Mental health experiences of public psychiatric healthcare workers during COVID-19 across southern Gauteng, South Africa: a call for strengthening public mental health care

The global COVID-19 pandemic and South Africa’s national lockdown introduced serious threats to public mental health in a society where one in three individuals develop a psychiatric disorder during their life. Studies worldwide have illustrated the acute psychosocial strain and chronic psychiatric sequelae experienced by healthcare employees during the pandemic. Over and above existing systemic constraints, national leaders in public mental healthcare have reported serious challenges in delivering psychiatric services during COVID-19. Despite these early reports on the psychological and healthcare-related consequences of COVID-19, no study has evaluated the impacts of the pandemic on mental healthcare workers and psychiatric facilities in South Africa, nor have the implications for public mental health policy been elucidated. Here we examine the impacts of the COVID-19 pandemic in five specialised and tertiary psychiatric facilities in southern Gauteng. In-depth qualitative interviews (n=55) were administered to examine the perceptions of psychiatric hospital workers. Survey-based data (n=54) and regression analyses were conducted to examine associations between COVID-19 healthcare experiences and psychiatric morbidity. Our study found elevated psychiatric morbidity among hospital staff. Healthcare-related stress during lockdown Levels 3 to 1 was strongly associated with worse symptoms of depression, anxiety, and post-traumatic stress disorder. We also found salient experiences of fear and COVID-19 infection risk, acute resource shortages, and long-term healthcare infrastructural constraints. These circumstances undergirded and exacerbated harmful conditions that posed major threats to patient care, worsened occupational health, and compromised each hospital’s capacity to overcome the pandemic. Without major and expeditious policy action towards improving public mental health, South Africa is at risk for yet another mental healthcare catastrophe in the wake of the COVID-19 pandemic. We offer these findings to highlight the need for mental health promotion among hospital staff, identify constraints in the public mental health system, and provide future direction for mental health policy planning.