A qualitative study of experiences of NHS mental healthcare workers during the Covid-19 pandemic

Abstract

Background 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. We aimed to characterise the experiences of those working in English NHS secondary mental health services during the first wave of the pandemic. Methods The 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. Results Participants 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. Conclusions Mental health workers faced multiple adversities during the pandemic that were highly consequential for their wellbeing. These findings can help in identifying targets for support.

What have we learned about what works in sustaining mental health care and support services during a pandemic? Transferable insights from the COVID-19 response

“…Visible and supportive management and leadership was viewed to be essential in supporting staff in dealing with constant change and adapting to new systems of working within mental health services. These findings highlight the important role that organizational management and leadership play in supporting staff wellbeing and protecting staff against burnout (Brooks et al, 2018;Chan & Huak, 2004;Coates & Howe, 2015;Liberati et al, 2021). The emotional and psychological impact of working in mental health is an ever-present challenge for MHWs.…”

“…After considering participant heterogeneity, data saturation (Fusch & Ness, 2015) and other qualitative research in the area (Billings et al, 2021;Liberati et al, 2021), a purposive sample of 30 participants working across mental health and social care settings were recruited through one NHS Health Board in Scotland. Participants were recruited during February to March 2021 via social media, online recruitment posters and through NHS organizational communications.…”

“…In the United Kingdom (UK) mental health services across health and social care settings were not considered 'essential' in the initial governmental response and so, operated based upon management discretion (Liberati et al, 2021). Lack of clear guidance and ongoing policy and procedural changes meant that health and social care sectors were tasked with continually modifying their mental health care provision.…”

Experiences of staff providing specialist palliative care during COVID-19A multiple qualitative case study

“…[23][24][25][26][27] This aligns with evidence demonstrating how many healthcare staff already experienced moral distress/injuries prior to COVID-19, but how the pandemic has brought these phenomenon into sharper focus. 27 The increased risk of moral distress for health care staff during the pandemic has been acknowledged by regulatory bodies and governments internationally, [27][28][29] and this concern is supported by emerging evidence in the fields of acute care, 30 community care, 31 intensive care, 32 medical family therapists, 33 mental health, 34 and medicine more generally. 10 Compared to many of these specialities, due to their specialist training and knowledge, palliative care staff may have been expected to be better prepared to manage experiences of death and dying on the scale seen during the COVID-19 pandemic.…”

What challenges did junior doctors face while working during the COVID-19 pandemic? A qualitative study

“… 9 Such stressors include the need for rapid training around treating a new illness 9 and the psychological impact of exposure to unprecedented levels of suffering and COVID-19 related deaths, both of patients and colleagues. 8 10 11 …”