By Karen Taylor and Krissie Ferris, Deloitte Centre for Health Solutions
This week, 18-24 May, is Mental Health Awareness week, aimed at encouraging people to talk about and take action to promote good mental health for all. The theme this year is ‘kindness’ to reflect the impact that acts of kindness can have on improving mental health.1 One area where acts of kindness have proliferated during the COVID-19 pandemic has been in the public’s acknowledgement and appreciation of the work of NHS staff. While this has undoubtedly helped boost morale, there is increasing evidence that the pandemic is taking its toll on the mental health of clinical staff. In recognition of these heightened risks, NHS employers at both national and local level, have used Mental Health Awareness week to raise the profile of, and signpost staff to, the numerous mental health initiatives that have been put in place to address their needs. This week’s blog explores the actions taken to protect and support the mental health of staff during the current pandemic, what more can be done to maintain staff resilience, and the lessons that can be built upon to ensure that the NHS has a sustainable future.
The impact of the pandemic on the mental health of clinical staff
NHS clinical staff have now spent some three months responding to the healthcare needs of patients with novel coronavirus symptoms for which no approved treatments are available. The health system, in the shortest of timeframes, had to reorganise services, train staff to work in new ways in unfamiliar teams, and develop an efficient and effective approach to supporting the workforce. At the start of Mental Health Awareness week the NHS Clinical Leaders Network has highlighted the stress and strain on frontline staff caused by working in high risk environments, changing job roles and working patterns and exhaustingly intense workloads, combined with a restricted ability to carry out, with their usual compassion, their roles towards patients and their families.2
Research on the eﬀects on mental health from previous pandemics shows that clinical staﬀ, if not adequately supported, are at higher risk of experiencing moral injury and developing mental health conditions such as depression, anxiety, and Post Traumatic Stress Disorder.3 Moreover, since the start of the pandemic, most NHS organisations have seen an increase in the need for mental health support among their staff and expect this to escalate as the emergency continues.4
A growing body of research published in early May illustrates the impact of the pandemic on healthcare professionals across the NHS:
- A BMA survey of 16,000 doctors found 30 per cent reporting they are more stressed and burned out than before the pandemic5
- Nearly 40 per cent of 1,651 Scottish doctors said that they were currently suffering from depression, anxiety, stress, burnout, emotional distress or other mental health condition relating to or made worse by their work. A quarter said this was directly due to the impact of COVID-196
- A Nursing Times survey of 3,500 nurses, showed a third describe their mental health as ‘bad’ or ‘very bad’, 50 per cent as “a lot” more anxious or stressed than usual, and over half (54 per cent) rated the support available as ‘inadequate/very inadequate’.7
Support is moving in the right direction
NHS England and NHS Improvement have launched a range of tools, free to all NHS staff, to support their wellbeing during this time. These include a mental health hotline and 24/7 text alternative, run by over 1,500 trained volunteers from charities including the Samaritans.8 They have also provided free to access wellbeing apps and digital services such as:
- SilverCloud, a digital health platform that provides online peer-to-peer, team and personal resilience support, and offers a range of COVID-19-specific cognitive behavioural therapy (CBT) courses free for all NHS staff and their families during the crisis9
- Sleepio and Daylight (developed by Big Health), which provide evidence-based CBT techniques through smartphone apps to help users manage poor sleep, anxiety and worry
- Headspace – a mindfulness and medication app that aims to reduce stress
- UnMind – a workplace mental health platform where employees can monitor their wellbeing and access programmes designed to help with stress, coping etc.10
New COVID-19 e-learning courses developed through Health Education England are also available.11 In addition, approaches being offered at individual NHS trusts include: debriefing sessions, ‘wobble rooms’ to share worries, listening ear newsletters and buddy systems.
The above are just some of the examples of services aimed at facilitating an open culture around wellbeing, while helping staff to feel supported and comfortable talking about mental health. As the NHS begins to recover from the current emergency there will be a need for multiple solutions to address mental health and wellbeing, and position the NHS to prepare for a sustainable future.
Maintaining support over the longer term
In Deloitte’s report, Mental health and employers, Refreshing the case for investment we highlighted how investing in mental health support benefits employers as well as employees and that the interventions with the highest returns tend to be preventative, using technology to identify and tailor support for those most in need. A case study yielding one of the highest returns on investment, proactively screened nurses at higher risk of burnout, aiming to detect mental health problems early and offer training to prevent problems worsening. Given that previous disease outbreaks have had longer lasting psychological effects on healthcare workers,12 there is a clear economic case for continuing to support staff wellbeing in the aftermath of COVID-19, thereby reducing avoidable lost days by investing in technology-based mental health support.
In February 2020, just before the impact of COVID-19 started to bite, the percentage of respondents who said there were not enough staff in their organisation for them to do their jobs properly had increased slightly from 30.3 per cent to 32.3 per cent, with 77 per cent reporting unrealistic time pressures. The percentage reporting work-related stress illnesses had increased from 37.1 per cent in 2014 to its highest level of 40.3 per cent in 2019.13 While the long-awaited ‘NHS People Plan’ offers a unique opportunity to ensure transformational change across the NHS, this will require staff to be given a voice and influence to shape the way they deliver care, something we have seen driving the response to the COVID-19 pandemic.
Preparing for the long term
Let’s hope that Mental Health Awareness week provides the much needed boost to supporting the mental health and wellbeing of NHS staff. However, as the peak of COVID-19 eases, staff are likely to face additional pressure from the ‘backlog’ of hospital activity postponed during the pandemic. Promoting an open culture around mental health, investing in preventative and tailored wellbeing interventions and using technologies to identify and tailor support to those in need could help organisations prepare for and meet the mental health needs of staff. The lessons learned from the way the NHS responded to the pandemic both what went well, and what went less well, and the structural gaps that have been exposed, need to be addressed as a matter of urgency and used to reshape the long-awaited ‘NHS People Plan’ to ensure a sustainable future for the NHS. As the NHS reset phase gets underway, additional support will be needed if the NHS is to be able to protect its workforce, maintain the delivery of services and retain crucial resources.