• Heather

The Urgent Need for Improved Mental Health Support for Healthcare Workers


Introduction

The global pandemic of COVID-19 has taken the world by surprise and put increasing stress on a healthcare sector that was already under pressure. In a world beginning to find its feet following the effects of COVID-19, physical support and appreciation was shown for these individuals. However, it is often overlooked that the nature of their work leaves many of these front-line workers at risk of suffering from poor mental health [1]. There is an urgent need to address this issue and provide necessary support. The aim of this report is to highlight a genuine and widely-recognised crisis in mental health within the healthcare profession, and therefore a need for supporting trials to provide confidence in a novel care-giver-centred (holistic) approach.

Mental Illness Amongst Healthcare Professionals

One in four people will experience a mental health problem at some point in their lives [2]; suggesting that many healthcare workers will also be affected. Mental illness is argued to top the list of leading causes for global burden of disease [3]. It has been revealed that almost nine in ten employed within blue-light professions had experienced stress and poor mental health during their work term within the sector [4].

High rates of mental illness, burnout, overwork and poor morale is common amongst NHS and care staff [5]. This is due to the fact that highly stressful jobs are more likely to cause burnout due to the demanding nature of work, leading to reduced levels of motivation, decreased productivity and lower quality of work [6]. This condition may manifest even when the practitioner is totally unaware of it and has no insight into the way they are managing their workload.

The psychological impact of the global response to COVID-19 will long be felt throughout society. A considerable amount of fear and anxiety continues to exist around the topic. Healthcare professionals will be amongst those most affected due to being confronted by unprecedented and traumatic experiences during the pandemic [7]. This is an issue that needs to be addressed as it poses one of the biggest risks to a safe healthcare service, for its trusting patients and the staff themselves.

A Holistic Approach

The changing healthcare landscape, evolving cultural norms, and use of technology within the NHS bears the potential to have a beneficial impact on the mental health of healthcare providers. Workload needs to be more compassionately managed and support provided to ensure the effects of underlying traumatic experiences are treated appropriately. This need can be fulfilled by incorporating a holistic approach to mental health healing and well-being.

The Harmonizing Process, which is a combination of coaching and counselling, is well-placed as a useful therapeutic tool to be used to provide support for healthcare workers [8]. Previous studies have shown the likes of Compassion Cultivation Training (CCT) [9] to promote positive mental health, by providing healthcare workers with increased job satisfaction, mindfulness and self-compassion [10]. Similarly, the Loving Kindness Meditation (LKM), has shown to encourage an increase in feelings of social connection and empathy, which leads to practitioners dealing with their patients in a more compassionate manner [11]. Therefore, this report shows early indications of The Harmonizing Process’ promise when utilised by healthcare workers. Additional trials are required to determine the necessary data and confidence in providing evidence-based therapeutic support. Caritas Neuro Solutions is a company well positioned to manage such future studies and projects.

Materials and Methods 

Participants

Participants were self-referred UNISON members and the age range was 29-64. Cohort 1 comprised of 19 participants and Cohort 2 comprised of 20 participants. Both Cohorts 1 and 2 completed the WHOQOL-BREF [12] questionnaire to assess their quality of life, and Cohort 2 also completed a PHQ-9 questionnaire [13] to assess possible depression symptoms of the participants.

Literature Review

Current literature was researched from various resources including websites and articles regarding the existing landscape of mental illness amongst healthcare workers.

The Harmonizing Process

Participants attended a two-day introductory session to the Harmonizing Process. The aim of the Harmonizing training was to empower participants with the skills, knowledge and confidence to make necessary behavioural changes to manage their health and well-being both in their professional and personal lives. The programme was designed in response to internal interviews which identified the core issues individuals were facing within the organisation.


Results


Graph 1: Participant percentage for each answer (ranging from very dissatisfied to very satisfied) to the question ‘How satisfied are you with your sleep?’



Graph 1 shows that 41% of the participants reported to be ‘dissatisfied’ or ‘very dissatisfied’ with their sleep. Statistics from the NHS state that 1 in 3 people suffer from poor sleep [14]. Sleep deprivation can lead to several physical problems, but it can also negatively affect one’s mental abilities [15]. Due to large percentage of participants having a negative response to this question, it is needs to be investigated further why employees are not getting a satisfactory sleep at night.



Graph 2: Participant percentage for each answer (ranging from never to always) to the question ‘How often do you have negative feelings, such as blue mood, despair, anxiety, depression?’  


