From themes to actions

Abbeygail Jones, Helen Winter and Alison Beck on supporting NHS Mental Health Staff during the Covid-19 outbreak.

When the pandemic hit the UK in Spring of 2020, there was an outpouring of public support for NHS workers (Wood & Skeggs, 2020). Media reports and politicians praised the efforts of NHS workers and the public took part in the weekly doorstep ‘clap for carers’. Such public displays of appreciation were generally well received by healthcare workers but coordinating and providing support was ultimately the responsibility of Trust-based staff support services.

In the staff support team at SLaM NHS Foundation Trust we have been reflecting on our response to Covid-19 whereby we tried to rapidly incorporate research evidence, react to the needs of colleagues and provide appropriate, effective support. This is our summary of the past year.

Behind the frontline

Research into the impact of Covid-19 demonstrated a negative impact on staff morale, sense of safety and confidence (Chen et al., 2020; Greenberg et al., 2020). Healthcare staff reported irritability, signs of anxiety and depression, and signs of burnout (Luo et al., 2020). In medical settings and acute care, staff wanted adequate rest, help providing psychological support to distressed patients, and adequate PPE provision which would allow them to feel safe returning to family after work (Chen et al., 2020).  

Away from the ‘frontline’ of A&E and ITU, NHS staff in mental health services were required to provide continuity of care to their service users whilst adapting to remote working, complying with changing infection control measures and in some cases, being relocated to make space for more physical health beds. Linked to infection control measures were increased bed pressures, changes to visiting rules and challenging behaviour. Staff working in mental health have long been confronted with verbal abuse and physical threats, as well as challenges such as responding to self-harm and caring for patients against their will. This can negatively impact wellbeing, staff retention and patient care (Johnson et al., 2018), and the pandemic threatened to have an additive effect on the psychological and physical health of staff.

As such, the pandemic called into action staff support services, expediting greater coordination of services. To ensure services were driven by the needs of the workforce, the staff involved in support provision began to collect themes from trust-based networks, staff support providers, and support services/events. In line with evidence-based implementation methodology it was hoped that themes would form a continual ‘exploration phase’, enabling support providers to identify emerging needs, be adaptive and responsive (Aarons, Hurlburt & McCue Horwitz, 2011).

Safety first

In the face of crisis, following the principals of Maslow’s (1943) Hierarchy of Needs, initial interventions focused on resources and safety. Driven by scenes of empty supermarket shelves and knowledge of rising infection rates, there was a nervous energy amongst colleagues and a collective ‘survival mode’. Rest and recharge (R&R) hubs were set up at hospital sites as spaces where staff could safely take breaks away from cramped workspaces and take advantage of donations whilst receiving peer support and evidence-based information on topics such as managing stress and improving sleep. Staff volunteered to facilitate hub spaces and had access to senior psychologists for daily debriefs, training and on-call supervision. 

In the first three weeks of the R&R Hub rollout across five main Trust sites there were 13,101 staff visits with 930 direct contacts between hub volunteers and staff visitors. At their peak, 1179 visits were made to R&R hubs in a single day, with 519 visits being made to one hub. Visitors were grateful for the extra effort made by the Trust to give back to them as staff members, and hub volunteers reported feelings of pride and purpose. This feedback suggests R&R Hubs provided spaces which aligned with the Institute for Healthcare Improvement Framework for Improving Joy in Work (Perlo et al., 2017); spaces where colleagues felt valued, and which helped them to find meaning and comradery at work (Schwartz & Sendor, 1999). 

Working up the Hierarchy of Needs pyramid, the focus of support shifted to staff safety and sense of belonging. Existing support structures, alongside staff counselling and Chaplaincy offerings, were bolstered with a 24-hour Advice and Support telephone line and an online resource hub for practical and emotional support. One-to-one resilience coaching was introduced for anyone seeking a more comprehensive intervention. It was important teams developed social bonds and a shared identity to facilitate resilience, as staff continued to face the day-to-day challenges of work in addition to the pressures of Covid-19 (Elahi et al., 2018; Post, 2005). Subsequently, Schwartz Rounds, reflective practice and critical incident support sessions moved online to maintain access to supportive spaces. The evidence for these spaces indicates that they are places for the impact of work to be recognised, and for colleagues to support and learn from each other (Thomas & Isobel, 2019; Taylor et al., 2018; Willard-Grace et al., 2014). 

