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A qualitative study of experiences of NHS mental healthcare workers during the Covid-19 pandemic.

Accepted version
Peer-reviewed

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Article

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Abstract

BACKGROUND: The Covid-19 pandemic has imposed extraordinary strains on healthcare workers. But, in contrast with acute settings, relatively little attention has been given to those who work in mental health settings. We aimed to characterise the experiences of those working in English NHS secondary mental health services during the first wave of the pandemic. METHODS: The design was a qualitative interview-based study. We conducted semi-structured, remote (telephone or online) interviews with 35 members of staff from NHS secondary (inpatient and community) mental health services in England. Analysis was based on the constant comparative method. RESULTS: Participants reported wide-ranging changes in the organisation of secondary mental health care and the nature of work in response to the pandemic, including pausing of all services deemed to be "non-essential", deployment of staff across services to new and unfamiliar roles, and moves to remote working. The quality of participants' working life was impaired by increasing levels of daily challenge associated with trying to provide care in trying and constrained circumstances, the problems of forging new ways of working remotely, and constraints on ability to access informal support. Participants were confronted with difficult dilemmas relating to clinical decision-making, prioritisation of care, and compromises in ability to perform the therapeutic function of their roles. Other dilemmas centred on trying to balance the risks of controlling infection with the need for human contact. Many reported features of moral injury linked to their perceived failures in providing the quality or level of care that they felt service users needed. They sometimes sought to compensate for deficits in care through increased advocacy, taking on additional tasks, or making exceptions, but this led to further personal strain. Many experienced feelings of grief, helplessness, isolation, distress, and burnout. These problems were compounded by sometimes poor communication about service changes and by staff feeling that they could not take time off because of the potential impact on others. Some reported feeling poorly supported by organisations. CONCLUSIONS: Mental health workers faced multiple adversities during the pandemic that were highly consequential for their wellbeing. These findings can help in identifying targets for support.

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Keywords

Covid-19, Healthcare workers, Mental health services, Qualitative, Staff, COVID-19, England, Health Personnel, Humans, Pandemics, SARS-CoV-2, State Medicine

Journal Title

BMC Psychiatry

Conference Name

Journal ISSN

1471-244X
1471-244X

Volume Title

21

Publisher

Springer Science and Business Media LLC

Rights

All rights reserved
Sponsorship
This project was funded by THIS Institute’s grant from the Health Foundation. The Health Foundation is an independent charity committed to bringing about better health and health care for people in the UK. All contracted parties contributed to the study under agreements through the same funding. PBJ is supported by the NIHR Applied Research Collaboration East of England and by RP-PG-0161-20003. MD-W is an NIHR Senior Investigator (NF-SI-0617-10026). The views expressed in this article are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care.