Mental Health Support: Frontline Staff

I beg to move,

That this House has considered mental health support for frontline staff.

It is an honour to move the motion with you in the Chair, Mr Paisley, now that Westminster Hall is once again available for our purposes. In this unique time of pandemic, the mental health of frontline and key workers should be fully supported. I declare an interest as a former psychologist in the NHS for 20-plus years—I am showing my age—before I came to this House, and as chair of the all-party parliamentary health group and the all-party parliamentary group on psychology.

No one should underestimate the severity of the mental health crisis that engulfs us all as a direct result of the advent and ongoing havoc wreaked by covid-19 across the UK, and indeed worldwide. I thank the organisations that have been involved on the frontline, supporting mental health strategy and the delivery of services, including: the child mental health charter and, in particular, Helen Clark, a former Member of this House; the British Psychological Society; the British Medical Association; the Royal College of Psychiatrists; Mind; the Centre for Mental Health; and EveryDoctor—that is to name but a few. I thank all the other parliamentarians who have taken the time on a Thursday afternoon to speak on this vital issue.

On 5 October, Dr Tedros Ghebreyesus of the World Health Organisation introduced the first global dataset on covid-19 access to mental health services. He said:

“COVID-19 has interrupted essential mental health services around the world just when they’re needed most.”

There were some devastating findings. Before the pandemic, countries were spending less than 2% of their national health budgets on mental health. More than 120 countries —93%—reported that mental health services had been stopped or disrupted during the pandemic, 72% said that mental health services to children and adolescents had been disrupted, and 75% had seen a disruption to mental health services in the workplace. Despite the fact that 89% of the countries surveyed said that mental health and psychosocial supports were included in their national coronavirus response plans, only a shocking 17% had full additional funding to cover the cost of those services. Together, those figures show that there is likely to be an international tsunami of mental health morbidity like no other seen in our time.

The Centre for Mental Health, a UK charity, estimates that in England alone up to 10 million people may need mental health support—including long-term support—for the foreseeable future as a result of covid-19, and that 1.5 million children may require support. Those numbers are a stark warning that the impact of the pandemic will have severe long-term repercussions for the mental health of the UK as a whole.

Those affected will need support for depression, anxiety, post-traumatic stress disorder and other mental health difficulties in the coming months and years. Of course, some groups are disproportionately affected, including those with disabilities, those from minority ethnic communities and those with pre-existing mental health conditions who have experienced increased morbidity during the pandemic. Responding to increased mental health needs must therefore be a priority when a recovery plan is drawn up for both NHS and social care sectors for the future of our public health and in fiscal planning across Governments.

On the impact on frontline staff, the national forecast for adults is that more than 200,000 NHS workers may need treatment for post-traumatic stress disorder, psychological distress and burnout. Although less data has been collected, it is likely that a similar pattern will affect those who work across social care settings such as nursing homes. Research is badly needed. Those staff must not be excluded from or let down by the data collection and resourcing that is required. I would be grateful if the Minister looked specifically at the resourcing of data on the psychological impact of covid-19 in the community, nursing and social care sectors.

The International Council of Nurses reminds us that the effects of covid-19 on the mental health of nurses and the wider health social care workforce is a ticking time bomb. Every Thursday, across the UK, we were glad to show our support for key workers on the frontline, who risk themselves daily as they confront the pandemic on our behalf, but we owe them much more than weekly applause, and Governments across the UK owe them that duty of care.

Data from previous pandemics analysed by the British Medical Journal shows that post pandemic, healthcare workers are at high risk of both psychological illnesses and physical outcomes. For frontline staff, decisions made during the pandemic have regularly determined who to prioritise for care, but they have also felt a lack of control, especially when patients are care home residents who are dying and no treatment has been available for them. Emotionally and physically, having to be there day in, day out for patients as well as their families, who often could not visit relatives in their time of need, has been unduly toiling. That has come alongside the use of personal protective equipment for long periods; times when PPE has not been provided to the extent that it should have been; and long periods of excess working hours, stress and exhaustion.

A study by Kisley and colleagues has identified risk factors for psychological distress for staff in the time of covid-19. Personal care and socioeconomic stressors included personal childcare needs, having an infected family member at one point during the pandemic, and having a lower household income, with fewer choices in how to cope. Trauma is triggered when trusted bodies act in a way that can harm their safety at work, such as the failure to obtain correct or sufficient PPE, or by the breakdown or absence of testing and systems. The study also identified enforced redeployment to care for covid-19 patients, a failure to screen and triage healthcare workers for mental health needs prior to the pandemic, and a reliance on crisis intervention when symptoms develop.

