Staff support during COVID-19: MHPSS initiatives from Miri General Hospital, Malaysia
Dr Raja Lope Adam is a psychiatrist and the Mental Health and Psychosocial Support (MHPSS) team leader at the Miri General Hospital, a public tertiary hospital in Sarawak, Malaysia. The hospital has approximately 350 beds with a psychiatric ward and a COVID-19 ward. The MHPSS team consists of psychiatrists, clinical psychologists, counsellors, medical officers, allied health officers and the assistant hospital director. In this post, Dr Adam and psychiatrist Dr. Bawih Inu Pu’un share the team’s activities to support hospital staff during the pandemic.
|Establish rapport with other departments and hospital admins||Group and individual sessions, a Rest N' Go lounge and a buddy system to support staff|
|Think outside of the box while adhering to ethical principles||Policy modifications incorporating national and international COVID-19 MHPSS guidelines|
|Look after others, but don’t forget to look after yourself and and your teammates||Workbook for patients affected by COVID-19|
This pandemic has affected all people around the globe psychologically, including members of the public, patients, health care workers and administrators. At our hospital, both COVID-19 and psychiatric patients, as well as their family members, have experienced increased anxiety. As a result of the government Movement Control Order, family members have increasingly requested admissions for relatives with mental health disorders as they struggle to cope and care for them at home.
Front-line health care workers providing medical treatment for COVID-19 patients face burnout with extremely high workloads. Medical staff not treating COVID-19 patients also feel anxious given potential exposure to high risk cases in general wards. Initially, they were not always included in certain information on the hospital's COVID-19 related activities, which caused confusion.
Over weeks of uncertainty, the MHPSS team and administrators have also experienced anxiety and mental exhaustion. This is the first time many of us have handled a disaster of this level, and every day we encounter new challenges, strategies and opportunities for cooperation.
Our team provides MHPSS, including psychological first aid (PFA) for patients, health care workers (hospital and district level) and hospital administrators. The challenge is to balance providing support in response to COVID-19 while continuing to care for existing psychiatric patients and their carers. One of the ways to mitigate risk of infection is to divide the team into two groups: one conducting MHPSS activities in response to COVID-19 and another continuing clinical psychiatric work.
The pandemic has required us to be flexible and make several adaptations to respond to the ever-changing situation. As instructed by the Ministry of Health, our MHPSS team was created in accordance with IASC recommendations. Our main activities have included:
1. Policy modifications. We adapted our local policies to incorporate international and national guidelines for disaster response. Updated MHPSS policies include staff wellbeing, suicide prevention and support for the homeless population. Updated clinical policies include outpatient and inpatient care, community psychiatry and contingency and disaster plans.
2. Organisational chart. We developed a clear organisational chart of personnel and their core functions for the MHPSS team.
3. Online training. We are providing training about MHPSS, PFA and suicide prevention via an online platform to staff at the hospital and district levels.
4. Staff support. Activities to support staff include:
- Group sessions for directors and administrators under the One Stop Centre for Psychological Support (OSCePS) programme. We limit sessions to 10 people, maintain physical distance, wear appropriate personal protective equipment (PPE) and practice good hygiene before and after sessions.
OSCePS group session
- Individual sessions provided via an online platform and face-to-face at the hospital. For in-person sessions, we conduct COVID-19 screenings, maintain physical distance, wear proper PPE and practice good hygiene before and after.
- The 24/7 ‘Rest ‘N’ Go’ lounge offers food, drinks, a washroom and a place to rest.
- A buddy system for top and middle management allows one person to rest intermittently while the buddy temporarily shoulders his/her responsibilities.
5. Information campaigns. We created the slogan #HMiritogetheragainstCovid-19 to boost staff motivation and build a sense of belonging. Daily mental health tips in the main hospital and district chat groups help educate staff and increase morale. We also share videos on mental health tips to hotels designated as quarantine centres that they can play on their channels.
6. Workbook for quarantined patients. The workbook includes information on the virus, symptoms and ward procedures along with arts activities, crossword puzzles and more to support Covid-19 patients during treatment.
Example workbook pages
To prepare for the possibility that the hospital will be converted to a full COVID-19 hospital, we have reduced admissions, increased community case management and converted clinical appointments into phone consultations.
We are also collaborating with the Social Welfare Department, District Health Office and enforcement agencies to provide screening among the homeless population and mental health care for those in need.
It is not easy to organise an MHPSS team in this disaster. Build rapport with administrators and the hospital director and make sure a member of your team is part of the main COVID-19 committee. Open communication and accurate and consistent information is key to coordinating the programme and helps manage the stress of everyone involved.
While policies are necessary, do not be too rigid as there will always be unexpected challenges. Think outside the box and explore new options while maintaining ethical principles. Taking intermittent breaks helps you take care of your own psychological health and the wellbeing of your team members.
- Basic Psychosocial Skills: A Guide for COVID-19 Responders (IASC) [Link]
- Remote Psychological First Aid during the COVID-19 outbreak (IFRC) [Link]
- Coronavirus disease (COVID-19) outbreak information for the Western Pacific (WHO) [Link]
- Basic psychological support for staff health during COVID-19 (ICRC) [Link]
- Mental Health & Psychosocial Support for Staff, Volunteers and Communities (IFRC) [Link]