Mental Health Support: Frontline Staff

Ian Paisley Excerpts

Thursday 8th October 2020 Westminster Hall

[Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)]

I beg to move,

That this House has considered mental health support for frontline staff.

It is an honour to move the motion with you in the Chair, Mr Paisley, now that Westminster Hall is once again available for our purposes. In this unique time of pandemic, the mental health of frontline and key workers should be fully supported. I declare an interest as a former psychologist in the NHS for 20-plus years—I am showing my age—before I came to this House, and as chair of the all-party parliamentary health group and the all-party parliamentary group on psychology.

No one should underestimate the severity of the mental health crisis that engulfs us all as a direct result of the advent and ongoing havoc wreaked by covid-19 across the UK, and indeed worldwide. I thank the organisations that have been involved on the frontline, supporting mental health strategy and the delivery of services, including: the child mental health charter and, in particular, Helen Clark, a former Member of this House; the British Psychological Society; the British Medical Association; the Royal College of Psychiatrists; Mind; the Centre for Mental Health; and EveryDoctor—that is to name but a few. I thank all the other parliamentarians who have taken the time on a Thursday afternoon to speak on this vital issue.

On 5 October, Dr Tedros Ghebreyesus of the World Health Organisation introduced the first global dataset on covid-19 access to mental health services. He said:

“COVID-19 has interrupted essential mental health services around the world just when they’re needed most.”

There were some devastating findings. Before the pandemic, countries were spending less than 2% of their national health budgets on mental health. More than 120 countries —93%—reported that mental health services had been stopped or disrupted during the pandemic, 72% said that mental health services to children and adolescents had been disrupted, and 75% had seen a disruption to mental health services in the workplace. Despite the fact that 89% of the countries surveyed said that mental health and psychosocial supports were included in their national coronavirus response plans, only a shocking 17% had full additional funding to cover the cost of those services. Together, those figures show that there is likely to be an international tsunami of mental health morbidity like no other seen in our time.

The Centre for Mental Health, a UK charity, estimates that in England alone up to 10 million people may need mental health support—including long-term support—for the foreseeable future as a result of covid-19, and that 1.5 million children may require support. Those numbers are a stark warning that the impact of the pandemic will have severe long-term repercussions for the mental health of the UK as a whole.

Those affected will need support for depression, anxiety, post-traumatic stress disorder and other mental health difficulties in the coming months and years. Of course, some groups are disproportionately affected, including those with disabilities, those from minority ethnic communities and those with pre-existing mental health conditions who have experienced increased morbidity during the pandemic. Responding to increased mental health needs must therefore be a priority when a recovery plan is drawn up for both NHS and social care sectors for the future of our public health and in fiscal planning across Governments.

On the impact on frontline staff, the national forecast for adults is that more than 200,000 NHS workers may need treatment for post-traumatic stress disorder, psychological distress and burnout. Although less data has been collected, it is likely that a similar pattern will affect those who work across social care settings such as nursing homes. Research is badly needed. Those staff must not be excluded from or let down by the data collection and resourcing that is required. I would be grateful if the Minister looked specifically at the resourcing of data on the psychological impact of covid-19 in the community, nursing and social care sectors.

The International Council of Nurses reminds us that the effects of covid-19 on the mental health of nurses and the wider health social care workforce is a ticking time bomb. Every Thursday, across the UK, we were glad to show our support for key workers on the frontline, who risk themselves daily as they confront the pandemic on our behalf, but we owe them much more than weekly applause, and Governments across the UK owe them that duty of care.

Data from previous pandemics analysed by the British Medical Journal shows that post pandemic, healthcare workers are at high risk of both psychological illnesses and physical outcomes. For frontline staff, decisions made during the pandemic have regularly determined who to prioritise for care, but they have also felt a lack of control, especially when patients are care home residents who are dying and no treatment has been available for them. Emotionally and physically, having to be there day in, day out for patients as well as their families, who often could not visit relatives in their time of need, has been unduly toiling. That has come alongside the use of personal protective equipment for long periods; times when PPE has not been provided to the extent that it should have been; and long periods of excess working hours, stress and exhaustion.

A study by Kisley and colleagues has identified risk factors for psychological distress for staff in the time of covid-19. Personal care and socioeconomic stressors included personal childcare needs, having an infected family member at one point during the pandemic, and having a lower household income, with fewer choices in how to cope. Trauma is triggered when trusted bodies act in a way that can harm their safety at work, such as the failure to obtain correct or sufficient PPE, or by the breakdown or absence of testing and systems. The study also identified enforced redeployment to care for covid-19 patients, a failure to screen and triage healthcare workers for mental health needs prior to the pandemic, and a reliance on crisis intervention when symptoms develop.

Prior to the pandemic, the British Medical Association set out in a 2019 NHS staff survey that 40.3% of healthcare staff reported feeling unwell due to work-related stress. With the onset of covid-19, the workload for healthcare workers has increased radically. Four in 10 psychiatrists have reported an increase in people requiring emergency healthcare, including new patients, in the aftermath of lockdown. NHS and social care jobs obviously involve exposure to a huge range of potential stressors, including competing demands, interpersonal conflict, complex and life-changing decision making, moral injury, shift work and long hours. Added to that in the past six months is the pausing of the working time directive, the limited scope for time off or holiday periods, the increasing morbidity of patients, and losing colleagues. As someone who has worked in the NHS for many years, I have to say that the loss of colleagues is a terrible shock, and not something that people expect in their day-to-day working lives. That is something that frontline staff have had to cope with in addition to their care roles.

