We know mental health will be a big issue for care staff coming out of the COVID-19 pandemic.

Quality Compliance Systems (QCS) spoke to the British Psychological Society, National Care Forum, Age UK, TRICRES and the Social Care Institute for Excellence to find out how managers can limit the impact on their staff, and share their findings here.

It has claimed the lives of over 315,000 people, hospitalised many more and deprived the world of its liberty. And without a vaccine, it may be some time before COVID-19 is beaten. But when it is finally tamed, it is not just the physical injuries that will leave a mark, but the psychological scars too. Particularly vulnerable in this crisis are the nation’s frontline care workers.

But how many people in the care sector have been affected? How many will experience mental health issues as a result of seeing too much? And most importantly, with budgets likely to be severely stretched after the crisis abates, will care workers be able to access the necessary resources to help them come to terms with what they have experienced?

With the pandemic still at a relatively early stage, nobody can be quite sure how many care workers will suffer from mental health issues. But the lessons of history, revealed in a recent webinar by the British Psychological Society (BPS), suggest that coronavirus will leave an indelible mark on the mental health of many.

In the webinar, Dr David Murphy, the President of the BPS, references the SARS outbreak, which, in 2003, affected the city of Toronto on a large scale. Researchers compared nine hospitals in Toronto, where staff had treated SARS patients, to a single hospital in nearby Hamilton, which had received none. Over a two-year period, the study found that the Toronto staff experienced significantly higher rates of burnout, psychological distress and post-traumatic stress disorder (PTSD) than their Hamilton counterparts. The study also revealed that there was a higher proportion of sickness and absenteeism amongst the Toronto staff.

While this example is centred on the experiences of medical professionals, Lesley Carter, a registered nurse and clinical lead at Age UK, believes that ‘the scale, duration and intensity’ of the COVID-19 pandemic makes this research relevant to the challenges faced by frontline care workers today.

She says, ‘Staff working in the care sector are being put at huge risk. They are much more vulnerable than doctors and nurses who work on the front lines. Arguably, it’s more challenging for them because they have got to know the people they care for on a personal level. Therefore, when lives have been lost to coronavirus in a home, it takes a much greater toll on their mental health.’

It is a view echoed by many of the 86,000 customers that subscribe to Quality Compliance Systems. Philippa Shirtcliffe, QCS’s Head of Care Quality, says, ‘We know from conversations that registered managers are worried about the long-term impact on the mental health and wellbeing of staff and we are providing a range of tools to support managers and staff to look after their wellbeing.’

At QCS, we have been gathering information and best practice and have written about the mental health challenges frontline workers face, as well as the strategies they can employ to promote wellbeing and manage mental health issues. We have referenced evidence-based best practice and guidance from several organisations including Age UK, the National Care Forum (NCF), the Social Care Institute for Excellence (SCIE), the British Psychological Society (BPS) and TRICRES, a business consultancy. We have summarised our findings into seven key points which are detailed here.

1) Inspirational leaders can promote and embed the foundations for good mental health

In any health crisis, strong leadership is essential. But according to the BPS, leadership must be accessible and visible. David Murphy, President of BPS says, ‘Leadership in a pandemic doesn’t mean that you have to have all the answers. It means being proactive and not waiting for your staff to come to you, and it’s about demonstrating to them that you’re always with them.’

Lesley Carter of Age UK agrees, suggesting, ‘There is a positive correlation between well-led homes and good mental health.’

Rebecca Bonnington, the Chief Executive of TRICRES, also emphasises that good mental health is closely aligned with good leadership. ‘When both are embedded within an organisation, mental health outcomes tend to be better and there is less sickness, less absenteeism and greater staff retention,’ she says.

2) Outstanding Leaders spot the warning signs

BPS says that breaking up the pandemic into three clearly defined stages – prepare, action and recovery – is key. Dr Murphy says that the psychological wellbeing of staff should not be picked up at the end of a crisis, but rather that ‘moral injury, burnout, compassion fatigue and PTSD are chronic difficulties that often develop over time’ and therefore, ‘staff should be constantly assessed and treated.’

But if you’re a registered manager, with limited resources, how do you spot the indicators that reveal that a frontline care worker, or indeed you, might be suffering from poor mental health?

Rebecca Bonnington, who trains leaders to recognise mental health issues believes it is not huge budgets that are important, but registered managers who have ‘the knowledge and experience to recognise the signs that something is wrong.’

She says, ‘Registered managers will probably know their staff quite well. The key signs that they should look out for are changes in behaviour and or appearance. These can be subtle, for example, if somebody is normally quite outgoing and chatty and suddenly becomes a bit reserved, then that could be a red flag that something is not quite right.

‘Sometimes, however, mental health issues are exceptionally difficult to detect. It could be a slight change in body language or a lack of engagement or a lack of self-care. Most crucially, it’s important to be aware that poor mental health doesn’t always mean that people will withdraw. Sometimes they’ll become more extrovert. So, it’s being vigilant and noticing changes in people that really counts.’

3) Excellent leaders intervene and engage

When a registered manager recognises that care staff are struggling with their mental health, TRICRES’s Rebecca Bonnington recommends ‘a light-touch conversation over a tea or coffee’ as being the best initial approach.

She says, ‘It might be that it takes several informal chats for the person to open up. But that doesn’t matter. Even if the care worker doesn’t wish to talk in the first or second conversation, it’s really important that the registered manager gently perseveres. Just listening without judgement holds great value. It demonstrates their support for the person and that’s what counts. When the manager earns that person’s trust, they should listen, comfort, support, and if need be put in place an appropriate action plan. That’s a sign of excellent leadership.’

