Amongst the many long-standing and previously hidden problems brought to light in the past 12 months, the pressures on care staff, thrust to the forefront of the fight against Covid-19, stand out as being particularly acute and requiring immediate and comprehensive responses.
Recognition of the impact that care work has on emotional wellbeing creates a challenge to ensure that permission and opportunity is offered to those who need it, to access support that allows them to stay well and continue in their work.
Making the case
Last January, I wrote a short piece for Care Management Matters sharing information about the British Association for Counselling and Psychotherapy’s (BACP) upcoming research into the feasibility of delivering counselling in care homes. In the early stages of the project, care home managers urged the research team to include recognition and support of the emotional wellbeing of staff as well as residents. The case was well made that, by taking a whole-system approach to the study, additional insights could be gained into the value of talking therapies in care settings. A year on and whilst our care homes research has been interrupted and delayed by the pandemic, the call for recognition of the needs of staff from the care managers is in sharper focus than ever.
Evidence from the early stages of lockdown indicated significant worsening in self-reported mental wellbeing amongst care staff and increases in experiences of tiredness, insomnia, stress, anxiety, and depression1. But of course, those with experience of working in the care sector know that, although not in public view, these emotional and mental health pressures were not new, but rather were underlying conditions known to many care staff long before the pandemic. And being aware that such problems exist is only a starting point. How can people access the right support when barriers like time, cost and stigma all get in the way?
Counselling changes lives
The Office for National Statistics reported alarming figures on the rates of Covid-19 mortality amongst care staff, finding that once data had been adjusted for age and gender, social care workers were twice as likely to die from contact with the virus than the population average2. For care staff from BAME backgrounds, this risk was found to be higher still and data on Covid-19 mortality in the UK has consistently aligned risk to socio-economic determinants of health3.
BACP is the professional body for over 54,000 counsellors and psychotherapists across the UK. Counselling changes lives and BACP believes that talking therapies, delivered by trained and qualified therapists, should be available to anyone who is struggling with difficult emotional circumstances leading to psychological distress. In response to the pandemic and lockdown there has been an increase in the delivery of therapy by telephone and video-conferencing platforms, and efforts to promote choice and autonomy for clients has remained at the forefront of the counselling profession.
For BACP member Susan Aston, there are particular barriers that prevent care staff from accessing the mental health and wellbeing help and support needed in times of crisis or when stress and worry are affecting their ability to get on with work and home life. These include the stigma of help-seeking, with many carers resolutely seeing themselves as ‘givers’ and often instinctively putting the needs of others before themselves. There’s also the challenge of finding the time to dedicate to regular counselling sessions or being able to commit to regular weekly patterns for appointments, when the requirements of care work may include being available at short notice.
Susan has worked as a carer for a domiciliary care agency in the southwest of England and knows well the stresses that accompany care work. ‘In the care giver role, the people we work with are always more than clients. We build friendships and trust that allow those who wish, to confide their innermost fears and concerns. We’re the people close enough to notice changes in their wellbeing and get the help they need. Many of our clients want to die at home; we look after them in those final weeks, days and hours. We’re there when a syringe driver is administered, we hear when a dying person is calling out for their mum, we sit with them and hold their hand when there is nothing else to do except wait for death to arrive. Yes, carers have training on end of life care, yet when it is over, we move on to another client and so the cycle begins again. Even when someone decides they might need counselling help, the limited availability of free therapy and the prohibitive cost of paying for private sessions get in the way.’
Supervision brings a personal approach
The recent announcement by The Care Workers Charity4 of a new scheme supporting care staff to access counselling support is a welcome and positive step. The offer has been made to any member of care staff across the UK to apply to the charity’s Mental Health Support Programme, which can cover the cost of up to 10 sessions of counselling provided by trained and qualified therapists.
In her role as counsellor, working with clients who are care staff working for a domiciliary care agency, Susan Aston knows that the prospect of counselling can be daunting for many people and that it can be a difficult step to seek help. ‘So many of the issues that people take to counselling, such as bereavement, loss and exposure to suffering, are part of the daily routine for many care staff. I’ve worked with counselling clients who have unresolved grief in their own lives that is brought to the surface every time a care client dies. Without the opportunity to address their personal loss and pain, their work carries an ever-present potential for great emotional distress.’
All qualified therapists commit to working to standards set out in the BACP Ethical Framework for the Counselling Professions, which states: ‘Supervision is essential to how practitioners sustain good practice throughout their working life. Supervision provides practitioners with regular and ongoing opportunities to reflect in depth about all aspects of their practice in order to work as effectively, safely and ethically as possible. Supervision also sustains the personal resourcefulness required to undertake the work.’5
For Susan, reflecting on her work as a therapist in comparison to her care work, there exists a stark contrast in approaches to self-care. ‘In counselling, supervision is one of the corner-stones of our profession, critical to ensuring safe practice and the wellbeing of counsellors, and, ultimately our clients,’ she says. ‘This is embedded as a compulsory part of our work when we undertake training – it’s a ‘must’, not a choice.’
As poignant and pertinent as anything written since the outbreak of the Covid-19 pandemic last year, Vic Rayner’s ‘Ode to the Unseen Care Worker’ 6 plots the meteoric rise in public perception and portrayals of care work, a journey that saw care staff move from ‘low skilled’ to ‘incredible’ in a few short weeks. But with this shift in status comes a challenge to back up the applause and plaudits with real change that recognises and rewards care work for the value it adds to communities and to society as a whole. An important part of this recognition should be an ongoing focus on the emotional wellbeing of care staff, acknowledgment of the personal toll of care work and increased choice and access to mental health and wellbeing support that cares for the carers.
- Institute for Public Policy Research (2020) Care Fit For Carers. Ensuring the safety and welfare of NHS and Social care Workers during and after Covid-19.
- The Health Foundation (2020) What has been the impact of COVID-19 on care homes and the social care workforce?
- Office for National Statistics (2020) Deaths involving COVID-19 by local area and socioeconomic deprivation.
- The Care Workers Charity (2021):
- BACP (2018) The Ethical Framework for the Counselling Professions.
- The National Care Forum (2020) Online blog: www.nationalcareforum.org.uk/blog/ode-to-the-unseen-care-worker/