Prior to the pandemic, the British Medical Association set out in a 2019 NHS staff survey that 40.3% of healthcare staff reported feeling unwell due to work-related stress. With the onset of covid-19, the workload for healthcare workers has increased radically. Four in 10 psychiatrists have reported an increase in people requiring emergency healthcare, including new patients, in the aftermath of lockdown. NHS and social care jobs obviously involve exposure to a huge range of potential stressors, including competing demands, interpersonal conflict, complex and life-changing decision making, moral injury, shift work and long hours. Added to that in the past six months is the pausing of the working time directive, the limited scope for time off or holiday periods, the increasing morbidity of patients, and losing colleagues. As someone who has worked in the NHS for many years, I have to say that the loss of colleagues is a terrible shock, and not something that people expect in their day-to-day working lives. That is something that frontline staff have had to cope with in addition to their care roles.

People join the caring professions to make a difference and make others better, but coronavirus has created an overwhelming feeling of helplessness in the midst of this trauma. It should be noted that previous coping strategies that those on the frontline utilised may play out differently if they have to cope with a second or third wave. The adrenaline with which they coped in those vital months so that they could be there to support those in need may be replaced by the dread of going through it all again and the fear of being retraumatised.

I have referred to some of the facts and figures impacting the mental health of care workers, but here are some voices from the frontline, expressed in letters sent to The Guardian and the nationwide EveryDoctor organisation, which has been in touch. One said: “The mental health exhaustion that comes from changing everything about the way you work on a weekly or sometimes daily basis for months is immense. All the while, you can see a light at the end of the tunnel, but then you are bracing yourself for the next disaster: a second wave or winter crisis, alongside mass staff absence.”

Another said: “There is the effect of not only seeing patients die, but losing colleagues. Everyone is struggling with this pandemic, but doctors are responsible for the decision making clinically. We can see that this is not going away. There is no respite in sight.”

Another said:

“I am employed on mental health wards as a support worker, helping people recover from acute problems… Covid-19 has not only affected general hospitals but has also had a huge impact on mental health facilities, which are more often run by a skeleton staff… On top of this we are also dealing with mental health patients infected with Covid-19… As we are not considered to be on the frontline, we are not equipped with proper personal protective equipment. We get a basic face mask, gloves and a flimsy apron.”

It should not be forgotten that school staff are also on the frontline, as they have to deal with the effects of the pandemic on children in their care. The mental health issues incurred by lockdown in the children they teach everyday are present upon return to schools. Anxiety and stress among a large group of pupils, alongside the experience of bereavement and a lack of community adolescent mental health services for those with acute problems, has been a feature of the recent past. That is alongside reduced assessment and diagnosis possibilities, due to staff having to change their working patterns, often from face-to-face to virtual sessions, after a period during which sessions were not offered.

Innovation will be key in ensuring that we can address the needs not only in the population but among the frontline staff who desperately need support. Using technology and ensuring that there is the capacity and technical knowledge to support the transition to other methods of care will be fundamental. Meeting the mental health needs that arise from coronavirus is a huge challenge, but it is not optional. Just as responding to the threat of the virus itself has tested our resources and resilience, so too will addressing the psychological and emotional consequences.

I am extremely grateful to the British Psychological Society, which has provided specialist guidance. I know that it has also been working with the Scientific Advisory Group for Emergencies and with the Minister’s office. It wants to see the planning of psychological support and resourcing of the psychological workforce to meet demands in the NHS and care homes and also in schools and the community. It also wants to see increased access to an in-house employee wellbeing service, which it believes will be critical, particularly if unemployment issues face the population in the coming months. It wants to see the employment of psychologists to focus specifically on staff. It tells me that it is not feasible, in the long term, to ask psychologists to work with patients in their work time and then to work with NHS staff in their spare time to meet psychological needs. The society would like to see more use of psychologists not just in supporting patients, but in a strategy to support staff over the long term.

My hon. Friend the Member for Midlothian (Owen Thompson) will be covering in depth the work of the Scottish Government in relation to mental health strategies during the pandemic, so I will focus on the issues that have been raised with me in my capacity as chair of the all-party parliamentary health group and the all-party parliamentary group on psychology.

