The COVID-19 pandemic had profound impacts on the wellbeing of NHS staff providing mental health services.
Working in collaboration with leading mental health charity the McPin Foundation and with the University of Cambridge Department of Psychiatry, THIS Institute conducted a study to understand service user, carer and NHS staff experiences of secondary mental health services during the COVID-19 pandemic. The findings we report here are one element of this project, drawing particularly on the experiences of staff.
We conducted in-depth interviews with 35 staff working in secondary mental health services. Their roles were diverse, including psychiatrists, care coordinators, mental health nurses, clinical psychologists and psychotherapists.
All staff experienced significant changes to the nature of their work. They experienced many forms of stress, ranging from trauma associated with Covid-related deaths of people for whom they cared, anxiety associated with unusual and highly demanding working conditions and new practices, and difficult dilemmas. Some of the most uncomfortable of these were linked to prioritisation decisions that had to be made, given significant reduction in service capacity caused by the pandemic and infection control measures. Staff reported that they felt they could not always provide the care they felt people needed, and felt especially compromised in their ability to perform the therapeutic function of their roles.
An especially prominent finding of our study was the extent to which forms of moral injury dominated mental healthcare workers’ accounts of their experiences. They described suffering when they were involved in, witnessed, or failed to prevent things that they felt were wrong.
Many staff experienced feelings of grief, helplessness, isolation and stress. These challenges were exacerbated when staff felt they could not take time off because of the potential impact on others, or when they did not have enough time to access the support that was on offer. Opportunities for informal support from colleagues were much more limited too. Communication about changes relating to the pandemic was reported to be often poor. Feelings of guilt and uncertainty about how service users and carers were faring during this time contributed to prolonged stress and other symptoms of burnout.
These findings draw attention to a group of NHS staff whose experiences during the pandemic have not so far received much attention. This work is important in guiding future action to support staff in a hugely important area of care.