Graph 2 shows that very few of the participants, only 8%, reported ‘never’ to have negative feelings. More than half (55%) reported to ‘quite often’ or ‘very often’ have such negative feelings, which is a worryingly high percentage. This raises a huge concern and requires urgent intervention. There needs to be better awareness in the workplace of mental health problems, and those suffering from such issues require the much needed support.


PHQ-9 DATA FOR COHORT 2

Participants from Cohort 2 completed the PHQ-9 questionnaire. It was asked “Over the past 2 weeks, how often have you been bothered by the following”:

1. Little interest or pleasure in doing things

2. Feeling down, depressed or hopeless

3. Trouble falling asleep or staying asleep or sleeping too much

4. Feeling tired or having little energy

5. Poor appetite or overeating

6. Feeling bad about yourself or that you are a failure or have let yourself or your family down

7. Trouble concentrating on things, such as reading the newspaper or watching television

8. Moving or speaking so slowly that other people could have noticed? Or the opposite-being so fidgety or restless that you have been moving around a lot more than usual

9. Thoughts that you would be better off dead or of hurting yourself in some way

The question numbers correspond to those shown in Graph 6.

Graph 3: Participant percentage for each question for the PHQ-9 section of the questionnaire.

Graph 3 shows that for questions 1 to 8, a significant percentage of the participants responded ‘several days’, ‘more than half the days’ and ‘nearly every day’. This could indicate early signs of depression and therefore requires immediate attention. Thankfully for question 9, the vast majority (90%) answered ‘not at all’.

The average total PHQ-9 score for all the participants from both Cohorts was calculated to be 8.5. This score falls in the category of ‘Mild Depression Severity (see Table 1) [13].This emphasises the need to highlight the problem of ill mental health within UNISON members and to address it. 6 out of 20 participants were reported to have a score of 10 or more, which ranges from the ‘Moderate Depression Severity’ to ‘Severe Depression Severity’. This further signifies how important it is to ensure positive mental well-being of the employees. 

Table 1: PHQ-9 scores, their corresponding depression severity and their proposed treatment actions.









Follow-up questionnaires were shared with participants after 1 month for Cohort 1 and 6 months for Cohort 2. 8 of 9 participants said they thought the course helped and all the participants said it made them feel more able to cope with stress. In addition, 4 out of the 9 participants said they found their workload to be more manageable.

Discussion

Harmonizing to Improve Mental Well-being of Healthcare Professionals


Our results suggest there is an overall critical need for improved solutions in managing mental health of healthcare professionals. 55% of participants reporting negative feelings ‘quite often’ or ‘very often’ shows that solid support to manage blue mood, despair, anxiety and depression is long overdue within the healthcare profession. In 2018, The Medical Protection survey revealed that 85% of doctors have experienced mental health issues [16], with doctors in the USA having the highest suicide rate of any profession [17]. It's been estimated that in the UK, the actual suicide rate of doctors is between two to five times more than the general population [18]. This raises a huge concern for the safety of our doctors and the rising need to protect their mental health.


Other healthcare workers are also at risk of developing ill mental health. More than a third of nurses rated their mental health as ‘bad’ or ‘very bad’ in April 2020, according to a survey by the Nursing Times. 90% reported to be more stressed and anxious at work than before the COVID-19 outbreak [19]. In addition, the Institute for Public Policy Research (IPPR) report published by Care Fit for Carers in April 2020, stated: ‘Half of healthcare workers reported their mental health had deteriorated since the COVID-19 crisis began.’ [20]. Poor mental health within the UK workforce is estimated to cost employers almost £35 billion annually [21]. Introducing early intervention programmes for mental illness can help reduce the impact of ill mental health on individuals, businesses and the economy.

The average PHQ-9 score from the participants of the study was 8.5, showing that most participants should seek ways to improve their quality of life by improving well-being, decreasing stress and seeking improved work-life balance. 30% of participants reported a PHQ-9 score of 10 or higher; indicating moderate to severe depression which requires a treatment plan. The number of people reporting poor mental health within the workplace increased from 14% in 2015 to 21% in 2019 [4]. It's difficult to suggest whether these figures indicate an increase in the prevalence of mental health disorders, or that people feel more able to identify struggles with their own mental health, and as a result are more willing to acknowledge it.

Results of the preliminary study imply that staff managers within the healthcare profession need to be well equipped in mental health first-aid and supportive protocols are necessary to refer staff for counselling or other appropriate measures. A mentally and physically healthy team of healthcare professionals should be top priority, to ensure detailed and compassionate care for patients. Researchers from the Southern Health NHS Foundation Trust are currently investigating the psychological impact of the COVID-19 pandemic. The study aims to explore its current and continuing influence on our emotions, behaviours and well-being. It will be necessary to assess the potential correlations with healthcare providers if available [22].

