Experiencing a pandemic can be very unsettling and have a negative impact on someone's mental health.
Individuals may have a variety of concerns about the impact of the virus on their own health, their patients and, directly or indirectly, on staff's wider family and friends, particularly if they have caring responsibilities.
Supporting staff's mental wellbeing is critical to ensuring the sustained health and capacity of our NHS workforce as they respond to COVID-19. Staff will be affected differently depending on the individual and the stage of the outbreak, and employers' mental wellbeing support offer should take account of this. NHS England and NHS Improvement have developed a comprehensive package of practical support which is freely available to all NHS staff and can be used to compliment local approaches.
Three phases of support for NHS staff during COVID-19
The British Psychological Society has outlined three phases of support for NHS staff as they respond to COVID-19, which employers should consider when developing and implementing robust and comprehensive mental wellbeing support offers.
During this phase, NHS staff will likely experience anticipatory anxiety about the unknown potential of the outbreak on their personal and working lives. Many staff may feel unprepared with limited time to sufficiently plan and input into the rapid planning phase. Some NHS trusts may have already passed through this phase.
To support staff during this time, employers should consider the support systems already in place and review if they have/offer the following recommendations.
- Clear communication strategy – collective, honest, open and transparent messaging about plans to keep frontline healthcare workers safe, supported, and in good health in this shared effort against the virus. Encouraging staff to avoid speculation and reassuring them that they will be provided with the latest expert advice and information. Staff with concerns or questions can be encouraged to actively speak with their manager or union to alleviate concerns, as well as directing them to the latest PHE guidance. See our dedicated guidance for good practice examples of how NHS trusts are communicating their health and wellbeing support offer with staff during COVID-19.
- Visible leadership – leaders must be visible, available and supportive to their staff while guiding them through this uncertainty. They should lead the communication setting out clear expectations for staff, preparing them for what is to come and how they will be supported, and signposting them to guidance and sources of support. For example, the chief executive of Sussex Partnership NHS Foundation Trust recorded and shared a thank you message with her staff to recognise their hard work during this unprecedented time.
- Enhanced line management support – supporting line managers to have psychologically informed, compassionate and supportive conversations with staff. Where managers are able to have open conversations, listen to their staff and are able to openly discuss concerns and anxieties, they will be better placed to support their staff and teams. They should also be aware of and able to confidently signpost to the relevant mental health sources of support through their local occupational health service. For more information, see our guidance on sources of support available to NHS staff nationally such as mental health services, a bereavement and loss helpline and apps.
- Safety provisions – It's important to acknowledge the link between physical safety needs and psychological wellbeing and this should be reflected in your mental wellbeing support offer. Staff should be reminded about how they can protect themselves by following PHE guidance in terms of hand hygiene, ‘catch it, bin it, kill it’ and stay at home if they feel unwell and contact NHS 111 (preferably online) for advice if they feel they may have symptoms of COVID-19. Employers should ensure consistent access to adequate PPE with relevant training, 24-hour access to food and water, and a safe place for staff to rest and recover in their breaks, and sleep when working out of hours. For more information see our guidance on infection control and top tips on managing fatigue during COVID-19.
- Peer support systems – ensuring that pre-existing peer support systems continue and establishing new peer support systems where needed so staff stay connected. Enhancing team cohesion so team members know how to work well together and look after each other. For example, University of North Midlands NHS Trust implemented a shift buddy system, pairing staff up on shifts to look after each other. Support from buddies include help with PPE such as donning and doffing, encouraging each other to take breaks, checking in to see if their colleague needs a chat to emotionally offload and reminding them of their going home checklist.
During this phase, staff will likely experience a sense of rising to a challenge and increased camaraderie as people come together. This can result in staff losing usual boundaries over working hours and breaks and letting social niceties slip as the focus turns to getting things done. The outbreak of COVID-19 will, however, create sustained pressure lasting weeks and possibly months. At this point, it is expected staff will experience disillusionment and exhaustion. This is the highest period of psychological risk where staff may neglect their physical and psychological self by putting their work above their own wellbeing. Employers should consider the risk of moral distress and injury on their staff and how this can be prevented and supported.
Maintaining staff morale and motivation will be essential as the outbreak progresses. The NHS and primary care have an exemplary record in sustaining services in emergency and stressful situations and responding to emergencies. Experience from previous outbreaks suggests that ongoing support to tackle staff fears will be vital. Clear communication from trusted sources, honesty and open discussion of fears, have been shown to be the most effective methods of sustaining morale.
In addition to implementing and maintaining the above recommendations set out in the preparation phase, employers should also consider:
- Normalising psychological responses – reminding staff this an unprecedented situation and giving them permission to step back, take breaks and discuss their emotional wellbeing. Letting them know it’s okay to experience symptoms of stress or anxiety. Equally, it’s also okay to be coping with the impact of outbreak.
- Delivering formal psychological care in stepped ways – It is recommended a stepped approach is adopted to support the mental wellbeing of NHS staff with basic physical needs, information and peer support and psychological first aid as the first line of support available to staff. Psychological interventions should be utilised for those who require it and can make effective use of it during crisis periods. Organisations may want to review their support for staff and expand provisions where possible, which could include debriefs, trauma risk management (TRiM), Schwartz rounds, engagement, and deployment of existing in-house clinical psychology teams.
- Providing psychological care to patients and their families - In addition to the changing nature of work, staff may also be dealing with patient deaths, as well as dealing with sick and/or dying family members and friends. Practitioner psychologists can help employers understand how frontline staff manage patient and family fears and concerns. Organisations may want to speak to and prepare their chaplains and counselling services as they will have a key role in supporting staff.
In this phase, staff will experience recovery and, in some cases, potentially the long-term psychological impacts of the outbreak. Having time to reflect, some individuals may experience a sense of regret over what they ‘should’ have done differently and shame or guilt.
To restore and maintain staff wellbeing during this period, as organisations start to recover and consider what the new ‘business as usual’ will become, employers should consider:
- How they can allow time and space for staff to take stock and seek help if needed. Employers may want to use trained practitioner psychologists to facilitate reflection and processing of experiences.
- Seeking feedback from staff about what their mental wellbeing needs are and how they can be best supported.
- Providing spaces for ongoing peer support to continue.
- Involving staff at all levels to share learning which can be fed into future preparedness plans.
- How they can recognise and reward the contribution of their staff for going above and beyond during this unprecedented time.
More information on the recommendations provided can be found in the full BPS guidance on Protecting the Psychological Needs of Healthcare Staff during COVID-19. This guidance has been adapted from an briefing paper for NHS England and NHS Improvement, and the NHS staff wellbeing offer during COVID-19 response, written by Dr Sonya Wallbank, head of culture transformation, COVID-19 clinical health and wellbeing lead.
Additional tips and specific guidance on COVID-19 and mental wellbeing can be found at Mental Health Foundation, Mind and PHE's Every Mind Matters. The NHS Employers Emotional wellbeing toolkit can be used to support staff to maintain good mental wellbeing.