This is a fast-moving issue and should be read as correct at the date of publication (18.05.20).
The Covid-19 pandemic has focused attention on the pressures faced by frontline health and social care workers.
This Insight considers the impact of the pandemic on the mental health of health and social care staff, and what measures have been put in place to support them.
Evidence from pandemics and disasters
Frontline healthcare workers are at increased risk of developing symptoms of post-traumatic stress disorder (PTSD) and depression, according to research from previous pandemics.
Initial data from the Covid-19 pandemic follows a similar pattern. In China, a study of healthcare workers revealed around half reported symptoms of depression and anxiety, whilst approximately one third reported insomnia.
In Italy, preliminary research has found 50% of healthcare workers reported PTSD symptoms, whilst 25% had symptoms of severe depression.
Who is most at risk?
Women, frontline workers (especially nurses) and younger workers with less clinical experience have reported more adverse mental health symptoms in Covid-19 research to date. This is in line with evidence from past pandemics.
Clinical experience is especially significant, considering around 15,000 student nurses, midwives and doctors enrolled to boost the workforce in England during the Covid-19 pandemic.
A study of healthcare workers deployed during Typhoon Haiyan, which hit the Philippines in 2013, found workers were at higher risk of developing PTSD when experiencing a combination of three factors. These were performing duties outside of perceived skills, the injury, death or serious illness of a co-worker, and feeling their life was in danger.
Similar risk factors were identified during the 2003 SARS outbreak in Hong Kong, and have been frequently cited concerns of UK healthcare workers during the Covid-19 pandemic.
It is not just frontline healthcare staff who are at risk of poor mental health. Staff who were deemed “non-essential” during the 2003 SARS outbreak in Canada reported a sense of isolation, lack of efficacy, and feelings of frustration about not contributing.
In the UK there have been reports that non-frontline healthcare workers have been feeling guilty and isolated during the pandemic.
Learning from the military
Military experience is being used to inform understanding of the effect of the pandemic on ‘frontline’ staff. In Nightingale hospitals, staff have been ‘buddied up’ based on trauma risk management used in the military.
Military research has also identified ‘moral distress’ created by ethical dilemmas, as a key risk factor for military nurses developing PTSD.
This has been likened to the ethical decisions that could be faced by health and social care workers during the current pandemic.
What is the impact on UK health workers?
A third of nurses rated their mental health as ‘bad’ or ‘very bad’ in April, according to a survey of 3,500 nurses by the Nursing Times. Around 90% reported they were more stressed and anxious at work than usual. The Institute for Public Policy Research (IPPR) report Care Fit For Carers, published in April 2020, similarly stated:
Half of healthcare workers said their mental health had deteriorated since the Covid-19 crisis began. Mental health impact was greatest on younger workers (aged 18 to 34) – where as many as 71 per cent said their mental health had got worse.(IPPR) report Care Fit For Carers
21% of healthcare workers said Covid-19 made them more likely to want to leave the sector. The figure rose to 29% for registered nurses and midwives, according to the IPPR report, and risks compounding existing shortages.
What is the impact on UK social care workers?
There is currently little data available on the effect of the pandemic on social care workers’ mental health.
However, a survey conducted by GMB Scotland in April found four in five carers said their mental health had been damaged by their work.
Measures to support the health and social care workforce
The World Health Organization has stated a ‘psychological first aid’ approach should be followed for frontline workers.
This includes practical care and support, fulfilling basic needs such as food provision, empathic listening and access to information. Intense support too early, such as psychological debriefing which focuses on traumatic experiences, has been found to be counterproductive.
In Scotland, initial mental health advice highlighted looking after basic needs, taking regular breaks and allowing time for sleep. The Scottish Government later launched a National Wellbeing Hub for health and social care workers to access resources aimed at improving wellbeing and increasing resilience.
NHS England has been commissioned by the Department of Health and Social Care to devise, “a comprehensive emotional, psychological and practical support package for NHS staff during and following the Covid-19 response.” This currently includes free access to wellbeing apps and online resilience support. There is also a dedicated support helpline and 24/7 text service, and a helpline offering bereavement support. The Government is working to extend both helplines to the social care workforce.
New Government guidance on health and wellbeing for the social care workforce was published on 11 May 2020, which includes advice to build resilience, manage stress and support mental health. A dedicated app for social care workers was also launched this month, which includes mental health toolkits .
Guidance for healthcare managers, from the British Psychological Society includes a “pyramid of interventions” for healthcare staff, with psychological interventions at the top.
As the pandemic progresses, demand for more intensive psychological interventions could increase, both from the health and social care workforce and the general public. This could result in unprecedented pressure on the UK’s mental health services.
Occurrence, prevention, and management of the psychological effects of emerging virus outbreaks on healthcare workers: rapid review and meta-analysis, The BMJ.
Managing mental health challenges faced by healthcare workers during covid-19 pandemic, The BMJ.
Mental health care for medical staff in China during the COVID-19 outbreak, The Lancet.
The health and social care workforce gap, House of Commons Library.
About the author: Melissa Macdonald is a researcher at the House of Commons Library, specialising in health.
Image: Nurse carrying out a bed changeover / Adrian Wressell, Heart of England NHS FT / CC BY 4.0