For the first time since the Second World War, we have all gone through a shared experience of crisis, loss, fear, and helplessness. But for some of us, the impact has been more severe. Whilst the physical health risks of potentially being exposed to COVID-19 are well known, the mental health impact is harder to qualify, and the extent may not be known for some time.
The social care workforce is one that has been under immense pressure over the past 15 months. The social care sector must address mental health support for its staff both now and in the future. This is because the mental health impact of working through the pandemic is something we shall live with for many years to come.
Support from Samaritans
When the need to support health and social care workers became apparent in the first days of the pandemic, Samaritans launched a free dedicated helpline that offered confidential and emotional support from trained Samaritans volunteers, seven days a week, between 7.00am and 11.00pm. We also joined forces with Mind, Shout, and Hospice UK to launch Our Frontline. Our Frontline is a collaborative partnership between the four charities to support the mental health of those working on the front line against coronavirus. Through the platform of Our Frontline, we collectively provide round-the-clock, one-to-one support, resources and advice for key workers all in one place. In fact, Our Frontline recently launched a new campaign aimed at health and social care workers, encouraging them to take a breath and check on themselves.
Through Samaritans’ dedicated NHS and social care helpline, we hear firsthand about the challenges social care and health workers are experiencing. All calls are confidential and anonymous; but certain overarching themes and trends emerge over time. So, what are we hearing about people’s experiences of the pandemic as health and social care workers?
A lot of health and social care staff are feeling stressed, anxious, lonely, frightened, overwhelmed and frustrated. Many are feeling guilty, for example, if they’ve taken time off, have caught COVID-19 and are shielding, or if they’re working hard and don’t have the energy to contribute to family time.
Some callers are not initially open to seeking emotional support, in part due to the nature of their professions. We’ve found some workers like to call before a shift so they can share their fears with someone, or after a shift so they can offload without bringing it home to their families. A number of care workers said sharing their feelings after a shift, before bed, makes them feel they will be able to sleep easier.
How time altered emotions
So, what has changed since the pandemic started?
We’ve noticed there was a sense of callers ‘running on adrenaline’ during the early peak in April 2020. During the first wave, calls would be more about what was going on in the here and now, such as a shift they had just been on. At the beginning of the pandemic, dealing with the unknown and so much rapid change meant callers were very overwhelmed and would look to ‘offload’ about the situation they found themselves in. For many, this was dealing with the high levels of death amongst COVID-19 patients. As the crisis continued, callers seemed to be more reflective rather than talking about acute experiences. Stronger emotions emerged once callers had a little more time and space to reflect. The longer-term impact of the pandemic built up. For example, some callers would discuss having flashbacks of working on COVID-19 wards and share fears of another wave. And there is a trend amongst callers who are exhausted and unsure they have the physical or emotional capacity or the energy to keep working at this rate.
Of course, everyone is different and there cannot be a single snapshot of people’s pandemic experience. However, linking our understanding of the mental health impact of the pandemic with the themes and trends we’ve seen from our dedicated helpline enables us to anticipate what support is needed over the coming months and years for health and social care workers.
We know that the impact of COVID-19 and working on the front line is greater for people marginalised in our society by low income or ethnic heritage. Quite simply, they have been hit harder and the recovery process will be correspondingly longer. For some, ‘long COVID’ or bereavement or the long-term impact of intensive treatment will last years. Even the ‘return to normality’ will trigger fears and divisions between groups who did not share the same experience – those furloughed versus those at work, those working from home versus those at the worksite.
As the pandemic ebbs and economic insecurities ease, people will need time and space to process everything they have been through during the past 18 months. This decompression stage is likely to be similar to what we see with patients discharged from intensive care units or military veterans or other trauma victims who can present – sometimes years later – with symptoms of post-traumatic stress disorder (PTSD).
While mental health support from the voluntary sector is being relied upon to help those struggling with the pandemic, it is everybody’s business to take care of those who’ve been caring for us over the past 15 months. I’m pleased to say that the health and social care sector is seeming to respond to the needs of its workforce – I have lost count of the number of talks I have given to management groups about leaders’ roles in promoting mentally healthy workplaces.
