NHS healthcare workers are being pushed above and beyond their limits as a result of the rising no. of COVID-19 cases, limited resources and staff shortages.

Staff are both emotionally and physically exhausted and the psychological effects of the pandemic will have a lasting impact on their mental health. The impact of other pandemics such as the SARS is well noted, with increased rates of depression, burnout, post-traumatic stress disorder (PTSD) and anxiety.

Early warning walls were available on the impact of COVID-19 from China and Singapore. Data published from these countries detailed the mental effects the pandemic was having on healthcare workers. Mix this with pre-existing rates of stress-related illness, high suicide rates compared to other occupations and we have a perfect storm. With all this data available the UK was still unprepared.

To assess the factors associated with staff burnout during the COVID-19 pandemic a study of 2,707 healthcare workers identified these to be:

1. Feeling pushed beyond training
2. Exposure to Covid-19 patients
3. Making life-prioritising decisions

To deal with the intensity of the current wave, many staff have been redeployed again to areas such as ICU, with limited experience and training, with increased exposure to Covid-19 patients, and senior staff increasingly having to make life-prioritising decisions, such as whether someone is suitable to be admitted to ICU and go on a ventilator. Staff are doing this day-in and day-out, for months. It is not difficult to understand why our workforce is burning out.

A senior nurse based in a London emergency department reported to the Independent “We were seven short this morning. Some are sick with Covid, some are isolating and some have been off for weeks for mental health reasons. Every day we are relying on the goodwill of colleagues to come in to do extra shifts.”

“The extra support we had in the first wave, with free food, transport, and extra pay for additional shifts has been scrapped. Many of us are not from the UK, feel isolated and drained, and haven’t seen our families for eight or nine months. I have never seen so many nurses cry during shifts. Every shift is a struggle.”

Some healthcare workers have been forced to take prolonged sick leave for mental health reasons or have even resigned. “I have already been off long term for mental health reasons and I became so unwell, I attempted to take my own life,” another nurse said. “On my return, I’m being pushed to be redeployed. I was told I had a job to do and to get on with it. Many of us felt like lambs to the slaughter.”

The support provided to staff during the first wave, such as free parking, food, accommodation, access to psychologists and wellbeing hubs, is no longer in place at most trusts, at a time when the staff need it the most.

A report from the Royal College of Nursing Research Society in May 2020 showed 24% of 4,063 nurses and midwives across the UK, surveyed between 28 April and 12 May, said they were suffering severe or extremely severe depression. This is a dangerous situation for a profession that already had a high suicide rate before Covid-19 struck.

One senior nurse said: “I feel sorry for some of the junior staff. I remember I had to teach someone over the phone how to do non-invasive ventilation, as we didn’t have enough staff and I just couldn’t leave.”

“When junior nurses ask for help and feel overwhelmed, sometimes they are left by themselves to get on with it, as there just isn’t enough support. After months of this, I was forced to take a period of sick leave as I couldn’t cope anymore and felt so guilty.”

The pandemic has also had an impact on the next generation of doctors and healthcare workers. Many postgraduate exams are being cancelled or postponed as have some speciality recruitment interviews, which trainees have dedicated months preparing for. The uncertainty, unpredictability and the detriment to their career pathway has also contributed to psychological distress and burnout.

The goodwill of staff, on which the NHS has run on for many years, is running out. Over the coming weeks and months, the Covid surge is likely to continue. The government, key policy makers and local/national stakeholders must ensure that the mental health of staff is not neglected in the face of the rising Covid admissions and deaths, and that adequate support is in place to curb an impending mental health epidemic in the UK – the aftermath of which may see many staff members off on long-term sick leave or resigning completely.   

If you’re concerned about yourself, a loved one or a colleague the NHS offers an urgent mental health helpline. To find your local helpline please visit https://www.nhs.uk/service-search/mental-health/find-an-urgent-mental-health-helpline.  

For a full list of mental health services available from charities, organisations and support groups please visit https://www.nhs.uk/conditions/stress-anxiety-depression/mental-health-helplines/.

As we begin to feel the effects of a second wave of the coronavirus (Covid-19) pandemic it can be extremely daunting for key workers to leave their home and go into work.
This page will give you some helpful tips on how to keep calm, focused and take care of your mental health and well-being.

During the coronavirus pandemic key workers (aka critical workers) and those whose are unable to work from home are required to go into their place of work.
Working under new conditions and might not be so easy and many can find it hard to cope with the new way of life. However, by doing small things for yourself you can make a massive difference to your mental health.

Understand difficult feelings and emotions

Going into work during the coronavirus pandemic might make if feel like a difficult and stressful time. Some of these feelings maybe new, or things you've experienced in the past. There is no right or wrong way to feel or react to your situation. But these are some common feelings that you might experience during this time:

Stress
Going into work during coronavirus might make you feel stressed, for example if you:
- come into contact with a lot of people, including those who may have coronavirus
- have more work to do or you are working longer hours than you normally would
- feel uncertain about keeping your job or worried about money

Some of these effects will be felt straight away. Other effects could take longer to notice, including after the stressful event has ended.

