Supporting the mental health of frontline NHS staff during COVID-19

Supporting the mental health of frontline NHS staff during COVID-19
© iStock/sturti

Guidance has been issued to help support the mental health of frontline NHS staff during the COVID-19 pandemic.

An academic review has highlighted the increased pressure that frontline NHS staff are under during the COVID-19 pandemic, and that they will need psychological support from multiple levels in their organisation.

Staff may be dealing with fears of catching the illness themselves or passing it on to their families, working with new and frequently changing protocols, and caring for very sick and quickly deteriorating patients – all of which can result in acute stress reactions, burnout, depression, anxiety, post-traumatic stress disorder and ‘moral injury’.

The review carried out by researchers from Queen Mary University of London, London’s Air Ambulance and Barts Health NHS Trust, and a London-based A&E doctor, and published in the European Heart Journal, includes pragmatic recommendations for individuals, teams and organisational leaders.

Mental health support for frontline staff

The paper, structured as a guide for mental health support, covers special circumstances such as staff being quarantined and returning to work, including guidance on how organisations can provide tangible support and address any pre-existing stressors. Advice on crisis leadership and how to support distressed colleagues is also detailed, including self-care.

Dr Mike Christian, Research & Clinical Effectiveness Lead, HEMS Doctor, London’s Air Ambulance, Barts Health NHS Trust, said: “Leadership during a crisis is always a challenge, however, leading during the COVID-19 situation is even more difficult given that leaders themselves are ‘living’ in the crisis and equally impacted by it as much as those who they are leading.

“Although there are many negative aspects of the current situation, teams can grow stronger, individuals can develop, relationships can grow deeper as a result of this crisis. The impact of this pandemic and how leaders respond during it will shape the future relationship of teams and culture of organisations for years to come.”

Moral injury

In the paper, emerging concepts such as ‘moral injury’ (originally from work with military veterans) are applied to frontline staff. Moral injury describes the psychological impact of bearing witness to unacceptable things or making decisions that contravene the morals of the individual making them, resulting in severe guilt and shame. For example, following new protocols about which patients will not receive life support if there are resource scarcities.

Dr Esther Murray, Senior Lecturer in Health Psychology at Queen Mary University of London, said: “The hero and angel tropes which we see bandied about are also highly problematic because they make it look as if people signed up to die, like a hero does, but they didn’t.

“It also makes it harder for NHS staff to talk about how they really feel because opinions get polarised – are you a hero or a coward? A lot of staff feel like cowards but they are not at all, they’re just quite justifiably frightened and angry.”

Dr Matt Walton, London-based A&E doctor, added: “Psychological support for frontline staff is a critical part of the public health response, I hope our paper can be useful for all those who need guidance in providing that support.”

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