NHS staff are at risk of high rates of post-traumatic stress disorder if they don’t get the right support as the coronavirus outbreak subsides, health service adviser Prof Neil Greenberg has said.
For now there’s a national focus on health and care workers.
Public billboards praise them, millions turn out on the street for a weekly round of applause and volunteers have been rushing to help in any way they can.
But the height of the crisis is when many staff will be in coping mode.
It’s when things slow down – and the clapping stops – that, psychologists believe, the real risk of difficulties will arise.
People may need months or even years of “active monitoring” of their mental health after things return to some semblance of normality, according to Prof Greenberg, a world-leading expert in trauma.
The NHS in England is providing crisis support to its staff. But it hasn’t produced a formal long-term plan to offer extra psychological services in the aftermath of the pandemic.
.Coronavirus: Mental health hotline for NHS staff
An invisible wound for health workers and soldiers
As the crisis passes its peak, there is an “urgent” need to work out how staff calling new NHS mental health hotlines can be referred on to specialist services, says Dr Michael Bloomfield who runs a traumatic stress clinic at University College London (UCL).
The clinic was set up as a result of the King’s Cross Station fire in 1987, which killed 31 people and injured 100, and specialises in helping people following events like terror attacks.
What are the risks?
Studies after the Sars outbreak found about 10% of health staff had PTSD, and many more had other signs of psychological distress.
The British Psychological Society (BPS) points out that health workers are highly resilient people who are used to dealing with difficult and sometimes traumatic situations. But this current crisis has particular risk factors – including fear for staff’s own and their families’ health and the loss of informal support networks because of social distancing and working outside their usual teams.
Dr Rony Berrebi, an intensive care consultant in London, says: “People are scared. I think the fear factor is massive.”
“Imagine going to work every day and coming back home knowing the virus could be in your hair, your clothes, your shoes, or you might be brewing it,” he says.
It’s what happens after the trauma that is “most predictive of what people will be like in terms of their mental health”, according to Prof Greenberg. How well people are supported and how much stress they’re put under as they try to recover can make or break whether someone manages well or develops far more serious difficulties including PTSD.
“If we muck it up then that’s going to make the trauma they’ve already had much more difficult to deal with,” he says.
What do staff need?
At the height of the crisis, evidence suggests good leadership from managers and support from peers are the most helpful things.
Psychologists expect the real demand for more structured mental health support to come later.
Dr Julie Highfield, a clinical psychologist in an intensive care unit who is involved in putting together national guidance through the BPS, says she doesn’t expect the NHS hotline to be used very much during the “active period when everyone’s just trying to cope moment to moment”.
She is concerned to stress the NHS shouldn’t see this lack of demand as a general lack of need.
“What’s really needed long-term is an 18-month to two-year recovery period,” with access to counselling and trauma-focused therapy, she says.
Some therapy can be accessed now through in-house psychological services – but provision across the UK is “patchy”, says Dr Highfield. She would like the NHS to commit to a shared “minimum response”.
Dr Berrebi says his hospital has in-house psychologists but thinks some of his colleagues are not aware that it’s available or how to access it. He’s made a music video to raise funds for counselling for front-line workers.
Some resist comparing intensive care units to the battlefield. But Prof Greenberg, who has worked for decades with the military on the mental health of personnel, says NHS staff should be treated like soldiers after tours – with time off and a gradual return to normal work.
What’s on offer?
National mental health director Claire Murdoch said NHS England is offering mental health care and support “within trusts, and new text, online and telephone support services”.
The Scottish government has launched a “national wellbeing hub” where staff can access online resources, which it says has been created by “trauma and other specialists”. This is designed to “respond to the current pandemic and to help provide long-term support to staff,” a spokesperson said.
Northern Ireland’s plan outlines support for both the “active” phase and the “recovery” phase, including access to “evidenced-based psychological therapies for those with ongoing difficulties” and team-based reflection.
While in Wales, £1m has been put aside to provide support services including for PTSD.
Thousands of volunteers
A number of voluntary schemes have also been set up to provide therapy for NHS staff, in an attempt to fill the gaps.
Some, like Project 5 and Frontline-19, require volunteers to be accredited, highly vetted and commit to a minimum number of sessions.
But this commitment varies.
Prof Greenberg says some voluntary schemes are really good, but the quality varies: “Some follow evidence-based guidelines, but some are, to be fair very well-intentioned, but often not very well put together.
“It would be quite dangerous to allow a proliferation of well-meaning charities, which might distract or detract people from going and getting the right care.”
And people may not want to access these services now, but later – at which point well-meaning volunteers may well have had to return to their day jobs.
Kate Perry, a psychologist volunteering for Frontline-19, says she is committed to providing free care in the longer-term: “It’s very clear – you take someone into practice and treat them as you would a paying client, for as long as they need it.”
Trauma experts are particularly concerned about schemes that offer just one session or those that do not carefully vet volunteers’ qualifications.
This would be a concern, Dr Bloomfield says, because “some interventions can interfere with the natural healing process and make PTSD more likely”.