Mental health problems across the healthcare sector was already a huge concern before the COVID-19 pandemic, but following the outbreak the need for support has increased dramatically. Individuals in this sector take care of several patients every day, whilst having to face the challenging psychological consequences of their jobs. A combination of raising of awareness of mental health, targeted interventions provided when required and emphasis of the culture of self-care can begin to provide a supportive environment in which employees can thrive [23]. Data from this report suggest that empowering healthcare professionals through the Harmonizing Process, allows better coping strategies to manage stress and improved resilience.

Limitations and Future Directions

Although the study shows promising results, a larger sample size is needed to draw full conclusions of effectiveness. Closer follow-up over, for example an 8-week time-frame, would allow increased guidance on the Harmonizing Process and assurance that participants understood all elements. Taking factors such as job role into account will help to better pin-point where the stress originates from and how to best provide support. Also, an improved strategy for participant retention until follow-up is required since only 23% of participants responded.


Conclusion

This study found existing research that highlights the urgent need to provide mental health support to healthcare workers. The results from the preliminary study demonstrated that a two-day session outlining the Harmonizing Process had positive consequences on the mental well-being of participants by enabling participants to better cope with stress and manage their overall mental health. This indicates the process shows promise as a viable practice for improving well-being and mental health in healthcare providers. Further trials and studies are now needed; which Caritas Neuro Solutions is well-positioned to conduct.



Data sharing not permitted without approval from Caritas Neuro Solutions.

This report is a summary version of the original report. Please contact Caritas Neuro Solutions if you would like to access the full version of the report.

Written by Heather Thomson and Ayela Irfan, reviewed by Leigh Fell

Supported by Caritas Neuro Solutions.


References

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2. Ginn S, Horder J. “One in four” with a mental health problem: the anatomy of a statistic. Bmj. 2012 Feb 22;344:e1302.

3. Vigo D, Thornicroft G, Atun R. Estimating the true global burden of mental illness. The Lancet Psychiatry. 2016 Feb 1;3(2):171-8.

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10. Seppala EM, Hutcherson CA, Nguyen DT, Doty JR, Gross JJ. Loving-kindness meditation: a tool to improve healthcare provider compassion, resilience, and patient care. Journal of Compassionate Health Care. 2014 Dec 19;1(1):1-9.

11. What is Harmonizing? [Internet]. Harmonizing by Dawn Breslin. 2018 [cited 16 September 2020]. Available from: https://dawnbreslin.com/aboutharmonizing/

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13. INSTRUCTION MANUAL - Instructions for Patient Health Questionnaire (PHQ) and GAD-7 Measures. PHQ and GAD-7 Instructions. 2020.

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15. Watson S, Cherney K. 11 Effects of Sleep Deprivation on Your Body. Healthline. 2020 May 15.

16. Bradshaw P. 85% of doctors have experienced mental health issues, reveals Medical Protection survey. Medical Protection. 2015 Jul 16.

17. Anderson P. Doctors' Suicide Rate Highest of Any Profession. Medscape Medical News. 2018.

18. Gerada C. Doctors, suicide and mental illness. BJPsych bulletin. 2018 Aug;42(4):165-8.

19. Ford S. Exclusive: Nursing Times survey reveals negative impact of Covid-19 on nurse mental health. Nursing Times. 2020 Apr 29.

20. Thomas C, Quilter-Pinner H: Institute for Public Policy Research.  Care Fit for Carers Ensuring the Safety and Welfare of NHS and Social Care Workers During and After COVID-19. April 2020. Available from: https://www.ippr.org/files/2020-04/care-fit-for-carers-april20.pdf

21. Mental health problems at work cost UK economy £34.9bn last year, says Centre for Mental Health | Centre for Mental Health [Internet]. Centre for Mental Health. 2020 [cited 15 September 2020]. Available from: https://www.centreformentalhealth.org.uk/news/mental-health-problems-work-cost-uk-economy-ps349bn-last-year-says-centre-mental-health

22. Southern Health is leading a global study into the psychological impact of Coronavirus [Internet]. Southernhealth.nhs.uk. 2020 [cited 16 September 2020]. Available from: https://www.southernhealth.nhs.uk/about/news/news-archive/psychological-impact-of-coronavirus-study/

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