After months of social distancing, isolation and lockdown, it’s possible that the negative mental health effects of the COVID-19 pandemic could outlast the physical health impacts. In August 2020, figures from the Office of National Statistics showed that the number of adults experiencing some form of depression in Great Britain had doubled during the pandemic.
Harpreet Chana, former digital programme director at the National Pharmacy Association and previously head of pricing at the Pharmaceutical Services Negotiating Committee, has experienced her own personal battle with depression — a battle which led her to consider taking her own life.
Describing it as a “divine moment”, Chana — now founder of the Mental Wealth Academy, an organisation aimed at helping professionals build their self-leadership and self-regulation skills — says she has chosen to devote her life to helping other people in order to prevent them from ever getting to the point that she experienced.
Chana spoke to The Pharmaceutical Journal from her home office, giving her insight into why the pandemic is having such an impact on our mental, as well as our physical, health; what she thinks of the government’s approach to help those with mental ill health; and what pharmacy teams can do to support each other through this difficult time.
Why have the past seven months had such a detrimental effect on our mental health?
The levels of stress and anxiety are going to go absolutely through the roof
The key things here are the feelings of loneliness and isolation; people that are living on their own, the elderly, people who are shielding — all of those people are going to feel really lonely.
The not so obvious bit is that you’ve got people like myself who’ve worked from home since the beginning of March; I don’t have colleagues that I check in with every day, so I do feel isolated. And there’ll be others that do as well; there are teams out there that don’t have social things, that don’t really get on with each other. You’ve got people living in house shares all over the country; they just have their rooms and the kitchen or the communal area, and they’ve been stuck in those rooms for seven months now.
I think it’s clear that, for the next six months or so, we’re going to be in and out of these types of lockdowns and it’s already impacting people’s mental wellbeing — we’re seeing more people drinking, putting on weight and not exercising because the gyms have been closed.
I’ve not even touched on the grief, the trauma, the anxiety. And it’s only set to get worse; we’ve got a lot of people that are facing losing their jobs and not knowing how they’re going to put food on the table. The levels of stress and anxiety are going to go absolutely through the roof.
And even then, there are the people that are working on the pharmacy frontline — we’re going to have a whole load of people who are going to be absolutely exhausted; not taking their holidays, not taking breaks, because they feel that they can’t because of the demand for medicines.
I’m talking about a tidal wave of mental health conditions.
What are the signs and symptoms pharmacists should be looking for?
A lot of the time, people who are struggling might not want other people to know that they are
A lot of the time, people don’t want to talk about it because they don’t know how. But it’s just about asking “Are you OK?” and then really listening to the response. If you know that people are vulnerable, if you know that people live on their own, just have a conversation with them.
If you’ve started to notice a change, for example, in a colleague — changes in their standard of work or their ability to focus on tasks, or if they’ve talked about being worried about things, or if they’re a bit withdrawn. Or, if it’s a patient who normally comes in and chats with you, and they’re not, or people who complain of feeling tired all the time, or who might have increased their smoking or drinking or eating junk food — it’s not always obvious so the need is to regularly check in, whether they’re a patient or a team member.
You’re not always going to pick up on everything; a lot of the time, people who are struggling might not want other people to know that they are, so they pretend that everything’s OK.
What can pharmacy teams do to support each other?
Open communication is key. Too many of us don’t want to have a conversation around mental health because it’s awkward and difficult, and we don’t feel equipped to be able to.
Every pharmacy should have some sort of wellbeing strategy — how do we manage our own wellbeing within the pharmacy environment? What initiatives can we put together to ensure that we’re looking out for one another? The next few months are going to be tough. Sitting back and hoping everyone will be OK is taking a risk.
As a line manager, it is so imperative that you regularly check in and ask how your team is; your staff need to feel that they can be open and honest with you and that they will be supported.
The NHS has allocated £15m to strengthen mental health support for healthcare professionals in England, including pharmacists — is this enough?
There is nothing that equips pharmacists with the skills to self-regulate and not fall victim to mental ill health
I’m pleased that there’s some recognition that pharmacists need support with their mental health, but it’s just a drop in the ocean. There is nothing that I can see out there that equips pharmacists with the skills that they need in order to be able to self-regulate and not fall victim to mental ill health. Last year a Royal Pharmaceutical Society and Pharmacist Support survey found that 80% of the profession was at a high or very high risk of burnout, and this was pre-COVID.
I’d like to know how that money is being spent. I’d like to be able to see who’s going to benefit from that. It’s only a few pennies per person — who’s benefiting from it, how’s it going to be spent?
I’d like to see it spent on more widescale programmes to improve the resilience, confidence, emotional intelligence and self-compassion of pharmacists on the ground, because that’s what they need.
Last year, New Zealand became the first country in the world to publish a “wellbeing budget” — should the UK follow suit?
This is where we fall down as a country; we just don’t see the value in wellbeing. It’s an afterthought. Anyone working in wellbeing will tell you, in order for your organisation to be “healthy”, your wellbeing strategy needs to align with your corporate strategy and it has to filter through the organisation from the chief executive, right down to the part-time cleaner.
Companies tell me they’ve not got money for training or coaching for wellbeing, and it baffles me. It shouldn’t be an afterthought. It should be at the heart of everything we do.
It’s not just about absenteeism, it’s the presenteeism that’s the problem. Staff might be there physically but they’re not there mentally. And then there’s discretionary effort; you can always tell how happy your staff are by the level of discretionary effort that they put in. Let’s say companies expect you to give 100% effort all the time — if you give that all the time, you will be at burnout. So, on average, most people think it should be at about 80% effort. The reality is that most employees give 30%; that’s the minimum that you can give without being sacked. That 50% gap between 30% and 80% is what’s called the discretionary effort.
Do you think pharmacists truly understand the link between physical and mental health?
I think we understand from a textbook point of view: we know that good physical health promotes good mental health. It’s the advice that we give to our patients but it doesn’t mean that we follow it ourselves.
One of the first things that I would say to anybody who feels that they’re at the point of burnout, stress, depression or anxiety is you’ve got to get your endorphins going. It’s nature’s way of lifting us out of that fog.
But it’s just not advocated enough. When you’re feeling depressed and anxious, or you haven’t slept properly in weeks, the last thing you want to do is go and push yourself to do exercise. But actually, one of the best things that we can do for mental health is to get out — at least half an hour in the day — if you can get some fresh air to get a bit of a walk.
Mental and physical health is inextricably linked and there is probably a bit more work that we could do as a sector to understand that better.
How else can people look after their own mental health?
You need to find a way to fill your cup back up
It’s about understanding — we all have empty cups now and again. The first thing is not to beat yourself up about it; everyone is struggling right now. You need to find a way to fill your cup back up and this will be different for everyone — going for a walk, sitting and having a chat with a good friend, a digital detox, something you really like to do but have told yourself you don’t have time for.
As pharmacists we put the needs of everyone before ourselves. We push ourselves to the brink because we believe that’s what we’re supposed to do, but we shouldn’t deplete ourselves in the process.