Leading the way
Legally and morally, employers are already obligated to protect their employees’ health and safety at work. No one would argue that leaders should not take seriously their impact on physical health at work and organisations are prosecuted for failures around physical health at work. But mental health also needs to be protected at work – and slowly the law is expanding into this area. For example, stigmatising mental ill health can lead to lawsuits alleging discrimination on grounds of disability under the Equality Act. Fending off the lawyers is one thing – leaders need to ask themselves: How different would our organisation look if we applied the same right to mental health at work?
Tackling stress at work should be a major priority, as should be creating a supportive workplace culture that promotes mental health. Organisational culture can be enhanced by offering effective leadership, line management training, and interventions to reduce stress and improve mental health at work.
A mentally healthy workplace in the care sector would:
- Demonstrate compassionate leadership
This is how it was for me – how was it for you? Having open conversations like this can break down the stigma particular to the health and care sector of not seeking help.
- Recognise the challenges of ‘returning to normal’
For the many people living with the impact of long COVID, post-treatment stress, bereavement, financial worries, family worries and other concerns, demonstrating an understanding of the individual impact and allowing time for recovery is paramount.
- Invest in personal resilience and peer support at the level of the individual
There is a hunger for advice about techniques to manage anxiety and depression. This is more than one-size-fits-all ‘wellbeing’ practices around good sleeping-eating-exercise patterns. What is needed is a series of tailored interventions for target populations, reflecting the challenges and stresses of their particular work situations. Peer support is vital – a Mental Health Foundation report1 found 49% of employees surveyed would not discuss their mental health with their line manager. In many workplaces, people are particularly susceptible to overworking and self-stressing – and peer support is essential to maintain balance.
- Invest in equipping managers from front-line supervisory level to senior managers
Line managers need practice in productive conversations to moderate the frequency and the severity of many of the incidents of anxiety and depression that are the most frequent evidence of mental ill health in the workplace. They need to address the 51% of employees willing to talk with their line manager and win over the 49% currently unwilling to1.
- Promote leaders as allies for mental health in the organisation
The power of personal example and apprenticeship is the most powerful signal of leadership commitment to ‘what matters around here’. Instead of ‘managing’ people struggling with mental health, ‘allies’ invite people to contribute, share career goals, push to get people on projects, speak up when stereotypes are being invoked – and talk about them as fellow humans, not ‘problems’.
- Appraise the impact of senior leaders, front-line leaders and management teams
Leaders need to think about the impact of their decisions on their organisation’s and people’s mental health. They need to avoid game-playing and instead engage in real conversation with their people.
- Educate your leaders and staff in other emotional support and mental health advice
If you are worried about someone and are not sure your workplace wellbeing initiatives will be enough, you can encourage them to reach out for help in other ways. They may benefit from spending time with their friends and family, or support offered through Our Frontline or Samaritans, or they may need to see their GP.
When we look longer term, this shared experience of crisis across the entire population of the UK and Ireland creates an opportunity for a fresh start with issues that governments have acknowledged, but not acted upon. This must include investing in mental health and proper funding for social care. Samaritans and others are keeping these lessons from the pandemic in front of governments. Recently we have seen the launch of the Archbishops Commission on the future of social care. It is everyone’s responsibility to advance the mental health agenda – and especially for leadership at all levels to promote mentally healthy workplaces.
For anyone struggling to cope, reach out to Samaritans on 0800 069 6222 or visit www.ourfrontline.org for free emotional support.
- ’Stress: Are we coping?’ Mental Health Foundation, May 2018 p11 available at www.mentalhealth.org.uk/publications/stress-are-we-coping
Keith Leslie is Chair of Samaritans in the UK & Ireland and Chair of Mental Health At Work CIC, and was Chair of the Mental Health Foundation 2014-20. Email: firstname.lastname@example.org Twitter: @KeithLeslie19
Have you devised a longer-term support strategy for your workplace? What does a mentally healthy workplace look like to you? Share your feedback below.