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The ‘other’ crisis: The critical mental state of the NHS workforce

The nation devoted the first lockdown to clapping for the NHS. Patients avoid seeking care to play their part in reducing the workload of the NHS staff. It seems like everyone in the country is empathising and acting towards the wellbeing of NHS staff; However, after almost a year of COVID-19 they are in a dire condition and in need of help – now and for the future.

A recent study in the journal of Occupational Medicine regarding the mental state of the ICU NHS workforce during the pandemic caught the media’s attention – a fully justifiable share of voice as the results are beyond alarming and a cry for help [1]. 45% of the survey respondents, that included healthcare professionals from six NHS hospitals reported symptoms consistent with PTSD, anxiety, and severe depression. 1 in 7 ICU clinicians reported self-harm and suicidal ideation [1]. Over 1,000 clinicians are planning to quit the NHS after the pandemic [2]. Over 35,000 full-time staff days were lost in a single Trust in the span of 3 months – and 1/3 of those were due to mental health-related conditions and symptoms [3]. Across the country, the increase of mental health-related absences rose 36% in spring compared to 2019 [3].

The media snippets reporting on the topic interviewed healthcare professionals who have been on the floor and cite some shattering reasons for their mental condition: The national management of the pandemic, lack of protective measures, silencing of clinicians make them feel expendable and unappreciated. However, apart from their working conditions, healthcare professionals also point out that their dedication, the force that is driving them to cope every day, is steadily hindering that very ability to cope. The high mortality rate of COVID-19, the inability of end-of-life patients to communicate with their families, the looming impact of the pandemic in non-COVID patients are all hits to the mental state of the NHS workforce.

While additional £15 million are invested for NHS staff mental health support, Trusts are taking actions on smoothly redeploying returning staff, and 400,000 have accessed the health and wellbeing programme, it seems like not everything in the arsenal has been deployed. Mental health support is conducted via telephone; An interviewee from the workforce assessed that phone consultations are not as effective and this approach did not prevent her from being sectioned for 3 weeks due to mental health issues [4]. In ICU units, wherever video calls are available, there is an insufficient amount of hardware and infrastructure to support communication between patients and their families, reporting one iPad for an entire London hospital.

Yet, even up until this point and with this shocking data and testaments, the narrative is still revolving around persuasion and justification of the magnitude of the problem. It seems like the public does not need convincing that their NHS staff is overworked and underequipped – so who remains to be persuaded, what actions should be taken, and most importantly when?

intensive care and digital health use case

The solution is complex and multi-layered – as is the problem and its causes – and it has been apparent even before the pandemic that fundamental change is needed in the NHS. Nevertheless, there are attainable solutions already available to the organisation that can be deployed fast and with minimal effort and, at the very least, ease a burden that has become an emergency.

Research has shown that online therapy is as effective as face-to-face therapy. Moreover, as mentioned previously, the financial groundwork and initiative for mental health support to the NHS workforce have already been taken and considering the uptake, the demand is strong. With the time and space limitations of the already pressed healthcare professionals, accessing this support online, instantly and from anywhere – as well as the mere sense of availability and accessibility can make a vast difference to the healthcare force’s feeling of appreciation and stress relief, as well as prevent feelings of despair.

Lack of infrastructure is a known dearth in the NHS but this is a prime opportunity to prioritise it: We have seen first-hand the effect of video calls between patients in ICU units and their relatives. This use case has been most impactful use case of our platform during the pandemic:

Doctors and nurses are working hard to take care of the patients, but at the same time, they have to update the relatives continuously – a sensitive and sometimes long procedure. The backlog of phone calls may be very long and during these calls, many questions need to be answered – often the same questions, asked by different individuals.

Having the opportunity to talk to patients’ relatives in multi-party conversations via video has been valuable to many patients and clinicians at ICU. Informing relatives and answering questions in a video call with several participants instead of contacting several people one by one saves an enormous amount of time for the healthcare professionals. In addition, families get the opportunity to see and support each other. The patient also experiences the value of meeting their loved ones via video. This kind of contact can make a huge difference in the recovery phase, but can be equally important if recovery is not foreseen in a patient’s development and people are facing a farewell

Nevertheless, as the picture is painted presently, the action plan for the mental health condition of healthcare professionals has to extend beyond prevention and into treatment and rehabilitation. Already a couple of years ago, we were filled with pride and admiration for a healthcare professional whose rehabilitation to full professional capacity after a burnout was facilitated by gradually returning to providing care via online consultations – from the safe environment of his home. Ulf Österstad, Operations Manager at that virtual clinic, Bra Liv Nära, told us back then.

I have an employee who wanted to return to work after a burnout. But returning to your normal workplace with all the stress, workload, and requirements meant slow progress. However, the Bra Liv nära scheme meant that he could work at home, in his own safe environment, and he has now been promoted. It’s great that an individual can return to work on their own terms, but it also benefits society as a whole when we take care of our employees so that they can do as much good as possible.

The NHS workforce continue to care for the country against all odds, despite and beyond considerable hindrances. Their thoughts and emotions have spiralled into the point where almost half of them are on the range of profoundly traumatised to personally and professionally incapacitated. While any person merely familiar with change management would say that fundamental change is the way to go, the point we are at now is not a change – it is a crisis. The fastest and most attainable way to improving their condition is removing the obstacles out of the way and using the tools that already exist – and digital is far more than the bare minimum: It is definitely one tool in the toolbox, but a mighty effective and immediate one. Let’s start there.

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Sofia Pyrgioti

Sofia Pyrgioti

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