People join the caring professions to make a difference and make others better, but coronavirus has created an overwhelming feeling of helplessness in the midst of this trauma. It should be noted that previous coping strategies that those on the frontline utilised may play out differently if they have to cope with a second or third wave. The adrenaline with which they coped in those vital months so that they could be there to support those in need may be replaced by the dread of going through it all again and the fear of being retraumatised.

I have referred to some of the facts and figures impacting the mental health of care workers, but here are some voices from the frontline, expressed in letters sent to The Guardian and the nationwide EveryDoctor organisation, which has been in touch. One said: “The mental health exhaustion that comes from changing everything about the way you work on a weekly or sometimes daily basis for months is immense. All the while, you can see a light at the end of the tunnel, but then you are bracing yourself for the next disaster: a second wave or winter crisis, alongside mass staff absence.”

Another said: “There is the effect of not only seeing patients die, but losing colleagues. Everyone is struggling with this pandemic, but doctors are responsible for the decision making clinically. We can see that this is not going away. There is no respite in sight.”

Another said:

“I am employed on mental health wards as a support worker, helping people recover from acute problems… Covid-19 has not only affected general hospitals but has also had a huge impact on mental health facilities, which are more often run by a skeleton staff… On top of this we are also dealing with mental health patients infected with Covid-19… As we are not considered to be on the frontline, we are not equipped with proper personal protective equipment. We get a basic face mask, gloves and a flimsy apron.”

It should not be forgotten that school staff are also on the frontline, as they have to deal with the effects of the pandemic on children in their care. The mental health issues incurred by lockdown in the children they teach everyday are present upon return to schools. Anxiety and stress among a large group of pupils, alongside the experience of bereavement and a lack of community adolescent mental health services for those with acute problems, has been a feature of the recent past. That is alongside reduced assessment and diagnosis possibilities, due to staff having to change their working patterns, often from face-to-face to virtual sessions, after a period during which sessions were not offered.

Innovation will be key in ensuring that we can address the needs not only in the population but among the frontline staff who desperately need support. Using technology and ensuring that there is the capacity and technical knowledge to support the transition to other methods of care will be fundamental. Meeting the mental health needs that arise from coronavirus is a huge challenge, but it is not optional. Just as responding to the threat of the virus itself has tested our resources and resilience, so too will addressing the psychological and emotional consequences.

I am extremely grateful to the British Psychological Society, which has provided specialist guidance. I know that it has also been working with the Scientific Advisory Group for Emergencies and with the Minister’s office. It wants to see the planning of psychological support and resourcing of the psychological workforce to meet demands in the NHS and care homes and also in schools and the community. It also wants to see increased access to an in-house employee wellbeing service, which it believes will be critical, particularly if unemployment issues face the population in the coming months. It wants to see the employment of psychologists to focus specifically on staff. It tells me that it is not feasible, in the long term, to ask psychologists to work with patients in their work time and then to work with NHS staff in their spare time to meet psychological needs. The society would like to see more use of psychologists not just in supporting patients, but in a strategy to support staff over the long term.

My hon. Friend the Member for Midlothian (Owen Thompson) will be covering in depth the work of the Scottish Government in relation to mental health strategies during the pandemic, so I will focus on the issues that have been raised with me in my capacity as chair of the all-party parliamentary health group and the all-party parliamentary group on psychology.

These are some of the questions that I have been asked to raise with the Minister. What steps is the Department of Health and Social Care taking to model and plan for demand for mental health support as a result of coronavirus and the consequent impact on the economy and employment? What additional funding will be made available to mental health providers to ensure that services are covid-19 safe and that they can meet increased demand for support and deliver on existing pledges in the NHS long-term plan for mental health? What resources will be made available for local initiatives that provide early mental health support in our communities, especially for those people who have been bereaved? What proportion of schoolchildren will benefit from the wellbeing for education return funding? How will children’s mental health be supported moving forward?

What resources will be made available to support health and care staff in the NHS, social care and voluntary sectors who are experiencing post-traumatic stress disorder, high levels of psychological distress or burnout? What specialist support will be made available? What resources will be made available to ensure that research and funding are provided for those working in social care settings so that we adequately address their mental health needs alongside the NHS staff population?

What plans are being put in place to protect NHS staff from a potential onslaught of claims against them because of the pressures that they have worked under during the pandemic? That may give rise to a number of negligence suits in the future. That issue has particularly been raised by the Medical Defence Union, which is concerned that staff have often been placed on the frontline with a lack of resources and with a lack of support medically or clinically themselves.

Now is the time when I feel that I and other hon. Members should be responding in the main Chamber to a detailed statement from the Government about their proposals for mental health directly arising from the devastating impact and ongoing effect of covid-19. Such a statement could include ways in which the Government propose to protect and sustain the mental health and wellbeing of key workers and that will be distinctly and separately resourced, rather than relying on any money from pots designed for other purposes. I look forward to the Minister’s reply today. I hope, on behalf of the key workers for whom I have been given the privilege to speak, that she will tell us that the Government have set a date for the announcement of a properly and realistically resourced mental health strategy that will be both integral and central to the overall covid-19 recovery plan.

[Ian Paisley (in the Chair)]

I thought I was going to be calling Jim Shannon to speak today, but he is not here, as we know, so I call Owen Thompson.