Blind spots

As the initial panic of the pandemic settled, staff could take stock and appreciate ‘blind spots’ in available services. The team began to gather themes from operational meetings, network meetings and staff support spaces across the Trust, considering carefully how we could hear diverse voices. For example, as a way of connecting with and amplifying quieter voices, a consultation piece was completed with admin staff based on the principle of Collective Narrative Practice (Denborough, 2008). From the process of gathering iterative feedback, it became apparent that colleagues in management roles and teams based away from main sites felt under-supported and under-resourced. 

The first response to this was to rollout satellite visits – a form of outreach support that recreated rest and recharge hubs for community teams; this led to a total of 25,960 staff visits to central R&R and satellite hubs held between 17 April and the end of September 2020. Next, team leader training was developed based on our own observations and evidence in the literature that teams rely heavily on team-based support (Greenberg & Tracy, 2020; Willard-Grace et al., 2014). The training is designed as two one-hour long sessions through which staff can better recognise signs of stress and distress, raise concerns, signpost to appropriate services and develop a strong team culture. The aim of this training is to increase the confidence of managers and supervising staff in supporting colleagues, as they shoulder responsibilities and anxieties of the team.

Thinking longer-term

As the longevity of the pandemic became evident, more needed to be done to assist staff adjusting to remote working and managing competing demands. Looking to build on teams’ resilience into the future, team wellbeing plans were developed and began to be implemented from Autumn of 2020 as a framework for providing more individual support to teams with differing needs. In line with our own findings, and those elsewhere in the literature (Billings et al., 2020), it was essential that wellbeing plans are flexible and personalised to the need of teams. 

As individuals began to contemplate working in a ‘new normal’, support resources reflecting the peak of the Hierarchy of Needs (i.e. self-fulfilment) were developed. Support services were required to adapt once again to facilitate stress management in the long-term. The rationale was to shift focus on to what staff can do for themselves; to move away from interventional support measures towards empowering staff to have agency over their own wellbeing. Resources relating to health, wellbeing and social connection were collated and made available via the staff intranet to help colleagues engage in self-directed self-care activities including lifestyle changes, making social contacts, and developing an awareness of stress triggers.

The importance of appropriate break spaces was a clear priority for staff and something which would allow the organisation to demonstrate their appreciation and commitment to their employees. As a result, the Kitchen projects scheme was initiated and has now received backing from Trust executives. In this proposal, the Trust commits to ensuring that it meets core standards for kitchen, rest spaces for all clinical and non-clinical teams as outlined in Workplace Health, Safety and Welfare Regulations (Health and Safety Executive, 2007) and the Trusts own Working Time Directive Policy. Only by having enough space and facilities to take a break from work can colleagues take advantage of formal and inform support services, allowing for resilience building and post-traumatic growth (Brooks et al., 2020). Additionally, the kitchens project aligns with the recommendation from Mental Wellbeing Commission report (Health Education England, 2019) that all staff should be able to access psychologically safe and confidential spaces in which to socialise and rest.

Continuing action

The last 12 months focused attention on providing colleagues with effective, easily accessible support, embedded into existing workplace structures. The integration of systematic feedback from across the organisation to inform staff support actions has been highly valuable, leading to renewed application of implementation science literature (Aarons, Hurlburt & McCue Horowitz, 2011) in SLaM staff support services. A recent coalition statement from health and care organisations clearly states the need for NHS organisations to continue prioritising the wellbeing of staff and respond to psychological needs with proactive action (The King’s Fund, 2021). With this in mind, we hope that the initiatives introduced over the last year will provide a platform to continue fostering supportive environments that promote reflection and resilience within teams and workforces across the Trust.

- Abbeygail Jones is an Assistant Psychologist and Helen Winter is a Consultant Clinical Psychologist and Programme Manager for Corporate Psychology & Psychotherapy. Alison Beck is Director of Psychology and Psychotherapy for South London & Maudsley NHS Foundation Trust. It is important to acknowledge the commitment of the wider SLaM staff support team, as well as the Community of Practice across the organisation, who continue to work tirelessly to provide support across the SLaM.

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