Since 2005 pandemic preparedness plans have highlighted the need to consider providing psychosocial support for health care workers. Despite this, several weeks into the Covid-19 UK outbreak there were significant gaps nationally in evidence, planning and implementation advice for what this provision should look like and who should be providing it. Hospital-based psychiatrists and psychologists were among the first to hear expressions of concern and need from colleagues facing sustained stress and loss. In our own liaison psychiatry service, that enquiry came from frontline intensivists on 10 March. We rapidly saw that support was needed.
Across the UK a range of staff-support responses evolved using different permutations of self-care advice, peer support, team-focused interventions and psychological first-aid. Staffing ranged from volunteers to inhouse mental health and social care professionals who adjusted their roles to support both patients’ and colleagues’ needs. There will, however, be telling variation in who got what support from whom in different health and care settings. This has been heavily influenced by local values and pre-pandemic investment in both mental health provision and staff health and wellbeing.
Evidence predicts an increase in workforce burnout, reduction in patient contact hours and, potentially, an increase in levels of mental illness following this and any further waves of Covid-19. Early learning on both the challenges and opportunities observed by those undertaking staff-support work may be helpful in planning for the next phase response. The experiences of the staff support team at King’s College Hospital suggest that those accountable for the health and wellbeing of the workforce should consider four priority issues
How accessible is staff support?
Previous work has shown that pre-existing relationships with embedded mental health clinicians are key to leveraging accessible and acceptable staff support during pandemics. At King’s we have seen that mutual respect, trust and also proximity have helped colleagues to acknowledge distress or seek advice about mental health concerns. Some colleagues perceived Employee Assistance Programmes – which are designed to offer staff support – as remote or too aligned to organisational objectives. This highlights that strategies to increase visibility and connection to these services, and to re-position beyond ‘fitness to work’, will be important in coming months. Reflective practice – a core component of many integrated mental health offers – and its role in helping teams work well has been valued by colleagues. This may raise needed visibility of the value of psychosocially informed care both for patients and the clinical teams caring for them.
Are there trained and available people to speak to?
Promotion of mental health awareness and encouraging staff to speak up if they are struggling is laudable, but only if there are trained and available people to speak up to. Mental health literacy is still not the norm and many supervisors and managers will understandably have felt out of their depth during the crisis. Furthermore, the health and care workforce is no less affected by domestic violence, substance use and mental illness than the rest of the population. Those providing staff support will have found these types of needs did not neatly delineate themselves from Covid-19-related distress or adjustment and created a challenge to ensuring safe and governed pathways for a range of mental health and social needs. An undoubted benefit of these staff-support responses has been a step change in openness to discuss mental health. Health care workers deserve a consistent response and now awareness has been raised this must come with a guarantee of available services to meet these needs.
Does the organisation listen to staff experience?
There is also an issue around the direct impact of organisational culture and the extent to which it is willing to ‘hear’ staff experience on workforce health and wellbeing. Operational and organisational challenges during Covid-19 may have manifested as staff distress or, worse, moral injury and may have presented ethically complex territory for staff in support roles. Connected leaders able to respond to these issues may have ameliorated damage and reduced the psychosocial support needed. Covid-19 has magnified and exacerbated pre-existing problems but has also illuminated solutions. The foundation of any staff health and wellbeing strategy is the ability of an organisation to hear what its workforce are thinking and feeling and the systems and structures it has in place to listen and respond.
There is opportunity now to raise the status and sophistication of local people plans, and to move beyond the perception that wellbeing is purely the responsibility of HR or workforce colleagues. Staff support is not just about psychosocial interventions; it spans equality and diversity, safe staffing, practical needs, organisational culture and psychologically informed leaders with the foresight to invest in holistic patient care. Equally, staff-support strategies must not be an add-on or tick box but a whole-organisation ethos and operational priority plugged into key decision-making structures with active and visible support from executive leaders.
What factors determined the organisation’s baseline?
We wait to see what other impact staff support initiatives like the ones described above may have had but hope that any planned evaluations of these initiatives and psychosocial outcomes do not overlook the organisational contexts that our colleagues were working within. This type of oversight is a known failure of existing workforce burnout literature. The story of Covid-19 workforce wellbeing so far is all about the baseline before the pandemic. Those communities and organisations that entered unequal, under-resourced and battered by ill-fitting policies will, of course, be feeling the brunt of this pandemic. Neither crisis responses nor short-term health and wellbeing offers will mask the problem of depleted material and relational workforce reserves. There must now be an honest dialogue about the policies that determined this baseline and substantial changes in culture and infrastructure to meet the needs of a workforce changed by what it has been through.