We have become used to hearing about the toll taken by lockdown measures on the mental health of the nation, but when doctors from the covid frontline took the unusual step of going public this week with fears for their own and their NHS colleagues’ mental wellbeing, we knew things were not merely serious but critical.
The British Medical Journal reports that in a recent survey nearly half the staff on intensive care units, and half of those responsible for anaesthetic procedures required to put people on ventilators, reported symptoms consistent with post-traumatic stress disorder (PTSD), severe depression, severe anxiety, or problem drinking.
It is therefore not surprising that doctors from the 1,600 strong campaigning organisation EveryDoctor are deeply concerned that the trauma triggered by the pandemic will have lasting consequences for the mental health of frontline NHS workers as well as the public, and leave the NHS unable to meet demand.
The Health Foundation estimates that there will be an increase of 11 percent in referrals to mental health services for adults and children over the next three years, requiring an average annual rise in funding of £1–1.4bn to meet the demand for help. Staffing constraints mean that demand cannot be met without investment: there is no slack anywhere.
At their press briefing this week, doctors from the frontline could not disguise their haunted looks, the sadness and exhaustion in their eyes and grief-stricken voices. Dr Julia Patterson, chief executive of EveryDoctor said quietly, “Frontline staff are utterly exhausted and have endured enormous pressure, many without rest, for 11 months now. It will take years for us all to process the grief and traumatic effects of this pandemic”.
We heard that the pandemic had cost the lives of healthcare staff, discouraged staff from returning to the profession and had exacerbated staff shortages, caused in part by the fact that many who had left the UK as a result of Brexit had not been replaced.
Others briefly mentioned their typical day: holding the hands of those saying their last farewells to families that were not allowed to be with them; unprecedented numbers of people dying; long shifts without breaks, working across weekends and ever-expanding working weeks that erased all holiday breaks; and the absence of down time at home.
They explained their fears for nurses, porters, cleaners and juniors struggling on low pay, home schooling and managing the basics of daily life, like shopping and cleaning. They said that the cost of self-isolating for some workers had been so great they had lost their homes. And they underlined that the cost of long covid would show up not just in prolonged physical problems, but also in the delayed shock and depression that was expected when the pandemic slowed down.
To address mental health needs in the workplace, staff are offered ‘resilience training’, which includes things like lunchtime yoga and mindfulness session. But the impact of all the deaths and stress is so unrelenting, and the workload is such that there is no time to take off the PPE and grab a coffee, let alone go to such a session.
There are also limits to anyone’s resilience. An anonymous GP worried that doctors had reached the end of the line in this respect: “When patients have delays for cancer or mental health appointments, it’s difficult to hear their distress and not be moved”. Her feelings were echoed by a senior emergency room doctor, who also had to remain anonymous for fear of reprisals from management: “I am seeing terrible sadness in doctors, myself included. Our wellbeing and mental health are being beaten to the ground. We need support that practically addresses problems and inspires, motivates and encourages us”.
In addition to stressing that what’s needed is proper trauma-focused mental health support for NHS staff, EveryDoctor is also calling for the government to work with leaders across the UK to create a coronavirus trauma recovery plan for our country. It was emphasised that this did not mean a premature return to the classroom for children and school staff, nor an over-reliance on the vaccination rollout. Hands, face, space needs to continue, backed up by effective, thorough, immediate and extensive public health local track and trace, and strict pre-entry and follow-up negative test requirements for anyone coming into the UK.
As the EveryDoctor press conference made clear, urgent action is required. The NHS, starved of resources for a decade, has been subjected to extraordinary pressures during this last year and the workforce is running on empty. We assume that they will always be there for us. But if we want this to continue to be the case, then we need to heed the warnings from the frontline and give the EveryDoctor campaign our wholehearted support in fighting for the wellbeing of NHS staff.
EveryDoctor have a Just Giving page where they’re hoping to raise £30,000 to run an urgent public awareness campaign about what is happening on the NHS frontline.