Anxiety
Feelings of anxiety may be felt because you are worried about your own health or the health of those around you, including those who you care for or live with. On top of this you may also have other worries such as losing your job or financial difficulties as a result of the coronavirus.

Guilt
If you are worried about spreading coronavirus you may feel guilty about going into work or you may feel guilty if your response to a particular situation was different to those around you or how you would have normally reacted.
But we all react to difficult situations in different ways, so it's important to be kind to yourself. These are unprecedented times and the first for all of us.

Anger
You might feel anger about having to go into work during coronavirus. This may be because:
- you have to go into work when others do not
- you have to keep working in an environment where you may catch coronavirus
- you don't feel supported by your employer to do your job
- you don't have the right equipment to do your job
- there are a lot of major changes in your life, including at work

When most of us experience anger, it doesn't have a big effect on our lives. Anger only becomes a problem when it gets out of control and harms you or the people around you.

Learning healthy ways to deal with anger can help your mental and physical health. Mind have some useful tips on how you can cope with anger.

Taking care of your mental health and wellbeing

Taking care of your mental health and wellbeing is vital in helping you cope if you are going into work during coronavirus. Working long hours or under a lot of pressure can make this even more challenging to do.
Doing small things for yourself can make a big difference to your mental wellbeing. These are some ideas you can try:

Connect with people
Talk to someone you can trust and rely on. Just by telling someone how you feel can make a difference even though they can’t change the situation.
Make plans to video chat with people or groups you enjoy the company of. Keeping in touch with others as much as you can be helpful and help you take your mind off things.

Use available support
It’s okay to ask for help if you are struggling with your mental health. You could talk to a helpline or listening service about your mental health:
Call, text or email Mind's Infoline for information and signposting to support your mental health
If you want to talk to someone at any time about how you're feeling, you can call Samaritans on 116 123
If you prefer not to talk, Shout has a textline supporting key workers and their mental health during coronavirus. Text the word KEYWORKER to 85258

Be cautious with news and information
Make sure you are getting your news from trusted sources. If news stories make you feel anxious or confused, think about switching off or limiting what you look at for a while.
Social media could help you stay in touch with people but might also make you feel anxious. This may include people sharing news stories that you want to avoid, or posting their worries about coronavirus. Consider taking a break or limiting how you use social media.

Make time for yourself where possible
It may feel very difficult to make time for yourself while you are working, particularly if you are working more than usual or if you are under a lot of pressure. You may feel guilty about relaxing while your colleagues are working. But making time for yourself is important for your physical and mental health. Try to use the time when you're not working to take care of yourself, as this can help you keep going when you are at work.

Mind have put together some ideas you could try:

Find ways to relax - If you're finding it difficult to switch off from work, try some relaxation exercises which you can try at home or if you are taking a break at work.
Do something you enjoy - Having something else to focus on outside work can help you stay well. This could be something small, like reading a book, colouring, having a video chat with a friend, having a bath or listening to music.
Try mindfulness- Mindfulness is a way of paying attention to the present moment, using techniques like meditation, breathing exercises and yoga. It has been shown to help people become more aware of their thoughts and feelings. This means that instead of being overwhelmed by your feelings, it becomes easier to manage them.

See Mind’s pages on mindfulness for more information, including some mindfulness exercises that you could try.

Try to keep active
Try to build physical activity into your daily routine, if possible. There are options for most ages and abilities. This includes things you can do in your home, as well as activities to try outdoors.

Getting active at home
These are lots of different ideas you could try for getting active around the house, including:
- cleaning your home
- dancing to music
- going up and down stairs
- seated exercises
- online exercise workouts that you can follow
- sitting less – if you notice you've been sitting down for a long time, just getting up or changing position can help

Getting active outdoors
If you are getting active outdoors, the current Government guidance for most of us is to stay a safe distance (at least 2 metres) from any people you don’t live with.
If you are self-isolating, the guidance is that you should not leave your house, even for exercise. But you can exercise in your garden, if you have one.

Look after your physical health
It may feel difficult to take care of your physical health if you're feeling busy or stressed. But looking after your physical health can have a big effect on your mental health. There are many small changes you can try to take care of your overall wellbeing:

Think about your sleep - establish a routine around bed time, to help set a regular sleeping pattern. Give yourself some tech-free time before sleep, avoiding bright screens. Practice a relaxation exercise before you go to bed. Make sure where you sleep is as comfortable as possible.

Eat regularly and stay hydrated - think about your diet. Your appetite might have changed since the start of lockdown. This may be because your routine has changed, for example if you’re working more than usual. If possible, try to eat regular meals and keep a balanced diet, as this can help your mood and energy levels. See our tips on food and mood for more information.

Drink water regularly - drinking enough water is important for your mental and physical health. Changing your routine might affect when you drink or what fluids you drink.

If you need to self-isolate because you have symptoms of coronavirus, you can ask someone to drop off essential food items for you. If they do this, ask them to leave food at your doorstep, to avoid face-to-face contact with each other. You may find that supermarkets feel busier than usual at the moment. If you're feeling anxious about going to the supermarket, arrange an online delivery.

