health workers in various other forms. For example, a Chinese property management company promised to use no less than 2.5 percent of its management fee collected to improve the physical and mental well-being of frontline health workers and their families living in properties under its management. Private health facilities also took measures to address these challenges, such as giving frontline health workers employed by them large amounts of bonuses and rewards.
How China and the Rest of World Can Learn From Each Other
China might have claimed victory against the COVID-19 outbreak, but it has undoubtedly been a difficult war won at great cost of the physical and mental health of Chinese frontline health workers. Needless to say, the situation in China is very different from countries such as Italy and the US. Nevertheless, according to surveys and studies, frontline health workers in these countries are facing similar mental health challenges that have troubled their Chinese counterparts. Reflecting on China’s experience will hopefully provide the international community with an invaluable early review of issues related to the mental health of frontline health workers during the pandemic.
At the same time, China has much to learn from the rest of the world. The underlying issue that caused many of the mental health challenges has been China’s unbalanced and underdeveloped health care system. Especially in the aftermath of the COVID-19 pandemic, many experts and government agencies in China have been examining the healthcare systems in other countries such as the US, the UK, Germany, and Singapore. Such learning has also extended to the area of mental health services. In a report on China’s response to the COVID-19 pandemic, the Chinese Academy of Sciences’ Institute of Psychology analyzed Germany’s emergency management model and recommended China to establish a national emergency management psychological service team leveraging lessons from Germany.
As we navigate a pandemic that has known no bounds, may exchange between China and the rest of the world — especially in an area with such enduring impact like mental health — similarly transcend borders, distance, and politics.