Age UK’s Lesley Carter, who has also worked for The Care Services Improvement Partnership, agrees that a mental health awareness culture must prioritise vigilance. So how should best practice look in this respect in both care homes and domiciliary care environments?

Lesley says, ‘Registered managers should bring people together at the start and at the end of a shift. They should also be monitoring staff throughout the day. Coffee breaks are a good time to observe a staff member’s level of concentration and their ability to make a decision. Managers, too, must deeply embed the notion that it’s natural to cry, to become angry and to be overwhelmed at times. It’s also fine not to become emotional. Everyone is wired differently and everybody has different psychological thresholds. For some, the best therapy is not talking. This is also important to recognise.’

Philippa Shirtcliffe adds, ‘For domiciliary care staff, providing one to one support by phone or video during the pandemic is important to help support staff who may be struggling or feel isolated. This is a particular issue when care offices may be closed, or where social distancing is restricting face-to-face contact with managers and staff.’

4) Effective leaders allow staff the time and space to grieve

Registered managers need to be fully prepared if a person using their services, member of staff or a member of someone’s family passes away. From a policy perspective, managers need to know who’s going to manage the situation, who needs to be notified and how the team should respond.

But frontline care workers must also be given the time and space to process their experiences. If they have witnessed someone they support or their colleagues pass away, they need time to grieve, to recognise the value of the people that they have lost and to think about the impact that that loss has had on their mental health.

Liz Jones, Policy Director for the National Care Forum, says, ‘It is important to recognise that everyone responds differently to traumatic events. Dedicated mental health resources and support for managers should enable people to understand the reasons why they feel they way they do, what the managers can do to help people self-manage their mental health, how their teams can come together to support each other and help to identify when that person might benefit from professional support, counselling or other help.’

Sheila Scott OBE, Care Strategy Consultant for QCS, notes that the physical environment that care staff work in can play a key role in helping them deal with trauma.

Mrs Scott, who works closely with several care homes in Cambridgeshire and Peterborough says, ‘It’s important that staff have access to a room or a garden where they can be alone or be with “buddies”, who understand what they’re going through. As the crisis eases, these rooms, that may have temporarily been used for additional PPE or cohorting symptomatic residents, need to become a space for staff again, as they are incredibly therapeutic environments for staff to collect and process their thoughts.’

5) Excellent leaders develop robust but agile communications strategies

Communication is absolutely critical in a fast-moving pandemic. Policies, procedures and guidance are being updated almost daily as regulators and governments adjust their strategies to keep pace. In this fluid environment, registered managers need to stay on top of best practice. But for Philippa Shirtclffe, therein lies the rub – and the solution.

She explains, ‘There’s no shortage of guidance out there. But a lot of it is neither accessible, digestible or in the same place. We’ve worked hard to make sure that information is presented in the form of accessible factsheets, blogs, webinars, and that each policy is broken down into manageable chunks. This enables registered managers to provide the guidance to the right care worker at the right time, drawing on the most relevant and up-to-date best practice information.’

But to what extent can technology really prove effective to help manage mental health? Liz Jones says, ‘Care managers have never been busier. A system that provides structured, up-to-date content on which they can build a pandemic mental health awareness programme into their existing policies and procedures is hugely beneficial. It enables managers to fulfil their responsibilities to support their staff, with access to the right resources at the right time. At the same time, it frees-up a manager to monitor and evaluate staff’s mental health, using these resources, instead of spending their time having to create policies and practice from scratch.’

6) The best leaders are never afraid to embrace technology

One beacon of light in this crisis has been technology and the innovative ways it is being deployed. A few weeks ago, when Spain was the epicentre of the global pandemic, a nurse in the hot-zone began relaying messages to worried relatives using her smart phone.

‘This may seem like a simple act, but it was incredibly important for mental health,’ says BPS’s Dr David Murphy. ‘Not only did the nurse reach out to the patients’ families, in doing so she also alleviated the psychological burden being carried by her fellow staff.’

7) Outstanding leadership means building future resilience

Nobody knows when the COVID-19 pandemic will end. It is clear that, as a society, the UK will be battling coronavirus for the next 12 to 18 months as we await a vaccine. The health and care sectors will have to find ways to adapt to this new reality along with everyone else.

Dr David Murphy believes that, unless registered managers can help their staff to manage their mental health throughout the crisis, the psychological curve could spike, even as the number of cases plateaus.

He says, ‘As the crisis begins to dissipate, people will naturally reflect on their experiences and try to make sense of what they have been through. A significant proportion will experience post-traumatic stress symptoms initially; many will recover naturally, but a proportion are at risk of developing chronic problems. At this point, we simply don’t know how many.’

But there will be positive consequences too. Sheila Scott says the crisis will serve as a catalyst for monumental change. She says that it has already given regulatory bodies and front line workers ‘a once in a generation opportunity to reflect on which policies work and which ones aren’t fit for purpose.’

But, much more importantly, Mrs Scott says that the media has revealed a gaping chasm between the resources available to the NHS and those available to social care sector.

This, she explains, ‘will inevitably mean closer union and that resources will be shared more evenly. In terms of mental health care and awareness, maybe this will open the ways for care workers to be able to access in-house employee wellbeing services and psychologists – as and when they need them. That is the very least that these brave men and women deserve.’

Thank you to CMM for publishing this article.