Think self-care, sleep, routine, rest. You may find yourself working longer hours or more shifts so take care of your physical health as best you can.

The coronavirus pandemic has changed the way we work, live, socialise, shop and travel on a scale we would never have thought.

Working in healthcare is demanding on any day, but with the pressure COVID-19 brings, it is more important now than ever to look after our mental health and well-being. Many healthcare workers have worked extremely long hours and under extreme high pressure. Many would have also been exposed to traumatic situations or faced with moral dilemmas as result of poor staffing levels, lack of proper equipment or confusion with new guidelines. The risk of long-term psychological issues arising from such situations is worrying for healthcare workers.

It’s natural for anyone working in the healthcare industry today to feel anxious and stressed, it is one of the most challenging industries and one that is faced with constant change and uncertainty.

Follow our five steps to help healthily cope with stress. 

1. Talk
Never has talking been more important. Everyone is going through change as a result of COVID-19. Talking helps to ease your worries and help you see things from a different point of view.
If you are feeling worried, scared or helpless at work, have a chat with your manager or a member of the senior team, it will help them see things from view and provide the support you require. If you don’t feel confident to be able to do that, there are people you can speak to via NHS recommended helplines.

Talking to close friends and family is also good as they can help to give you advice and sometimes it’s nice to talk to people outside of your work without the fear of being judged or worry about any implications your concerns may have.

It’s equally important to keep talking to your students and check-in with them of how they are feeling. Young minds are constantly developing and taking in new information, however many of them won’t have the emotional capacity to handle or healthily process this.

If you can encourage all the staff to adopt the same practices, it can help the well-being of the whole workplace.

2. Stay connected
You may find yourself locked away due to the ever-increasing number of restrictions and overtime find that you are out of touch with friends and family. Technology surrounds us, so there are lots of ways you can remain connected. WhatsApp, video calls via Zoom, Skype, Google Duo and Facetime to name just a few and various social media platforms can all help you from feeling isolated. And, if social media becomes too overwhelming then it’s okay to disconnect for a while. 

3. Stick to a routine
Whilst there is disruption around us, you must stick to a normal routine. Do the things you would usually do (as much as the restrictions allow). This includes keeping on top of basic things like shopping, cleaning, laundry, eating, sleeping and exercising. If you keep up with the little things, you’ll be able to handle new changes and extra tasks that come your way.

 4. Don’t be hard on yourself

Each day we are all facing new situations, no-one knows what the future holds, all we can do is our best. As a healthcare professional you are fully trained, qualified and experienced so never doubt yourself. You wouldn’t be hard on your patients when you are treating and supporting them, so why be hard on yourself?

If you find yourself having to take on more responsibilities, or work a different way. i.e. treating patients via online videos, try to keep what you are doing simple. Don’t over complicate your work or do things that are not necessary, keeping to the basics will help keep the pressure off yourself.

5. Take time out for yourself
Regularly taking some time out for your physical well-being is vital.
Find a few minutes in the day for a bit of peace or get some fresh air. Even if it means taking 10 minutes out to eat lunch without having any distractions around you. this will do wonders in easing your mind, refocus and help to keep you calm and in control.

When you’re not at work, it’s important to take your mind of ‘work’ by finding something to distract yourself with. There are lots of things you can do which don’t require a lot of investment, such as:
- Going for walks, bicycle rides or even a class at the gym. If going out is not an option; join a fitness class online
- Jigsaw puzzles – doing a bit at a time will give you the motivation to complete it
- Painting, making a collage, embroidery, pottery
- Playing an instrument – there are lots of tutorials on YouTube
- Cooking, learning a new dish or just experimenting with different foods. There are tonnes of social media groups, recipes and videos online showing you step by step guides

Whatever you do, remember the time is for you, no one else. It’s tempting to keeping looking at our phones, to stop temptation, switch off your phone and leave it another room.

We all need time to reflect, relax and recharge; after all, we’re only human.

Further guidance and support can be found by visiting the following websites.

The government’s guidance on mental health and well-being - https://www.gov.uk/government/publications/covid-19-guidance-for-the-public-on-mental-health-and-wellbeing?priority-taxon=774cee22-d896-44c1-a611-e3109cce8eae

Macmillan Cancer Support - Emotional Health and Well-Being for Health and Social Care Professionals - https://www.macmillan.org.uk/coronavirus/healthcare-professionals/mental-health-and-wellbeing-support

MIND is a leading mental health charity that provides support to anyone experiencing mental health problems - https://www.mind.org.uk/information-support/coronavirus/coping-as-a-key-worker/

NHS practitioner help supports the well-being of all NHS staff  - https://www.practitionerhealth.nhs.uk/covid-19-workforce-wellbeing

Royal College of Nursing has published COVID-19 guidance on mental health care delivery - https://www.rcn.org.uk/clinical-topics/mental-health/covid-19-guidance-on-mental-healthcare-delivery

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