These are some of the questions that I have been asked to raise with the Minister. What steps is the Department of Health and Social Care taking to model and plan for demand for mental health support as a result of coronavirus and the consequent impact on the economy and employment? What additional funding will be made available to mental health providers to ensure that services are covid-19 safe and that they can meet increased demand for support and deliver on existing pledges in the NHS long-term plan for mental health? What resources will be made available for local initiatives that provide early mental health support in our communities, especially for those people who have been bereaved? What proportion of schoolchildren will benefit from the wellbeing for education return funding? How will children’s mental health be supported moving forward?

What resources will be made available to support health and care staff in the NHS, social care and voluntary sectors who are experiencing post-traumatic stress disorder, high levels of psychological distress or burnout? What specialist support will be made available? What resources will be made available to ensure that research and funding are provided for those working in social care settings so that we adequately address their mental health needs alongside the NHS staff population?

What plans are being put in place to protect NHS staff from a potential onslaught of claims against them because of the pressures that they have worked under during the pandemic? That may give rise to a number of negligence suits in the future. That issue has particularly been raised by the Medical Defence Union, which is concerned that staff have often been placed on the frontline with a lack of resources and with a lack of support medically or clinically themselves.

Now is the time when I feel that I and other hon. Members should be responding in the main Chamber to a detailed statement from the Government about their proposals for mental health directly arising from the devastating impact and ongoing effect of covid-19. Such a statement could include ways in which the Government propose to protect and sustain the mental health and wellbeing of key workers and that will be distinctly and separately resourced, rather than relying on any money from pots designed for other purposes. I look forward to the Minister’s reply today. I hope, on behalf of the key workers for whom I have been given the privilege to speak, that she will tell us that the Government have set a date for the announcement of a properly and realistically resourced mental health strategy that will be both integral and central to the overall covid-19 recovery plan.

I thought I was going to be calling Jim Shannon to speak today, but he is not here, as we know, so I call Owen Thompson.

It is a pleasure to serve under your chairmanship, Mr Paisley. I congratulate my hon. Friend the Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron) on securing the debate. It is important to focus on mental health, and today we have a great opportunity to do that. I know that my hon. Friend brings a wealth of invaluable professional experience to the topic, which I cannot begin to understand.

In mental health, as with other aspects of health, time needs to be dedicated to caring for and looking after people, to reduce the chances of someone becoming seriously unwell. If we relentlessly push our bodies every day we soon pick up physical ailments, stresses and strains, and they can develop into something more serious if they are not given time to recover. Our bodies will send signals telling us to stop before we collapse, and the same goes for our minds. Downtime is not a luxury. It is essential, and we all need to be able to read the signs before reaching breaking point. The brain is an unbelievably complex organ, and is constantly processing something even more complex—human experiences and emotions. I am amazed that it does not go down, and that something does not go wrong with it, more often.

On the frontline, our carers and health staff have faced the brunt of the pandemic response. We may moan about working from home, or not being able to go to the pub or to see friends, but they see people scared, alone and in pain, gasping for breath. They see families unable to get close enough to offer their loved ones the most basic human comfort—a hug. Dealing with that every day takes its toll.

[Siobhain McDonagh in the Chair]

The World Health Organisation reported a recent review of healthcare professionals finding that one in four was suffering from depression and anxiety and one in three had insomnia during the coronavirus outbreak. There was also an appalling rise in verbal harassment and discrimination and physical violence. No wonder they are battle-scarred.

It is indeed a pleasure to speak for the Opposition with you in the Chair, Ms McDonagh. I thank the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron) for securing this extremely important debate and other hon. Members for their thoughtful contributions. I pay tribute to all staff on the frontline, far too many of whom have made the ultimate sacrifice while trying to keep us safe and well. Their unwavering courage in standing up to the virus, knowing full well the risks to themselves and their families, has been inspirational and truly deserving of the gratitude of Members across the House.

