NHS staff are physically and emotionally exhausted. The Covid-19 pandemic has exposed a system plagued by staff shortages and inadequate funding – a system that has relied on goodwill for years.
The psychological burden of the pandemic on health workers was predictable. The adverse impact of other pandemics, such as SARS, on health workers’ mental health has been well documented, with increased dose of depression, burnout, post-traumatic stress disorder (PTSD) and anxiety.
Combine that with a high rate of psychiatric, stress-related illnesses experienced by UK doctors, and suicide rates higher than many other professions, and we have a perfect storm. There were early warnings, with published data on the impact of Covid-19 on the mental health of health workers from China and Singapore. We were simply ill-prepared.
With increasing cases, limited resources and staff shortages, health workers are being pushed to the limit. One senior nurse at a busy London emergency department said: ‘We were seven short this morning. Some are ill with Covid, others are isolating and others are off for weeks due to mental health reasons.
“We rely every day on the goodwill of colleagues to come in for extra shifts,” she continued. ‘The extra support we had in the first wave, with free food, transport and extra payment for additional shifts, has been scrapped. Many of us are not from the UK, feel isolated and drained and have seen our families for eight or nine months. I have never seen so many nurses cry during shifts. Every shift is a struggle. ‘
Some health workers have been forced to take long-term sick leave for mental health reasons or have even resigned. “I was no longer due to mental health for a long time and I got so bad that I wanted to take my own life,” said another nurse. “On my return, I am pressured to be redeployed. I was told I had a job to do. Many of us felt like lambs to slaughter. ”
A study among 2,707 health workers identified several factors related to staff burnout during the Covid-19 pandemic. This included the following: 1 feeling that it goes beyond training 2 – exposure to Covid-19 patients and 3 – to make life-prioritizing decisions.
As the current wave increases, many staff have been redeployed to areas such as ICUs, with limited experience and training, with increased exposure to Covid-19 patients, and senior staff increasingly have to make life-prioritizing decisions, such as whether someone is eligible to be admitted to the ICU to become and go on a fan. Staff do it day-in and day-out, for months. It’s not hard to understand why our staff is burning out.
One senior nurse said: ‘I feel sorry for some of the junior staff. I remember I had to teach someone by telephone how to do non-invasive ventilation because we did not have enough staff and I just could not leave.
‘When junior nurses ask for help and feel overwhelmed, they are sometimes left alone to continue with it because there is simply not enough support. After months of this, I was forced to take a period of sick leave because I could no longer cope and felt so guilty. ‘
The pandemic also had a major impact on the training of doctors. Vocational postgraduate exams have been canceled or postponed, as well as some special recruitment interviews for which students have spent months preparing. The uncertainty, the unpredictability and the disadvantage of their careers also contributed to psychological distress and burnout.
“I’ve been reviewing for this exam for months, but I’m not even sure if it will continue,” a student doctor said. “The uncertainty caused me so much anxiety and tension; I do not know what is going to happen. ”
The support provided to staff during the first wave, such as free parking, food, accommodation, access to psychologists and wellness points, is no longer in place with most trusts, at a time when staff need it most. Our group’s ongoing research found that 37 per cent of health workers in the UK drank more than one coping mechanism during the pandemic. In addition, many staff members working in some of the most at-risk areas of the hospital, such as ICU and A&E, have not yet received a vaccination slot.
Since her own trust did not have access to psychological support / therapy, one anesthetist had to arrange private therapy sessions. “In April last year, morale was high. But no one thought we would be dealing with this yet, and honestly, everyone is somewhat hesitant and exhausted. “I see the doctors being redeployed are just discouraged,” she said.
‘Two beds are crammed into one bed, one nurse looks after three or four ventilated patients and there is no team spirit. The conditions are terrible. Shifts are difficult, everyone is burnt out and the erratic day / night schedule means that there is little continuity with work colleagues. Camaraderie is dead.
‘Really difficult decisions are made due to limited resources. I remember an elderly patient who had to be intubated and transferred to the ICU, but I was told by my consultant that he was not fit for the ICU. He then, unfortunately, passed away. I suffered from insomnia and could not switch off after shifts. I also had flashbacks about patients ”.
The goodwill of staff, on which the NHS has been working for years, is running out. The Covid boom is likely to continue over the coming weeks and months. The government, key policymakers and local / national stakeholders need to ensure that the mental health of staff is not neglected in the face of increasing admissions and deaths in Covid, and that adequate support is available to curb a looming mental health epidemic in the UK . – its aftermath can cause many staff members to go on long-term sick leave or resign altogether.
Dr Ankur Khajuria is an NHS surgeon and principal investigator of the Royal College of Surgeons study on the impact of Covid-19 on mental health.