Frontline workers need better mental health support, experts say

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Researchers have called for urgent improvements to mental health support for frontline healthcare workers in England.

A team of psychiatrists and psychologists from University College London (UCL), who formed the ‘Covid Trauma Response Working Group’, have issued a call for increased mental health awareness training in health and social care settings. The warning comes after the team carried out a study investigating the mental health support available for frontline workers during the COVID-19 pandemic.

The research has been published in the journal PLOS ONE.

COVID-19’s impact on mental health

Explaining the study, lead author Dr Jo Billings, Associate Professor at UCL Division of Psychiatry, said: “In the UK, it has been estimated that 45-58% of the frontline health and social care workforce met criteria for clinically significant levels of anxiety, depression, and/or PTSD shortly following the first wave of the pandemic.

“This is amongst a workforce already under considerable strain pre-COVID-19, as evidenced by the growing incidence of stress, burnout, depression, drug and alcohol dependence, and suicide across all groups of health professionals, worldwide.

“The need to support the mental health of frontline staff during COVID-19 has been recognised, however this pandemic has also highlighted a paucity of research on the mental health needs of frontline health and social care workers, and a lack of evidence-based guidance about what psychosocial support might be most effective in helping them.”

The qualitative interview study included 25 frontline staff, from a range of professions, services, and localities, who all worked directly with COVID-19 patients. The participants, who were interviewed between 1 June and 23 July, were asked to describe their experiences and views about psychosocial support during the pandemic.

Availability of and access to mental health services

The responses from the interview showed that support from psychological services, when available, was of valuable importance to frontline workers and that those who had accessed them, or knew others who had, spoke positively about them. The findings did, however, reveal large disparities in availability of these services and significant access barriers.

Many of the interviewees in the study described service provision as ‘confusing and poorly communicated’, leading to a lack of awareness about services available. Mental health support was also considered as ‘inflexible’, with some services only available from Monday-Friday during typical working hours, making it difficult for those working shift patterns to access them.

The research team recognised ‘striking inconsistencies’ in the provision of mental health support across healthcare services, noted by those who moved between locations and specialties. They found that staff who were not employed by the NHS, such as social care and agency staff, faced significant access barriers. Participants also referenced an ongoing reluctance and stigma.

Nathan, a junior doctor, said: “The problem with healthcare is that mental health is slightly stigmatised in healthcare workers and people don’t want to admit that there is a problem. They stress a culture of resilience and I don’t think anyone wants to be seen as being unable to cope with anything.”

Dr Billings, who is also a Consultant Clinical Psychologist, said: “Significant steps need to be urgently taken to improve the psychological wellbeing and morale of the UK health and social care workforce and to ensure that the services they deliver to the UK population are sustainable, during the COVID-19 pandemic and beyond. Resources for support need to be made consistently available, and easily accessible to all staff. However, systemic and cultural barriers to access need to be addressed to ensure that accessing such resources is not inadvertently stigmatising. Access to resources also needs to be equitable, within different teams and localities and across the health and social care workforce.”

The researchers have concluded that staff need ‘protected time’ during work to access wellbeing and psychological services. They have also suggested that staff who are redeployed between teams should receive additional support.

Co-author, Dr Michael Bloomfield, UCL Division of Psychiatry and Consultant NHS Psychiatrist, said: “The results of this study show that a ‘one-size fits all’ approach to providing support is unlikely to be helpful. Nevertheless, these systems of support need to be coherent, consistently communicated and easily accessible.”

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