From the very beginning of the pandemic, health and care staff have made immense sacrifices. When we were asked to stay home to avoid the virus, they were going to work and facing it head-on anyway. They were sadly left unprepared, with PPE problems and no access to testing that lasted for months. Ahead of World Mental Health Day on Saturday, this is a fitting time to acknowledge that frontline staff have a unique need. Everyone across the country has had their life disrupted, but our frontline health and care staff have had to deal with patients, colleagues and friends dying on their watch. As the hon. Member for East Kilbride, Strathaven and Lesmahagow said, nothing prepares you for losing a colleague, particularly when you think it could have been avoided. Frontline staff are trained to deal with high-pressure scenarios, but even then, they were not trained to tell people that their loved ones had died via phone calls. Covid-19 has stripped the humanity out of grieving.

The additional pressure has undoubtedly had a significant impact on the emotional wellbeing of frontline health and care staff. They have had no break, no support and no relief from the Government. Fatigue and burn-out are setting in on an already exhausted workforce, who are in desperate need of respite. We need only look at the latest NHS staff absence figures to grasp the true magnitude of the hidden crisis. Over half a million sick days were taken by NHS staff in England because of mental ill health in May alone—one month. Half a million days in just one month.

I echo the sentiments of the hon. Member for Tooting (Dr Allin-Khan): it is an absolute pleasure to see you in the Chair, Ms McDonagh. I thank the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron) for securing the debate. I have heard her speak many times in Westminster Hall, including when I have been in the Chair. She always speaks with passion, particularly on this subject, and she always bring her experience as a consultant psychologist. We are the better and the richer for it.

The onset of the covid-19 pandemic in March was the beginning of a hugely challenging time for all our frontline staff, who have so brilliantly supported our essential frontline workers. I echo everything that has been said in praise of our frontline workers. They have been beyond exceptional—beyond words. I spoke to some of them this week. When they were going into work in March and April, every day it got a bit worse. Every day they had no idea what they would face that day, but they did it, sometimes working 12 hours without a break. Those staff in ICU went on a hugely emotional journey with their patients. As we know, the pathology of covid once someone is in ICU changes very rapidly. That took some getting used to for the staff who were nursing those patients—one moment they thought they were doing fine, and the next their condition fell off a cliff. That was hugely challenging emotionally for the staff who were nursing those patients.

I endorse everything that has been said in the debate, and I give my thanks and praise to staff. They worked long hours doing emotional and draining work, which is why it was important to ensure that support was put in place. We know that staff resilience has been tested to the nth degree, and the Government recognised early on that this would be a difficult situation and that we had to prioritise the mental health of the staff who were working in those very challenging conditions—not just staff in ICU and in hospitals, but staff who were working in care homes and social workers, too. That is why, at the beginning of covid-19, we commissioned NHS England and NHS Improvement to develop a comprehensive package of emotional, psychological and practical support for NHS workers. We ensured that the same offer was in place for all social care staff and their colleagues in the NHS, wherever possible.

Thank you, Ms McDonagh, and I thank everyone who has spoken. It is vital that we continue to raise awareness of mental health, particularly for frontline workers. Saturday is World Mental Health Day, so it is apt that we have spoken about the issues today. The fact that 2 million people have downloaded the Every Mind Matters app shows that the population are reaching out for mental health support, that mental health is at the front of their minds and that they want support to build their resilience.

It is absolutely correct to view mental health as a continuum, but something such as a pandemic can push people who were perhaps coping well previously towards the end of the continuum where they need additional support. Those supports have to be stepped and matched to their clinical needs. Some will have acute clinical needs, and others will be able to cope with the support of family and friends or colleagues, and in different ways. Support needs to be matched. We need to ensure, right across the UK, that best practice is shared; that people work together so that when something is rolled out, it works extremely well; and that there is dialogue and sharing for all staff in the NHS of the four nations.

Before I finish, I want to mention that next year—when we have events back, which I hope will be towards the summer—the all-party parliamentary health group will host awards for staff who have shown themselves to have supported others, whether patients or their communities. I would be so pleased if the Minister and the shadow Minister were able to attend. I can let them know about it well in advance.

I also want to bring up something that I wrote to the Prime Minister about, which I hope to hear about at some point in the near future and which can perhaps gain cross-party support. That is to have a national memorial for those who served on the frontline and lost their lives during this pandemic. I hope that is another discussion that can be taken forward from today.

I thank everyone who took part. I know it is late afternoon on a Thursday, but it is so vital to pay tribute to all those on the frontline who have been there to support our needs in this time of crisis. We must always be mindful of supporting their needs, too.

That this House has considered mental health support for frontline staff.

Sitting adjourned.