At the start of the COVID-19 pandemic, Lancashire Teaching Hospitals Trust (LTHTR) recognised that more staff would need to access psychology services. Almost 1000 staff have been able to access psychological support since adopting new pathways as part of their overall health and wellbeing offer.
Key benefits and outcomes
A number of key steps were taken, including:
- development and delivery of a staff support helpline
- provision of individual therapy for identified staff
- provision of tailored group support to specific staff groups
- delivery of mindfulness based cognitive therapy to support mental wellbeing and resilience.
What the organisation faced
LTHTR had already made a commitment to support staff psychological wellbeing prior to the pandemic, with the provision of mindfulness sessions and courses since 2016, and individual therapy with a clinical psychologist since 2017. Additional investment for a cognitive behavioural therapist was established in 2019 to expand the provision of one-to-one and group therapy.
The incident support service was established in 2017/18 with a remit to support staff who had experienced distressing incidents at work through group and one-to-one sessions.
Early on in the pandemic, many staff groups and wards in the hospital were identified as requiring additional support to manage psychological wellbeing. This was delivered by staff from the health and wellbeing team, with strong support from other teams, building on the existing psychological wellbeing services.
What the organisation did
A number of staff support measures were introduced during the initial peak period of COVID-19, where significant changes to working practices of many staff occurred in addition to significant personal stressors. These additional measures included:
Introducing a staff support helpline
The trust was able to develop this new pathway quickly due to the pre-existing incident support processes and trained staff already in place.
Psychological wellbeing staff linked up with colleagues from health psychology, organisational development and the learning team to staff the helpline. To establish a consistent service as staff went back to business as usual, two psychological wellbeing practitioners were also recruited.
Staff contacting the helpline initially speak to a member of administrative staff, who gathers contact details and provides information on confidentiality. Callers are then contacted by a staff supporter either immediately or at a time convenient to them. Staff supporters can give psychological first aid, basic self-help strategies, signposting to relevant services/resources, or referral on for additional support during the first call.
All staff working on the helpline are trained in understanding and responding to common presentations following distressing incidents.
They have either undergone a robust selection process to evaluate their communication skills, non-judgemental attitudes and ability to escalate issues appropriately (for example, risk), or had a qualification and experience that covered these skills, such as mediator or mental health professional.
Senior supporters, clinical psychologists or cognitive behavioural therapists are on hand each shift for check-in, debrief, escalation of risk and triage of clients requiring additional help.
Providing individual therapy
To address issues such as anxiety, low mood and sleep disturbance, staff could be allocated to up to four sessions of brief intervention with either a cognitive behavioural therapist or clinical psychologist.
These sessions were initially offered remotely via telephone or MS Teams, although some staff were seen via socially-distanced face to face sessions where requested. The staff psychological wellbeing service was supported by the health psychology team in the early stages to increase their capacity for this support.
Mindfulness based cognitive therapy
Starting in October 2020, and in response to the increased demand for mental health related support, the trust offered their first mindfulness based cognitive therapy (MBCT) course. This course was delivered by their staff clinical psychologist who is trained and experienced in delivering eight-week mindfulness courses.
It is an established, evidence-based course that combines mindfulness meditation techniques with cognitive therapy techniques and aims to reduce the recurrence of depression and anxiety. The first course was supported by a psychological wellbeing practitioner who provided check-ins and between-session support where this was needed.
20 people started the course and attendance was excellent, with 15 people attending at least 6 of the 8 sessions. Initial feedback was very positive.
"The course has really helped me get through the recent tough times: I can’t thank you enough for the calm and peace you have brought to me."
Their second course was in January 2021 with 15 staff completing the training. The trust plans to run this course at least twice a year.
Group support sessions
Another offer to teams was the increased availability of group staff support sessions.
Teams, or groups requiring support, were identified through a variety of channels including manager referral or HR reviews. Examples of identified needs included distress in response to a staff member suicide, staff issues following redeployment, and staff groups identified as being of increased risk in the workplace including BAME staff.
Sessions lasted approximately 1 hour 15 minutes and followed a standard format:
- Group purpose and safety.
- Brief introduction to mental health and wellbeing.
- Staff share experiences.
- Introduction to psychological techniques (e.g. grounding technique).
- Psychological concepts (such as moral injury).
- Signposting to additional resources.
For some staff a single session was sufficient, whereas with other staff/groups a follow up session was needed.
Results and benefits
The demand for psychological support for staff during the pandemic has been sizeable. Between 30 March 2020 and 23 July 2021, the helpline received 710 requests for support from staff. In addition to telephone requests, email requests for support are also accepted and have proved a popular method of seeking support. Approximately 30 per cent of those who contacted the helpline were then referred on for brief therapy.
To date approximately 45 group support sessions have been delivered, reaching approximately 230 staff, with regular time slots for further sessions established.
For the majority of staff, access to psychological support has been rapid, with most callers contacted on the same day, and waiting times for brief intervention with a psychologist or therapist averaging 3.4 weeks, in comparison with previous waiting times for longer term therapy averaging at 19 months.
89 per cent of staff who completed the evaluation survey after contact with the staff support helpline, rated it as ‘helpful’; 65 per cent rating it as ‘very helpful’.
50 per cent of respondents commented that contact with the helpline either helped them to stay in work or return to work.
"They are valuable and a great support. This is the first time I have sought help of this kind and it was a positive experience, and just knowing it is there if I need it again, helps."
Some groups of staff have been difficult to reach (to date, BAME staff and domestic/housekeeping staff sessions have been poorly attended). Working closely with the organisation development team, HR and relevant managers has been important in trying to access harder to reach groups of staff and to understand their barriers to accessing support.
Although the majority of staff feedback has been positive, a small number of callers have been disappointed by the service provision. Limits to session availability and service remit means some staff have been unable to access additional in-house sessions.
Extra staff training has been offered to help communicate with clients whose needs may be better met by another service. As teams external to the psychological wellbeing service have returned to their usual jobs, with further peaks in COVID-19 emerging, waiting times for therapy have extended, meaning greater reliance on referrals to external services such as the resilience hub, while funding for additional posts is sought.
Due to the complexity and range of issues presenting through the helpline, a robust selection process was important for staff supporters. A high rate of offers of support at the start of the pandemic. were appreciated, but it didn’t always make best use of resources. It was important to establish a consistent skill set over a longer-term period. They found recruiting mental health professionals in temporary posts to be very difficult but offering permanent posts has been much more successful.
There was a significant amount of work involved in expanding systems to provide new services in a safe way. It was helpful that they had already considered this possibility as part of their major incident planning.
In meeting the psychological support needs of the staff at LTHTR in 2020, a number of new and innovative approaches have been developed to provide timely, varied, accessible and acceptable forms of intervention, which have included:
- a staff support helpline
- group support sessions
- brief individual therapy
- mindfulness based cognitive therapy.
To date, demand for psychological support continues, and further innovations including an introduction to CBT skills group and managing emotions and relationships pathway are now also being delivered. Interventions offered should be delivered by suitably trained individuals with robust support networks in place.
They were able to provide this level of support to staff much more quickly than other trusts, due to having an established psychological wellbeing service and continued investment in staff mental health. Planning staff psychological wellbeing support as a long term plan makes it easier to expand in times of greater need.