Mental health – protecting the protectors

It’s clear that people at all levels of the NHS and those who support them face significant challenges – not least with potential mental health issues.

Our work with them shows they’re as stoic and resilient as usual, and it’s great they’re open to suggestions on how to improve support to peers in particular. NHS staff and other emergency services are no strangers to dealing with stress and trauma. Thousands have bravely chosen to be in harm’s way during the coronavirus pandemic, working with scant resources for long periods. Many find themselves in exceptional circumstances outside their normal experience. Combined with fatigue and potential moral challenges, although most people will cope, some may be at risk of longer term problems with their health and wellbeing. There is little opportunity to process what is happening right now. Of course, there will be events that have had significant impact. But experience tells us that robust professional people tend to put these things behind them quickly, so that they can face the next challenge. Failing to process traumatic experiences can cause problems. Good leadership and effective peer support are probably needed right now. It is crucial to provide colleagues with chances to share their experiences.

Issues for NHS staff mental health

We should identify people who are not doing well early on and offer them rest, support, and clinical help where needed. These are helpful for a positive return to work. Managers with little time now for comprehensive interventions should  look to the future. Unprocessed emotions and memories may prove challenging for some people when the operational tempo slows down. When the coronavirus pandemic eventually recedes, I hope we will see a return to normality. But, let us be clear; normality in the NHS was frantic before this. Many areas were stretched already – so do we expect those people that we all applauded to simply carry on? Of course, our doctors and nurses will continue to provide the highest levels of care and will put themselves last – but we need to consider their longer-term support.

Proven value of Trauma Risk Management – TRiM

The NHS has been listening to hard-earned military experience in how to provide support and manage risk around trauma. Evidence shows interventions such as Trauma Risk Management – TRiMare very effective. The military has a well-understood pathway for personnel returning from high tempo operations – decompression, normalisation, in service support, and aftercare. This is a coherent model, but it does not fit neatly to the demands of the NHS. Managing staff transition from high tempo Covid operations to more normal work routines may be challenging. Many staff members are staffing unfamiliar areas and working in ad hoc teams. Formerly retired staff are integrated into these teams and most will return to more sedate environments.

When teams break up

Experience tells us that when people suddenly find themselves removed from fast moving and threatening environments, they can be disorientated and may struggle to find normality. This is especially true when teams break up and natural peer support disappears. People may find themselves trying to come to terms with some of those unprocessed emotions and memories. For a minority, this can lead to issues with their mental health. A form of peer led decompression can be helpful – allowing people to share and process experience together is powerful. Individual staff members’ return into teams should be done very sensitively. Some people may take longer to recover than others, but we do know that most people make good recoveries from traumatic experiences.

What helps with mental health issues?

Creating safe and supportive environments and taking care about early exposure to high levels of subsequent stress – these are essential elements of a recovery pathway.Good leadership, sensitive management and help from peer support groups and TRiM practitioners will help to facilitate early intervention for the minority who may need additional support. I have talked mainly about doctors and nurses but there are many others providing essential service. As normality returns, management may do well to consider reintegration and long-term support. For now, these incredibly courageous staff will keep their shoulders to the wheel – but they may need help in healing the bruises.

Can we help you and your colleagues?