It is no surprise that Covid-19 has negatively impacted the mental health of the healthcare workforce.

A blog post from the Greater Manchester Mental Health NHS Foundation Trust [1] acknowledges that experiencing distress and mental health problems during a pandemic is not a novel occurrence for healthcare workers.

Previous health crises including SARS, Ebola and MERS have been associated with increased risk of stress-related disorders, depression, and anxiety. Cross-cultural studies during the Covid-19 pandemic have similarly identified an increased risk of mental health issues in healthcare workers.

Everyone has their own story about the pandemic. Those working on the frontline have had to deal with an increased level of worry and stress:

  • Anticipation and fear. The fear comes in waves depending on the personal journey with and connection to the virus.
  • For staff working on the frontline, concerns for their own safety as well as the safety of their loved ones has to be considered, causing significant worry and stress.
  • Frontline workers were thrown into a different world where homelife and work life became intertwined. The boundaries were changed in that unsafe actions in the workplace could result in harm at home.
  • Witnessing the deterioration in colleagues who unfortunately contracted the virus at work.
  • Moral injury in healthcare. The guilt that comes from a fear of not being able to do the job to a normal standard.
  • Workers can suffer from survivors’ guilt, especially after witnessing colleagues fall victim to the virus.

Reflecting on Less Spoken Impacts

“We have all felt the impact of Covid-19. It has had a damaging effect on us physically and mentally, on our sense of ourselves, our ability to cope, on our relationships, our communities, on the economy and global partnership. However, some groups of people have felt the impact much more than others because they were already vulnerable, or they now find themselves particularly at risk” – Al Beck, South London & Maudsley Resilience webinar series [2].

There was a disproportionate amount of Covid related deaths in the black and ethnic minority frontline workforce with severe implications on the mental health of surviving colleagues.

Our systems better suit the needs of more senior clinical staff than junior colleagues, with junior colleagues being more likely to come from black and ethnic minority backgrounds. Reflective spaces are necessary for trauma treatment, but these are more easily available to predominantly white clinical staff and exclude other frontline workers such as porters, housekeepers, and cleaning staff.

Impact of the Pandemic on Staff Mental Health (Wave 1)

Estelle Moore is the Strategic Lead for Psychological Services at West London NHS Trust [3]. They presented two studies that assessed the impact of the pandemic on the mental health of healthcare workers.

Vanhaecht et al. (2021) [4] found a higher level of negative personal and professional symptoms in healthcare workers during Covid-19 than before e.g., hypervigilance, fear, fatigue, difficulty sleeping, unhappy and dejected, doubting knowledge and skills, feeling on their own and avoiding risks.

Tracy et al. (2020) [5] found that treating Covid-19 poses a risk for moral injury, which is associated with emotions such as shame and guilt and can lead to the development of mental illnesses such as depression or PTSD.

Research shows that where NHS trusts prioritise staff health and wellbeing and actively engage with staff to develop work in this area, levels of engagement increase. As does staff morale, loyalty, innovation, and productivity, all resulting in higher quality patient care.

Three Phases of Support Needed for Staff During Covid-19

Dr Sonya Wallbank is the Head of Culture Transformation for NHS England and Improvement and a Consultant Clinical Psychologist [6]. Sonya identified three phases in which NHS staff needed support during the pandemic.

At each phase, healthcare workers will be going through different experiences which will have an impact on their mental health.

  • Anticipating peak of demand: Worrying about own safety and safety of family and loved ones. Fear about the demand to come and worry about what they will be asked to do. Insecurity about whether they will perform well enough and who will have their back if things go wrong.
  • Demands reach peak: At this stage, work is intense and consuming. Staff pay limited attention to their own needs. Guilt, remorse and worry about performance crops up and fear of disappointing families, colleagues and the media comes into play.
  • Through the peak: Survivor guilt is common, especially in situations where a worker has watched a colleague pass away. Moral injury occurs in which performance is scrutinised.

Support Available for the NHS Workforce around London

Throughout the pandemic, there was an array of mental health resources available for healthcare workers to access to help. These included:

  • Decompression rooms with tea and coffee
  • Dedicated helplines and inboxes
  • Regular ward visits from psychologists, chaplaincy, and counsellors
  • Wellbeing apps and podcasts
  • Staff Wellbeing Champions to check in on staff in hospitals
  • Peer to peer staff support line
  • Rest and recharge hubs
  • 24hr chaplaincy helpline

Keeping Well

One of the things that the pandemic has taught us is the need to work across boundaries to move towards integrated care. A good example of this is the introduction of Keeping Well by the West London NHS Trust.

Keeping Well is a free and confidential psychological support service run by care professionals for care professionals in Northwest London. It was launched in response to Covid-19. The service gives quick access to support for healthcare workers who need to speak about their mental health.

All NHS staff in Northwest London (including non-clinical staff) have access to Keeping Well. Additionally, all staff in care/residential homes in Northwest London and all London ambulance staff have access to the service.

Part of the project involved reaching out to the managers of care homes to try and get wellbeing messages across to staff.

There were over 1000 referrals to the Keep Well service between June 2020 and February 2021. Of all those that have been referred to the service since June 2020, 61% have made a recovery.

Of those known, 55% of referrals are from black and ethnic minority staff.

The West London Trusts’ Response to any Future Waves

The West London Trust have developed a framework that has identified 4 key areas that need to be taken care of to promote the better mental health of workers, should there be another wave of the virus. These are:

  • Physiological essentials: Easy access to hot food and water. Implementing regular breaks and rest. Support for staff with taxis and travel. Accommodation help. Spiritual and financial wellbeing.
  • Compassionate inclusive leadership behaviour: Compassionate leadership to address staff concerns. To ensure leaders are good role models and supportive.
  • Reflective practice: Focus on encouraging teams to check in with each other. Support for non-clinical staff. Rebuilding of teams who have been fractured due to redeployment.
  • Active listening and psychological conversations: Provide time and space for short wellbeing conversations. Provide access to psychologists and counsellors. Promote rapid access to Keeping Well digital hub.

Final Recommendations

Estelle Moore recommends that Integrated Care Systems be required to facilitate access to wellbeing support for NHS and social care workers across their systems and that they are accountable for the accessibility and take-up of those services.

To recognise and support all staff to ‘rest, reset and recover’ post Covid-19 and to retain an ongoing and strong focus on staff physical, mental, and emotional wellbeing is essential. By offering great staff support, benefits and working environments the NHS can achieve this.

[1] Greater Manchester Mental Health NHS Foundation Trust. 2021. CARMS Blog: The Impact of the COVID-19 Pandemic on the Mental Health of Healthcare Workers

[2] Al Beck, South London & Maudsley Resilience webinar series

[3] Moore, Estelle. 2021. Strategic Lead for Psychological Services at West London NHS Trust

[4] Vanhaecht, K., Seys, D., Bruyneel, L., Cox, B., Kaesemans, G., Cloet, M., … & Claes, S. (2021). COVID-19 is having a destructive impact on healthcare workers’ mental well-being. International Journal for Quality in Health Care.

[5] Tracy, D. K., Tarn, M., Eldridge, R., Cooke, J., Calder, J. D., & Greenberg, N. (2020). What should be done to support the mental health of healthcare staff treating COVID-19 patients?. The British Journal of Psychiatry

[6] Wallbank, Sonya. 2021. Head of Culture Transformation for NHS England and Improvement

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The Covid-19 pandemic has taken an unprecedented toll on our healthcare workers. Consequently, the workforce are struggling with their mental health. This case study examines this and suggests ways to help these workers.

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