Providing mental health support to NHS staff

Working in the NHS can be stressful and emotionally exhausting at the best of times. But the pandemic has made that worse for many staff.

Many are now working to deliver elective recovery or coping with high levels of emergency demand, with some feeling they are suffering moral injury from not being able to give the standard of care they would like.

Until recently all NHS staff in England – along with those working in social care – had access to mental health and wellbeing hubs, which were set up during the pandemic. But this year, ring-fenced funding for these hubs came to an end with many closing and others scrabbling around for short-term funding.

The mental health and wellbeing of staff is high up on the agenda of many NHS organisations, stressed Saffron Cordery, deputy chief executive of NHS Providers. But it has been an issue since before covid, even if this has exacerbated it. “Even before the pandemic we had a number of core fault lines that ran across the NHS and its ability to deliver and to support staff,” said Ms Cordery speaking at a recent HSJ webinar, run in association with The British Psychological Society. “So significant workforce shortages, really high levels of demand, a lack of capital and other investment in the NHS, and around health inequalities have an impact on the wellbeing of staff and the wellbeing of patients.”

The pressures during covid and beyond had affected everyone in the NHS, including leaders, who felt the need to do the right thing for their staff, she added.

“We’ve recently surveyed our trust leaders, and 84 per cent said that they were concerned about staff burnout and 83 per cent were really concerned about staff morale. The 2022 staff survey said that 32 per cent of staff often thought about leaving their organisation.”

This picture was very much backed up by research, suggested Kevin Teoh, who is a senior lecturer in organisational psychology at Birkbeck, University of London. “We’ve got higher rates of various indicators of mental health stress, depression, anxiety, and burnout. They were already high before the pandemic, but since then the evidence shows that, broadly speaking, it has deteriorated,” he said.

“The research is quite clear that a lot of the antecedent factors don’t actually lie so much with individuals, but much more within the system and in the working environment that we’re in. So we’re talking about things like workload, staffing, time pressures, and funding.

“We see lots of really good research demonstrating a very clear link between how well staff are feeling, their levels of mental health and the quality of care that they deliver.”

“Rather than putting out fires, we need to rewire the house. There’s a lot of money being spent on initiatives which are just firefighting.”

There was also evidence of a relationship between how well staff felt and retention levels, Dr Teoh added. Staff leaving could lead to a vicious circle where those remaining came under additional pressure.

But how serious is the situation with staff who have sought help from mental health and wellbeing hubs? Jo Jordan, clinical lead for the Humber and North Yorkshire Resilience Hub, said: “We’re seeing an increased degree of trauma, an increased degree of acuity and suicidal ideation. Sixty per cent of our referrals alone every year have significant, complex trauma. [There is] increased suicidal ideation and 58 per cent of all the people that we are seeing are off work and 58 per cent of those have been off for more than 10 weeks.

“We’re also seeing increasing issues around fitness to practice, because of the combinations of the interplay between pre-covid factors and then also the enormity of financial pressures.”

The hubs had done something different to the typical NHS approach of stepped care, she said, with high-level assessment and support within a psychological framework. The hubs offered a confidential single point of access working within the National Institute for Health and Care Excellence guidelines, she added.

But they also offered parity of provision which might not otherwise happen: “We have large organisations. Some of them have their own brilliant wellbeing offers of psychological services but other smaller organisations – care homes, our emergency staff, primary care – they don’t have access to the same resources that these big organisations have.”

BPS president-elect Roman Raczka added that anxiety, stress, depression, and other mental health concerns accounted for 23 per cent of all NHS sickness days – the equivalent of 6 million full-time equivalent days of work lost a year.

“The hubs provided a real lifeline for people during the period of the pandemic. The situation now is worse than it was before the pandemic, we are struggling with a really significant concern, and there is no one quick fix,” he said. Mr Raczka welcomed the investment promised in the NHS long-term workforce plan but said that people trained under it would be coming on board in some years’ time while support was needed now. “That requires money that’s put in place in order to deliver the support that’s needed. We’re seeing a real difference and variation within and across England.”

Urgent need for sustainable funding and system-wide solutions

The BPS has produced a report, identifying eight key principles to guide the decision-making by integrated care boards and systems to develop wellbeing within the local systems, he added. But the key to this was psychologically informed evidence-based support.

“We need a proper systematic evaluation of all the lessons learned from the hubs to be able to then think how we move forward, how we can then work within the systems to make things happen and then we need long-term and sustainable investment. We need to be able to plan. We’re calling for ring-fenced funding for five years.”

Ms Cordery suggested that what was being seen was “almost the sense of let’s pretend covid did not happen. Let’s put it behind us. Let’s not use that as the reason to invest.” In addition, decisions were being taken which were “quick fixes” or “dopamine boosts for the government”.

“We’re not running things for long enough to actually be able to learn the lessons, understand what’s going on, and then perhaps transform what we’ve learned into a program of prevention rather than cure.”

So what did the panel feel ought to be done? Dr Teoh urged those listening to speak out and involve different people in decision-making and processes. “Really consider how wellbeing runs across everything that we do as an organisation, how we support staff, how we recruit staff, how it’s reflecting in our policies.”

And Ms Jordan urged them to “think big, think systemwide and stop being reactive”. “Rather than putting out fires, we need to rewire the house. There’s a lot of money being spent on initiatives which are just firefighting,” she said. “I think we need to centralise our wellbeing provision and resource in our ICSs.”

“Let’s remember the return on investment that you get from investing in staff health and wellbeing. And that’s not a free Crunchie for everyone on their desk. This is about proper health and wellbeing support and remember that the solutions are structural,” urged Ms Cordery. 

And Mr Raczka said that the BPS has been lobbying MPs and urged people to work together. “But it’s in the report – lots of really practical guiding principles and case examples and evidence as well contained within there,” he said. “So please do read that, and we’ll certainly be lobbying ICS chairs and other leaders.”

For more information on the Learning from NHS Staff Mental Health and Wellbeing Hubs report, click here.

The BPS has created a short film to accompany their report urging investment in NHS and social care staff wellbeing provision to safeguard the future of health and care services. Click here to watch.