Abstract
BackgroundThe Covid-19 pandemic has imposed extraordinary strains on healthcare workers. But, in contrast with acute settings, relatively little attention has been given to those who work in mental health settings. We aimed to characterise the experiences of those working in English NHS secondary mental health services during the first wave of the pandemic.MethodsThe design was a qualitative interview-based study. We conducted semi-structured, remote (telephone or online) interviews with 35 members of staff from NHS secondary (inpatient and community) mental health services in England. Analysis was based on the constant comparative method.ResultsParticipants reported wide-ranging changes in the organisation of secondary mental health care and the nature of work in response to the pandemic, including pausing of all services deemed to be “non-essential”, deployment of staff across services to new and unfamiliar roles, and moves to remote working. The quality of participants’ working life was impaired by increasing levels of daily challenge associated with trying to provide care in trying and constrained circumstances, the problems of forging new ways of working remotely, and constraints on ability to access informal support. Participants were confronted with difficult dilemmas relating to clinical decision-making, prioritisation of care, and compromises in ability to perform the therapeutic function of their roles. Other dilemmas centred on trying to balance the risks of controlling infection with the need for human contact. Many reported features of moral injury linked to their perceived failures in providing the quality or level of care that they felt service users needed. They sometimes sought to compensate for deficits in care through increased advocacy, taking on additional tasks, or making exceptions, but this led to further personal strain. Many experienced feelings of grief, helplessness, isolation, distress, and burnout. These problems were compounded by sometimes poor communication about service changes and by staff feeling that they could not take time off because of the potential impact on others. Some reported feeling poorly supported by organisations.ConclusionsMental health workers faced multiple adversities during the pandemic that were highly consequential for their wellbeing. These findings can help in identifying targets for support.
Highlights
The Covid-19 pandemic has imposed extraordinary strains on healthcare workers
A systematic review found that healthcare workers are at especially high risk of mental health difficulties during viral epidemic outbreaks [2], a problem that has been vividly highlighted during the Covid-19 pandemic [6]
Between June and August 2020, we undertook a qualitative study involving remote interviews with 69 people, including 24 people with mental health difficulties, 10 carers, and 35 point-of-care staff working in NHS secondary mental health services
Summary
The Covid-19 pandemic has imposed extraordinary strains on healthcare workers. But, in contrast with acute settings, relatively little attention has been given to those who work in mental health settings. Supporting wellbeing is understood as an ethical imperative and employer responsibility [2, 3]. It is important in reducing sick leave and staff turnover, and in securing the sustainability of health systems [4, 5]. People were instructed to stay at home and avoid all ‘non-essential’ contact with others outside of their household. The introduction of these measures had a profound impact on the healthcare system while simultaneously creating a range of extraordinary strains on healthcare workers. As well as exposure to a potentially deadly infection that could affect them directly or be transmitted to their families, many staff were routinely faced with unprecedented situations, deaths of those they were caring for, and having to make highly consequential decisions under severe pressure [7]
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